en-us	Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected 
zh-cn	疑似新型冠状病毒引起的严重急性呼吸道感染的临床管理 

en-us	This is the first edition of this document for novel coronavirus, an adaption of WHO Clinical management of severe acute respiratory infection when MERS-CoV infection is suspected publication (2019). 
zh-cn	本文件为新型冠状病毒感染临床管理指导的第一版，改编自《世卫组织疑似中东呼吸综合征冠状病毒引起的严重急性呼吸道感染的临床管理》（2019 年出版）。

en-us	This document is intended for clinicians taking care of hospitalised adult and paediatric patients with severe acute respiratory infection (SARI) when a nCoV infection is suspected. 
zh-cn	本文件旨在为临床医生对疑似新型冠状病毒引起严重急性呼吸道感染住院病例（包括成人和儿童）的临床处置提供指导。

en-us	It is not meant to replace clinical judgment or specialist consultation but rather to strengthen clinical management of these patients and provide to up-to-date guidance. 
zh-cn	本指导不能取代临床诊断或专家意见，但有助于此类患者的临床管理，并及时提供最新指导。

en-us	Best practices for SARI including IPC and optimized supportive care for severely ill patients are essential. 
zh-cn	在处置严重急性呼吸道感染时必须采用最佳医学干预措施，包括：实施感染防控措施、完善重症病例的支持性治疗。

en-us	This document is organized into the following sections: 
zh-cn	本文件包含以下内容：

en-us	1.Triage: recognize and sort patients with SARI 
zh-cn	1. 分诊：严重急性呼吸道感染病例的识别与分类

en-us	2.Immediate implementation of appropriate infection prevention and control (IPC) measures 
zh-cn	2. 立即实施适宜的感染防控措施

en-us	3.Early supportive therapy and monitoring 
zh-cn	3. 及早进行支持性治疗和监控

en-us	4.Collection of specimens for laboratory diagnosis
zh-cn	 4. 收集样本用于实验室诊断 

en-us	5. Management of hypoxemic respiratory failure and acute respiratory distress syndrome (ARDS)
zh-cn	5. 低氧血症型呼吸衰竭和急性呼吸窘迫综合征的管理  

en-us	 6.Management of septic shock 
zh-cn	6. 感染性休克的管理

en-us	 7. Prevention of complications
zh-cn	7.并发症的预防

en-us	 8. Specific anti-nCoV treatments
zh-cn	8. 抗新型冠状病毒的特效治疗

en-us	 9. Special considerations for pregnant patients 
zh-cn	 9. 针对孕妇患者的特别注意事项

en-us	These symbols are used to flag interventions: 
zh-cn	以下标志用于标示干预措施：

en-us	√Do: the intervention is beneficial (strong recommendation) OR the intervention is a best practice statement 
zh-cn	√采用：该措施有益（强烈建议）或该措施为最佳措施。

en-us	×Don’t: the intervention is known to be harmful.
zh-cn	×不能采用：该措施已知有明确危害。 

en-us	！Consider: the intervention may be beneficial in selected patients (conditional recommendation) OR be careful when considering this intervention. 
zh-cn	！可考虑：该措施对于特定患者可能有益（有条件推荐）或谨慎考虑采用该措施。

en-us	This document aims to provide clinicians with updated interim guidance on timely, effective, and safe supportive management of patients with nCoV and SARI, particularly those with critical illness.
zh-cn	本文件旨在为临床医生提供最新的临时指导，指导其对新型冠状病毒感染的严重急性呼吸道感染患者（特别是重症病例）进行及时、有效、安全的支持性治疗。

en-us	The recommendations in this document are derived from WHO publications.1-4
zh-cn	本文件的建议来源于世卫组织出版物 1-4。

en-us	 Where WHO guidance is not available, we refer to evidence-based guidelines. 
zh-cn	对于没有世卫组织指导可参考的部分，我们参考了循证指南。

en-us	Members of a WHO global network of clinicians, and clinicians who have treated SARS, MERS or severe influenza patients have reviewed the recommendations (see Acknowledgements). 
zh-cn	世卫组织全球医师网络成员，以及参与过严重急性呼吸窘迫综合征、中东呼吸综合征或重症流感治疗的临床医生对意见进行了评审（见致谢部分）。

en-us	For queries, please email outbreak@who.int with ‘nCoV clinical question’ in the subject line. 
zh-cn	如有疑问，请发送电子邮件至 outbreak@who.int，并在标题行注明“nCoV clinical question”。 

en-us	√1. Triage: early recognition of patients with SARI associated with nCoV infection Triage: recognize and sort all patients with SARI at first point of contact with health care system (such as the emergency department). 
zh-cn	√1. 分诊：及早识别新型冠状病毒引起的严重急性呼吸道感染病例分诊：在严重急性呼吸道感染患者进入医疗机构（如急诊部）的第一时间进行识别和分类。

en-us	Consider nCOV as a possible etiology of SARI under certain conditions (see Table 1). 
zh-cn	在一定条件下考虑将新型冠状病毒作为可能的病原体（见表 1）。

en-us	Triage patients and start emergency treatments based based on disease severity. 
zh-cn	根据病情的严重程度对患者进行分类并采取紧急治疗。

en-us	Remarks: nCoV may present with mild, moderate, or severe illness; the latter includes severe pneumonia, ARDS, sepsis and septic shock. 
zh-cn	备注：新型冠状病毒感染可表现为轻度、中度或重度疾病；后者包括重症肺炎、急性呼吸窘迫综合征、败血症和感染性休克。

en-us	Early recognition of suspected patients allows for timely initiation of IPC (see Table 2). 
zh-cn	尽早发现疑似病例以及时采取感染防控措施（见表 3）。

en-us	Early identification of those with severe manifestations (see Table 2) allows for immediate optimized supportive care treatments and safe, rapid admission (or referral) to intensive care unit according to institutional or national protocols. 
zh-cn	尽早识别重症病例（见表 2），并依据机构或国家方案，立即开展完善的支持性治疗，并安全、快速地转入（或转诊）重症监护室。

en-us	For those with mild illness, hospitalization may not be required unless there is concern for rapid deterioration. 
zh-cn	对于临床症状较轻的患者，除非病情有快速恶化的风险，否则也许不必住院治疗。

en-us	All patients discharged home should be instructed to return to hospital if they develop any worsening of illness. 
zh-cn	告知所有出院病例，一旦病情加重，应重新入院治疗。

en-us	Table 1. Definitions of patients with SARI, suspected of nCoV* 
zh-cn	表 1. 严重急性呼吸道感染和疑似新型冠状病毒感染的病例定义*

en-us	SARI
zh-cn	严重急性呼吸道感染

en-us	 An ARI with history of fever or measured temperature ≥38 C° and cough; onset within the last ~10 days; and requiring hospitalization.  However, the absence of fever does NOT exclude viral infection.
zh-cn	急性呼吸道感染病例，有发热史或体温≥38°C、咳嗽；过去 10 天内发病；需住院治疗 。无发热症状并不能排除病毒感染 。

en-us	Surveillance case definitions for nCoV* 
zh-cn	新型冠状病毒感染监测病例定义

en-us	1.Severe acute respiratory infection (SARI) in a person, with history of fever and cough requiring admission to hospital, with no other etiology that fully explains the clinical presentation1 (clinicians should also be alert to the possibility of atypical presentations in patients who are immunocompromised); AND any of the following:
zh-cn	1. 患者呈现严重急性呼吸道感染症状，有发热和咳嗽病史，并需入院治疗，无其他病因可完全解释其临床表现1（临床医生还要警惕免疫功能低下患者可能出现非典型临床表现）；同时，具有以下任何情况：

