在退伍军人事务部安阿伯医疗系统，将麻醉后护理单元改造成重症监护病房以应对新冠疫情高峰。

Creating an Intensive Care Unit From a Postanesthesia Care Unit for the COVID-19 Surge at the Veterans Affairs Ann Arbor Healthcare System.

作者信息

Jarzebowski Mary, Curran Tom, Dorsey Megan, Cederquist William, Claar Dru, Derrig Elisa, Dick Weston, Push Katrina, Hausman Mark, Lake Tamar

机构信息

, and are Staff Physicians; is Director, Surgical Intensive Care Unit; is Director, Medical Intensive Care Unit; is Chief CRNA, Section of Anesthesiology; is Chief, Facilities Management Service; is a Nurse Manager, Post-Anesthesia Care Unit; is Chief of Staff; and is Chief, Section of Anesthesiology and Perioperative Care; all at the Veterans Affairs Ann Arbor Healthcare System in Michigan. Mary Jarzebowski is a Clinical Assistant Professor; Tom Curran, Megan Dorsey, and William Cederquist are Clinical Instructors; Mark Hausman is an Assistant Professor; all in the Department of Anesthesiology, University of Michigan. Dru Claar is a Clinical Assistant Professor, Department of Pulmonary and Critical Care Medicine at the University of Michigan. Mark Hausman is Assistant Dean for Veterans Affairs, University of Michigan Medical School.

出版信息

Fed Pract. 2020 Aug;37(8):348-353. doi: 10.12788/fp.0020.

DOI:10.12788/fp.0020

PMID:32908341

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7473736/

Abstract

OBJECTIVES

To prepare for the predicted surge of patients with COVID-19 in Southeast Michigan, the US Department of Veterans Affairs Ann Arbor Healthcare System engineered, built, and staffed a 12-bed intensive care unit (ICU) from the existing postanesthesia care unit (PACU).

OBSERVATIONS

Considerations including floor planning, reversal of airflow, strict airborne precautions, sealing off a dedicated nursing station, and developing an infection control plan in an open care unit. A staffing model was created that included anesthesiologist intensivists, advanced practice providers, residents, certified registered nurse anesthetists, and perioperative nurses working alongside ICU trained nurses. Challenges arose in infection control, communication, mechanical ventilation using anesthesia machines, providing renal replacement therapy, and maintaining patient privacy in an open unit.

CONCLUSIONS

This article describes the setup, challenges, and solutions that allowed the creation of the PACU-ICU to help serve veterans and civilians during a time of unprecedented strain on the health care system due to COVID-19.

摘要

目标

为应对美国密歇根州东南部预计激增的新冠病毒疾病患者，美国退伍军人事务部安娜堡医疗系统利用现有的麻醉后护理单元（PACU）设计、建造并配备了一个拥有12张床位的重症监护病房（ICU）。

观察结果

包括楼层规划、气流逆转、严格的空气传播预防措施、封闭专用护理站以及在开放式护理单元制定感染控制计划等方面的考量。创建了一种人员配置模式，其中包括麻醉重症医生、高级执业医疗人员、住院医师、注册护士麻醉师以及与经过ICU培训的护士并肩工作的围手术期护士。在感染控制、沟通、使用麻醉机进行机械通气、提供肾脏替代疗法以及在开放式单元中维护患者隐私等方面出现了挑战。