Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, Pa.
Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, Pa.
J Vasc Surg. 2020 Oct;72(4):1178-1183. doi: 10.1016/j.jvs.2020.05.058. Epub 2020 Jun 17.
We established the Co-Operative Vascular Intervention Disease (COVID) Team of Greater Philadelphia because national guidelines may not apply to different geographic areas of the United States owing to varying penetrance of the virus. On April 10, 2020, a 10-question survey regarding issues and strategies dealing with COVID-19 was e-mailed to 58 vascular surgeons (VSs) in the Greater Philadelphia area. Fifty-four VSs in 18 surgical groups covering 28 hospitals responded. All groups accepted transfers because of continued availability of intensive care unit beds. Thirteen groups were asked to "redeploy" if the need arose to function outside of the usual duties of a VS. None imposed age restrictions regarding older VSs continuing clinical hospital work. The majority restricted noninvasive vascular laboratory studies to those studies for which findings might mandate intervention within 2 or 3 weeks, restricted dialysis access operations to urgent revisions of arteriovenous fistulas or grafts that were failing or had ulcerations, converted from in-person to telemedicine clinic interactions, and experienced moderate-severe anxiety or fear about personal COVID-19 exposure in the hospital. The majority of VSs in the Philadelphia area dramatically adjusted their clinical practices before the COVID-19 crisis reached peak levels experienced in other metropolitan areas.
我们成立了大费城合作血管介入疾病(COVID)团队,因为由于病毒的不同传播率,国家指南可能不适用于美国不同的地理区域。2020 年 4 月 10 日,向大费城地区的 58 名血管外科医生(VS)发送了一份关于 COVID-19 问题和策略的 10 个问题调查。18 个外科组中的 54 名 VS 回复了 28 家医院。所有小组都因重症监护室床位的持续可用性而接受了转院。如果需要,13 个小组被要求“重新部署”,以执行 VS 的通常职责之外的工作。没有一个小组对继续进行临床医院工作的年长 VS 施加年龄限制。大多数小组将非侵入性血管实验室研究限制在那些在 2 或 3 周内可能需要干预的研究范围内,将透析通路手术限制在需要紧急修复动静脉瘘或移植物的情况下,这些瘘或移植物正在失效或出现溃疡,将面对面的诊所互动转换为远程医疗诊所互动,并对在医院中 COVID-19 暴露的个人感到中度至重度焦虑或恐惧。在 COVID-19 危机达到其他大都市区经历的高峰水平之前,费城地区的大多数 VS 大幅调整了他们的临床实践。