en-us	 a) A history of travel to Wuhan, Hubei Province China in the 14 days prior to symptom onset; or 
zh-cn	a) 发病前 14 天内有中国湖北省武汉市旅行史；

en-us	b) the disease occurs in a health care worker who has been working in an environment where patients with severe acute respiratory infections are being cared for, without regard to place of residence or history of travel; 
zh-cn	b) 医务人员发病，其工作机构有严重急性呼吸道感染病例，不考虑其居住地或旅行史；

en-us	c) the person develops an unusual or unexpected clinical course, especially sudden deterioration despite appropriate treatment, without regard to place of residence or history of travel, even if another etiology has been identified that fully explains the clinical presentation. 
zh-cn	 c) 病人病情进展异常或超过预期，特别是在正常治疗情况下突然加重，不考虑其居住地或旅行史，即使已明确其他病因可完全解释其临床表现。 

en-us	2. A person with acute respiratory illness of any degree of severity who, within 14 days before onset of illness, had any of the following exposures:
zh-cn	2. 任何程度的急性呼吸道症状的患者，发病前 14 天内有以下暴露：

en-us	 a) close physical contact2 with a confirmed case of nCoV infection, while that patient was symptomatic; 
zh-cn	 a) 与新型冠状病毒感染确诊病例有过密切接触 2，且该病例已出现症状；

en-us	b) a healthcare facility in a country where hospital-associated nCoV infections have been reported; 
zh-cn	b) 去过已报告发生过院内新型冠状病毒感染（如医护人员被感染）的医疗保健机构； 

en-us	see https://www.who.int/health-topics/coronavirus for latest case definitions 1 Testing should be according to local guidance for management of community‐acquired pneumonia. 
zh-cn	最新病例定义见 https://www.who.int/health-topics/coronavirus 1 需根据当地社区获得性肺炎管理指导开展检测。

en-us	Examples of other etiologies include Streptococcus pneumoniae, Haemophilus influenzae type B, Legionella pneumophila, other recognized primary bacterial pneumonias, influenza viruses, and respiratory syncytial virus.
zh-cn	其他病因可包括：肺炎链球菌、乙型流感嗜血杆菌、嗜肺军团菌、其他已知的主要的细菌性肺炎、流感病毒、以及呼吸道合胞病毒。

en-us	 2Close contact’ is defined as: - Health care associated exposure, including providing direct care for nCoV patients, working with health care workers infected with nCoV, visiting patients or staying in the same close environment of a nCoV patient. 
zh-cn	2 密切接触的定义为： - 医疗相关的暴露，包括：直接为新型冠状病毒感染患者提供医疗服务、与感染新型冠状病毒感的医务人员一起工作、探视新型冠状病毒感染患者或与其在同一个密闭环境中停留。 

en-us	- Working together in close proximity or sharing the same classroom environment with a with nCoV patient
zh-cn	- 与新型冠状病毒感染患者近距离工作或共用教室。 

en-us	 - Traveling together with nCoV patient in any kind of conveyance
zh-cn	- 与新型冠状病毒感染患者共用任何一种交通工具旅行。 

en-us	- Living in the same household as a nCoV patient 
zh-cn	- 与新型冠状病毒感染患者共同居住生活。 

en-us	The epidemiological link may have occurred within a 14‐day period before or after the onset of illness in the case under consideration.
zh-cn	目标病例的流行病学联系可能发生在发病前后的 14 天内。

en-us	Table 2. Clinical syndromes associated with nCoV infection 
zh-cn	表 2 新型冠状病毒感染相关临床症状 

en-us	Uncomplicated illness
zh-cn	无并发症病例 

en-us	Patients with uncomplicated upper respiratory tract viral infection, may have non-specific symptoms such as fever, cough, sore throat, nasal congestion, malaise, headache, muscle pain or malaise.
zh-cn	患者表现为单纯的上呼吸道病毒感染，可能出现非特异性症状，如：发热、咳嗽、咽痛、鼻塞、乏力、头痛、肌肉痛或不适。

en-us	The elderly and immunosuppressed may present with atypical symptoms.
zh-cn	老年人或免疫功能低下者的症状可能不典型。

en-us	   These patients do not have any signs of dehydration, sepsis or shortness of breath. 
zh-cn	患者无脱水、败血症或呼吸短促。

en-us	Mild pneumonia
zh-cn	轻型肺炎 

en-us	Patient with pneumonia and no signs of severe pneumonia.
zh-cn	无重症肺炎症状的肺炎患者。

en-us	Child with non-severe pneumonia has cough or difficulty breathing + fast breathing: fast breathing (in breaths/min): <2 months, ≥60; 2–11 months, ≥50; 1–5 years, ≥40 and no signs of severe pneumonia.
zh-cn	非重症肺炎的儿童出现咳嗽或呼吸困难+呼吸急促：呼吸急促（呼吸次数/分钟）：≥60 次/分（<2 月龄）；≥50 次/分（2-11 月龄）；≥40 次/分（1-5 岁），且无重症肺炎症状。

en-us	Severe pneumonia
zh-cn	重症肺炎 

en-us	Adolescent or adult: fever or suspected respiratory infection, plus one of respiratory rate >30 breaths/min, severe respiratory distress, or SpO2 <90% on room air (adapted from [1 ]).
zh-cn	青少年或成人：发热或疑似呼吸道感染，加以下情况之一：呼吸频率>30 次/分、呼吸严重困难，或室内条件下 SpO2<90%（改编自[1]）。

en-us	Child with cough or difficulty in breathing, plus at least one of the following: central cyanosis or SpO2 <90%; severe respiratory distress (e.g. grunting, very severe chest indrawing); signs of pneumonia with a general danger sign: inability to breastfeed or drink, lethargy or unconsciousness, or convulsions.
zh-cn	儿童出现咳嗽或呼吸困难，加至少以下情况之一：中枢性紫绀或 SpO2 <90%；呼吸严重困难（如发出咕噜声、胸部严重凹陷）；常见肺炎危险症状：拒奶或拒饮、嗜睡、昏迷、或惊厥。

en-us	Other signs of pneumonia may be present: chest indrawing, fast breathing (in breaths/min): <2 months, ≥60; 2–11 months, ≥50; 1–5 years, ≥40. 2
zh-cn	可能出现其他肺炎症状：胸部凹陷、呼吸急促（呼吸次数/分钟）：≥60 次/分（<2 月龄）；≥50 次/分（2-11 月龄）；≥40 次/分（1-5 岁）。2 

en-us	 The diagnosis is clinical; chest imaging can exclude complications.
zh-cn	可做出临床诊断；胸部影像学可排除并发症。

en-us	 Acute Respiratory Distress Syndrome7-9 
zh-cn	急性呼吸窘迫综合征（ARDS）7-9

en-us	Onset: new or worsening respiratory symptoms within one week of known clinical insult. 
zh-cn	发病：明确临床疾病后一周内出现呼吸系统新症状或原有症状加重。

