RESUMEN
INTRODUCTION: Prone positioning has been shown to improve ventilation status for patients with severe COVID-19 who are receiving mechanical ventilation. This case report describes the nursing care of a patient with severe COVID-19 who underwent prone ventilation for 72 hours. Relevant nursing management and operational considerations are also discussed. CLINICAL FINDINGS: An 83-year-old woman was admitted to the hospital with fatigue, dizziness, and positive tests for SARS-CoV-2 on nasopharyngeal swab specimens. The patient was intubated. DIAGNOSIS: The patient's positive tests for SARS-CoV-2, chest computed tomography findings, and clinical symptoms were consistent with a diagnosis of severe COVID-19. INTERVENTIONS: When the patient's condition did not improve with mechanical ventilation and intermittent prone positioning, she was placed in the prone position for 72 hours. She received sedation, analgesics, anti-infective medications, and enteral nutrition support in the intensive care unit. Nurses performed dynamic monitoring based on blood gas analysis results to guide lung rehabilitation. OUTCOMES: The patient was weaned from the ventilator on day 20 and successfully discharged home on day 28 of hospitalization. CONCLUSION: During prolonged prone ventilation of a patient with severe COVID-19, nursing strategies included airway management, early lung rehabilitation training guided by pulmonary ultrasonography, skin care, hierarchical management of nurses, hemodynamic support, and enteral nutrition. This report may assist critical care nurses caring for similar patients.
Asunto(s)
COVID-19 , Atención de Enfermería , Femenino , Humanos , Anciano de 80 o más Años , Respiración Artificial/métodos , SARS-CoV-2 , Unidades de Cuidados Intensivos , Posición PronaAsunto(s)
Betacoronavirus/patogenicidad , Calostro/química , Infecciones por Coronavirus/inmunología , Leche Humana/química , Neumonía Viral/inmunología , Proteoma/genética , Adulto , Animales , Lactancia Materna , COVID-19 , Estudios de Casos y Controles , Cesárea , Calostro/inmunología , Calostro/virología , Infecciones por Coronavirus/genética , Infecciones por Coronavirus/virología , Femenino , Expresión Génica , Perfilación de la Expresión Génica , Humanos , Recién Nacido , Lipidómica , Metaboloma/inmunología , Proteínas de la Leche/clasificación , Proteínas de la Leche/genética , Proteínas de la Leche/inmunología , Leche Humana/inmunología , Leche Humana/virología , Pandemias , Neumonía Viral/genética , Neumonía Viral/virología , Periodo Posparto , Embarazo , Proteoma/clasificación , Proteoma/inmunología , SARS-CoV-2RESUMEN
The coronavirus disease 2019 (COVID-19) pandemic is a global public health crisis. However, little is known about the pathogenesis and biomarkers of COVID-19. Here, we profiled host responses to COVID-19 by performing plasma proteomics of a cohort of COVID-19 patients, including non-survivors and survivors recovered from mild or severe symptoms, and uncovered numerous COVID-19-associated alterations of plasma proteins. We developed a machine-learning-based pipeline to identify 11 proteins as biomarkers and a set of biomarker combinations, which were validated by an independent cohort and accurately distinguished and predicted COVID-19 outcomes. Some of the biomarkers were further validated by enzyme-linked immunosorbent assay (ELISA) using a larger cohort. These markedly altered proteins, including the biomarkers, mediate pathophysiological pathways, such as immune or inflammatory responses, platelet degranulation and coagulation, and metabolism, that likely contribute to the pathogenesis. Our findings provide valuable knowledge about COVID-19 biomarkers and shed light on the pathogenesis and potential therapeutic targets of COVID-19.