新型冠状病毒感染重型及危重型患者呼吸治疗相关操作防护措施专家共识  

Expert consensus on preventing nosocomial transmission during respiratory care for critically ill patients infected by 2019 novel coronavirus pneumonia

作　　者：无 李洁 陈荣昌 景国强 倪忠 何国军[6] 无;Li Jie;Chen Rongchang(Respiratory Care Committee of Chinese Thoracic Society;Rush University,Chicago 60612,USA;Shenzhen People's Hospital,Shenzhen Institute of Respiratory Disease,Shenzhen 518020,China)

机构地区：[1]中华医学会呼吸病学分会呼吸治疗学组 [2]美国芝加哥Rush大学,60612 [3]深圳呼吸疾病研究所,518020 [4]滨州医学院附属民院 [5]四川大学华西医院 [6]浙江大学医学院附属第一医院

出　　处：《中华结核和呼吸杂志》2020年第4期288-296,共9页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：自首例新型冠状病毒肺炎确诊以来,已有大量人传人的病例,其中超过1700例医护人员遭受了感染。对危重症患者进行呼吸治疗时有大量高危操作,例如气管插管、简易呼吸器辅助通气、无创正压通气、高流量鼻导管治疗、气管镜检查、吸痰以及转运等均可引起或加重患者气道内呼出病毒的大量传播。因此,我们根据目前最佳证据以及国内现有条件制定了本防范建议,旨在降低医护人员感染风险的同时为患者提供最佳治疗。Definite evidence has shown that the novel coronavirus(COVID-19)could be transmitted from person to person,so far more than 1700 bedside clinicians have been infected.A lot of respiratory treatments for critically ill patients are deemed as high-risk factors for nosocomial transmission,such as intubation,manual ventilation by resuscitator,noninvasive ventilation,high-flow nasal cannula,bronchoscopy examination,suction and patient transportation,etc,due to its high possibility to cause or worsen the spread of the virus.As such,we developed this consensus recommendations on all those high-risk treatments,based on the current evidence as well as the resource limitation in some areas,with the aim to reduce the nosocomial transmission and optimize the treatment for the COVID-19 pneumonia patients.Those recommendations include:(1)Standard prevention and protection,and patient isolation;(2)Patient wearing mask during HFNC treatment;(3)Using dual limb ventilator with filters placed at the ventilator outlets,or using heat-moisture exchanger(HME)instead of heated humidification in single limb ventilator with HME placed between exhalation port and mask;avoid using mask with exhalation port on the mask;(4)Placing filter between resuscitator and mask or artificial airway;(5)For spontaneous breathing patients,placing mask for patients during bronchoscopy examination;for patients receiving noninvasive ventilation,using the special mask with bronchoscopy port to perform bronchoscopy;(6)Using sedation and paralytics during intubation,cuff pressure should be maintained between 25-30 cmH2O(1 cmH2O=0.098 kPa);(7)In-line suction catheter is recommended and it can be used for one week;(8)Dual-limb heated wire circuits are recommended and only changed with visible soiled;(9)For patients who need breathing support during transportation,placing an HME between ventilator and patient;(10)PSV is recommended for implementing spontaneous breathing trial(SBT),avoid using T-piece to do SBT.When tracheotomy patients are weaned from ventilator,HM

关 键 词：新型冠状病毒 重型及危重型感染患者 呼吸治疗 院内感染 防护措施 

分 类 号：R563.1[医药卫生—呼吸系统]