en-us	Chest imaging (radiograph, CT scan, or lung ultrasound): bilateral opacities, not fully explained by effusions, lobar or lung collapse, or nodules.
zh-cn	胸部影像学（X 光片、CT 扫描或肺部超声）：双肺浑浊，不能用肺积液、肺叶或肺萎缩或肺结节完全解释。

en-us	Origin of oedema: respiratory failure not fully explained by cardiac failure or fluid overload.
zh-cn	水肿原因：呼吸衰竭，不能用心力衰竭或体液过多完全解释。

en-us	Need objective assessment (e.g. echocardiography) to exclude hydrostatic cause of oedema if no risk factor present.
zh-cn	如无危险因素，需进行客观评估（如超声心动图）排除流体静力压引起的水肿。

en-us	Oxygenation (adults): • Mild ARDS: 200 mmHg < PaO2/FiO2 ≤ 300 mmHg (with PEEP or CPAP ≥5 cmH2O, 7 or non-ventilated8 ) • Moderate ARDS: 100 mmHg < PaO2/FiO2 ≤200 mmHg with PEEP ≥5 cmH2O, 7 or non-ventilated8 ) • Severe ARDS: PaO2/FiO2 ≤ 100 mmHg with PEEP ≥5 cmH2O, 7 or non-ventilated8 ) • When PaO2 is not available, SpO2/FiO2 ≤315 suggests ARDS (including in non-ventilated patients)
zh-cn	氧合程度（成人）： • 轻度 ARDS：200 mmHg < PaO2/FiO2 ≤ 300 mmHg（PEEP 或 CPAP ≥5 cmH2O,7 或无机械通气 8） • 中度 ARDS：100 mmHg < PaO2/FiO2 ≤200 mmHg（PEEP ≥5 cmH2O,7或无机械通气 8） • 重度 ARDS：PaO2/FiO2 ≤ 100 mmHg（PEEP ≥5 cmH2O,7 或无机械通气 8） • 不能获得 PaO2 值时，SpO2/FiO2 ≤315 提示 ARDS（包括无机械通气的患者）

en-us	Oxygenation (children; note OI = Oxygenation Index and OSI = Oxygenation Index using SpO2): • Bilevel NIV or CPAP ≥5 cmH2O via full face mask: PaO2/FiO2 ≤ 300 mmHg or SpO2/FiO2 ≤264 • Mild ARDS (invasively ventilated): 4 ≤ OI < 8 or 5 ≤ OSI < 7.5 • Moderate ARDS (invasively ventilated): 8 ≤ OI < 16 or 7.5 ≤ OSI < 12.3 • Severe ARDS (invasively ventilated): OI ≥ 16 or OSI ≥ 12.3 
zh-cn	氧合程度（儿童；注：OI =氧合指数，OSI = 使用 SpO2 的氧合指数）： • 正压无创通气或全面罩 CPAP≥5 cmH2O：PaO2/FiO2 ≤ 300 mmHg 或 SpO2/FiO2 ≤264 • 轻度 ARDS（有创通气）：4 ≤ OI < 8 或 5 ≤ OSI < 7.5 • 中度 ARDS（有创通气）：8 ≤ OI < 16 或 7.5 ≤ OSI < 12.3 • 重度 ARDS（有创通气）：OI ≥ 16 或 OSI ≥ 12.3 

en-us	Sepsis10,11 
zh-cn	败血症 10,11

en-us	Adults: life-threatening organ dysfunction caused by a dysregulated host response to suspected or proven infection, with organ dysfunction*. 
zh-cn	成人：由疑似或确诊的感染引起机体应答失调导致器官功能不全，危及生命*。

en-us	Signs of organ dysfunction include: altered mental status, difficult or fast breathing, low oxygen saturation, reduced urine output, fast heart rate, weak pulse, cold extremities or low blood pressure, skin mottling, or laboratory evidence of coagulopathy, thrombocytopenia, acidosis, high lactate or hyperbilirubinemia.
zh-cn	器官功能不全的症状包括：意识改变、呼吸困难或呼吸急促、血氧饱和度下降、少尿、心率过快、脉搏减弱、四肢冰冷或低血压、皮肤花斑、或实验室诊断为：凝血障碍、血小板减少症、酸中毒、高乳酸或高胆红素血症。

en-us	 Children: suspected or proven infection and ≥2 SIRS criteria, of which one must be abnormal temperature or white blood cell count.
zh-cn	儿童：疑似或确诊感染，并符合 2 条以上 SIRS 标准，其中之一必须为体温或白细胞计数异常。

en-us	 Septic shock10,12
zh-cn	感染性休克 10,12

en-us	 Adults: persisting hypotension despite volume resuscitation, requiring vasopressors to maintain MAP ≥65 mmHg and serum lactate level >2 mmol/L. 
zh-cn	成人：尽管已实施容量复苏，血压仍持续过低，需要血管加压药来维持平均动脉压≥65mmHg、血清乳酸水平>2mmmol/L。

en-us	Children (based on [ 12]): any hypotension (SBP <5 th centile or >2 SD below normal for age) or 2-3 of the following: altered mental state; tachycardia or bradycardia (HR <90 bpm or >160 bpm in infants and HR <70 bpm or >150 bpm in children); 
zh-cn	儿童（依据[12])：存在低血压（收缩压<该年龄组第 5 百分位，或低于正常值 2 个标准差或符合 2-3 条以下情况：意识改变；心动过速或心动过缓（婴儿心率<90 次/分钟或>160 次/分钟，儿童心率<70 次/分钟或>150 次/分钟）；

en-us	prolonged capillary refill (>2 sec) or warm vasodilation with bounding pulses; 
zh-cn	毛细血管再充盈时间延长（>2 秒）或热性血管舒张伴洪脉；

en-us	tachypnea;
zh-cn	呼吸急促；

en-us	mottled skin or petechial or purpuric rash; 
zh-cn	皮肤花斑、皮疹或紫癜；

en-us	increased lactate; 
zh-cn	乳酸增加；

en-us	oliguria; 
zh-cn	少尿；

en-us	hyperthermia or hypothermia
zh-cn	体温过高或过低。

en-us	Abbreviations:
zh-cn	缩略词：

en-us	ARI, acute respiratory infection; 
zh-cn	ARI：急性呼吸道感染；

en-us	BP, blood pressure;
zh-cn	BP：血压；

en-us	bpm, beats/minute;
zh-cn	bpm：心跳次数/分钟；

en-us	CPAP, continuous positive airway pressure;
zh-cn	CPAP：持续正压通气；

en-us	FiO2, fraction of inspired oxygen;
zh-cn	FiO2：吸氧浓度；

en-us	MAP, mean arterial pressure;
zh-cn	MAP：平均动脉压；

en-us	NIV, noninvasive ventilation;
zh-cn	NIV：无创通气； 

en-us	OI, Oxygenation Index;
zh-cn	OI：氧合指数；

en-us	OSI, Oxygenation Index using SpO2;
zh-cn	OSI：使用 SpO2 的氧合指数；

en-us	PaO2, partial pressure of oxygen;
zh-cn	PaO2：氧分压；

en-us	PEEP, positive end-expiratory pressure;
zh-cn	PEEP：呼气终末正压；

en-us	SBP, systolic blood pressure;
zh-cn	SBP：收缩压；

en-us	SD, standard deviation;
zh-cn	SD：标准差；

en-us	SIRS, systemic inflammatory response syndrome;
zh-cn	SIRS：全身性炎性反应综合征； 

en-us	 SpO2, oxygen saturation. *If altitude is higher than 1000m, then correction factor should be calculated as follows: PaO2/FiO2 x Barometric pressure/760. 
zh-cn	SpO2：血氧饱和度。*如果海拔超过 1000 米，则按以下进行校正：PaO2/FiO2×大气压/760。 *

