COVID-19患者への心理的・リハビリ的治療だけでなく、呼吸気道管理の重要性

Importance of respiratory airway management as well as psychological and rehabilitative treatments to COVID-19 patients.

• Yichun Jiang
• Jun Chen
• Fulan Cen
• Xu Li
• Zhi Song
• Mian Peng
• Xueyan Liu

抄録

2019年重症コロナウイルス疾患（すなわち、COVID-19）患者の臨床治療は比較的困難である。ここでは、重症COVID-19患者のサルベージに関わるプロセスをレトロスペクティブに分析した。肥満症の女性COVID-19重症患者の状態は、入院後の初期に徐々に悪化していった。症状と検査報告によると，気管挿管と人工呼吸が適時に行われ，同時に高用量の鎮静剤と鎮痛剤が投与された．しかし，治療後期には鎮静・鎮痛剤の投与量を徐々に減らし，痰の喀出を促進するための気道ケアを強化するとともに，心理療法・リハビリテーション療法を行った。最終的には、18日間の挿管後に気管内チューブを抜去し、非侵襲的人工呼吸と高流量鼻カニューレ酸素療法に置き換えた。集中的な気道ケアと心理療法やリハビリテーション療法を併用することで、機械的換気の時間を短縮し、COVID-19患者の予後を改善することができる。

The clinical therapy for severe 2019 coronavirus disease (i.e., COVID-19) sufferers is relatively challenging. Herein, the processes involving salvage of a critical COVID-19 patient were retrospectively analyzed. The condition of an obese female critical COVID-19 sufferer progressively worsened in the initial period after admission. According to her symptoms and examination reports, endotracheal intubation and mechanical ventilation were timely conducted and meanwhile high-dose sedatives and analgesics were administrated. In the later therapeutic phase, however, sedative and analgesic dosages were gradually reduced, and psychological and rehabilitative therapies were conducted, concomitantly with enhancement of airway care to facilitate sputum expectoration. Eventually, the endotracheal tube was feasibly removed after intubation for 18 days and subsequently replaced with noninvasive ventilation and a high-flow nasal cannula oxygen therapy. Intensive airway care alongside psychological and rehabilitative therapies can shorten the mechanical ventilation time and improve the prognosis of COVID-19 sufferers.

Copyright © 2020. Published by Elsevier Inc.