From the Department of Anaesthesia and Intensive Care Medicine, Imperial College London, London, United Kingdom.
Department of Anaesthetics and Critical Care, Harefield Hospital, Royal Brompton and Harefield National Health System (NHS) Foundation Trust, London, United Kingdom.
Anesth Analg. 2020 Aug;131(2):351-364. doi: 10.1213/ANE.0000000000004985.
Health care systems are belligerently responding to the new coronavirus disease 2019 (COVID-19). The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a specific condition, whose distinctive features are severe hypoxemia associated with (>50% of cases) normal respiratory system compliance. When a patient requires intubation and invasive ventilation, the outcome is poor, and the length of stay in the intensive care unit (ICU) is usually 2 or 3 weeks. In this article, the authors review several technological devices, which could support health care providers at the bedside to optimize the care for COVID-19 patients who are sedated, paralyzed, and ventilated. Particular attention is provided to the use of videolaryngoscopes (VL) because these can assist anesthetists to perform a successful intubation outside the ICU while protecting health care providers from this viral infection. Authors will also review processed electroencephalographic (EEG) monitors which are used to better titrate sedation and the train-of-four monitors which are utilized to better administer neuromuscular blocking agents in the view of sparing limited pharmacological resources. COVID-19 can rapidly exhaust human and technological resources too within the ICU. This review features a series of technological advancements that can significantly improve the care of patients requiring isolation. The working conditions in isolation could cause gaps or barriers in communication, fatigue, and poor documentation of provided care. The available technology has several advantages including (a) facilitating appropriate paperless documentation and communication between all health care givers working in isolation rooms or large isolation areas; (b) testing patients and staff at the bedside using smart point-of-care diagnostics (SPOCD) to confirm COVID-19 infection; (c) allowing diagnostics and treatment at the bedside through point-of-care ultrasound (POCUS) and thromboelastography (TEG); (d) adapting the use of anesthetic machines and the use of volatile anesthetics. Implementing technologies for safeguarding health care providers as well as monitoring the limited pharmacological resources are paramount. Only by leveraging new technologies, it will be possible to sustain and support health care systems during the expected long course of this pandemic.
医疗保健系统正在积极应对 2019 年新型冠状病毒病（COVID-19）。严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）是一种特殊的病症，其显著特征是严重低氧血症与（超过 50%的病例）正常呼吸系统顺应性相关。当患者需要插管和有创通气时，结果往往不佳，并且在重症监护病房（ICU）的停留时间通常为 2 到 3 周。在本文中，作者回顾了几种技术设备，这些设备可以为在床边护理 COVID-19 患者的医护人员提供支持，这些患者处于镇静、麻痹和通气状态。特别关注的是视频喉镜（VL）的使用，因为这些喉镜可以帮助麻醉师在 ICU 之外进行成功的插管，同时保护医护人员免受这种病毒感染。作者还将回顾处理后的脑电图（EEG）监测仪，这些监测仪可用于更好地滴定镇静剂，以及使用肌松监测仪更好地管理神经肌肉阻滞剂，以节约有限的药理学资源。COVID-19 也会在 ICU 内迅速耗尽人力和技术资源。本综述重点介绍了一系列技术进步，这些进步可以显著改善需要隔离的患者的护理。隔离环境下的工作条件可能会导致沟通不畅、疲劳以及提供的护理记录不佳。现有的技术具有以下几个优势：（a）促进在隔离病房或大型隔离区域内工作的所有医护人员之间进行无纸化的适当文档记录和沟通；（b）使用智能即时检验（SPOCD）在床边对患者和员工进行检测，以确认 COVID-19 感染；（c）通过即时床旁超声（POCUS）和血栓弹力图（TEG）进行诊断和治疗；（d）调整麻醉机的使用和挥发性麻醉剂的使用。保护医护人员和监测有限的药理学资源的技术的实施至关重要。只有利用新技术，才有可能在预计的长时间大流行期间维持和支持医疗保健系统。