en-us	* The SOFA score ranges from 0 to 24 and includes points related to 6 organ systems: respiratory (hypoxemia defined by low PaO2/FiO2), coagulation (low platelets), liver (high bilirubin), cardiovascular (hypotension), central nervous system (low level of consciousness defined by Glasgow Coma Scale), and renal (low urine output or high creatinine). Sepsis is defined by an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score13 of ≥2 points.
zh-cn	序贯器官衰竭评分（SOFA）的区间值为 0-24，包含 6 个器官系统：呼吸系统（PaO2/FiO2过低指示血氧不足）、凝血系统（低血小板计数）、肝脏（高胆红素）、心血管（低血压）、中枢神经系统（格拉斯哥昏迷量表界定为意识水平低下）和肾脏（少尿或高肌酐）。败血症定义为 SOFA 值 13≥2 分。

en-us	Assume the baseline score is zero if data are not available 
zh-cn	如果无法获取数据则假设基线值为 0。 

en-us	2. Immediate implementation of appropriate IPC measures
zh-cn	2. 立即采取适宜的感染防控措施

en-us	IPC is a critical and integral part of clinical management of patients and should be initiated at the point of entry of the patient to hospital (typically the Emergency Department).
zh-cn	感染防控是病例管理的重要环节，从病人一进入医院（一般是急诊部）即应开展。

en-us	 Standard precautions should always be routinely applied in all areas of health care facilities.
zh-cn	医疗机构的所有区域都要常规实施标准化预防措施，

en-us	 Standard precautions include hand hygiene; use of PPE to avoid direct contact with patients’ blood, body fluids, secretions (including respiratory secretions) and non-intact skin. 
zh-cn	包括：洗手；使用个人防护装备，避免直接接触病人血液、体液、分泌物（包括呼吸道分泌物）和破损皮肤。

en-us	Standard precautions also include prevention of needle-stick or sharps injury; safe waste management; cleaning and disinfection of equipment; and cleaning of the environment 
zh-cn	标准化预防措施还需要包括：预防针头或锐器伤害；废弃物安全处置；设备清洗与消毒；环境清洁。  

en-us	Table 2. How to implement infection prevention and control measures for patients with suspected or confirmed nCoV infection 1 
zh-cn	表 2 如何对疑似或确诊新型冠状病毒感染患者实施感染防控措施 

en-us	At triage
zh-cn	分诊阶段 

en-us	Give suspect patient a medical mask and direct patient to separate area, an isolation room if available.
zh-cn	为疑似患者提供医用口罩并指引至隔离区，如有条件可提供隔离病房。

en-us	Keep at least 1meter distance between suspected patients and other patients.
zh-cn	疑似患者与其他患者之间至少保持 1 米的距离。

en-us	 Instruct all patients to cover nose and mouth during coughing or sneezing with tissue or flexed elbow for others. Perform hand hygiene after contact with respiratory secretions  
zh-cn	指导所有患者在咳嗽或打喷嚏时用纸巾或曲肘捂住口鼻。接触呼吸道分泌物后要洗手。 

en-us	Apply droplet precautions 
zh-cn	预防飞沫传播 

en-us	Droplet precautions prevent large droplet transmission of respiratory viruses.
zh-cn	预防呼吸道病毒经飞沫传播。

en-us	 Use a medical mask if working within 1-2 metre s of the patient.  
zh-cn	工作时，如果距离患者 1-2 米，要使用医用口罩。

en-us	Place patients in single rooms, or group together those with the same etiological diagnosis. 
zh-cn	将患者单间隔离，或将病原学诊断结果一致的患者放在一起。

en-us	If an etiological diagnosis is not possible, group patients with similar clinical diagnosis and based on epidemiological risk factors, with a spatial separation. 
zh-cn	如果不能进行病原学诊断，可依据流行病学危险因素，将具有相似临床诊断的病人进行空间隔离。

en-us	When providing care in close contact with a patient with respiratory symptoms (e.g. coughing or sneezing), use eye protection (face-mask or goggles), because sprays of secretions may occur. 
zh-cn	当与有呼吸道症状（如咳嗽或喷嚏）的患者密切接触时，因为可能会有分泌物喷射，需佩戴护眼设备（如面罩或防护镜）。

en-us	Limit patient movement within the institution and ensure that patients wear medical masks when outside their rooms.
zh-cn	限制患者在医院内移动，保证患者离开病房时佩戴医用口罩。 

en-us	Apply contact precautions 
zh-cn	预防接触传播 

en-us	Droplet and contact precautions prevent direct or indirect transmission from contact with contaminated surfaces or equipment (i.e. contact with contaminated oxygen tubing/interfaces). 
zh-cn	预防因接触被污染的物体表面或设备（如接触污染的氧气管/接口）而导致的直接或间接传播。

en-us	Use PPE (medical mask, eye protection, gloves and gown) when entering room and remove PPE when leaving. 
zh-cn	在进入病房时使用 PPE（医用口罩、护目镜、手套和防护服）并在离开时脱掉。

en-us	If possible, use either disposable or dedicated equipment (e.g. stethoscopes, blood pressure cuffs and thermometers).
zh-cn	如有可能，可使用一次性或专用设备（如听诊器、血压袖套和体温计）。

en-us	If equipment needs to be shared among patients, clean and disinfect between each patient use. 
zh-cn	如果患者共用设备，则需在每一名患者使用时进行清洁和消毒。

en-us	Ensure that health care workers refrain from touching their eyes, nose, and mouth with potentially contaminated gloved or ungloved hands. 
zh-cn	确保医务人员避免用潜在污染的手套或手接触自己的眼睛、鼻子和嘴。

en-us	Avoid contaminating environmental surfaces that are not directly related to patient care (e.g. door handles and light switches). 
zh-cn	避免污染与病人治疗不直接相关的物体表面（如门把手、灯开关）。

en-us	Ensure adequate room ventilation.  
zh-cn	保证病房适当通风。

en-us	Avoid movement of patients or transport.
zh-cn	避免病人移动或转送。

en-us	Perform handhygiene. 
zh-cn	正确洗手保证卫生。 

en-us	Apply airborne precautions when performing an aerosol generating procedure 
zh-cn	在进行产生气溶胶的操作时预防空气传播

en-us	Ensure that healthcare workers performing aerosol-generating procedures (i.e. open suctioning of respiratory tract, intubation, bronchoscopy, cardiopulmonary resuscitation) use PPE, 
zh-cn	在实施可能产生气溶胶的操作时（如开放式呼吸道吸痰、插管、支气管镜检、心肺复苏），使用个人防护装备，

en-us	including gloves, long-sleeved gowns, eye protection, and fit-tested particulate respirators (N95 or equivalent, or higher level of protection).
zh-cn	包括：手套、长袖防护服、护目镜和经过适应性测试的高效过滤口罩（N95 相同及以上水平）。

en-us	(The scheduled fit test should not be confused with user seal check before each use.)
zh-cn	（这里的适应性测试不能与每次使用前的密封性检查相混淆）。

