About: Positionspapier zur praktischen Umsetzung der apparativen Differenzialtherapie der akuten respiratorischen Insuffizienz bei COVID-19: Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e.V. (DGP)

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About: Positionspapier zur praktischen Umsetzung der apparativen Differenzialtherapie der akuten respiratorischen Insuffizienz bei COVID-19: Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e.V. (DGP) Goto Sponge NotDistinct Permalink

An Entity of Type : schema:ScholarlyArticle, within Data Space : covidontheweb.inria.fr associated with source document(s)

Attributes	Values
type	Academic Article research paper schema:ScholarlyArticle
isDefinedBy	Covid-on-the-Web dataset
has title	Positionspapier zur praktischen Umsetzung der apparativen Differenzialtherapie der akuten respiratorischen Insuffizienz bei COVID-19: Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e.V. (DGP)
Creator	Ewig, S Kluge, S Lepper, P Windisch, W Bauer, T Geiseler, J Randerath, W Dellweg, D Westhoff, M Pfeifer, Autoren Schönhofer, B Voshaar, T
Source	Medline; PMC
abstract	Against the background of the pandemic caused by infection with the SARS-CoV-2, the German Society for Pneumology and Respiratory Medicine (DGP e.V.), in cooperation with other associations, has designated a team of experts in order to answer the currently pressing questions about therapy strategies in dealing with COVID-19 patients suffering from acute respiratory insufficiency (ARI). The position paper is based on the current knowledge that is evolving daily. Many of the published and cited studies require further review, also because many of them did not undergo standard review processes.Therefore, this position paper is also subject to a continuous review process and will be further developed in cooperation with the other professional societies. This position paper is structured into the following five topics: 1. Pathophysiology of acute respiratory insufficiency in patients without immunity infected with SARS-CoV-2 2. Temporal course and prognosis of acute respiratory insufficiency during the course of the disease 3. Oxygen insufflation, high-flow oxygen, non-invasive ventilation and invasive ventilation with special consideration of infectious aerosol formation 4. Non-invasive ventilation in ARI 5. Supply continuum for the treatment of ARI Key points have been highlighted as core statements and significant observations. Regarding the pathophysiological aspects of acute respiratory insufficiency (ARI), the pulmonary infection with SARS-CoV-2 COVID-19 runs through three phases: early infection, pulmonary manifestation and severe hyperinflammatory phase. There are differences between advanced COVID-19-induced lung damage and those changes seen in Acute Respiratory Distress Syndromes (ARDS) as defined by the Berlin criteria. In a pathophysiologically plausible - but currently not yet histopathologically substantiated – model, two types (L-type and H-type) are distinguished, which correspond to an early and late phase. This distinction can be taken into consideration in the differential instrumentation in the therapy of ARI. The assessment of the extent of ARI should be carried out by an arterial or capillary blood gas analysis under room air conditions and must include the calculation of the oxygen supply (measured from the variables of oxygen saturation, the Hb value, the corrected values of the Hüfner number and the cardiac output). In principle, aerosols can cause transmission of infectious viral particles. Open systems or leakage systems (so-called vented masks) can prevent the release of respirable particles. Procedures in which the invasive ventilation system must be opened, and endotracheal intubation must be carried out are associated with an increased risk of infection. The protection of personnel with personal protective equipment should have very high priority because fear of contagion must not be a primary reason for intubation. If the specifications for protective equipment (eye protection, FFP2 or FFP-3 mask, gown) are adhered to, inhalation therapy, nasal high-flow (NHF) therapy, CPAP therapy or NIV can be carried out according to the current state of knowledge without increased risk of infection to the staff. A significant proportion of patients with respiratory failure presents with relevant hypoxemia, often also caused by a high inspiratory oxygen fraction (FiO2) including NHF, and this hypoxemia cannot be not completely corrected. In this situation, CPAP/NIV therapy can be administered under use of a mouth and nose mask or a respiratory helmet as therapy escalation, as long as the criteria for endotracheal intubation are not fulfilled. In acute hypoxemic respiratory insufficiency, NIV should be performed in an intensive care unit or in a comparable unit by personnel with appropriate expertise. Under CPAP/NIV, a patient can deteriorate rapidly. For this reason, continuous monitoring with readiness to carry out intubation must be ensured at all times. If CPAP/NIV leads to further progression of ARI, intubation and subsequent invasive ventilation should be carried out without delay if no DNI order is in place. In the case of patients in whom invasive ventilation, after exhausting all guideline-based measures, is not sufficient, extracorporeal membrane oxygenation procedure (ECMO) should be considered to ensure sufficient oxygen supply and to remove CO (2) .
has issue date	2020-04-22(xsd:dateTime)
bibo:doi	10.1055/a-1157-9976
bibo:pmid	32323287
has license	no-cc
sha1sum (hex)	96b46966d0417a658fa1a0bee3bcc5c2cd74f03a
schema:url	https://doi.org/10.1055/a-1157-9976
resource representing a document's title	Positionspapier zur praktischen Umsetzung der apparativen Differenzialtherapie der akuten respiratorischen Insuffizienz bei COVID-19: Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e.V. (DGP)
has PubMed Central identifier	PMC7378547
has PubMed identifier	32323287
schema:publication	Pneumologie
resource representing a document's body	covid:96b46966d0417a658fa1a0bee3bcc5c2cd74f03a#body_text
is schema:about of	named entity 'Sepsis' named entity '49, 50' named entity 'respiratory insufficiency' named entity 'intensive care unit' named entity 'Intubation' named entity 'Granulocyte-colony stimulating factor' named entity 'oder' named entity 'kann' named entity 'FiO2' named entity 'TNI' named entity 'respiratory insufficiency' named entity 'PEEP' named entity 'insufflation' named entity 'ARDS' named entity 'IL-6' named entity 'log-rank Test' named entity 'CPAP' named entity 'ARDS' named entity 'ARDS' named entity 'kann' named entity 'Ferritin' named entity 'infection' named entity 'respiratory failure' named entity 'd-Dimer' named entity 'oder' named entity 'COVID-19' named entity 'Tab. 2' named entity 'ARDS' named entity 'Lung' named entity 'COVID-19' named entity 'hypoxemia' named entity 'hypoxemic' named entity 'endotracheal intubation' named entity 'protein' named entity 'COVID-19' named entity 'ARDS' named entity 'ARDS' named entity 'Kontakte' named entity 'Sars-CoV-2' named entity 'ARDS' named entity 'COVID-19' named entity 'IL-2' named entity 'CPAP' named entity 'eye protection' named entity 'CPAP' named entity 'kann' named entity 'oder' named entity 'COVID-19' named entity 'kann' named entity 'oder' named entity 'odds ratio' named entity 'oder' named entity 'ARDS' named entity 'oder' named entity 'ACE2' named entity 'CPAP' named entity 'Gasen' named entity 'COVID-19' named entity 'mmHg' named entity 'chemoattractant' named entity 'FFP2' named entity 'ARDS' named entity 'oder' named entity 'Influenza' named entity 'kann' named entity 'non-invasive ventilation' named entity 'FFP-3' named entity 'respirable' named entity 'ARDS' named entity 'NHS'

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