Jones Carolynn T, Kopf R Scott, Tushla Lisa, Tran Sarah, Hamilton Caroline, Lyman Meghan, McMullen Rachel, Shah Drashti, Stroman Angela, Wilkinson Eryn, Kelmenson Daniel, Vazquez Jose, Pappas Peter G
Carolynn T. Jones is a clinical professor at The Ohio State University, College of Nursing, Columbus, Ohio, and the Executive Director and Nurse Planner for the Mycoses Study Group Education and Research Consortium.
R. Scott Kopf is a nurse practitioner, Division of Pulmonary and Critical Care Medicine at the University of Alabama at Birmingham, Birmingham, Alabama.
Crit Care Nurse. 2022 Dec 1;42(6):36-46. doi: 10.4037/ccn2022237.
In March 2020, the World Health Organization declared COVID-19, caused by the SARS-CoV-2 virus, a pandemic. Patients with severe cases resulting in hospitalization and mechanical ventilation are at risk for COVID-19-associated pulmonary aspergillosis, an invasive fungal infection, and should be screened for aspergillosis if they have persistent hemodynamic instability and fever. Early detection and treatment of this fungal infection can significantly reduce morbidity and mortality in this population.
To develop an evidence-based care step pathway tool to help intensive care unit clinicians assess, diagnose, and treat COVID-19-associated pulmonary aspergillosis.
A panel of 18 infectious disease experts, advanced practice registered nurses, pharmacists, and clinical researchers convened in a series of meetings to develop the Care Step Pathway tool, which was modeled on a tool developed by advanced practice nurses to evaluate and manage side effects of therapies for melanoma. The Care Step Pathway tool addresses various aspects of disease management, including assessment, screening, diagnosis, antifungal treatment, pharmacological considerations, and exclusion of other invasive fungal coinfections.
The Care Step Pathway tool was applied in the care of a patient with COVID-19-associated aspergillosis. The patient was successfully treated.
The Care Step Pathway is an effective educational tool to help intensive care unit clinicians consider fungal infection when caring for COVID-19 patients receiving mechanical ventilation in the intensive care unit, especially when the clinical course is deteriorating and antibiotics are ineffective.
2020年3月，世界卫生组织宣布由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）病毒引起的2019冠状病毒病（COVID-19）为大流行病。因重症而住院并接受机械通气的患者有患COVID-19相关肺曲霉病（一种侵袭性真菌感染）的风险，若他们持续存在血流动力学不稳定和发热，应接受曲霉病筛查。早期发现并治疗这种真菌感染可显著降低该人群的发病率和死亡率。
开发一种基于证据的护理步骤路径工具，以帮助重症监护病房的临床医生评估、诊断和治疗COVID-19相关肺曲霉病。
一个由18名传染病专家、高级执业注册护士、药剂师和临床研究人员组成的小组召开了一系列会议，以开发护理步骤路径工具，该工具是以高级执业护士开发的用于评估和管理黑色素瘤治疗副作用的工具为蓝本。护理步骤路径工具涉及疾病管理的各个方面，包括评估、筛查、诊断、抗真菌治疗、药理学考量以及排除其他侵袭性真菌合并感染。
护理步骤路径工具应用于一名COVID-19相关曲霉病患者的护理中。该患者得到了成功治疗。
护理步骤路径是一种有效的教育工具，可帮助重症监护病房的临床医生在护理重症监护病房中接受机械通气的COVID-19患者时考虑真菌感染，尤其是在临床病程恶化且抗生素治疗无效的情况下。
