新型冠状病毒肺炎疫情期间患者的安全转运

目的 探讨在疫情期间如何实施新型冠状病毒肺炎疑似及确诊患者的安全转运.方法 选取2020年1月至3月院内转运的22例新型冠状病毒肺炎疑似患者和院外转运的3例确诊患者为研究对象,通过转运前评估、制订转运计划、实施分级转运等精细化管理对患者实施转运.结果 19例新型冠状病毒肺炎轻症疑似患者和3例危重症疑似患者及3例确诊患者...     

应用体外膜肺氧合联合机械通气的危重症新型冠状病毒肺炎患者院内转运的安全管理

本文总结了2例应用体外膜肺氧合(ECMO)联合机械通气的危重症新型冠状病毒肺炎患者院内转运的安全管理经验,包括成立ECMO转运小组、三级防护、转运前准备以及转运中和转运后的安全管理,以期为进一步提升新型冠状病毒肺炎患者院内转运效率提供参考。     

院内转运流程在新型冠状病毒肺炎机械通气患者中的应用

危重患者需要院内转运进行全面检查和诊断,但在转运过程中可能发生危险,需要医护人员配合。本文介绍了湖北黄冈新型冠状病毒肺炎防治一线中危重症机械通气患者院内转运流程,在临床取得较好成效,为临床人员提供参考。     

新型冠状病毒肺炎心脏骤停预防与心肺复苏专家共识

在新型冠状病毒肺炎(COVID-19)死亡患者中,其心脏骤停原因及其心肺复苏策略与传统的、心源性心脏骤停心肺复苏有明显差异性,这些差异性主要体现在COVID-19特点、心脏骤停原因、个人防护、复苏策略与复苏伦理等方面.因此,需要有涉及新型冠状病毒肺炎患者心脏骤停预防与心肺复苏专家共识,以指导这一特殊情况下的心肺复苏实践...     

新型冠状病毒肺炎的临床特征与病原体检测

新型冠状病毒肺炎(COVID-19)是一种由新型冠状病毒(SARS-CoV-2)引起的急性传染病,传播途径主要为经呼吸道飞沫和接触传播,不排除通过气溶胶和消化道等途径传播的可能性。COVID-19病例多数表现为普通型和轻型,少数病例病情进展较快,迅速进入重症与危重症阶段,救治难度较大。SARS-CoV-2的核酸检测的缺点是容易产生假阴性、检测时间长,影像学检查成为辅助诊断COVID-19快捷、方便的手段之一,并在判断肺炎的严重程度中发挥重要作用,联合采用血清免疫学检测可提高检出率。     

新型冠状病毒肺炎重型/危重型患者护理专家共识

全球新型冠状病毒肺炎(COVID-19)疫情形势严峻,尚无特效治疗药物。为了降低重型和危重型COVID-19患者的病死率,复旦大学附属中山医院一线抗疫护理专家对重型/危重型患者的护理措施进行分析、探讨、总结,并结合有关文件规定和规范,制定本护理专家共识。     

福州地区重症型新型冠状病毒肺炎危险因素的临床分析

目的 探索预测新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)重症型的危险因素,指导临床实践.方法 回顾性分析福建医科大学教学医院福州肺科医院2020年1月至2020年4月收治的COVID-19患者90例的临床资料和入院24h内的相关实验室检查结果.根据《重症新型冠状病毒肺炎管理专...     

