Salins Naveen, Mani Raj Kumar, Gursahani Roop, Simha Srinagesh, Bhatnagar Sushma
Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Mahe, Manipal, Karnataka, India.
Department of Critical Care and Pulmonology, Batra Hospital and Medical Research Centre, Delhi, India.
Indian J Crit Care Med. 2020 Jun;24(6):435-444. doi: 10.5005/jp-journals-10071-23400.
Coronavirus disease-19 (COVID-19) pandemic is causing a worldwide humanitarian crisis. Old age, comorbid conditions, end-stage organ impairment, and advanced cancer, increase the risk of mortality in serious COVID-19. A subset of serious COVID-19 patients with serious acute respiratory illness may be triaged not to receive aggressive intensive care unit (ICU) treatment and ventilation or may be discontinued from ventilation due to their underlying conditions. Those not eligible for aggressive ICU measures should receive appropriate symptom management. Early warning scores (EWS), oxygen saturation, and respiratory rate, can facilitate categorizing COVID-19 patients as stable, unstable, and end of life. Breathlessness, delirium, respiratory secretions, and pain, are the key symptoms that need to be assessed and palliated. Palliative sedation measures are needed to manage intractable symptoms. Goals of care should be discussed, and advance care plan should be made in patients who are unlikely to benefit from aggressive ICU measures and ventilation. For patients who are already in an ICU, either ventilated or needing ventilation, a futility assessment is made. If there is a consensus on futility, a family meeting is conducted either virtually or face to face depending on the infection risk and infection control protocol. The family should be sensitively communicated about the futility of ICU measures and foregoing life-sustaining treatment. Family meeting outcomes are documented, and consent for foregoing life-sustaining treatment is obtained. Appropriate symptom management enables comfort at the end of life to all serious COVID-19 patients not receiving or not eligible to receive ICU measures and ventilation. Salins N, Mani RK, Gursahani R, Simha S, Bhatnagar S. Symptom Management and Supportive Care of Serious COVID-19 Patients and their Families in India. Indian J Crit Care Med 2020;24(6):435-444.
新型冠状病毒肺炎（COVID-19）大流行正在引发一场全球性的人道主义危机。高龄、合并症、终末期器官损害和晚期癌症会增加重症COVID-19患者的死亡风险。一部分患有严重急性呼吸疾病的重症COVID-19患者可能会被分类为不接受积极的重症监护病房（ICU）治疗和通气，或者由于其基础疾病而停止通气。那些不符合积极ICU措施条件的患者应接受适当的症状管理。早期预警评分（EWS）、血氧饱和度和呼吸频率有助于将COVID-19患者分类为稳定、不稳定和生命终末期。呼吸困难、谵妄、呼吸道分泌物和疼痛是需要评估和缓解的关键症状。需要采取姑息性镇静措施来处理难治性症状。对于不太可能从积极的ICU措施和通气中获益的患者，应讨论护理目标并制定预先护理计划。对于已经在ICU的患者，无论是否正在通气或需要通气，都要进行无效性评估。如果就无效性达成共识，则根据感染风险和感染控制方案以虚拟或面对面的方式召开家庭会议。应向家属敏感地传达ICU措施的无效性以及放弃维持生命治疗的情况。记录家庭会议结果，并获得放弃维持生命治疗的同意。适当的症状管理能让所有未接受或不符合接受ICU措施和通气条件的重症COVID-19患者在生命终末期感到舒适。萨林斯N、马尼RK、古尔萨哈尼R、西玛S、巴特纳格尔S。印度重症COVID-19患者及其家属的症状管理和支持性护理。《印度危重症医学杂志》2020年；24（6）：435 - 444。
