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2020, vol. 42, br. 1-2, str. 41-48
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Uloga anesteziologa u zbrinjavanju pacijenata obolelih od COVID-19 - iskustva sa Klinike za infektivne i tropske bolesti Kliničkog centra Srbije - iskustvo u zbrinjavanju pacijenata sa COVID-19 infekcijom
Anesthesiologists assignment in management of patients with COVID-19 infection: Experience from the Clinic for Infectious and Tropical Diseases Clinical Centre of Serbia: Single center experience in management of patients with COVID-19
aKlinički centar Srbije, Centar za anesteziologiju i reanimatologiju, Beograd bKlinički centar Srbije, Centar za anesteziologiju i reanimatologiju, Beograd + Univerzitet u Beogradu, Medicinski fakultet
e-adresa: jovicicjelena@ymail.com
Sažetak
Prema dnevnom izveštaju, u Srbiji je na Corona Virus Infection Disease (COVID-19) pozitivno oko 10.000 testiranih, sa stopom mortaliteta od oko 2%, dok je u izveštaju Svetske zdravstvene organizacije prijavljena stopa mortaliteta od oko 7%. Timski rad i multidisciplinarni pristup su značajne stavke terapije. Prema aktuelnom sistemu organizovanja, radno mesto anesteziologa je u jedinici intenzivnog lečenja - "crvenoj zoni" Klinike za infektivne i tropske bolesti, u kojoj su smešteni pacijenti kod kojih je potvrđena infekcija virusom SARS CoV-2 i kod kojih postoji srednje teški i teški oblik bolesti COVID-19. Radna smena anesteziologa u "crvenoj zoni" je trajala četiri sata, uz upotrebu kompletne lične zaštitne opreme. U zbrinjavanju najtežih formi bolesti učestvovali su i specijalisti drugih oblasti medicine (infektolozi, pulmolozi, hematolozi, kardiolozi, gastroenterolozi, nefrolozi). Rad lekara u COVID intenzivnoj jedinici su usklađivali anesteziolozi-kordinatori. U "crvenoj zoni" se respiratorna potpora, sedacija, kontrola hemodinamskih parametara, tromboprofilaksa i nutritivna potpora sprovode prema važećim preporukama. Na početku epidemije, bilo je 90,5% intubiranih, a kasnije 25-30%. Primenili smo nekoliko metoda neinvazivne respiratorne potpore: NIV 11,1%, HFNC 13,3%, kiseonična maska 15,6%. Potrebno je da se doze sedativnih agenasa individualno prilagode, s obzirom na to da oboleli od COVID-19 zahtevaju veće doze od uobičajenih. Za bezbedan rad zdravstvenog osoblja u "crvenoj zoni" od presudnog značaja je poštovanje preporuka o upotrebi ličnih zaštitnih sredstava. Preporuke su zasnovane na iskustvu, a obuhvataju: poštovanje preporučenog slojevitog rasporeda lične zaštitne opreme, neprimenjivanje dodatnih zaštitnih sredstava "radi sigurnosti", neophodnost da redosled oblačenja zaštitne opreme uvek bude isti, praktičnije je nositi skafander za broj veći od idealnog.
Abstract
According to the report, COVID-19 infection was confirmed in 10000 patients followed with 2% mortality rate in Serbia, compared with 7% global mortality rate reported by WHO. Team work and multidisciplinary therapy approach is crucial in COVID-19 management. According to the current organizational plan, the anesthesiology teams were assigned to the ICU of the Clinic for Infectious and Tropical Diseases for treatment of patients with moderate to severe form of SARS CoV-2 infection. The each work shift of anesthesiology team is scheduled for 4 hours with personal protective equipment (PPE) available. In addition to anesthesiologists, health-care providers in other fields of medicine also took part in management of patients with most severe forms of infection (infectologist, pulmologist, hematologist, cardiologist, gastroenterologist, nephrologist). The anesthesiologist-coordinator coordinated the work of different specialists. In the "red zone", the principle of treatment was organized according to the current recommendations: respiratory, hemodynamic and nutritional support, tromboprophylaxis. At the beginning of the epidemic, 90.5% were intubated, and later 25-30%. We applied several non-invasive respiratory support methods: NIV 11.1%, HFNC 13.3%, oxygen mask 15.6%. Doses of sedative agents need to be individually adjusted as COVID-19 patients require higher doses than usual. But, the most important is to follow instructions related to PPE use for safe work in the "red zone". Recommendations based on experience: always respect the recommended layered arrangement of PPE, do not apply additional protective equipment "for safety", it is necessary that the order of wearing PPE is always the same, it is more practical to wear a spacesuit for more than ideals.
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