COVID-19: ÁßÁõ ¼ºÀÎȯÀÚ ICU ÆÐÇ÷Áõ °¡À̵å¶óÀÎ(Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults With Coronavirus Disease 2019 (COVID-19)
ÁßÁõ±Þ¼ºÈ£Èí±âÁõÈıºÀ» ¾ß±âÇÏ´Â SARS-CoV-2´Â Àü¼¼°èÀûÀ¸·Î ±Þ¼ÓÇÏ°Ô È®»êµÇ°í ÀÖÀ¸¸ç ¼ö¸¹Àº »ç¶÷µéÀÇ »ý¸íÀ» À§ÇùÇÏ°í ÀÖ´Ù. À̵éÀ» µ¹º¸´Â º¸°ÇÀÇ·áÀεé°ú ÀÓ»óÀǻ縦 À§ÇÑ ±ä±ÞÇÑ °¡À̵å¶óÀÎ °³¹ßÀÌ ÇÊ¿äÇÏ´Ù.
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1. 12°³±¹ÀÇ 36¸íÀÇ Àü¹®°¡ ÆгÎÀ» ±¸¼º
2. ±¸¼ºµÈ ÆгÎÀº ÁßȯÀڽǿ¡¼ ÇÊ¿äÇÑ COVID -19¿Í °ü·ÃµÈ 53°³ÀÇ Áú¹®À» Á¦¾È
3. ¹®Çå°íÂûÀ» ÅëÇÏ¿© COVID-19·Î ÀÎÇÑ ICU¿¡ ÀÖ´Â ÁßÁõȯÀÚ°ü¸®¸¦ À§ÇÑ Áõ°ÅÀÚ·á µµÃâÇÏ°í ¸ðµç ½ÇÇà°¡´ÉÇÑ Áöħ¿¡ ´ëÇÑ Áú¹®µéÀº PICO Çü½Ä¿¡ µû¶ó ¸í¹éÇÏ°Ô Á¤ÀÇÇÏ¿© ±¸Á¶È½ÃÅ´;
- Population
- Intervention
- Control
- Outcome(s) ÁöÁöÄ¡·á(supportive care)¿Í °ü·ÃµÈ °¡Àå ÃÖ±ÙÀÇ Ã¼°èÀû °íÂûÀ» ¼öÇà
4. GRADE (±Ç°í Æò°¡, Æò°¡, °³¹ß ¹× Æò°¡) Á¢±Ù¹æ½ÄÀ» Àû¿ëÇÏ¿© Áõ°ÅÀÇ È®½Ç¼ºÀ» Æò°¡ÇÏ°í À§Çؼº°ú À¯Àͼº, ÀÚ¿ø ¹× ºñ¿ë ºÎºÐ µîÀÇ Å¸´ç¼º°£ÀÇ ±ÕÇüÀ» ±â¹ÝÀ¸·Î ±ÇÀå »çÇ×À» »ý¼ºÇÔ
±×¸² 1 COVID-19 guideline development process. (Source: Crit Care Med. 2020 Jun;48(6):e440-e469 doi: 10.1097/CCM.0000000000004363)
±×¸² 2. Summary of recommendations on the initial management of hypoxic COVID-19 patients.(Source: Crit Care Med. 2020 Jun;48(6):e440-e469 doi: 10.1097/CCM.0000000000004363)
COVID-19·Î ÀÎÇÑ ÆÐÇ÷Áõ °ü¸® ÁöħÀ» À§ÇØ ÆгÎÀº 54°³ÀÇ Áø¼ú¹®À» ¸¸µé¾ú°í ÀÌÁß¿¡¼ 4°¡Áö º£½ºÆ® ½Ç¹«°¡À̵å¶óÀΰú 9°¡Áö °·ÂÇÑ ±Ç°í»çÇ×°ú, 35°¡Áö Áõ°Å°¡ ºÎÁ·ÇÑ Á¦¾ÈµéÀº ¹ßÇ¥Çß´Ù.
Best Practice 1: For healthcare workers performing aerosol-generating procedures*
¿¡¾î·ÎÁ¹ »ý¼º ÀýÂ÷¸¦ ¼öÇàÇÏ´Â ÀÇ·á Á¾»çÀÚ ¿ë *
ICU¿¡ COVID-19°¡Àִ ȯÀÚÀÇ °æ¿ì ´Ù¸¥ °³ÀÎ º¸È£ ÀåÄ¡ ¿Ü¿¡ ¼ö¼ú / ÀÇ·á ¸¶½ºÅ©¿Í´Â ´Þ¸® ÀåÂø µÈ È£Èí±â ¸¶½ºÅ© (N95 È£Èí±â, FFP2 ¶Ç´Â ÀÌ¿¡ »óÀÀÇÏ´Â ¸¶½ºÅ©)¸¦ »ç¿ë±Ç°íÇÔ. Àåºñ (¿¹ : Àå°©, °¡¿î ¹× º¸¾È°æ°ú °°Àº º¸¾È°æ)
Best Practice 2: À½¾Ð½Ç¿¡¼ COVID-19 °¨¿°µÈ ICU ȯÀÚ¿¡ ´ëÇÑ ¿¡¾î·ÎÁ¹ ÀýÂ÷¸¦ ¼öÇàÇÏ´Â °ÍÀ» ±Ç°íÇÔ
Best Practice 3: ±â°ü ³» »ð°üÀÌ ÇÊ¿äÇÑ COVID-19 ȯÀÚÀÇ °æ¿ì¿¡, ±â°ü³» »ð°ü °æÇèÀÌ °¡Àå ¸¹Àº ÀÇ·áÀÎÀÌ ¼öÇàÇÏ´Â °ÍÀÌ ÁÁ´Ù. ÀÌ´Â ½Ãµµ Ƚ¼ö¿Í °¨¿°ÀüÆÄ À§ÇèÀ» ÃÖ¼ÒÈÇϱâ À§ÇÑ °ü¸®ÀÓ.
Best Practice 4: NIPPV ¶Ç´Â HFNC¸¦ ¹Þ´Â ¼ºÀÎ COVID-19ȯÀÚÀÇ °æ¿ì¿¡, È£Èí»óÅ ¾ÇÈ¿¡ ´ëÇÑ ¸é¹ÐÇÑ ¸ð´ÏÅ͸µ°ú ¾ÇÈ°¡ ¹ß»ýÇÒ °æ¿ì ÅëÁ¦µÈ ȯ°æ¿¡¼ Á¶±â »ð°üÀ» ±ÇÀåÇÔ
Figure 3. Summary of recommendations on the management of patients with COVID-19 and ARDS.
±×¸² 3. Summary of recommendations on the initial management of hypoxic COVID-19 patients. (Source: Crit Care Med. 2020 Jun;48(6):e440-e469 doi: 10.1097/CCM.0000000000004363)
53°³ÀÇ COVID-19 °ü¸®Áöħ°³¹ßÀ» À§ÇÑ Áú¹® Áß¿¡¼ ¾Æ·¡ Ç׸ñ¿¡ ´ëÇؼ´Â ¾ÆÁ÷ ±Ù°Å°¡ ¾ø±â¶§¹®¿¡ °ü¸®Áöħ¿¡ ´ëÇÑ ¾Æ¹«·± Á¦¾ÈÀ» ÇÒ ¼ö ¾ø´Ù.
1) Infection control
2) Laboratory diagnosis and specimens
3) Hemodynamic support
4) Ventilatory support
5) COVID-19 therapy
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