Anesthesiologists assignment in management of patients with COVID-19 infection: Experience from the Clinic for Infectious and Tropical Diseases Clinical Centre of Serbia: Single center experience in management of patients with COVID-19

Abstract

According to the report, COVID-19 infection was confirmed in 10000 patients followed with 2% mortality rate in Serbia, compared with 7% global mortality rate reported by WHO. Team work and multidisciplinary therapy approach is crucial in COVID-19 management. According to the current organizational plan, the anesthesiology teams were assigned to the ICU of the Clinic for Infectious and Tropical Diseases for treatment of patients with moderate to severe form of SARS CoV-2 infection. The each work shift of anesthesiology team is scheduled for 4 hours with personal protective equipment (PPE) available. In addition to anesthesiologists, health-care providers in other fields of medicine also took part in management of patients with most severe forms of infection (infectologist, pulmologist, hematologist, cardiologist, gastroenterologist, nephrologist). The anesthesiologist-coordinator coordinated the work of different specialists. In the "red zone", the principle of treatment was organized according to the current recommendations: respiratory, hemodynamic and nutritional support, tromboprophylaxis. At the beginning of the epidemic, 90.5% were intubated, and later 25-30%. We applied several non-invasive respiratory support methods: NIV 11.1%, HFNC 13.3%, oxygen mask 15.6%. Doses of sedative agents need to be individually adjusted as COVID-19 patients require higher doses than usual. But, the most important is to follow instructions related to PPE use for safe work in the "red zone". Recommendations based on experience: always respect the recommended layered arrangement of PPE, do not apply additional protective equipment "for safety", it is necessary that the order of wearing PPE is always the same, it is more practical to wear a spacesuit for more than ideals.