en-us	Whenever possible, use adequately ventilated single rooms when performing aerosol-generating procedures, meaning negative pressure rooms with minimum of 12 air changes per hour or at least 160 litres/second/patient in facilities with natural ventilation. 
zh-cn	尽量在通风充分的隔离病房实施可能产生气溶胶的操作，即负压病房（每小时至少换气 12 次）或自然通风的病房（至少 160 升/秒/病人）。

en-us	Avoid the presence of unnecessary individuals in the room.
zh-cn	病房中避免闲人出现。

en-us	Care for the patient in the same type of room after mechanical ventilation commences. 
zh-cn	完成机械通气后在同类病房中治疗病人。 

en-us	:ARI, acute respiratory infection; 
zh-cn	ARI：急性呼吸道感染；

en-us	PPE, personal protective equipment
zh-cn	PPE：个人防护装备 

en-us	Early supportive therapy and monitoring 
zh-cn	3. 及早进行支持性治疗和监控 

en-us	√Give supplemental oxygen therapy immediately to patients with SARI and respiratory distress, hypoxaemia, or shock.  
zh-cn	√对严重急性呼吸道感染、呼吸困难、低氧血症或休克的患者，立即进行辅助性氧疗。

en-us	Remarks: Initiate oxygen therapy at 5 L/min and titrate flow rates to reach target SpO2 ≥90% in non-pregnant adults and SpO2 ≥92-95 % in pregnant patients.1,2 
zh-cn	备注：按照 5L/分钟的流量进行氧疗，使非妊娠成人患者血氧饱和度（SpO2）≥90%，妊娠患者≥92-95%1,2。

en-us	Children with emergency signs (obstructed or absent breathing, severe respiratory distress, central cyanosis, shock, coma or convulsions) should receive oxygen therapy during resuscitation to target SpO2 ≥94%; otherwise, the target SpO2 is ≥90%. 
zh-cn	有紧急指征的儿童（呼吸阻塞或呼吸停止、严重呼吸窘迫、中枢性紫绀、休克、昏迷或惊厥），应在复苏阶段实施氧疗，使 SpO2≥94%；其他情况下使 SpO2≥90%。

en-us	All areas where patients with SARI are cared for should be equipped with pulse oximeters, functioning oxygen systems and disposable, single-use, oxygen-delivering interfaces (nasal cannula, simple face mask, and mask with reservoir bag). 
zh-cn	所有 SARI 患者的治疗区域都要装备脉搏血氧仪、有效供氧设备和一次性供氧接口（鼻导管、简易面罩和储氧袋口罩）。

en-us	Use contact precautions when handling contaminated oxygen interfaces of patients with nCoV infection. 
zh-cn	处理被新型冠状病毒感染患者污染的氧气接口时，应预防接触传播。 

en-us	√Use conservative fluid management in patients with SARI when there is no evidence of shock. 
zh-cn	√对无休克症状的严重急性呼吸道感染患者采用保守的输液治疗。

en-us	Remarks: Patients with SARI should be treated cautiously with intravenous fluids, because aggressive fluid resuscitation may worsen oxygenation, especially in settings where there is limited availability of mechanical ventilation.16 
zh-cn	备注：对严重急性呼吸道感染患者进行静脉输液时需慎重，因为大量的液体复苏可能会使患者氧合功能恶化，特别是在机械通气使用受限的情况下 16。 

en-us	√Give empiric antimicrobials to treat all likely pathogens causing SARI. 
zh-cn	√经验性使用抗生素治疗所有可能导致严重急性呼吸道感染的病原体。

en-us	Give antimicrobials within one hour of initial patient assessment for patients with sepsis. 
zh-cn	评估为败血症的患者一小时内启用抗生素治疗。

en-us	Remarks: Although the patient may be suspected to have nCoV, administer appropriate empiric antimicrobials within ONE hour of identification of sepsis.17 
zh-cn	备注：尽管病人可能疑似新型冠状病毒感染，但在确诊为败血症后，应在一小时内经验性给予适当的抗生素治疗 17。

en-us	Empiric antibiotic treatment should be based on the clinical diagnosis (community-acquired pneumonia, health care-associated pneumonia [if infection was acquired in healthcare setting], or sepsis), local epidemiology and susceptibility data, and treatment guidelines.
zh-cn	经验性使用抗生素的依据包括：临床诊断（社区获得性肺炎、医疗保健相关性肺炎[医疗机构内感染]，或败血症）、当地流行病学、药敏数据和治疗指南。

en-us	 Empiric therapy includes a neuraminidase inhibitor for treatment of influenza when there is local circulation or other risk factors, including travel history or exposure to animal influenza viruses.18 
zh-cn	如果当地存在流感流行或其他危险因素（包括有旅行史或动物流感暴露史），经验性治疗还包括使用神经氨酸酶抑制剂治疗流感 18。

en-us	Empiric therapy should be de-escalated on the basis of microbiology results and clinical judgment.
zh-cn	应根据病原学的检测结果和临床诊断逐步减少经验性治疗。 

en-us	×Do not routinely give systemic corticosteroids for treatment of viral pneumonia or ARDS outside of clinical trials unless they are indicated for another reason. 
zh-cn	×禁止超出临床试验范围常规地全身性使用糖皮质激素治疗病毒性肺炎或急性呼吸窘迫综合征，除非有其他指征。

en-us	Remarks: A systematic review of observational studies of corticosteroids administered to patients with SARS reported no survival benefit and possible harms (avascular necrosis, psychosis, diabetes, and delayed viral clearance).19
zh-cn	备注：一项观察性研究的系统综述结果显示，使用糖皮质激素不能提高急性呼吸窘迫综合征患者的生存率且可能存在危害（缺血性坏死、精神失常、糖尿病、延迟病毒清除）19。

en-us	A systematic review of observational studies in influenza found a higher risk of mortality and secondary infections with corticosteroids; the evidence was judged as very low to low quality due to confounding by indication.
zh-cn	一项针对流感观察性研究的系统综述提示，糖皮质激素可能会增加死亡和二次感染的风险；由于存在混杂因素，该证据的质量等级判定为极低到低 20。

en-us	20 A subsequent study that addressed this limitation by adjusting for time-varying confounders found no effect on mortality.21
zh-cn	随后的一项研究通过调整时间变化的混杂影响，解决了此局限性，发现糖皮质激素对病死率无影响 21。

en-us	 Finally, a recent study of patients receiving corticosteroids for MERS used a similar statistical approach and found no effect of corticosteroids on mortality but delayed lower respiratory Clinical management of severe acute respiratory infection when Novel coronavirus (nCoV) infection is suspected: Interim Guidance 5 tract (LRT) clearance of MERS-CoV.22
zh-cn	最终，近期的一项研究采用了相似的统计学方法，对糖皮质激素治疗中东呼吸综合征的效果进行分析，发现糖皮质激素对病死率无影响，但会延迟下呼吸道对中东呼吸综合征冠状病毒的清除 22。

en-us	Given lack of effectiveness and possible harm, routine corticosteroids should be avoided unless they are indicated for another reason.  
zh-cn	由于缺乏有效性，同时可能存在危害，应避免常规使用糖皮质激素，除非有其他指征。

en-us	See section 6 for the use of corticosteroids in sepsis.
zh-cn	见第 6 节使用糖皮质激素治疗败血症。 

en-us	√Closely monitor patients with SARI for signs of clinical deterioration, such as rapidly progressive respiratory failure and sepsis, and apply supportive care interventions immediately. 
zh-cn	√密切监控严重急性呼吸道感染患者，一旦出现病情恶化（例如快速进展性呼吸衰竭和败血症），立即采取支持性治疗。

