Author(s): Manju Dhandapani, VR Vijay, Nadiya Krishnan, Lakshmanan Gopichandran, Alwin Issac, Shine Stephen, Jaison Jacob, Thilaka, Lakshmi Narayana Yaddanapudi, Sivashanmugam Dhandapani

Email(s): manjuseban@gmail.com

DOI: 10.52711/2349-2996.2022.00031   

Address: Manju Dhandapani1*, VR Vijay2, Nadiya Krishnan2, Lakshmanan Gopichandran3, Alwin Issac2, Shine Stephen2, Jaison Jacob2, Thilaka4, Lakshmi Narayana Yaddanapudi5, Sivashanmugam Dhandapani6
1National Institute of Nursing Education.
5Dept of Anesthesia and Intensive Care.
6Dept of Neurosurgery, PGIMER, Chandigarh.
2College of Nursing, AIIMS, Bhubaneswar.
3College of Nursing.
4Dept of Anesthesia AIIMS, New Delhi, India.
*Corresponding Author

Published In:   Volume - 12,      Issue - 1,     Year - 2022


ABSTRACT:
Background: Nursing care plays a vital role in critically ill patients’ recovery process and outcome with COVID-19. Though there is a tremendous surge in COVID-19 literature, there is no comprehensive documentation of nursing aspects. Objective: To develop nursing care standards for critically ill patients with COVID-19. Methodology: To prepare this scoping review, a detailed literature review was done by the experts and trainers involved in the critical care of patients with COVID-19 from India’s premier institutes. Results: Rapidly progressing hypoxemia with respiratory failure induced by COVID-19 in critically ill patients poses a management challenge. Patients of COVID-19 progressing to critical stage must be identified early, and appropriate management initiated while taking all the specific measures to prevent infection to the healthcare providers. The essential components of critically ill patients’ nursing care include constant monitoring and maintenance of ventilation, oxygenation, fluid volume/hemodynamic status, and shock prevention. The other adjunctive measures include meeting the nutritional demands, prevention, early identification of complications, timely initiation of rehabilitation, and personal and environmental hygiene. Ensuring the safety of the healthcare providers with adequate PPE and infection control measures is of utmost importance while caring for the patients of COVID-19. Conclusion: The nursing interventions must be tailored vigilantly for the individual patient. The evidence is evolving, and the nursing care strategies discussed in this article based on existing evidence may guide the nurses and healthcare providers in managing critically ill patients of COVID-19.


Cite this article:
Manju Dhandapani, VR Vijay, Nadiya Krishnan, Lakshmanan Gopichandran, Alwin Issac, Shine Stephen, Jaison Jacob, Thilaka, Lakshmi Narayana Yaddanapudi, Sivashanmugam Dhandapani. An evidence-based nursing care guide for critically ill patients with COVID-19: A scoping Review. Asian Journal of Nursing Education and Research. 2022; 12(1):144-7. doi: 10.52711/2349-2996.2022.00031

Cite(Electronic):
Manju Dhandapani, VR Vijay, Nadiya Krishnan, Lakshmanan Gopichandran, Alwin Issac, Shine Stephen, Jaison Jacob, Thilaka, Lakshmi Narayana Yaddanapudi, Sivashanmugam Dhandapani. An evidence-based nursing care guide for critically ill patients with COVID-19: A scoping Review. Asian Journal of Nursing Education and Research. 2022; 12(1):144-7. doi: 10.52711/2349-2996.2022.00031   Available on: https://ajner.com/AbstractView.aspx?PID=2022-12-1-31


