新型冠状病毒肺炎儿童重症急性呼吸衰竭的呼吸支持策略建议

Consideration of the respiratory support strategy of severe acute respiratory failure caused by SARS-CoV-2 infection in children

最近,一种新型冠状病毒(命名为SARSCoV-2)引起的重症肺炎在中国暴发流行,造成了一场全球公共卫生机构高度戒备的紧急状态。SARSCoV-2感染的特点是在最初的发热和咳嗽后迅速演变成严重甚至致命的呼吸衰竭,类似于急性呼吸窘迫综合征(ARDS)。在大多数情况下,可以通过常规的对症治疗痊愈,但严重者要入住重症监护病房(ICU),这类患者病死率很高[4-6]。

The recent ongoing outbreak of severe pneumonia associated with a novel coronavirus(SARS-CoV-2),currently of unknown origin,creates a world emergency that has put global public health institutions on high alert.At present there is limited clinical information of the SARS-CoV-2 and there is no specific treatment recommended,although technical guidances and suggestions have been developed and will continue to be updated as additional information becomes available.Preventive treatment has an important role to control and avoid the spread of severe respiratory disease,but often is difficult to obtain and sometimes cannot be effective to reduce the risk of deterioration of the underlining lung pathology.In order to define an effective and safe treatment for SARS-CoV-2-associated disease,we provide considerations on the actual treatments,on how to avoid complications and the undesirable side effects related to them and to select and apply earlier the most appropriate treatment.Approaching to treat severe respiratory disease in infants and children,the risks related to the development of atelectasis starting invasive or non-invasive ventilation support and the risk of oxygen toxicity must be taken into serious consideration.For an appropriate and effective approach to treat severe pediatric respiratory diseases,two main different strategies can be proposed according to the stage and severity of the patient conditions:patient in the initial phase and with non-severe lung pathology and patient with severe initial respiratory impairment and/or with delay in arrival to observation.The final outcome is strictly connected with the ability to apply an appropriate treatment early and to reduce all the complications that can arise during the intensive care admission.