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因新型冠状病毒肺炎相关呼吸衰竭导致的危重症患者的院际转运

Interhospital Transfer of Critically Ill Patients Because of Coronavirus Disease 19-Related Respiratory Failure.

作者信息

Allen Rebecca, Wanersdorfer Karen, Zebley James, Shapiro Geoff, Coullahan Tiffany, Sarani Babak

机构信息

Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, DC.

Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, DC.

出版信息

Air Med J. 2020 Nov-Dec;39(6):498-501. doi: 10.1016/j.amj.2020.07.007. Epub 2020 Jul 25.

Abstract

OBJECTIVE

Interfacility transfer of patients with coronavirus disease 2019-related acute respiratory failure is high risk because of the severity of respiratory failure and potential for crew exposure. This article describes a hospital-based transport team's experience with interfacility transport of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients.

METHODS

A retrospective study of transports for respiratory failure caused by SARS-CoV-2 was performed. All transports were performed by a single critical care transport team. The team was already trained in advanced mechanical ventilation, blood gas interpretation, and management of shock. Guidance from the Centers for Disease Control and Prevention was followed regarding the use of personal protective equipment.

RESULTS

Twenty patients were enrolled. The average patient age was 47 years (standard deviation [SD] = 12 years). The average Acute Physiology and Chronic Health Evaluation and Sequential Organ Failure Assessment scores were 10 (SD = 4) and 24 (SD = 7), respectively. The average transport distance and time were 18 miles (SD = 9 miles) and 25 minutes (SD = 11 minutes), respectively. Nineteen patients were intubated, 9 of whom required advanced ventilation. Two patients were transported prone. One patient experienced unintentional extubation upon transfer from the stretcher to the destination facility bed. The patient was reintubated without event. No crewmembers contracted SARS-CoV-2 infection.

CONCLUSION

Interfacility transfer of severely ill SARS-CoV-2-positive patients is safe and feasible.

摘要

目的

由于呼吸衰竭的严重性以及机组人员暴露的可能性,2019年冠状病毒病相关急性呼吸衰竭患者的机构间转运具有高风险。本文描述了一个医院转运团队在转运严重急性呼吸综合征冠状病毒2(SARS-CoV-2)阳性患者方面的经验。

方法

对由SARS-CoV-2引起的呼吸衰竭患者的转运进行回顾性研究。所有转运均由一个重症监护转运团队进行。该团队已接受过高级机械通气、血气解读和休克管理方面的培训。在个人防护装备的使用方面遵循了疾病控制与预防中心的指导意见。

结果

纳入20例患者。患者平均年龄为47岁(标准差[SD]=12岁)。急性生理学与慢性健康状况评分系统(APACHE)和序贯器官衰竭评估(SOFA)的平均得分分别为10分(SD=4分)和24分(SD=7分)。平均转运距离和时间分别为18英里(SD=9英里)和25分钟(SD=11分钟)。19例患者进行了气管插管,其中9例需要高级通气支持。2例患者以俯卧位转运。1例患者在从担架转移至目的地医疗机构病床时意外拔管,该患者再次插管过程顺利。没有机组人员感染SARS-CoV-2。

结论

SARS-CoV-2阳性重症患者的机构间转运是安全可行的。

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