Defects of intensive care of patients with COVID-19. Expert doctors and opinion

Abstract

Background. A significant proportion of patients infected with the SARS-CoV-2 virus had a severe course of the disease required hospitalization and intensive care The objective was to analyze the defects allowed during intensive care of patients with SARS-CoV-2, and to assess the causes of their occurrence.Materials and methods. An analytical study was made on the basis of expert opinions on 60 case histories of deceased patients in the intensive care unit with the main diagnosis: “COVID-19. Community-acquired bilateral polysegmental viral pneumonia ARDS”. To identify the reasons that led to defects in the diagnosis and treatment of patients with NCI COVID-19 in intensive care units, an anonymous survey of 92 anesthesiologists-resuscitators who worked in the “red zone” during the COVID-19 pandemic was conducted.Results. The defects identified by experts can be divided into two main groups: diagnostic defects and treatment defects. ARDS in 25%, PE in 8% of cases were not diagnosed. There was no ECG control and cardiac monitoring in 22%, lung CT in 6.7%, echocardiography in 10% of cases. Consultations of specialized specialists were not held in 11.7% of patients. There were defects in the correction of EBV and ABS in 30%, unreasonable prescribing of drugs in 58%, defects in vasopressor support in 10%, defects associated with mechanical ventilation in 40% of cases. The survey of physicians showed that the defects were based on insufficient knowledge of the governing documents and the limited capabilities of medical organizations to implement the necessary research.Conclusion. The obtained results made it possible to demonstrate the limitations and subjectivity of the existing assessment of the quality of medical care, which sometimes does not take into account the existing conditions for treating patients and the material and technical capabilities of a medical organization.