新型冠状病毒肺炎合并急性ST段抬高型心肌梗死的诊治

新型冠状病毒肺炎(COVID-19)是由新型冠状病毒(2019-nCoV)引起的急性传染病,于2019年12月底在我国湖北省武汉市出现[1]。目前全国已确诊77658例,其中不乏合并急性ST段抬高型心肌梗死(acute ST elevation myocardial infarction,STEMI)患者。根据中国《新型冠状病毒感染肺炎诊疗方案(试行第六版)》[2],COVID-19合并STEMI、心力衰竭、高血压、糖尿病等基础疾病时,多表现为重症COVID-19。近期国外一项研究对41例COVID-19进行分析,约12%的COVID-19患者存在心肌损伤[3]。     

新型冠状病毒肺炎合并肥胖症的评估与治疗策略

新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)已成为危及全球的传染性疾病,重症患者死亡风险极高.临床研究显示,肥胖症是COVID-19患者发生重症及死亡的独立危险因素.对于合并肥胖症的COVID-19患者,应尽早评估肥胖相关合并症,并在营养、气道管理、抗凝、合并症控制等方面采取更...     

新型冠状病毒肺炎患者血清白细胞介素2R测定及其评价

目的检测新型冠状病毒肺炎(COVID-19)患者血清白细胞介素-2受体(IL-2R)的含量,探讨其临床意义。方法用放射免疫法检测了47例COVID-19患者血清IL-2R含量,并与正常对照组作比较分析,又将COVID-19患者按新型冠状病毒肺炎诊疗方案(试行第六版)分为普通、重症及危重型,并进行相互比对。结果进展期COVID-19患者血清IL-2R为545.89±337.065U/ml,高于对照组391.12±123.921U/ml(P0.05);危重型患者IL-2R为1085.38±434.166U/ml,显著高于重症型440.34±177.845U/ml及普通型411.86±138.815U/ml(r=0.53,P0.01)。结论 COVID-19患者体内存在免疫反应异常,炎性细胞因子IL-2在危重型患者的发病机制中可能起重要作用。     

预见性护理程序在急诊危重患者院内转运中的效果观察

目的探讨预见性护理程序在急诊危重患者院内转运的效果。方法抽取2010年1~12月需院内转运的60例急诊危重患者设为对照组,用一般护士平车护送,取适当体位,保持呼吸道通畅,管路通畅,注意监测;抽取2011年1~12月需院内转运的60例急诊危重患者设为实验组,在转运前、转运中、转运后应用预见性护理程序。观察2组的转运时间、不良事件和医患纠纷发生率。结果院内转运时间,对照组为(38.6±6)min,实验组为(30.2±3.0)min。实验组转运效率快于对照组(P<0.01);不良事件和医患纠纷发生率实验组明显低于对照组(P<0.05)。结论在急诊危重患者院内转运中应用预见性护理程序,可有效降低转运时间,提高治疗质量,优化医患关系,有效降低护理不良事件的发生,值得应用推广。     

高原高寒地区长途跨海拔转运新冠肺炎患者的生物安全防护规范探讨

高海拔地区长途跨海拔转运新型冠状病毒肺炎（简称“新冠肺炎”）患者的生物安全防护和应用效果问题值得探讨。我院采用多种措施,包括：多学科联合会诊,医院临时组建转运专家组,分析讨论长途转运存在的风险、困难及应对措施,制定了详细周密的转运方案,成功完成21例新冠肺炎患者长途跨海拔转运,并达到了生物安全防护要求。新冠肺炎患者的跨海拔长途转运较为特殊,任务较为紧急,准备时间较短,流程有一定的局限性,还需要不断的完善和改进,逐步建立更为全面的跨海拔长途转运体系。     

Geriatric nurse involvement during intra-hospital transitions

Geriatric nurses are skilled in the special needs of hospitalized older adults. While significant focus has been placed on improving care transitions upon discharge, less attention has been placed on intra-hospital transitions. Intra-hospital transitions represent transfers occurring between hospital units or rooms. Intra-hospital transitions challenge normal nursing workflow and require careful consideration of care coordination to prevent adverse events for older adults. Frequent changes in environment and a lack of consistency in care may support the development or prolongation of delirium as older adults are transferred between units and rooms. Additional adverse event risks include infections and falls, which also increases with each transfer. Geriatric nurse involvement can enhance communication between units as well as ensuring appropriate geriatric assessments occur. Geriatric nurses are thus well positioned to act as leaders during intra-hospital transitions, potentially reducing these and adverse events.     