REFERENCE:
1.    Issac A, Stephen S, Jacob J, et al. The Pandemic League of COVID-19: Korea Versus the United States, With Lessons for the Entire World. J Prev Med Public Health. Jul 2020;53(4):228-232. doi:10.3961/jpmph.20.166
2.    Stephen S, Issac A, Jacob J, Vijay VR, Radhakrishnan RV, Krishnan N. COVID-19: Weighing the Endeavors of Nations, with Time to Event Analysis. Osong Public Health Res Perspect. Aug 2020;11(4):149-157. doi:10.24171/j.phrp.2020.11.4.02
3.    Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. Oct 2 2018;169(7):467-473. doi:10.7326/m18-0850
4.    Zheng M, Song L. Novel antibody epitopes dominate the antigenicity of spike glycoprotein in SARS-CoV-2 compared to SARS-CoV. Cell Mol Immunol. May 2020;17(5):536-538. doi:10.1038/s41423-020-0385-z
5.    Li Q, Guan X, Wu P, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. Mar 26 2020;382(13):1199-1207. doi:10.1056/NEJMoa2001316
6.    van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and surface stability of HCoV-19 (SARS-CoV-2) compared to SARS-CoV-1. medRxiv. Mar 13 2020;doi:10.1101/2020.03.09.20033217
7.    Commentaries. Accessed December 24 hwwin-rc. Transmission of SARS-CoV-2: implications for infection prevention precautions. 20209 July 2020. Accessed 9 July 2020. https://www.who.int/news-room/commentaries/detail/transmission-of-sars-cov-2-implications-for-infection-prevention-precautions
8.    Adhikari SP, Meng S, Wu YJ, et al. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review. Infect Dis Poverty. Mar 17 2020;9(1):29. doi:10.1186/s40249-020-00646-x
9.    Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet (London, England). Mar 7 2020;395(10226):809-815. doi:10.1016/s0140-6736(20)30360-3
10.    Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet (London, England). Mar 28 2020;395(10229):1054-1062. doi:10.1016/s0140-6736(20)30566-3
11.    Wan Y, Shang J, Graham R, Baric RS, Li F. Receptor Recognition by the Novel Coronavirus from Wuhan: an Analysis Based on Decade-Long Structural Studies of SARS Coronavirus. J Virol. Mar 17 2020;94(7)doi:10.1128/jvi.00127-20
12.    Costela-Ruiz VJ, Illescas-Montes R, Puerta-Puerta JM, Ruiz C, Melguizo-Rodríguez L. SARS-CoV-2 infection: The role of cytokines in COVID-19 disease. Cytokine Growth Factor Rev. Aug 2020;54:62-75. doi:10.1016/j.cytogfr.2020.06.001
13.    Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet (London, England). Feb 15 2020;395(10223):497-506. doi:10.1016/s0140-6736(20)30183-5
14.    Kochi AN, Tagliari AP, Forleo GB, Fassini GM, Tondo C. Cardiac and arrhythmic complications in patients with COVID-19. J Cardiovasc Electrophysiol. May 2020;31(5):1003-1008. doi:10.1111/jce.14479
15.    Varghese PM, Tsolaki AG, Yasmin H, et al. Host-pathogen interaction in COVID-19: Pathogenesis, potential therapeutics and vaccination strategies. Immunobiology. Nov 2020;225(6):152008. doi:10.1016/j.imbio.2020.152008
16.    Giannis D, Ziogas IA, Gianni P. Coagulation disorders in coronavirus infected patients: COVID-19, SARS-CoV-1, MERS-CoV and lessons from the past. J Clin Virol. Jun 2020;127:104362. doi:10.1016/j.jcv.2020.104362
17.    Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet (London, England). Feb 15 2020;395(10223):507-513. doi:10.1016/s0140-6736(20)30211-7
18.    Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. Features, Evaluation, and Treatment of Coronavirus. StatPearls. StatPearls Publishing
1.    Copyright © 2020, StatPearls Publishing LLC.; 2020.
19.    Clinical management of COVID-19: interim guidance. WHO/2019-nCoV/clinical/2020.5. World Health Organization; May 2020. Accessed 31.Dec.2020 https://www.who.int/publications/i/item/clinical-management-of-covid-19
20.    Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. Jama. Apr 7 2020;323(13):1239-1242. doi:10.1001/jama.2020.2648
21.    Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19). Centers for Disease Control and Prevention. Updated Dec. 8, 2020. Accessed 30.Dec, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html
22.    Struyf T, Deeks JJ, Dinnes J, et al. Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19 disease. The Cochrane database of systematic reviews. Jul 7 2020;7(7):Cd013665. doi:10.1002/14651858.Cd013665