en-us	Remarks: Application of timely, effective, and safe supportive therapies is the cornerstone of therapy for patients that develop severe manifestations of nCoV. 
zh-cn	备注：及时、有效、安全地开展支持性治疗，是治疗新型冠状病毒感染重症患者最重要的措施。 

en-us	√Understand the patient’s co-morbid condition(s) to tailor the management of critical illness and appreciate the prognosis. 
zh-cn	√掌握患者合并症的情况，对重症调整临床处置、改善预后。

en-us	Communicate early with patient and family. 
zh-cn	及早与病人和家属进行沟通。

en-us	Remarks: During intensive care management of SARI, determine which chronic therapies should be continued and which therapies should be stopped temporarily. 
zh-cn	备注：在严重急性呼吸道感染患者重症监护期间，要判断哪种慢性治疗需要继续，哪种需要暂时中止。

en-us	Communicate proactively with patients and families and provide support and prognostic information. 
zh-cn	主动与患者及其家属进行沟通，交代治疗和预后信息。

en-us	Understand the patient’s values and preferences regarding life-sustaining interventions.
zh-cn	掌握患者对生命维持治疗措施的认识和选择。 

en-us	4. Collection of specimens for laboratory diagnosis 
zh-cn	4. 采集样本用于实验室诊断

en-us	WHO guidance on specimen collection, processing, and laboratory testing, including related biosafety procedures, is available. 23 
zh-cn	世卫组织制定了关于样本采集、处理和实验室检测（包括相关的生物安全步骤）的指导文件 23。

en-us	√Collect blood cultures for bacteria that cause pneumonia and sepsis, ideally before antimicrobial therapy.  
zh-cn	√最好在使用抗生素治疗之前，采集血液样本以对引起肺炎和败血症的细菌进行培养。

en-us	DO NOT delay antimicrobial therapy to collect blood cultures.
zh-cn	但不能因为要进行血液细菌培养而延误抗生素治疗。

en-us	√Collect specimens from BOTH the upper respiratory tract (URT; nasopharyngeal and oropharyngeal) AND lower respiratory tract (LRT; expectorated sputum, endotracheal aspirate, or bronchoalveolar lavage) for nCoV testing by RT-PCR.
zh-cn	√同时采集上呼吸道（鼻咽部和口咽部）和下呼吸道（咳痰、气管内吸出物、或支气管肺泡灌洗液）样本，采用逆转录聚合酶链反应方法（RT-PCR）检测新型冠状病毒。

en-us	Clinicians may elect to collect only LRT samples when these are readily available (for example, in mechanically ventilated patients). 
zh-cn	当便于采集时（例如对机械通气患者），临床医生通常选择收集下呼吸道样本。

en-us	√Serology for diagnostic purposes is recommended only when RT-PCR is not available.23 
zh-cn	√只有在无法采用 RT-PCR 方法的情况下，才建议进行血清学诊断 23。 

en-us	Remarks: Use appropriate PPE for specimen collection (droplet and contact precautions for URT specimens; airborne precautions for LRT specimens).
zh-cn	备注：穿戴合适的个人防护装备采集样本（采集上呼吸道样本时预防飞沫和接触传播；采集下呼吸道样本时预防空气传播）。

en-us	When collecting URT samples, use viral swabs (sterile Dacron or rayon, not cotton) and viral transport media. 
zh-cn	在收集上呼吸道样本时，采用病毒拭子（无菌涤纶或人造棉，不能用棉拭子）和病毒运送培养基。

en-us	Do not sample the nostrils or tonsils. 
zh-cn	不要采集鼻孔和扁桃体样本。

en-us	In a patient with suspected novel coronavirus, especially with pneumonia or severe illness, a single URT sample does not exclude the diagnosis, and additional URT and LRT samples are recommended. 
zh-cn	对于疑似新型冠状病毒感染者，特别是出现肺炎或重症的患者，单纯上呼吸道样本不能排除诊断，建议同时采集上呼吸道和下呼吸道样本 。

en-us	LRT (vs. URT) samples are more likely to be positive and for a longer period.
zh-cn	下呼吸道（相比于上呼吸道）样本更容易呈现阳性结果，并维持较长时间 。

en-us	Clinicians may elect to collect only LRT samples when these are readily available (for example, in mechanically ventilated patients).
zh-cn	当便于采集时（例如对机械通气患者），临床医生可能会选择只收集下呼吸道样本。

en-us	Sputum induction should be avoided due to increased risk of increasing aerosol transmission.
zh-cn	由于可能增加空气传播风险，应避免采用痰诱导方式收集样本。

en-us	Remarks: Dual infections with other respiratory viral infections have been found in SARS and MERS cases.
zh-cn	备注：在严重急性呼吸窘迫综合征和中东呼吸综合征患者中，曾发现与其他呼吸道病毒双重感染者。

en-us	At this stage we need detailed microbiologic studies in all suspected cases.
zh-cn	此阶段应对所有疑似病人进行详细的病原学检测。

en-us	 Both URT and LRT specimens can tested for other respiratory viruses, such as influenza A and B (including zoonotic influenza A), respiratory syncytial virus, parainfluenza viruses, rhinoviruses, adenoviruses, enteroviruses (e.g. EVD68), human metapneumovirus, and endemic human coronaviruses (i.e. HKU1, OC43, NL63, and 229E).  
zh-cn	上呼吸道和下呼吸道样本均可用于检测其他呼吸道病毒，如甲型和乙型流感（包括动物源性甲型流感）、呼吸道合胞病毒、副流感病毒、鼻病毒、腺病毒、肠道病毒（例如 EVD68）、人偏肺病毒和地方性人类冠状病毒（例如 HKU1、OC43、NL63 和 229E）。

en-us	LRT specimens can also be tested for bacterial pathogens, including Legionella pneumophila.
zh-cn	下呼吸道样本还可以用于细菌检测，包括嗜肺军团菌。 

en-us	√对于确诊的新型冠状病毒感染的住院患者，需要重复采集上呼吸道和下呼吸道样本，查看病毒的清除状况。
zh-cn	√对于确诊的新型冠状病毒感染的住院患者，需要重复采集上呼吸道和下呼吸道样本，查看病毒的清除状况。

en-us	样本采集频率要依据当地条件而定，但至少每 2-4 天采集一次，直到临床康复病人间隔至少 24 小时连续两次检测结果阴性（如果上呼吸道和下呼吸道样本都被采集，两者应均为阴性）。
zh-cn	样本采集频率要依据当地条件而定，但至少每 2-4 天采集一次，直到临床康复病人间隔至少 24 小时连续两次检测结果阴性（如果上呼吸道和下呼吸道样本都被采集，两者应均为阴性）。

en-us	如果当地感染防控措施要求双份样本阴性才能解除飞沫传播预防措施，则可能需要每天采集样本。 
zh-cn	如果当地感染防控措施要求双份样本阴性才能解除飞沫传播预防措施，则可能需要每天采集样本。 

en-us	5. Management of hypoxemic respiratory failure and ARDS 
zh-cn	5. 低氧血症型呼吸衰竭和急性呼吸窘迫综合征的管理 