Interhospital transportation of a COVID-19 patient undergoing veno-venous extracorporeal membrane oxygenation by helicopter

Some coronavirus disease 2019 (COVID-19) patients develop rapidly progressive acute respiratory distress syndrome and require veno-venous extracorporeal membrane oxygenation (V-V ECMO). A previous study recommended the transfer of ECMO patients to ECMO centers. However, because of the pandemic, a limited number of ECMO centers are available for patient transfer. The safe long-distance interhospital transport of these patients is a concern. To minimize transportation time, helicopter use is a suitable choice. We report the first case of a COVID-19 patient on V-V ECMO, transferred to our ECMO center by helicopter.A 45-year-old man with rheumatoid arthritis history, treated with immunosuppressants, presented with fever and sore throat. He was diagnosed with COVID-19 following a positive severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test result and was subsequently prescribed favipiravir. However, his respiratory failure progressively worsened. On day 10 of hospitalization at the previous hospital, he was intubated, and we received a request for ECMO transport on the next day. The ECMO team, who wore personal protective equipment (N95 respirators, gloves, gowns, and face shields), initiated V-V ECMO in the referring hospital and safely transported the patient by helicopter. The flight time was 7 min. He was admitted to the intensive care unit of our hospital and received tocilizumab. He was discharged on hospital day 31 with no significant sequelae.In this case report, we discuss important factors for the safe and appropriate interhospital transportation of COVID-19 patients on ECMO as well as staff and patient safety during helicopter transportation.     

Fatty liver on computed tomography scan on admission is a risk factor for severe coronavirus disease

ObjectivesTo alleviate the overflow of coronavirus disease 2019 (COVID-19) patients in hospitals, less invasive and simple criteria are required to triage the patients. We evaluated the relationship between COVID-19 severity and fatty liver on plain computed tomography (CT) scan performed on admission.MethodsIn this retrospective cohort study, we considered all COVID-19 patients at a large tertiary care hospital between January 31 and August 31, 2020. COVID-19 severity was categorized into severe (moderate and severe) and non-severe (asymptomatic and mild) groups, based on the Japanese National COVID-19 guidelines. Fatty liver was detected on plain CT scan. Multivariate logistic regression analysis was performed to evaluate factors associated with severe COVID-19.ResultsOf 222 patients (median age: 52 years), 3.2%, 58.1%, 20.7%, and 18.0% presented with asymptomatic, mild, moderate, and severe COVID-19, respectively. Although 59.9% had no fatty liver on plain CT, mild, moderate, and severe fatty liver occurred in 13.1%, 18.9%, and 8.1%, respectively. Age and presence of fatty liver were significantly associated with severe COVID-19.ConclusionOur study showed that fatty liver on plain CT scan on admission can become a risk factor for severe COVID-19. This finding may help clinicians to easily triage COVID-19 patients.     

Deterioration of respiratory function after intra-hospital transport of critically ill surgical patients

Objective To evaluate the impact of intra-hospital transport of artificially ventilated patients on respiratory function, and to define predictors that may allow estimation of the risk of post-transport pulmonary deterioration.Design Prospective observation study.Setting Surgical ICU, University Hospital.Patients 49 intra-hospital transports (median Apache-score before transport 21, of 28 consecutive patients (all intubated and mechanically ventilated) were studied.Interventions 32 transports were destined to the radiology department and 17 to the operating theatre. Patients were ventilated during transportation with a transport ventilator.Measurements and results The base-line condition of the patients and any changes of hemodynamic function were noted. Arterial blood gases were determined before transport as well as 0.25, 1, 6, 12, and 24 h after return of the patient to the ICU. Of the transports 41 (83.7%) resulted in a decrease of PO₂/FIO₂-ratio with a deterioration of more than 20% from baseline in 21 cases (42.8%). The impairment of respiratory function lasted longer than 24 h in 10 subjects (20.4%). Ventilation with positive end-expiratory pressure correlated significantly (r=–0.4) with post-transport change of PO₂/FIO₂-ratio, whereas initial FIO₂, initial PO₂/FIO₂-ratio, Apache II-score, patients' age or transport time did not distinguish between patients with and without a consecutive decrease of pulmonary function.Conclusion Intra-hospital transport of ventilated critically ill patients may result in a considerable and long-standing deterioration of respiratory function. Patients ventilated with positive end-expiratory pressure are at an increased risk and the indication for procedures away from the ICU has to be weighed carefully in these subjects.     