23.    Ogbebor O, Min Z, Cheema T, Bhanot N. COVID-19: Diagnostic Testing and Challenges. Crit Care Nurs Q. Oct/Dec 2020;43(4):343-348. doi:10.1097/cnq.0000000000000320
24.    Tang EW, Bobenchik AM, Lu S. Testing for SARS-CoV-2 (COVID-19): A General Review. R I Med J (2013). Sep 4 2020;103(8):20-23.
25.    Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review. Jama. Aug 25 2020;324(8):782-793. doi:10.1001/jama.2020.12839
26.    Malbrain M HS, Wong A. Thoughts on COVID-19 from the International Fluid Academy. ICU Management & Practice. 2020;20(1):80-85. https://healthmanagement.org/c/icu/issuearticle/thoughts-on-covid-19-from-the-international-fluid-academy.
27.    Varghese GM, John R, Manesh A, Karthik R, Abraham OC. Clinical management of COVID-19. The Indian journal of medical research. May 2020;151(5):401-410. doi:10.4103/ijmr.IJMR_957_20
28.    Guidelines on Clinical Management of COVID – 19. Government of India, Ministry of Health & Family Welfare, Directorate General of Health Services, (EMR Division). Updated 17 Mar 2020. Accessed 31 Dec, 2020. https://www.mohfw.gov.in/pdf/GuidelinesonClinicalManagementofCOVID1912020.pdf
29.    Horby P, Lim WS, Emberson JR, et al. Dexamethasone in Hospitalized Patients with Covid-19 - Preliminary Report. N Engl J Med. Jul 17 2020;doi:10.1056/NEJMoa2021436
30.    Kim MS, An MH, Kim WJ, Hwang TH. Comparative efficacy and safety of pharmacological interventions for the treatment of COVID-19: A systematic review and network meta-analysis. PLoS Med. Dec 30 2020;17(12):e1003501. doi:10.1371/journal.pmed.1003501
31.    Zhaori G, Lu L, Liu C, Guo Y. Progresses in clinical studies on antiviral therapies for COVID-19-Experience and lessons in design of clinical trials. Pediatr Investig. Dec 2020;4(4):263-274. doi:10.1002/ped4.12227
32.    Li L, Zhang W, Hu Y, et al. Effect of Convalescent Plasma Therapy on Time to Clinical Improvement in Patients With Severe and Life-threatening COVID-19: A Randomized Clinical Trial. Jama. Aug 4 2020;324(5):460-470. doi:10.1001/jama.2020.10044
33.    Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. Consensus guidelines for managing the airway in patients with COVID-19: Guidelines from the Difficult Airway Society, the Association of Anaesthetists the Intensive Care Society, the Faculty of Intensive Care Medicine and the Royal College of Anaesthetists. Anaesthesia. Jun 2020;75(6):785-799. doi:10.1111/anae.15054
34.    Jacob J, Vr V, Issac A, et al. Factors associated with psychological outcomes among frontline healthcare providers of India during COVID-19 pandemic. Asian journal of psychiatry. Dec 25 2020;55:102531. doi:10.1016/j.ajp.2020.102531
35.    Gordon A, Lyons C, Rao S, Finoli L. Health Care Workers' Challenges in the Care of a COVID-19 Patient. Crit Care Nurs Q. Oct/Dec 2020;43(4):400-406. doi:10.1097/cnq.0000000000000325
36.    Dhandapani S, Aggarwal A, Srinivasan A, et al. Serum lipid profile spectrum and delayed cerebral ischemia following subarachnoid hemorrhage: Is there a relation? Surg Neurol Int. 2015;6(Suppl 21):S543-8. doi:10.4103/2152-7806.168067
37.    Kapoor A, Dhandapani S, Gaudihalli S, Dhandapani M, Singh H, Mukherjee KK. Serum albumin level in spontaneous subarachnoid haemorrhage: More than a mere nutritional marker! Br J Neurosurg. Feb 2018;32(1):47-52. doi:10.1080/02688697.2017.1344615
38.    Caputo ND, Strayer RJ, Levitan R. Early Self-Proning in Awake, Non-intubated Patients in the Emergency Department: A Single ED's Experience During the COVID-19 Pandemic. Acad Emerg Med. May 2020;27(5):375-378. doi:10.1111/acem.13994
39.    Möhlenkamp S, Thiele H. Ventilation of COVID-19 patients in intensive care units. Herz. Jun 2020;45(4):329-331. Beatmung von COVID-19-Patienten auf Intensivstationen. doi:10.1007/s00059-020-04923-1
40.    Han Q, Guo M, Zheng Y, et al. Current Evidence of Interleukin-6 Signaling Inhibitors in Patients With COVID-19: A Systematic Review and Meta-Analysis. Front Pharmacol. 2020;11:615972. doi:10.3389/fphar.2020.615972
