新冠肺炎是一新興傳染疾病,目前臨床缺乏治療新冠肺炎的重症病患的治療指引;美國醫學會臨床醫學期刊於2020年3月26日刊登戰勝敗血症治療處理指南 (Surviving Sepsis Campaign)對治療新冠肺炎的重症病患幾項臨床指引:1.對新冠肺炎重症病患定伴隨有急性呼吸窘迫(acute respiratory distress syndrome)者,建議使用類固醇治療(systematic corticosteroids);2.建議使用鼻高流量濕化氧療(high-flow nasal cannula)救治呼吸衰竭的新冠肺炎重症病患,若無法使用鼻高流量濕化氧療或無療效時,可採用非侵襲性正壓呼吸器(noninvasive positive pressure ventilation (NIPPV));此外,雖使用頭盔式非侵襲性正壓呼吸器(helmet NIPPV)也是可能的備案之一;然而,頭盔式非侵襲性正壓呼吸器對新冠肺炎重症病患的安全性及有效性,目前仍未知,故不建議使用;同時也建議增加負壓病房和 N95或FFP2口罩的數量,已因應照護短期間湧入的大量新冠肺炎重症病患,此為史無前例的重大挑戰。本篇刊登的治療處理指南是根據過去治療重症病患,但非根據新冠肺炎重症病患的臨床專家建議,隨著對新冠肺炎重症病患的臨床病程逐漸明瞭,即時更新並提供正確的新冠肺炎治療指引,有其迫切需要。

(財團法人國家衛生研究院 蔡慧如博士摘要整理)

Summary of the Clinical Problem Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of COVID-19, a pandemic that has affected more than 400 000 individuals and caused nearly 20 000 deaths as of late March 2020. Approximately 5% to 10% of patients require intensive care unit (ICU) admission and mechanical ventilation.1

Characteristics of the Guideline Source The Surviving Sepsis Campaign (SSC) has previously published a series of guidelines for sepsis and septic shock. Based on this experience, experts were recruited to write guidelines on the management of COVID-19 in critically ill adults. These guidelines were authoredby 36experts from 12countries (Table).2Recommendations were developed based on limited direct evidence with COVID-19 cases and indirect evidence derived from previous pandemics such as Middle East respiratory syndrome (MERS), severe acute respiratory syndrome (SARS), and other coronavirus infections. Overall, the panel issued 54 statements: 4 best practice statements, 9 strong recommendations, and 35 weak recommendations. (No recommendations were made for the remaining 6 topics.)

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Author:Jason T. Poston, Bhakti K. Patel, Andrew M. Davis, et al.
原文連結:https://jamanetwork.com/journals/jama/fullarticle/2763879