en-us	√Recognize severe hypoxemic respiratory failure when a patient with respiratory distress is failing standard oxygen therapy. 
zh-cn	√当呼吸困难的患者采用标准氧疗治疗失败时，要识别严重低氧血症型呼吸衰竭。

en-us	Remarks: Patients may continue to have increased work of breathing or hypoxemia even when oxygen is delivered via a face mask with reservoir bag (flow rates of 10-15 L/min, which is typically the minimum flow required to maintain bag inflation; FiO2 0.60-0.95).  
zh-cn	备注：即使采用储氧袋面罩吸氧（流量 10-15L/分，这是维持储氧袋膨胀的最低流量要求；吸氧浓度 FiO2：0.60- 0.95），患者仍有可能出现呼吸频率增加和低氧血症。

en-us	Hypoxemic respiratory failure in ARDS commonly results from intrapulmonary ventilation-perfusion mismatch or shunt and usually requires mechanical ventilation.
zh-cn	急性呼吸窘迫综合征患者出现的低氧血症型呼吸衰竭通常是由肺内通气灌注不匹配或分流导致，通常需要机械通气。 

en-us	！High-flow nasal oxygen (HFNO) or non-invasive ventilation (NIV) should only be used in selected patients with hypoxemic respiratory failure.  
zh-cn	！高流量鼻导管氧疗或无创通气仅适用于未出现低氧血症型呼吸衰竭的特定患者。

en-us	The risk of treatment failure is high in patients with MERS treated with NIV, and patients treated with either HFNO or NIV should be closely monitored for clinical deterioration.
zh-cn	采用无创通气治疗中东呼吸综合征患者的失败风险较高，因此无论是采用高流量鼻导管氧疗还是无创通气的病人，都需要密切监控以防病情恶化。 

en-us	Remark 1: HFNO systems can deliver 60 L/min of gas flow and FiO2 up to 1.0; paediatric circuits generally only handle up to 15 L/min, and many children will require an adult circuit to deliver adequate flow.
zh-cn	备注 1：高流量鼻导管氧疗系统可设置气流量为 60L/分、吸氧浓度（FiO2）最高至 1.0；儿童输氧管最高流量设置为 15L/分，因此许多儿童需要采用成人输氧管来保证足够的气流量。

en-us	Compared to standard oxygen therapy, HFNO reduces the need for intubation.
zh-cn	与标准氧疗相比，高流量鼻导管氧疗减少了插管的必要性 。

en-us	Patients with hypercapnia (exacerbation of obstructive lung disease, cardiogenic pulmonary oedema), hemodynamic instability, multi-organ failure, or abnormal mental status should generally not receive HFNO, although emerging data suggest that HFNO may be safe in patients with mild-moderate and non-worsening hypercapnia.
zh-cn	尽管有数据表明高流量鼻导管氧疗也许可安全用于治疗轻中度和未加重的高碳酸血症，但伴有高碳酸血症（阻塞性肺疾病加重、心源性肺水肿）、血压不稳、多器官衰竭或者意识失常的患者，通常要避免使用高流量鼻导管氧疗 。

en-us	 Patients receiving HFNO should be in a monitored setting and cared for by experienced personnel capable of endotracheal intubation in case the patient acutely deteriorates or does not improve after a short trial (about 1 hr). 
zh-cn	应对采用高流量鼻导管氧疗法的患者进行监控，并由经验丰富的医务人员看护，一旦患者病情快速加重或经短期处置（约 1 小时）后不能改善，需进行气管插管。

en-us	Evidence-based guidelines on HFNO do not exist, and reports on HFNO in MERS patients are limited.
zh-cn	目前尚无针对高流量鼻导管氧疗的循证指南，有关中东呼吸综合征患者使用高流量鼻导管氧疗的报道也非常有限 。 

en-us	Remark 2: NIV guidelines make no recommendation on use in hypoxemic respiratory failure (apart from cardiogenic pulmonary oedema and post-operative respiratory failure) or pandemic viral illness (referring to studies of SARS and pandemic influenza). 27 
zh-cn	备注 2：无创通气指南不推荐将其用于低氧血症型呼吸衰竭（心源性肺水肿和术后呼吸衰竭除外）或病毒性疾病大流行（参考严重急性呼吸窘迫综合征和流感大流行的研究）27。

en-us	Risks include delayed intubation, large tidal volumes, and injurious transpulmonary pressures. Limited data suggest a high failure rate when MERS patients receive NIV.28
zh-cn	无创通气的风险包括：插管延迟、潮气量大和经肺压造成损伤。有限的数据表明，无创通气治疗中东呼吸综合征患者的失败率高 28。

en-us	Patients receiving a trial of NIV should be in a monitored setting and cared for by experienced personnel capable of endotracheal intubation in case the patient acutely deteriorates or does not improve after a short trial (about 1 hr).  
zh-cn	应对采用无创通气的患者进行监控，并由经验丰富的医务人员看护，一旦患者病情快速加重或经短期处置（约 1 小时）后不能改善，需进行气管插管。

en-us	Patients with hemodynamic instability, multiorgan failure, or abnormal mental status should not receive NIV.
zh-cn	血压不稳、多器官功能衰竭或意识失常的患者不应接受无创通气治疗。 

en-us	Remark 3: Recent publications suggest that newer HFNO and NIV systems with good interface fitting do not create widespread dispersion of exhaled air and therefore should be associated with low risk of airborne transmission. 29-31 
zh-cn	备注 3：最近研究表明，新一代高流量鼻导管氧疗和无创通气装置的接口良好，呼出的气体不会广泛扩散，因此空气传播的风险较低 29-31。 

en-us	√Endotracheal intubation should be performed by a trained and experienced provider using airborne precautions.  
zh-cn	√气管插管应由经过培训的、有经验的医务人员进行操作，并预防空气传播。

en-us	Remarks: Patients with ARDS, especially young children or those who are obese or pregnant, may desaturate quickly during intubation. Pre-oxygenate with 100% FiO2 for 5 minutes, via a face mask with reservoir bag, bag-valve mask, HFNO, or NIV. 
zh-cn	备注：急性呼吸窘迫综合征患者，尤其是年幼、肥胖或怀孕的患者，在插管过程中氧饱和度可能会迅速下降。可通过佩戴储氧袋面罩、袋瓣罩，或经高流量鼻导管氧疗、无创通气使吸氧浓度（FiO2）达 100%，预吸氧 5 分钟。

en-us	Rapid sequence intubation is appropriate after an airway assessment that identifies no signs of difficult intubation32 .
zh-cn	经气道评估后显示无插管困难，可选择快速诱导插管 32。 

en-us	The following recommendations in this section pertain to mechanically ventilated patients with ARDS. 17,33 These focus on adults; 
zh-cn	本节以下建议针对成人，适用于需要机械通气的急性呼吸窘迫综合征（ARDS）患者 17,33。

en-us	consensus-based recommendations for children are available. 3 
zh-cn	而有关儿童的共识建议请见参考文献 34。 

en-us	Implement mechanical ventilation using lower tidal volumes (4–8 ml/kg predicted body weight, PBW) and lower inspiratory pressures (plateau pressure <30 cmH2O). 
zh-cn	√机械通气选择低潮气量（4-8ml/kg 预测体重）和低吸气压（平台压<30cmH2O）。 

