chuka_lis (chuka_lis) wrote,
chuka_lis
chuka_lis

Пора, пора..


Давным давно было дело,
Но актуально и  в нынешнее время. Хоть и в несколько другом аспекте.
Потому что, в США
Примерно 20 аппаратов искусственной вентиляции легких на 100 тыс населения.
И распределены они по США не равномерно.

И всего на страну примерно 116 тыс таких аппаратов.
Наверное, это прилично.  Но, как отмечают сами же работники системы здравоохранения, в случае эпидемии.- явно недостаточно, и  решаться будет, кому из нуждающихся достанется аппарат - "тройками", и ими же будет решаться, кого снять с аппарата, потому что "другому более важно".

" Specifically, many more patients will require the use of ventilators than can be accommodated with current supplies.  New York State may have enough ventilators to meet the needs of patients in a moderately severe pandemic.  In a severe public health emergency on the scale of the 1918 influenza pandemic, however, these ventilators would not be sufficient to meet the demand.  Even if the vast number of ventilators needed were purchased, a sufficient number of trained staff would not be available to operate them.  If the most severe forecast becomes a reality, New York State and the rest of the country will need to allocate ventilators. 
...
..to save the most lives in an influenza pandemic where there are a limited number of available ventilators.  To accomplish this goal, patients for whom ventilator therapy would most likely be lifesaving are prioritized.  The Guidelines define survival by examining a patient’s short-term likelihood of surviving the acute medical episode and not by focusing on whether the patient may survive a given illness or disease in the long-term (e.g., years after the pandemic).  Patients with the highest probability of mortality without medical intervention, along with patients with the smallest probability of mortality with medical intervention, have the lowest level of access to ventilator therapy.  Thus, patients who are most likely to survive without the ventilator, together with patients who will most likely survive with ventilator therapy, increase the overall number of survivors.
....
To ensure that patients receive the best care possible in a pandemic, a patient’s attending physician does not determine whether his/her patient receives (or continues) with ventilator therapy; instead a triage officer or triage committee makes the decision.  While the attending physician interacts with and conducts the clinical evaluation of a patient, a triage officer or triage committee does not have any direct contact with the patient.  Instead, a triage officer or triage committee examines the data provided by the attending physician and makes the determination about a patient’s level of access to a ventilator.  This role sequestration allows the clinical ventilator allocation protocol to operate smoothly.  The decision regarding whether to use either a triage officer or committee is left to each acute care facility (i.e., hospital) because available resources will differ at each site.
..
The Task Force explored various non-clinical approaches to allocating ventilators, including distributing ventilators on a first-come first-serve basis, randomizing ventilator allocation (e.g., lottery), requiring only physician clinical judgment in making allocation decisions, and prioritizing certain patient categories (i.e., health care workers andpatients with certain social criteria).

A patient’s attending physician provides all clinical data to a triage officer/committee.  At Steps 2 and 3, a triage officer/committee examines a patient’s clinical data and uses this information to assign acolor code to the patient.  The color (blue, red, yellow, or green) determines the level of access to a ventilator.  Blue code patients (lowest access/palliate/ discharge) are those who have a medical condition on the exclusion criteria list or those who have a high risk of mortality and these patients do not receive ventilator therapy when resources are scarce.  Instead, alternative forms of medical intervention and/or palliative care are provided.  However, if more resources become available, patients in the blue color category, or those with exclusion criteria, are reassessed and may be eligible for ventilator therapy.  Red code patients (highest access) are those who have the highest priority for ventilator therapy because they are most likely to recover with treatment (and likely to not recover without it) and have a moderate risk of mortality.  Patients in the yellow category (intermediate access) are those who are very sick, and their likelihood of survival is intermediate and/or uncertain.  These patients may or may not benefit (i.e., survive) with ventilator therapy. They receive such treatment if ventilators are available after all patients in the red category receive them.  Patients in the green color code (defer/discharge) are those who do not need ventilator therapy.
...
In some circumstances, a triage officer/committee must select one of many eligible red color code patients to receive ventilator therapy.  A patient’s likelihood of survival (i.e., assessment of mortality risk) is the most important consideration when evaluating a patient.  However, there may be a situation where multiple patients have been assigned a red color code, which indicates they all have the highest level of access to ventilator therapy, and they all have equal (or near equal) likelihoods of survival.
...
 If the pool of ventilated patients vulnerable for removal consists of only adults or only children, a randomization process, such as a lottery, is used each time to select the (blue or yellow) patient who will no longer receive ventilator therapy. "
и тд. Это "Руководство" по распределению недостаточного количества вентиляторов в случае масштабной эпидемии (предположительно, гриппа) среди нуждающихся  в них для Нью Йорка примерно такое же, как и для других штатов\городов США.
Вот и врачи из Мединститута Джона Хопкинса прогнозируют:
"The case fatality rate (CFR) of confirmed COVID-19 patients in China is estimated to be 1-3%, although this may not account for all mildly symptomatic or asymptomatic infections. In some regions of China outside Hubei, the CFR has been less than 1%. For comparison, the CFR of the 2009 influenza pandemic was around 0.1%, the 1968 and 1957 pandemics in the United States were about 0.5%, and the CFR of the 1918 pandemic was estimated to be 2.5 % in the United States."
The impact of a COVID-19 pandemic on hospitals is expected to be severe in the best of circumstances. Currently, US hospitals routinely operate at or near full capacity and have limited ability to rapidly increase services. There are currently shortages of healthcare workers of all kinds. Emergency departments are overcrowded and often have to divert patients to other hospitals.
In recent years, there has been a reduction in the overall number of hospitals, hospital beds, and emergency rooms. During an epidemic, the healthcare workforce would be greatly reduced. Healthcare workers would face a high risk of infection because of contact with infected patients; many would need to stay home to care for sick relatives, and, in the absence of vaccine, others might fear coming to work lest they bring a lethal infection home to their families. The provision of medical services to both COVID-19 and non–COVID-19 patients may be adversely affected in most communities.
there are about 46,500 medical ICU beds in the United States and perhaps an equal number of other ICU beds that could be used in a crisis. Even spread out over several months, the mismatch between demand and resources is clear."
Вообще, полезно почитать, чтобы уяснить себе  состояние  здравоохранения и его готовность.

Это только первые пациенты попадают в условия, когда "хватает всем". И то,  надо отметить, что большая часть имеющихся аппаратов искусственной вентиляции легких в США обычно задействованы.  примерно 70%. На коронавирусных, которые могут пойти валом,  да еще и порой на длительное время, вентиляторов, скорее всего, не хватит. Да и специалистов респираторных, наверное, тож не хватит. Все это ухудшит  картину (по тяжести и смертности).
И, врачи респиратологи, будут в группе риска, тк не все ( а точне редкие) госпиталиСША оборудованы для того, чтобы лечить(содержать) инфекционных больных  и поддерживать их дыхание искуственно.
Да, еще нюанс- в США  "стретагический запас"- 12 млн фильтрующих масок, в то время как в случае эпидемии только врачам понадобится примерно 300 млн.
Tags: 5минутка музыки, здравоохранение, коронавирус, медицина, сша
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