Lin Yu-Hua
PhD, RN, Department of Nursing, I-Shou University, Taiwan, ROC.
Hu Li Za Zhi. 2020 Jun;67(3):4-5. doi: 10.6224/JN.202006_67(3).01.
The global spread of coronavirus disease 2019 (COVID-19) is rapidly increasing the number of patients who are critically ill with this disease, with the related rate of mortality expected to peak in 2020 (Alhazzani et al., 2020). As severe acute respiratory syndrome is the major cause of mortality after COVID-19 infection, patients with COVID-19 who are prone to severe acute respiratory problems may require mechanical ventilation or extracorporeal membrane oxygenation (ECMO; Alhazzani et al., 2020). Ongoing advances in intensive care medicine are continuing to improve survival in critically ill patients (Kaukonen, Bailey, Suzuki, Pilcher, & Bellomo, 2014). However, intensive care unit (ICU) survivors may experience complications and problems related to their disease and treatment such as critical illness polyneuropathy, critical illness myopathy, and post intensive care syndrome (PICS; Alhazzani et al., 2020). Harvey (2012) reported that 85%-95% of ICU patients have ICU-acquired weakness after ICU discharge and 74% of ICU patients with acute respiratory distress syndrome have cognitive impairment after ICU discharge. Physical disabilities, cognitive impairment, and mental or psychological distress (e.g., anxiety, depression, and post-traumatic stress disorder) after ICU discharge may be symptoms of PICS, and may continue to affect surviving patients for several years after ICU discharge (Elliott et al., 2014; Held & Moss, 2019; Jackson et al., 2014; Jubran et al., 2010). Efforts to prevent and treat COVID-19 in Taiwan have proven more effective compared to most other places in the world. In addition to the low number of diagnosed cases, the mortality rate (seven of 440 confirmed cases) in Taiwan has been significantly lower than in most other countries (Taiwan Centers for Disease Control, ROC, 2020, May 14). However, post-discharge care for ICU survivors, especially those hospitalized after a sudden onset of severe disease symptoms and then discharged after a long ICU stay or after receiving mechanical ventilation, require specialized care to minimize PICS. Nurses are responsible not only for treating patients with the disease but also for preventing the further spread of disease. Therefore, providing continued care to patients discharged from the ICU is essential. Specifically, interventions to avoid PICS must be implemented rapidly by multidisciplinary medical teams during and immediately after ICU discharge.
2019冠状病毒病（COVID-19）在全球的传播正迅速增加患此病重症患者的数量，预计相关死亡率将在2020年达到峰值（阿尔哈扎尼等人，2020年）。由于严重急性呼吸综合征是COVID-19感染后死亡的主要原因，易出现严重急性呼吸问题的COVID-19患者可能需要机械通气或体外膜肺氧合（ECMO；阿尔哈扎尼等人，2020年）。重症医学的不断进步持续提高了重症患者的生存率（考科宁、贝利、铃木、皮尔彻和贝洛莫，2014年）。然而，重症监护病房（ICU）幸存者可能会经历与疾病和治疗相关的并发症和问题，如重症多发性神经病、重症肌病和重症监护后综合征（PICS；阿尔哈扎尼等人，2020年）。哈维（2012年）报告称，85% - 95%的ICU患者在出院后出现ICU获得性肌无力，74%的急性呼吸窘迫综合征ICU患者在出院后出现认知障碍。ICU出院后的身体残疾、认知障碍以及精神或心理困扰（如焦虑、抑郁和创伤后应激障碍）可能是PICS的症状，并且可能在ICU出院后持续影响幸存患者数年（埃利奥特等人，2014年；赫尔德和莫斯，2019年；杰克逊等人，2014年；朱布兰等人，2010年）。台湾地区防治COVID-19的努力已被证明比世界上大多数其他地方更有效。除了确诊病例数量较少外，台湾地区的死亡率（440例确诊病例中有7例死亡）显著低于大多数其他国家（中国台湾地区疾病管制中心，2020年5月14日）。然而，ICU幸存者出院后的护理，尤其是那些在突然出现严重疾病症状后住院、在ICU长时间停留或接受机械通气后出院的患者，需要专门护理以尽量减少PICS。护士不仅负责治疗患病患者，还负责防止疾病进一步传播。因此，为从ICU出院的患者提供持续护理至关重要。具体而言，多学科医疗团队必须在ICU住院期间及出院后立即迅速实施避免PICS的干预措施。