41.    Tu Z, Xia Q, Xu M, Lu Y. Nursing of Patients Critically Ill With Coronavirus Disease Treated With Extracorporeal Membrane Oxygenation. J Emerg Nurs. Nov 2020;46(6):862-868.e2. doi:10.1016/j.jen.2020.07.006
42.    York NL, Kane C. Trends in caring for adult respiratory distress syndrome patients. Dimens Crit Care Nurs. May-Jun 2012;31(3):153-8. doi:10.1097/DCC.0b013e31824dffa4
43.    Lucchini A, Bambi S, Mattiussi E, et al. Prone Position in Acute Respiratory Distress Syndrome Patients: A Retrospective Analysis of Complications. Dimens Crit Care Nurs. Jan/Feb 2020;39(1):39-46. doi:10.1097/dcc.0000000000000393
44.    D'Silva DF, McCulloch TJ, Lim JS, Smith SS, Carayannis D. Extubation of patients with COVID-19. Br J Anaesth. Jul 2020;125(1):e192-e195. doi:10.1016/j.bja.2020.03.016
45.    Pandian V, Morris LL, Brodsky MB, et al. Critical Care Guidance for Tracheostomy Care During the COVID-19 Pandemic: A Global, Multidisciplinary Approach. Am J Crit Care. Nov 1 2020;29(6):e116-e127. doi:10.4037/ajcc2020561
46.    Poston JT, Patel BK, Davis AM. Management of Critically Ill Adults With COVID-19. Jama. May 12 2020;323(18):1839-1841. doi:10.1001/jama.2020.4914
47.    Li D, Li X, Cui W, Shen H, Zhu H, Xia Y. Liberal versus conservative fluid therapy in adults and children with sepsis or septic shock. The Cochrane database of systematic reviews. Dec 10 2018;12(12):Cd010593. doi:10.1002/14651858.CD010593.pub2
48.    Griffiths MJD, McAuley DF, Perkins GD, et al. Guidelines on the management of acute respiratory distress syndrome. BMJ Open Respir Res. 2019;6(1):e000420. doi:10.1136/bmjresp-2019-000420
49.    Smith V, Devane D, Nichol A, Roche D. Care bundles for improving outcomes in patients with COVID-19 or related conditions in intensive care - a rapid scoping review. The Cochrane database of systematic reviews. Dec 21 2020;12:Cd013819. doi:10.1002/14651858.Cd013819
50.    Gamper G, Havel C, Arrich J, et al. Vasopressors for hypotensive shock. The Cochrane database of systematic reviews. Feb 15 2016;2(2):Cd003709. doi:10.1002/14651858.CD003709.pub4
51.    Heneka MT, Golenbock D, Latz E, Morgan D, Brown R. Immediate and long-term consequences of COVID-19 infections for the development of neurological disease. Alzheimers Res Ther. Jun 4 2020;12(1):69. doi:10.1186/s13195-020-00640-3
52.    Fowler BM. Clinical Education to Decrease Perceived Barriers to Delirium Screening in Adult Intensive Care Units. Crit Care Nurs Q. Jan/Mar 2019;42(1):41-43. doi:10.1097/cnq.0000000000000235
53.    Ronco C, Reis T. Kidney involvement in COVID-19 and rationale for extracorporeal therapies. Nat Rev Nephrol. Jun 2020;16(6):308-310. doi:10.1038/s41581-020-0284-7
54.    Xu L, Liu J, Lu M, Yang D, Zheng X. Liver injury during highly pathogenic human coronavirus infections. Liver Int. May 2020;40(5):998-1004. doi:10.1111/liv.14435
55.    Mehta Y, Mithal A, Kulkarni A, et al. Practice Guidelines for Enteral Nutrition Management in Dysglycemic Critically Ill Patients: A Relook for Indian Scenario. Indian J Crit Care Med. Dec 2019;23(12):594-603. doi:10.5005/jp-journals-10071-23298
56.    Dhandapani S, Kapoor A, Gaudihalli S, Dhandapani M, Mukherjee KK, Gupta SK. Study of trends in anthropometric nutritional indices and the impact of adiposity among patients of subarachnoid hemorrhage. Neurol India. Jul-Aug 2015;63(4):531-6. doi:10.4103/0028-3886.162026
57.    Kaafarani HMA, El Moheb M, Hwabejire JO, et al. Gastrointestinal Complications in Critically Ill Patients With COVID-19. Ann Surg. Aug 2020;272(2):e61-e62. doi:10.1097/sla.0000000000004004
58.    Ashraf O, Young M, Malik KJ, Cheema T. Systemic Complications of COVID-19. Crit Care Nurs Q. Oct/Dec 2020;43(4):390-399. doi:10.1097/cnq.0000000000000324
59.    Wells PS, Anderson DR, Bormanis J, et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet (London, England). Dec 20-27 1997;350(9094):1795-8. doi:10.1016/s0140-6736(97)08140-3
60.    Dudoignon E, Caméléna F, Deniau B, et al. Bacterial Pneumonia in COVID-19 critically ill patients: a case series. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. Jun 16 2020;doi:10.1093/cid/ciaa762
