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DOI: 10.1055/a-1164-4100
COVID-19 aus Sicht der Intensivmedizin
COVID-19: The Intensive Care Point-of-View
Abstract
Approx. 93 % of COVID-19 infections are mild, and not all severely ill patients are transferred to the intensive care unit. But the Corona crisis implies high demands on intensive care medicine. Many treatment modalities of COVID patients are “best practice”, but some aspects remain unclear at present. This article deals with diagnostics, monitoring and therapy with COVID-19 patients in intensive care units and with a suitable hygiene concepts.
A hygiene concept is obligatory and must ensure – in addition to general measures – the training of employees and the hygienic discharge of material. Ideally, a cohort isolation is implemented.
Monitoring of patients with COVID-19 is not different from other intensive care patients and should be adapted to the clinical situation of the individual patient. In laboratory analysis the typical abnormality of COVID-19 patients should be taken into account. In case of increasing inflammatory parameters, fungal infections should be tested.
Due to the formation of aerosols, disconnection of the respiratory system must be avoided in invasive ventilation. If a disconnection from the respirator is necessary, the tube should be disconnected. After extubation, an intermittent NIV treatment for atelectase prophylaxis can be performed.
In Deutschland verlaufen ca. 93 % der COVID-19-Infektionen milde, und nicht alle Schwererkrankten werden auf die Intensivstation verlegt. Doch die Corona-Krise stellt hohe Ansprüche an die Intensivmedizin. Viele Behandlungsmodalitäten von COVID-Patienten sind „beste intensivmedizinische Praxis“, aber derzeit bleiben noch Aspekte unklar. Dieser Beitrag behandelt neben Hygienekonzepten vor allem Diagnostik, Monitoring und Therapie auf Intensivstationen.
Publication History
Article published online:
30 July 2020
© Georg Thieme Verlag KG
Stuttgart · New York
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Literatur
- 1 Kluge S, Janssens U, Welte T. et al Recommendations for critically ill patients with COVID-19. Med Klin Intensivmed Notfmed 2020; 115: 175-177 . doi:10.1007/s00063-020-00674-3
- 2 Ojha V, Mani A, Pandey NN. et al. CT in coronavirus disease 2019 (COVID-19): a systematic review of chest CT findings in 4410 adult patients. Eur Radiol 2020; DOI: 10.1007/s00330-020-06975-7.
- 3 Leo F, Wormann D, Grohé C. COVID-19 aus Sicht der Pneumologie. Dtsch Med Wochenschr 2020; 145: 1086-1092
- 4 Spiekermann K, Subklewe M, Hildebrandt M. et al. COVID-19 aus Sicht der Hämatologie. Dtsch Med Wochenschr 2020; 145: 1044-1050
- 5 Guan WJ, Ni ZY, Hu Y. et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020; DOI: 10.1056/NEJMoa2002032.
- 6 Feldt T, Heim K, Klug B. et al Hinweise zu Erkennung, Diagnostik und Therapie von Patienten mit COVID-19. Im Internet. wwwstakobrki.de ; Stand: 23.06.2020
- 7 Bianco F, Incollingo P, Grossi U. et al. Preventing transmission among operating room staff during COVID-19 pandemic: the role of the Aerosol Box and other personal protective equipment. Updates Surg 2020; DOI: 10.1007/s13304-020-00818-2.
- 8 Voiriot G, Fajac A, Lopinto J. et al. Bronchoalveolar lavage findings in severe COVID-19 pneumonia. Intern Emerg Med 2020; DOI: 10.1007/s11739-020-02356-6.
- 9 Rijnders BJA, Schauwvlieghe A, Wauters J. Influenza-associated pulmonary aspergillosis: a local or global lethal combination?. Clin Infect Dis 2020; DOI: 10.1093/cid/ciaa010.
- 10 Tomcsanyi J, Tomcsanyi K. The risk of acquired long QT syndrome during a coronavirus epidemic. Focus on hydroxychloroquine. Orv Hetil 2020; 161: 689-691 . doi:10.1556/650.2020.31817
- 11 Beigel JH, Tomashek KM, Dodd LE. et al. Remdesivir for the Treatment of Covid-19 – Preliminary Report. N Engl J Med 2020; DOI: 10.1056/NEJMoa2007764.
- 12 Magagnoli J, Naredndran S, Pereira F. et al. Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19. DOI: 101101/2020.04.16.20065920.
- 13 Colaneri M, Bogliolo L, Valsecchi P. et al. Tocilizumab for Treatment of Severe COVID-19 Patients: Preliminary Results from SMAtteo COvid19 REgistry (SMACORE). Microorganisms 2020; 8 DOI: 10.3390/microorganisms8050695.
- 14 Herold T, Jurinovic V, Arnreich C. et al. Elevated levels of interleukin-6 and CRP predict the need for mechanical ventilation in COVID-19. J Allergy Clin Immunol 2020; DOI: 10.1016/j.jaci.2020.05.008.
- 15 Rajendran K, Krishnasamy N, Rangarajan J. et al. Convalescent plasma transfusion for the treatment of COVID-19: Systematic review. J Med Virol 2020; DOI: 10.1002/jmv.25961.
- 16 Reynolds HR, Adhikari S, Pulgarin C. et al. Renin-Angiotensin-Aldosterone System Inhibitors and Risk of Covid-19. N Engl J Med 2020; DOI: 10.1056/NEJMoa2008975.
- 17 Fadel R, Morrison AR, Vahia A. et al. Early Short Course Corticosteroids in Hospitalized Patients with COVID-19. Clin Infect Dis 2020; DOI: 10.1093/cid/ciaa601.
- 18 Chakraborty C, Sharma AR, Bhattacharya M. et al. COVID-19: Consider IL6 receptor antagonist for the therapy of cytokine storm syndrome in SARS-CoV-2 infected patients. J Med Virol 2020; DOI: 10.1002/jmv.26078.
- 19 Bataille S, Pedinielli N, Bergounioux JP. Could ferritin help the screening for COVID-19 in hemodialysis patients?. Kidney Int 2020; DOI: 10.1016/j.kint.2020.04.017.
- 20 Wang C, Fei D, Li X. et al. IL-6 may be a good biomarker for earlier detection of COVID-19 progression. Intensive Care Med 2020; DOI: 10.1007/s00134-020-06065-8.
- 21 Scaravilli V, Grasselli G, Castagna L. et al Prone positioning improves oxygenation in spontaneously breathing nonintubated patients with hypoxemic acute respiratory failure: A retrospective study. J Crit Care 2015; 30: 1390-1394 . doi:10.1016/j.jcrc.2015.07.008
- 22 Zhou Y, Jin X, Lv Y. et al Early application of airway pressure release ventilation may reduce the duration of mechanical ventilation in acute respiratory distress syndrome. Intensive Care Med 2017; 43: 1648-1659 . doi:10.1007/s00134-017-4912-z