新型专科心肺入路在重症监护室重症COVID-19患者管理中的经验

A. Anwar, N. Ramos-Bascon, A. Crerar-Gilbert, N. Barnes, B. Madden
{"title":"新型专科心肺入路在重症监护室重症COVID-19患者管理中的经验","authors":"A. Anwar, N. Ramos-Bascon, A. Crerar-Gilbert, N. Barnes, B. Madden","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2550","DOIUrl":null,"url":null,"abstract":"Introduction:During the Corona-virus pandemic, our intensive care units and staff were overwhelmed by both patient numbers and the complexities of their clinical presentation. We believed that a specialist dedicated team would assist our medical and nursing colleagues and help identify and treat the various cardio-pulmonary pathologies contributing to the critical illness of our patients. To support our colleagues and to assist with diagnosis and treatment, we developed a specialist team. We named this team the Acute Respiratory Disease Support (ARDS) team. The purpose of our team was to provide specialist input for severely unwell patients with COVID-19 early in their disease and to assess for conditions that may respond to specific therapies including advanced pulmonary vasodilator therapy and steroids. Methods:The Acute Respiratory Disease Support team reviewed 44 consecutive patients referred from the intensive care units from mid-April to end of May 2020 on a daily basis and coordinated therapies for pulmonary hypertension, pulmonary thrombosis and evolving fibrosis. A follow-up post hospital discharge clinic was set up. Results:The mortality for this group was significantly lower (34%) than the total group admitted to critical care as a whole (51%) and for those not reviewed by the team (55%;p=0.012). Mortality among Asian and African-Caribbean patients was higher than Caucasians (p=0.035). Twenty-three patients (52%) were diagnosed with pulmonary thrombosis. Pulmonary hypertension was present in 84% of the patients. Thirty-two patients received sildenafil therapy and this was associated with improvement in right heart function in all survivors. Short time on mechanical ventilation was associated with a poorer outcome (p=0.0003). Ten patients with evolving pulmonary fibrosis and no evidence of sepsis received high dose steroid therapy in the form of intravenous pulsed methylprednisolone early in their disease. Repeat thoracic computerised tomographic (CT) scans were performed which showed excellent effect (Figure 1). Conclusion:Our experience has reinforced the concept that there are many contributing factors to impaired cardio-pulmonary function in COVID-19 patients and that many of these may be co-contributory to the patient's clinical presentation. It suggests that a coordinated specialised cardio-pulmonary team approach contributes significantly to successful management and outcome of severely unwell patients with COVID-19 and offers an important platform for continuity of patient care, education and staff well-being.","PeriodicalId":111156,"journal":{"name":"TP49. TP049 COVID: ARDS AND ICU MANAGEMENT","volume":"3 1","pages":"0"},"PeriodicalIF":0.0000,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Experience of a Novel Specialised Cardio-Pulmonary Approach in the Management of Severely Ill Patients with COVID-19 in Intensive Care Settings\",\"authors\":\"A. Anwar, N. Ramos-Bascon, A. Crerar-Gilbert, N. Barnes, B. Madden\",\"doi\":\"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2550\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Introduction:During the Corona-virus pandemic, our intensive care units and staff were overwhelmed by both patient numbers and the complexities of their clinical presentation. We believed that a specialist dedicated team would assist our medical and nursing colleagues and help identify and treat the various cardio-pulmonary pathologies contributing to the critical illness of our patients. To support our colleagues and to assist with diagnosis and treatment, we developed a specialist team. We named this team the Acute Respiratory Disease Support (ARDS) team. The purpose of our team was to provide specialist input for severely unwell patients with COVID-19 early in their disease and to assess for conditions that may respond to specific therapies including advanced pulmonary vasodilator therapy and steroids. Methods:The Acute Respiratory Disease Support team reviewed 44 consecutive patients referred from the intensive care units from mid-April to end of May 2020 on a daily basis and coordinated therapies for pulmonary hypertension, pulmonary thrombosis and evolving fibrosis. A follow-up post hospital discharge clinic was set up. Results:The mortality for this group was significantly lower (34%) than the total group admitted to critical care as a whole (51%) and for those not reviewed by the team (55%;p=0.012). Mortality among Asian and African-Caribbean patients was higher than Caucasians (p=0.035). Twenty-three patients (52%) were diagnosed with pulmonary thrombosis. Pulmonary hypertension was present in 84% of the patients. Thirty-two patients received sildenafil therapy and this was associated with improvement in right heart function in all survivors. Short time on mechanical ventilation was associated with a poorer outcome (p=0.0003). Ten patients with evolving pulmonary fibrosis and no evidence of sepsis received high dose steroid therapy in the form of intravenous pulsed methylprednisolone early in their disease. Repeat thoracic computerised tomographic (CT) scans were performed which showed excellent effect (Figure 1). Conclusion:Our experience has reinforced the concept that there are many contributing factors to impaired cardio-pulmonary function in COVID-19 patients and that many of these may be co-contributory to the patient's clinical presentation. It suggests that a coordinated specialised cardio-pulmonary team approach contributes significantly to successful management and outcome of severely unwell patients with COVID-19 and offers an important platform for continuity of patient care, education and staff well-being.\",\"PeriodicalId\":111156,\"journal\":{\"name\":\"TP49. TP049 COVID: ARDS AND ICU MANAGEMENT\",\"volume\":\"3 1\",\"pages\":\"0\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2021-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"TP49. TP049 COVID: ARDS AND ICU MANAGEMENT\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2550\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"TP49. TP049 COVID: ARDS AND ICU MANAGEMENT","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2550","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

