Paroya Azzam A, Patel Kinner M, Ahmad Sahar
Department of Medicine, Stony Brook University Hospital, Stony Brook, NY.
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Stony Brook University Hospital, Stony Brook, NY.
Crit Care Explor. 2020 Jul 1;2(7):e0161. doi: 10.1097/CCE.0000000000000161. eCollection 2020 Jul.
Preventing the dispersion of virulent particles during aerosol generating procedures has never been more relevant than during the current coronavirus pandemic. The American Heart Association released interim guidelines to assist in limiting exposure during advanced cardiovascular life support. These include maintaining a closed circuit on the ventilator for intubated patients and to use a high-efficiency particulate air filter during airway management of nonintubated patients. We developed additional modifications to the suggested guidelines such that providers are even further protected from unnecessary aerosolization, and illustrate a sample protocol for provider safety during advanced cardiovascular life support in the coronavirus pandemic. For the intubated patient, our protocol maintains the patient to the ventilator in addition to being draped with a plastic barrier over the mouth and nares. In the nonintubated patient, a plastic drape or a non-rebreather mask is used to help reduce aerosolization during manual chest compressions. Our modified protocol allows providers to perform advanced cardiac life support by further minimizing exposure risk.
在当前冠状病毒大流行期间,防止在气溶胶生成操作过程中有毒颗粒的扩散比以往任何时候都更加重要。美国心脏协会发布了临时指南,以协助在高级心血管生命支持期间限制暴露。这些措施包括为插管患者在呼吸机上保持闭合回路,并在非插管患者的气道管理期间使用高效空气过滤器。我们对建议的指南进行了额外修改,以使医护人员能进一步免受不必要的气溶胶化影响,并展示了在冠状病毒大流行期间进行高级心血管生命支持时保障医护人员安全的示例方案。对于插管患者,我们的方案除了在患者口和鼻上覆盖塑料屏障外,还让患者连接呼吸机。对于非插管患者,使用塑料单或非重复呼吸面罩来帮助减少胸外按压期间的气溶胶化。我们修改后的方案通过进一步降低暴露风险,使医护人员能够进行高级心脏生命支持。