From Pulmonary and Critical Care Medicine (J.R.G.) Anesthesia and Perioperative Care (M.D.M., M.J.L.), San Francisco Veterans Administration Health Care System, San Francisco, California Laboratory Medicine (L.W.) University of California, San Francisco, California (J.R.G., M.D.M., M.J.L.).
Anesthesiology. 2020 Jun;132(6):1346-1361. doi: 10.1097/ALN.0000000000003303.
Healthcare systems worldwide are responding to Coronavirus Disease 2019 (COVID-19), an emerging infectious syndrome caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus. Patients with COVID-19 can progress from asymptomatic or mild illness to hypoxemic respiratory failure or multisystem organ failure, necessitating intubation and intensive care management. Healthcare providers, and particularly anesthesiologists, are at the frontline of this epidemic, and they need to be aware of the best available evidence to guide therapeutic management of patients with COVID-19 and to keep themselves safe while doing so. Here, the authors review COVID-19 pathogenesis, presentation, diagnosis, and potential therapeutics, with a focus on management of COVID-19-associated respiratory failure. The authors draw on literature from other viral epidemics, treatment of acute respiratory distress syndrome, and recent publications on COVID-19, as well as guidelines from major health organizations. This review provides a comprehensive summary of the evidence currently available to guide management of critically ill patients with COVID-19.
全球的医疗体系正在应对 2019 年冠状病毒病(COVID-19),这是一种由严重急性呼吸综合征冠状病毒 2 型(SARS-CoV-2)病毒引起的新兴传染病综合征。COVID-19 患者可从轻症或无症状进展为低氧血症性呼吸衰竭或多器官功能衰竭,需要进行插管和重症监护管理。医疗保健提供者,特别是麻醉师,处于这一流行病的前线,他们需要了解最佳的现有证据,以指导 COVID-19 患者的治疗管理,并在这样做的同时保护自己的安全。在这里,作者回顾了 COVID-19 的发病机制、表现、诊断和潜在的治疗方法,重点是 COVID-19 相关呼吸衰竭的管理。作者参考了来自其他病毒流行、急性呼吸窘迫综合征治疗和最近关于 COVID-19 的出版物以及主要卫生组织的指南。这篇综述提供了目前指导 COVID-19 危重症患者管理的证据的综合总结。