摘要

导言:在冠状病毒大流行期间,我们的重症监护室和工作人员被患者数量和临床表现的复杂性所淹没。我们相信,一个专门的专家团队将协助我们的医疗和护理同事,并帮助识别和治疗导致患者危重疾病的各种心肺疾病。为了支持我们的同事并协助诊断和治疗,我们组建了一个专家团队。我们把这个小组命名为急性呼吸系统疾病支持小组。我们团队的目的是为疾病早期严重不适的COVID-19患者提供专家意见,并评估可能对特定治疗(包括晚期肺血管扩张剂治疗和类固醇治疗)有反应的病症。方法:急性呼吸系统疾病支持团队回顾了2020年4月中旬至5月底重症监护室连续转诊的44例患者,并对肺动脉高压、肺血栓形成和进展性纤维化进行了协调治疗。建立随访出院后门诊。结果:该组的死亡率(34%)明显低于全部接受重症监护的组(51%)和未经小组审查的组(55%;p=0.012)。亚洲和非洲-加勒比患者的死亡率高于白种人(p=0.035)。23例(52%)诊断为肺血栓形成。84%的患者存在肺动脉高压。32名患者接受了西地那非治疗,这与所有幸存者的右心功能改善有关。机械通气时间短与预后较差相关(p=0.0003)。10例进展性肺纤维化且无脓毒症证据的患者在疾病早期以静脉脉冲甲基强的松龙的形式接受了大剂量类固醇治疗。重复胸部计算机断层扫描(CT)扫描显示了良好的效果(图1)。结论:我们的经验强化了这样一个概念,即导致COVID-19患者心肺功能受损的因素很多,其中许多因素可能共同导致患者的临床表现。研究表明,协调一致的专业心肺团队方法对COVID-19严重不适患者的成功管理和结果有重大贡献,并为患者护理、教育和工作人员福祉的连续性提供了重要平台。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Experience of a Novel Specialised Cardio-Pulmonary Approach in the Management of Severely Ill Patients with COVID-19 in Intensive Care Settings
Introduction:During the Corona-virus pandemic, our intensive care units and staff were overwhelmed by both patient numbers and the complexities of their clinical presentation. We believed that a specialist dedicated team would assist our medical and nursing colleagues and help identify and treat the various cardio-pulmonary pathologies contributing to the critical illness of our patients. To support our colleagues and to assist with diagnosis and treatment, we developed a specialist team. We named this team the Acute Respiratory Disease Support (ARDS) team. The purpose of our team was to provide specialist input for severely unwell patients with COVID-19 early in their disease and to assess for conditions that may respond to specific therapies including advanced pulmonary vasodilator therapy and steroids. Methods:The Acute Respiratory Disease Support team reviewed 44 consecutive patients referred from the intensive care units from mid-April to end of May 2020 on a daily basis and coordinated therapies for pulmonary hypertension, pulmonary thrombosis and evolving fibrosis. A follow-up post hospital discharge clinic was set up. Results:The mortality for this group was significantly lower (34%) than the total group admitted to critical care as a whole (51%) and for those not reviewed by the team (55%;p=0.012). Mortality among Asian and African-Caribbean patients was higher than Caucasians (p=0.035). Twenty-three patients (52%) were diagnosed with pulmonary thrombosis. Pulmonary hypertension was present in 84% of the patients. Thirty-two patients received sildenafil therapy and this was associated with improvement in right heart function in all survivors. Short time on mechanical ventilation was associated with a poorer outcome (p=0.0003). Ten patients with evolving pulmonary fibrosis and no evidence of sepsis received high dose steroid therapy in the form of intravenous pulsed methylprednisolone early in their disease. Repeat thoracic computerised tomographic (CT) scans were performed which showed excellent effect (Figure 1). Conclusion:Our experience has reinforced the concept that there are many contributing factors to impaired cardio-pulmonary function in COVID-19 patients and that many of these may be co-contributory to the patient's clinical presentation. It suggests that a coordinated specialised cardio-pulmonary team approach contributes significantly to successful management and outcome of severely unwell patients with COVID-19 and offers an important platform for continuity of patient care, education and staff well-being.
求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信