Anwar Asad, Ramos-Bascon Nordita, Crerar-Gilbert A Agatha, Barnes Natalie, Madden Brendan
St George's University Hospitals NHS Foundation Trust, London, UK.
Clin Med (Lond). 2021 Mar;21(2):101-106. doi: 10.7861/clinmed.2020-0788.
During the coronavirus pandemic, our intensive care units were faced with large numbers of patients with an unfamiliar disease. To support our colleagues and to assist with diagnosis and treatment, we developed a specialist team.
The acute respiratory disease support team reviewed 44 consecutive patients referred from the intensive care and coordinated therapies for pulmonary hypertension, pulmonary thrombosis, evolving lung fibrosis and large airway intervention.
The mortality for this group was significantly lower (34%) than the total group admitted to critical care as a whole (51%) and for those not reviewed by the team (55%; p=0.012). Pulmonary hypertension was present in 84% of the patients and pulmonary thrombosis in 52%. Thirty-two patients received sildenafil therapy and this was associated with improvement in right heart function in survivors. Ten patients with evolving fibrosis and no evidence of sepsis received high-dose steroid therapy with excellent effect. Five patients developed airway complications requiring intervention. Short time on mechanical ventilation was associated with a poorer outcome (p<0.001).
A specialised cardiorespiratory team approach contributes significantly to successful management of severely unwell patients with COVID-19 and offers an important platform for continuity of patient care, education and staff well-being.
在新冠疫情期间，我们的重症监护病房面临大量患有陌生疾病的患者。为了支持我们的同事并协助诊断和治疗，我们组建了一个专家团队。
急性呼吸道疾病支持团队对44例从重症监护病房转诊来的患者进行了评估，并协调了针对肺动脉高压、肺血栓形成、进展性肺纤维化和大气道干预的治疗。
该组患者的死亡率（34%）显著低于整个重症监护病房收治患者的总死亡率（51%）以及未接受该团队评估患者的死亡率（55%；p=0.012）。84%的患者存在肺动脉高压，52%的患者存在肺血栓形成。32例患者接受了西地那非治疗，这与幸存者右心功能改善相关。10例有进展性纤维化且无脓毒症证据的患者接受了大剂量类固醇治疗，效果良好。5例患者出现气道并发症需要干预。机械通气时间短与预后较差相关（p<0.001）。
专业的心肺团队方法对成功管理重症COVID-19患者有显著贡献，并为患者护理的连续性、教育和员工福祉提供了一个重要平台。
