{"id":18793,"date":"2020-04-12T05:09:21","date_gmt":"2020-04-11T21:09:21","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=18793"},"modified":"2020-07-14T16:18:52","modified_gmt":"2020-07-14T08:18:52","slug":"icu-management-practice-%e5%86%a0%e7%8a%b6%e7%97%85%e6%af%92%e7%96%ab%e6%83%85%ef%bc%9a%e5%8d%b1%e9%87%8d%e7%97%85%e6%82%a3%e8%80%85%e7%9a%84%e6%b2%bb%e7%96%97%ef%bc%9a%e8%b6%8b%e5%8a%bf%e3%80%81","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=18793","title":{"rendered":"[ICU Management &#038; Practice]: \u51a0\u72b6\u75c5\u6bd2\u75ab\u60c5\uff1a\u5371\u91cd\u75c5\u60a3\u8005\u7684\u6cbb\u7597\uff1a\u8d8b\u52bf\u3001\u6cbb\u7597\u53ca\u75c5\u6b7b\u7387"},"content":{"rendered":"\n<h1 class=\"wp-block-heading\">#CoronavirusOutbreak: Caring for the Critically Ill - Trends, Treatment and Mortality<\/h1>\n\n\n\n<p>COVID-19 is associated with severe disease requiring intensive care in approximately 5% of proven infections. As with similar outbreaks in the past, including SARS, MERS, A(H7N9), and H1N1, critical care continues to be an integral component of the global response to Coronavirus.<\/p>\n\n\n\n<p><strong><em>You might also like<\/em><\/strong>:\u00a0<a rel=\"noreferrer noopener\" href=\"https:\/\/healthmanagement.org\/c\/icu\/news\/coronavirus-and-the-potential-role-of-ecmo\" target=\"_blank\">Coronavirus and the Potential Role of ECMO<\/a><\/p>\n\n\n\n<p>Antiviral and\/or immunomodulatory therapies have so far proven ineffective for treating patients infected with COVID-19. So how are critical care workers handling the crisis? What are the trends, patient characteristics, and critical care response when dealing with infected patients? Here is a quick overview:<\/p>\n\n\n\n<ul><li>COVID-19 is primarily infecting older patients with comorbid conditions such as diabetes and cardiac disease.&nbsp;<\/li><li>Children so far have experienced milder symptoms.&nbsp;<\/li><li>Pregnant women who have been infected have also had a milder effect.&nbsp;<\/li><li>The median duration between onset of symptoms and admission to the ICU is around 9 to 10 days.&nbsp;<\/li><li>Primary reasons for ICU admission have been respiratory support. Two-thirds of patients have met the criteria for ARDS.&nbsp;<\/li><li>Rapid access to diagnostic testing continues to be a priority as it enables clinicians to take action and implement infection control practices.&nbsp;<\/li><li>The principal feature of those suffering from serious disease from COVID-10 is the development of ARDS.&nbsp;<\/li><li>Treatment strategies for such patients include conservative fluid strategies for patients without shock following initial resuscitation, early antibiotics if bacterial co-infection is suspected, lung-protective ventilation, prone positioning, and ECMO for refractory hypoxaemia.&nbsp;<\/li><li>Septic shock and specific organ dysfunction are also being observed in a significant proportion of patients with COVID-19-related critical illness.&nbsp;<\/li><li>A large majority of severely affected patients have received targeted therapies, including neuraminidase inhibitors and corticosteroids.&nbsp;<\/li><li>Mortality among all infected patients remains between 0.5% to 4%, but among those who have to be hospitalised, mortality is around 5 to 15%. Mortality rates are between 22 to 62% among those who become critically ill.&nbsp;<\/li><li>The exact cause of death remains unknown, but presumed reasons include progressive hypoxia and multiorgan dysfunction.<\/li><li>Additional critical care strategies are also being implemented including admission of patients with suspected infection to private rooms, use of face masks during assessment and transfer, maintaining a distance of at least 2 m between patients, extra caution when using high-flow nasal oxygen or non-invasive ventilation, and additional airborne precautions including N95 respirators and eye protection.&nbsp;<\/li><li>Critical care facilities are also ensuring their staff receives updated training in infection prevention and control, including the use of protective equipment.&nbsp;<\/li><\/ul>\n\n\n\n<p>If cases continue to increase at the same rate, resources such as hospital beds, ventilators, ECMO, renal replacement therapy will become strained. Active preparation measures are needed to address this situation.<\/p>\n\n\n\n<p>Source:\u00a0<a rel=\"noreferrer noopener\" href=\"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2762996\" target=\"_blank\">JAMA<\/a><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">References:<\/h4>\n\n\n\n<p>Murthy, S et al. (2020)&nbsp;<a href=\"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2762996\" target=\"_blank\" rel=\"noreferrer noopener\">Care for Critically Ill Patients With COVID-19.<\/a>&nbsp;JAMA,&nbsp; doi:10.1001\/jama.2020.3633<\/p>\n","protected":false},"excerpt":{"rendered":"<p>#CoronavirusOutbreak: Caring for the Critically Ill &#8211; T [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[24,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18793"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=18793"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18793\/revisions"}],"predecessor-version":[{"id":18794,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18793\/revisions\/18794"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=18793"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=18793"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=18793"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}