The purpose of this article is providing recommendations about management of intensive care units (ORIT) in which it is helped patients with COVID-19. In it special attention is paid to forming of crisis management of ORIT in the period of COVID-19 pandemic. In process of distribution of a pandemic of COVID-19 ORIT face the physical, material and emotional problems caused by huge loading. Relevant knowledge of epidemiology, disease and use of resources provides valuable information for strategic and daily scheduling of intensive care units. Thus, understanding of number of patients, available capacities of ORIT and directions of use of resources is necessary for the adequate solution of the problems connected with personnel, the equipment, rooms and systems to provide the adequate answer to an overload as a result of a crisis situation.
Epidemic of COVID-19 revealed vulnerability of health care systems and the fact of their prompt overload at excess of quantity of the available beds in ORIT and ventilators. For the help to governing bodies of health care in early planning of resources, personnel, capacities of ORIT and quantity of beds predictive models were offered. Early assessment of the existing capacity of hospital or free capacities of ORIT are necessary for planning of partial reduction or full cancellation of planned operations and other similar actions and also hospitalization in the situations which are not demanding acute management. In this regard, health care systems and hospitals are recommended to use mathematical modeling when planning capacities in the conditions of crisis and to apply the following principles: to begin forecasting as soon as possible during epidemic, models have to be pragmatic and aimed at only important issue about capacity-building: how many patients will need hospitalization — in general and ORIT. Also forecasts have to include the best, worst and most probable scenario, use different statistical approaches and compare results.
For reduction of deficiency of ventilators hospitals are offered to develop and introduce protocols of an intubation and also use of high-line nasal oxygenation and noninvasive artificial ventilation of the lungs (NAVL) to reduce the need for an intubation. Also it is recommended to increase the number of standard full-function ventilators according to the predicted number of the patients needing it and to use standard full-function ventilators (unlike generators of a stream or basic resuscitation devices with a controlled volume) for patients with COVID-19 which need invasive mechanical ventilation, in particular, completely controlled ventilation. At the shortage of standard full-function ventilators it is also possible to use the alternative devices providing invasive IVL, in particular devices for long ventilation, the mobile ventilators, narcotic devices, ventilators compatible to the magnetic and resonant tomograph (MRT). When planning increase in capacities for artificial ventilation it is recommended to consider requirements to oxygen supply / medical air, to power supply, expendables for supply of oxygen and ventilation, to rooms and the personnel necessary for effective and safe ensuring mechanical ventilation.
In the conditions of pandemic splash many types of expendables are necessary for ensuring the vital help to seriously ill patients to patients. The shortage of various materials, including, in addition, the individual protection equipment (IPE), and so on can result monitors, devices for intravenous administration of drugs, medicine in considerable incidence and mortality of patients and to limit the number of patients who can receive the effective resuscitation help. Proceeding from it, it is recommended that hospitals made the list of the expendables and the equipment necessary for rendering in the period of a pandemic of medical care to the patients who are in a critical state and also revealed potential deficiency of resources on the basis of the predicted requirements of ORIT.
At emergence of the crisis situations connected with COVID-19 pandemic, hospital can be required more than doubling of opportunities of ORIT. It can result in the serious shortage of skilled staff and demands careful preliminary planning. Strategy can be divided into methods which increase the number of available personnel, minimize losses and maximize use of personnel. For preservation of capacities of ORIT in the available recommendations it is recommended to consider the possibility to suspend all planned therapeutic and surgical interventions as soon as chains of COVID-19 broadcast or its distribution to populations are registered.