Recommendations for perinatal and neonatal surgical management during the COVID-19 pandemic

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 has spread rapidly around the world and is a significant threat to global health. Patients in the Neonatal Surgery Department have rapidly progressing diseases and immature immunity, which makes them vulnerable to pulmonary infection and a relatively higher mortality. This means that these patients require multidisciplinary treatment including early diagnosis, timely transport, emergency surgery and intensive critical care. The COVID-19 pandemic poses a threat to carrying out these treatments. To provide support for the health protection requirements of the medical services in the Neonatal Surgery Department, we developed recommendations focusing on patient transport, surgery selection and protection requirements with the aim of improving treatment strategies for patients and preventing infection in medical staff during the current COVID-19 pandemic.     

Lung Ultrasound in Patients with Acute Respiratory Failure Reduces Conventional Imaging and Health Care Provider Exposure to COVID-19

Lung ultrasound gained a leading position in the last year as an imaging technique for the assessment and management of patients with acute respiratory failure. In coronavirus disease 2019 (COVID-19), its role may be of further importance because it is performed bedside and may limit chest X-ray and the need for transport to radiology for computed tomography (CT) scan. Since February 21, we progressively turned into a coronavirus-dedicated intensive care unit and applied an ultrasound-based approach to avoid traditional imaging and limit contamination as much as possible. We performed a complete daily examination with lung ultrasound score computation and systematic search of complications (pneumothorax, ventilator-associated pneumonia); on-duty physicians were free to perform CT or chest X-ray when deemed indicated. We compared conventional imaging exams performed in the first 4 wk of the COVID-19 epidemic with those in the same time frame in 2019: there were 84 patients in 2020 and 112 in 2019; 64 and 22 (76.2% vs. 19.6%, p < 0.001) had acute respiratory failure, respectively, of which 55 (85.9%) were COVID-19 in 2020. When COVID-19 patients in 2020 were compared with acute respiratory failure patients in 2019, the median number of chest X-rays was 1.0 (1.0–2.0) versus 3.0 (1.0–4.0) (p = 0.0098); 2 patients 2 (3.6%) versus 7 patients (31.8%) had undergone at least one thoracic CT scan (p = 0.001). A self-imposed ultrasound-based approach reduces the number of chest X-rays and thoracic CT scans in COVID-19 patients compared with patients with standard acute respiratory failure, thus reducing the number of health care providers exposed to possible contamination and sparing personal protective equipment.     

新型冠状病毒肺炎患者院前转运中所关注的问题调查

目的通过了解新型冠状病毒肺炎患者在院前转运过程中关注的问题,采取措施提高转运效率。方法对2020年1月21日—2020年2月9日经医院成功转运的47例新型冠状病毒肺炎患者进行访谈,总结患者转运过程中关心的问题。结果47例新型冠状病毒肺炎患者院前转运中关心的问题包括:“入院后是否会相互传染”,占89.36%(42/47);“我是怎么被传染的”,占85.11%(40/47);“家人会不会被传染”,占65.96%(31/47);“疾病能否被治愈”,占53.19%(25/47);“什么时候可以出院”,占48.94%(23/47);“可以带哪些东西入院和费用”,占29.79%(14/47)。结论护理人员应及时了解患者转运过程中关注的问题,以问题为导向主动采取干预,以此缓解患者不良情绪,提高转运效率。