COVID-19 患者俯卧位的护理管理。

Nursing Management of Prone Positioning in Patients With COVID-19.

机构信息

Filippo Binda is a senior critical care registered nurse, Intensive and Critical Care Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

Federica Marelli is a senior critical care registered nurse, Intensive and Critical Care Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico.

出版信息

Crit Care Nurse. 2021 Apr 1;41(2):27-35. doi: 10.4037/ccn2020222.

DOI:10.4037/ccn2020222

PMID:33341885

Abstract

BACKGROUND

At the height of the coronavirus disease 2019 (COVID-19) pandemic, Italy had the highest number of deaths in Europe; most occurred in the Lombardy region. Up to 4% of patients with COVID-19 required admission to an intensive care unit because they developed a critical illness (eg, acute respiratory distress syndrome). Numerous patients with acute respiratory distress syndrome who had been admitted to the intensive care unit required rescue therapy like prone positioning.

OBJECTIVE

To describe the respiratory management of and the extensive use of prone positioning in patients with COVID-19 at the intensive care unit hub in Lombardy, Italy.

METHODS

A total of 89 patients (67% male; median age, 59 years [range, 23-80 years]) with confirmed COVID-19 who were admitted between February 23 and March 31, 2020, were enrolled in this quality improvement project.

RESULTS

Endotracheal intubation was required in 86 patients (97%). Prone positioning was used as rescue therapy in 43 (48%) patients. Significantly more younger patients (age ≤ 59 years) were discharged alive (43 of 48 [90%]) than were older patients (age ≥ 60 years; 26 of 41 [63%]; P < .005). Among the 43 patients treated with prone ventilation, 15 (35% [95% CI, 21%-51%]) died in the intensive care unit, of which 10 (67%; P < .001) were older patients.

CONCLUSIONS

Prone positioning is one strategy available for treating acute respiratory distress syndrome in patients with COVID-19. During this pandemic, prone positioning can be used extensively as rescue therapy, per a specific protocol, in intensive care units.

摘要

背景

在 2019 年冠状病毒病（COVID-19）大流行期间，意大利的死亡人数位居欧洲之首；大多数死亡发生在伦巴第地区。多达 4%的 COVID-19 患者需要入住重症监护病房，因为他们患有重病（例如急性呼吸窘迫综合征）。许多因急性呼吸窘迫综合征而入住重症监护病房的患者需要接受俯卧位等抢救治疗。

目的

描述意大利伦巴第重症监护病房 COVID-19 患者的呼吸管理和广泛使用俯卧位。

方法

本质量改进项目共纳入 89 名（67%为男性；中位年龄为 59 岁[范围，23-80 岁]）确诊 COVID-19 患者，他们于 2020 年 2 月 23 日至 3 月 31 日期间入院。

结果

86 名患者（97%）需要气管插管。43 名（48%）患者使用俯卧位作为抢救治疗。明显更多年轻患者（≤59 岁）存活出院（48 例中的 43 例[90%]）多于老年患者（≥60 岁；41 例中的 26 例[63%]；P<.005）。在接受俯卧通气治疗的 43 名患者中，有 15 名（35%[95%CI，21%-51%]）在重症监护病房死亡，其中 10 名（67%）为老年患者。