| Abstract | SARS – CoV – 2 je prvi puta identificiran u Kini 2019., a zbog kapljičnog puta prijenosa i lakog širenja, u oţujku 2020. proglašena je pandemija COVID – 19. Izazivajući brojne respiratorne simptome, od onih lakih kao što su kongestija nosa i kašalj pa sve do teških u smislu upale pluća i respiratorne insuficijencije, virus je prepoznat kao opasan. Liječenje same COVID – 19 infekcije provodi se simptomatskom terapijom i antivirusnim i imunomodulacijskim lijekovima. U teškim i kritičnim oblicima bolesti moţe se razviti ARDS. ARDS je sindrom karakteriziran hipoksemijom, pojavom obostranih difuznih infiltrata u plućima, edemom pluća, povećanjem mrtvog prostora i smanjenom popustljivosti pluća. Kliničke manifestacije klasičnog ARDS – a su dispneja, tahipneja, bolovi u prsnom košu, centralna cijanoza, hipoksemija i hipokapnija, koje su se pojavile unutar 7 dana od početka bolesti. Patofiziološki mehanizam odgovoran za razvoj ARDS – a je upalna reakcija sa oštećenjem alveolarnog epitela i endotela, a dovodi do povećanja permeabilnosti alveo – kapilarne membrane i izlaska tekućine u ekstravaskularni prostor uzrokujući plućni edem. Proces nastanka COVID – ARDS – a obuhvaća ulazak virusa u stanicu domaćina i infekcija koja dovodi do pretjeranog imunološkog odgovora i razvoja citokinske oluje uz endotelnu disfunkciju i koagulopatiju. Manifestira se kasnije u odnosu na klasični ARDS, u prosjeku 8 do 12 dana nakon početka bolesti s niţim stupnjem dispneje, ali s teškom hipoksemijom. Karakteristični radiološki nalaz pluća bolesnika s COVID – 19 i COVID – ARDS – om pokazuje obostrane infiltrate tipa zrnatog staka uz područja konsolidacije. Glavne kliničke razlike između klasičnog ARDS –a i COVID – ARDS –a su vrijeme pojave, stupanj dispneje, vrsta hipoksemije, razlika u oblicima i pO2/ FiO2 omjeru te radiološkoj snimci pluća. Temeljni način liječenja COVID – ARDS – a je respiratorna potpora i to u većini slučajeva mehanička ventilacija. Liječenje se u Hrvatskoj temelji na preporukama Svjetske zdravstvene organizacije i Europskog društva za intenzivnu medicinu, a obuhvaća primjenu antivirusnih lijekova, imunomodulatora, kortikosteroida, antikoagulantne terapije, potrbušnog poloţaja i recruitment manevara. Uz tim liječnika, medicinska sestra ima značajnu ulogu u zbrinjavanju bolesnika s COVID – ARDS – om. |
| Abstract (english) | SARS – CoV – 2 was first identified in China in 2019 and due to its droplet transmission and easy spreading, the COVID – 19 pandemic was declared in March 2020. Causing numerous respiratory symptoms, from mild ones such as nasal congestion and cough up to severe ones such as pneumonia and respiratory failure, the virus was recognized as dangerous. The treatment for the COVID – 19 infection consists of symptomatic therapy, antiviral and immunomodulating drugs. ARDS can develop in severe and critical forms of the disease. ARDS is a syndrome characterized by hypoxemia, the appearance of bilateral diffuse infiltrates in the lungs, pulmonary edema, an increase in dead space and reduced lung compliance. The clinical manifestations of classic ARDS are dyspnea, tachypnea, chest pain, central cyanosis, hypoxemia and hypocapnia, which appeared within 7 days of the onset of the main symptoms. The pathophysiological mechanism responsible for the development of ARDS is an inflammatory reaction with damage to the alveolar epithelium and endothelium, which leads to increased permeability of the alveo – capillary membrane and the release of fluid into the extravascular space, causing pulmonary edema. The development of COVID – ARDS includes entry of the virus into the host cell and infection, which leads to an excessive immune response and the development of a cytokine storm with endothelial dysfunction and coagulopathy. It manifests itself later than classic ARDS, in average 8 to 12 days after the onset of the symptoms with milder dyspnea, but severe hypoxemia. The characteristic radiological findings in the lungs of patients with COVID – 19 and COVID – ARDS is bilateral ground glass oppacity with areas of consolidation. The main clinical differences between classic ARDS and COVID – ARDS are the time of onset, dyspnea, type of hypoxemia, difference in shapes and pO2/FiO2 ratio and radiological imaging of the lungs. The basic method of treating COVID – ARDS is respiratory support and in most cases mechanical ventilation. Treatment in Croatia is based on the recommendations of the World Health Organization and the European Society of Intensive Care Medicine, and includes the use of antiviral drugs, immunomodulators, corticosteroids, anticoagulant therapy, prone position and recruitment maneuvers. Along with the team of doctors, nurses play a significant role in the care of patients with COVID – ARDS . |
