Профилактика иммобилизационных осложнений пациентов с НКИ COVID-19 в отделении реанимации и интенсивной терапи

252. У пациентов с НКИ COVID-19 рекомендуется обеспечивать выполнение раздела «Позиционирование и мобилизация» клинических рекомендаций ФАР по ранней реабилитации в условиях ОРИТ (УДД – 3, УУР – Б)

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Комментарий: нет специальных рекомендаций по ранней мобилизации и профилактике синдрома «последствий интенсивной терапии» для пациентов с НКИ. Опыт отделений ОРИТ, в которых есть персонал для проведения ранней реабилитаций предостерегает от выполнения маневров мобилизации, провоцирующих кашель. В целях защиты персонала не рекомендуется привлекать других участников мультидисциплинарной бригады (логопеды, психологи) в случаях лечения пациентов с острой церебральной недостаточности.

 

При ИВЛ в прон-позиции в дополнение к стандартным приемам ухода за пациентом рекомендуется использовать чек-лист (Приложение 19) мероприятий по профилактике развития пролежней и прочих иммобилизационных осложнений (УДД – 1, УУР – Б).

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Комментарий: использование чек-листа после пронирования нацелено на снижение последующих осложнений. Это пример чек-листа после пронирования для использования медсестрами. Чек-лист должен быть индивидуальным для учреждения и модифицироваться в соответствии с вопросами безопасности пациента в конкретном отделении

Критерии оценки качества медицинской помощи

№	Критерии качества	Уровень достоверности доказательств	Уровень убедительности рекомендаций
1	При проведении аэрозоль-генерирующих процедур персоналом отделений анестезиологии, реанимации и интенсивной терапии использованы средства индивидуальной защиты третьего уровня	5	С
2	У пациентов с НКИ COVID-19 выполнены общий (клинический) анализ крови, биохимический анализ крови, исследование уровня С-реактивного белка, и дополнительные исследования с учетом показателей пульсоксиметрии	4	В
3	У пациентов, находящихся в отделении интенсивной терапии в связи с дыхательной недостаточностью, осуществлен мониторинг ЭКГ с подсчетом ЧСС, неинвазивного измеряемого артериального давления, насыщения гемоглобина кислородом, температуры тела	5	С
4	У пациентов с НКИ COVID-19 и множественной органной дисфункцией проведен мониторинг суточного и кумулятивного гидробаланса	5	С
5	Интубация трахеи пациентам с НКИ COVID-19 проведена анестезиологом-реаниматологом, обладающим наибольшим опытом работы	5	С
6	У пациентов с НКИ COVID-19 и SpO2 менее 92% начата оксигенотерапия до достижения величины 96%	4	С
7	При искусственной вентиляции лёгких у пациентов НКИ COVID-19 и с ОРДС использован дыхательный объём 4-8 мл/кг идеальной массы тела	2	В
8	У пациентов с ОРДС вследствие НКИ COVID-19 использован РЕЕР 12-20 см вод. ст.	2	В
9	При проведении энтерального питания в прон-позиции изголовье кровати было приподнятым (обратный Тренделенбург) не менее, чем на 10-25 градусов	3	В
10	У пациентов с гипергликемией глюкоза крови определялась каждые 4 часа с момента поступления в ОРИТ	2	В
11	Пациентам с НКИ COVID-19 для профилактики ТЭЛА назначены низкомолекулярный или нефракционированный гепарин и механическая профилактика	5	С
12	У пациентов с НКИ COVID-10 учтены известные сведения о совместимости препаратов	5	С

 

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