61.    Leininger-Hogan S. Pneumonia management in the intensive care setting. Crit Care Nurs Q. Apr-Jun 2011;34(2):110-5. doi:10.1097/CNQ.0b013e318210ecb7
62.    Advanced Infection Prevention and Control Training: Prevention of catheter associated urinary tract infection (CAUTI): student handbook. World Health Organization; May 2018:1-28. Accessed 31 Dec 2020. https://www.who.int/infection-prevention/tools/core-components/CAUTI_student-handbook.pdf
63.    Central Line-associated Bloodstream Infections: Resources for Patients and Healthcare Providers. Centers for Disease Control and Prevention. Accessed 31 Dec, 2020. https://www.cdc.gov/hai/bsi/clabsi-resources.html
64.    Hellyer TP, Ewan V, Wilson P, Simpson AJ. The Intensive Care Society recommended bundle of interventions for the prevention of ventilator-associated pneumonia. J Intensive Care Soc. Aug 2016;17(3):238-243. doi:10.1177/1751143716644461
65.    Guan WJ, Liang WH, Zhao Y, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J. May 2020;55(5)doi:10.1183/13993003.00547-2020
66.    Veer M, Kumar AM, Ivanova V. COVID-19 and the Cardiovascular System. Crit Care Nurs Q. Oct/Dec 2020;43(4):381-389. doi:10.1097/cnq.0000000000000323
67.    Sahoo SK, Dhandapani S, Singh A, Gendle C, Karthigeyan M, Salunke P, Aggarwal A, Singla N, Singla R, Tripathi M, Chhabra R. COVID-19: changing patterns among neurosurgical patients from North India, efficacy of repeat testing, and inpatient prevalence. Neurosurgical focus. 2020 Dec 1;49(6):E7
68.    Thakur D, Dhandapani M, Ghai S, Mohanty M, Dhandapani S. Intracranial Tumors: A Nurse-Led Intervention for Educating and Supporting Patients and Their Caregivers. Clin J Oncol Nurs. Jun 1 2019;23(3):315-323. doi:10.1188/19.Cjon.315-323
69.    Back A, Tulsky JA, Arnold RM. Communication Skills in the Age of COVID-19. Ann Intern Med. Jun 2 2020;172(11):759-760. doi:10.7326/m20-1376
70.    VR V, Krishnan N, Issac A, et al. Safeguarding the Frontier Covidians During the Covid-19 Pandemic: Scuffles and Proposed Strategies. Indian Journal of Psychological Medicine. 0(0):0253717620978586. doi:10.1177/0253717620978586
71.    Matava CT, Yu J, Denning S. Clear plastic drapes may be effective at limiting aerosolization and droplet spray during extubation: implications for COVID-19. Canadian journal of anaesthesia = Journal canadien d'anesthesie. Jul 2020;67(7):902-904. doi:10.1007/s12630-020-01649-w
72.    Zhao HM, Xie YX, Wang C. Recommendations for respiratory rehabilitation in adults with coronavirus disease 2019. Chin Med J (Engl). Jul 2020;133(13):1595-1602. doi:10.1097/cm9.0000000000000848
73.    Jiang DH, McCoy RG. Planning for the Post-COVID Syndrome: How Payers Can Mitigate Long-Term Complications of the Pandemic. J Gen Intern Med. Oct 2020;35(10):3036-3039. doi:10.1007/s11606-020-06042-3
74.    Dhandapani M, Dhandapani S, Agarwal M, Mahapatra AK. Pain perception following different neurosurgical procedures: a quantitative prospective study. Contemporary nurse. Aug 2016;52(4):477-485. doi:10.1080/10376178.2016.1222240
75.    Dhandapani S, Gupta A, Singh J, Sharma BS, Mahapatra AK, Mehta VS. Spinal dural arterio-venous fistula: clinico-radiological profile and outcome following surgical occlusion in an Indian neurosurgical center. Neurology India. 2013 Jul 1;61(4):406.
76.    Simpson R, Robinson L. Rehabilitation After Critical Illness in People With COVID-19 Infection. Am J Phys Med Rehabil. Jun 2020;99(6):470-474. doi:10.1097/phm.0000000000001443
77.    Dhandapani M, Dhandapani S. Challenges posed by COVID-19 and neurosurgical nursing strategies in developing countries. Surgical Neurology International. 2020;11(441):1.
78.    Dhandapani S, Gupta A, Singh J, Sharma BS, Mahapatra AK, Mehta VS. Spinal dural arterio-venous fistula: clinico-radiological profile and outcome following surgical occlusion in an Indian neurosurgical center. Neurology India. 2013 Jul 1;61(4):406.
79.    Prakash P, Dhandapani M, Ghai S, Singh NV, Dhandapani S. Quality of life among children who had undergone ventriculoperitoneal shunt surgery. Journal of pediatric neurosciences. 2018 Apr;13(2):189.

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