en-us	Remarks: This is a strong recommendation from a clinical guideline for patients with ARDS,33 and is suggested for patients with sepsis-induced respiratory failure who do not meet ARDS criteria.
zh-cn	备注：一项针对急性呼吸窘迫综合征患者临床指南的强力推荐 33 该措施；该措施也适用于由败血症诱发呼吸衰竭但不符合急性呼吸窘迫综合征标准的的患者 17。

en-us	The initial tidal volume is 6 ml/kg PBW; tidal volume up to 8 ml/kg PBW is allowed if undesirable side effects occur (e.g. dyssynchrony, pH <7.15).
zh-cn	初始潮气量为 6ml/kg 预测体重；如果发生不良副作用（例如，人机不同步，pH<7.15），潮气量可最高调至 8ml/kg 预测体重。

en-us	Hypercapnia is permitted if meeting the pH goal of 7.30-7.45.
zh-cn	如果 pH 值达 7.30-7.45，则为允许性高碳酸血症。

en-us	Ventilator protocols are available. 35
zh-cn	呼吸机使用方案可见参考文献 35。

en-us	The use of deep sedation may be required to control respiratory drive and achieve tidal volume targets.
zh-cn	可能需要使用深度镇静剂来控制呼吸驱动，达到目标潮气量。

en-us	 Although high driving pressure (plateau pressure−PEEP) may more accurately predict increased mortality in ARDS compared to high tidal volume or plateau pressure,36 RCTs of ventilation strategies that target driving pressure are not currently available 
zh-cn	尽管与高潮气量或平台压相比，高驱动压（平台压-呼气末正压）更能准确地提示急性呼吸窘迫综合征患者的死亡风险增加 36，但目前尚无针对驱动压通气策略的随机对照试验。 

en-us	In patients with severe ARDS, prone ventilation for >12 hours per day is recommended.  
zh-cn	√对于重度急性呼吸窘迫综合征患者，建议每日俯卧位通气>12 小时。

en-us	Remarks: Application of prone ventilation is strongly recommended for adult and paediatric patients with severe ARDS33 but requires sufficient human resources and expertise to be performed safely.37,38
zh-cn	备注：强烈建议成年和儿童急性呼吸窘迫综合征患者采用俯卧位通气，但需要足够的人力资源和专业知识才能保证安全操作 37,38。 

en-us	√Use a conservative fluid management strategy for ARDS patients without tissue hypoperfusion. 
zh-cn	√对无组织灌注不足的急性呼吸窘迫综合征患者，应采用保守性输液治疗。

en-us	Remarks: This is a strong guideline recommendation;17 the main effect is to shorten the duration of ventilation. See reference [39] for details of a sample protocol. 
zh-cn	备注：强烈推荐 17；主要作用是缩短通气时间。更多方案信息，请见参考文献[39]。 

en-us	！In patients with moderate or severe ARDS, higher PEEP instead of lower PEEP is suggested.
zh-cn	！对于中度或重度急性呼吸窘迫综合征患者，建议使用较高而不是较低的呼气末正压。

en-us	 Remarks: PEEP titration requires consideration of benefits (reducing atelectrauma and improving alveolar recruitment) vs. risks (end-inspiratory overdistension leading to lung injury and higher pulmonary vascular resistance). 
zh-cn	备注：呼气末正压滴定需要平衡收益（减少不张性肺损伤、促进肺泡复张）与风险（吸气末过度扩张导致肺损伤和肺血管阻力增加）。

en-us	Tables are available to guide PEEP titration based on the FiO2 required to maintain SpO2. 35
zh-cn	根据维持血氧饱和度所需的吸氧浓度来进行呼气末正压滴定，指导见参考文献 35。

en-us	A related intervention of recruitment manoeuvres (RMs) is delivered as episodic periods of high continuous positive airway pressure [30–40 cm H2O], progressive incremental increases in PEEP with constant driving pressure, or high driving pressure; considerations of benefits vs. risks are similar.
zh-cn	肺复张可疑似新型冠状病毒引起的严重急性呼吸道感染的临床管理：临时指导文件 7 以提供短时间内持续气道内正压[30-40 cm H2O]，并快速增加呼气末正压，维持稳定的或更高的驱动压；同样需要考虑收益与风险。

en-us	Higher PEEP and RMs were both conditionally recommended in a clinical practice guideline.
zh-cn	临床实践指南都是有条件地推荐高呼气末正压和肺复张 33。

en-us	33 For PEEP, the guideline considered an individual patient data meta-analysis40 of 3 RCTs.
zh-cn	对于呼气末正压，该指南参考了患者数据荟萃分析（纳入 3 项随机对照试验）的结果 40。

en-us	However, a subsequent RCT of high PEEP and prolonged high-pressure RMs showed harm, suggesting that the protocol in this RCT should be avoided. 41  
zh-cn	但随后一项随机对照试验显示，高呼气末正压和长期高压肺复张会造成损伤，这表明应避免使用此试验方案 41。

en-us	Monitoring of patients to identify those who respond to the initial application of higher PEEP or a different RM protocol, and stopping these interventions in non-responders, is suggested.42
zh-cn	建议监测患者，识别对初次使用较高呼气末正压或其他肺复张方案有反应的患者；而无反应的患者，建议中止干预措施 42。 

en-us	！In patients with moderate-severe ARDS (PaO2/FiO2 <150), neuromuscular blockade by continuous infusion should not be routinely used. 
zh-cn	！对于中度-重度急性呼吸窘迫综合征的患者（氧合指数 PaO2 / FiO2 <150），不应常规持续神经肌肉阻滞。

en-us	Remarks: One trial found that this strategy improved survival in patients with severe ARDS (PaO2/FiO2 <150) without causing significant weakness, 43 but results of a recent larger trial found that use of neuromuscular blockage with high PEEP strategy was not associated with survival when compared to a light sedation strategy without neuromuscular blockade44 .
zh-cn	备注：一项试验发现，该策略可提高重度急性呼吸窘迫综合征患者（氧合指数 PaO2 / FiO2 <150）的生存率，而不引起严重虚弱 43，但近期一项更大的试验结果表明，与不采用神经肌肉阻滞的轻度镇静策略相比，神经肌肉阻滞联合高呼气末正压并不能增加患者的生存率 44。

en-us	Continuous neuromuscular blockade may still be considered in patients with ARDS in certain situations: ventilator dyssnchony despite sedation, such that tidal volume limitation cannot be reliably achieved; or refractory hypoxemia or hypercapnia 
zh-cn	在某些情况下，仍可考虑对急性呼吸窘迫综合征患者进行持续的神经肌肉阻滞，例如：使用镇静剂后仍存在人机不同步，而无法确切地限制潮气量；或顽固性低氧血症或高碳酸血症。 

en-us	In settings with access to expertise in extracorporeal life support (ECLS), consider referral of patients with refractory hypoxemia despite lung protective ventilation.
zh-cn	！对于顽固性低氧血症的患者，不管是否已采取肺保护性通气，如有条件进行体外生命支持，仍应考虑转介。

en-us	 Remarks: A recent guideline made no recommendation about ECLS in patients with ARDS. 33 
zh-cn	备注：最新发布的指南未对急性呼吸窘迫综合征患者实施体外生命支持提出任何建议 33。

en-us	Since then, an RCT of ECLS for patients with ARDS was stopped early and found no statistically significant difference in the primary outcome of 60-day mortality between ECLS and standard medical management (including prone positioning and neuromuscular blockade). 45
zh-cn	此后，一项关于急性呼吸窘迫综合征患者实施体外生命支持的随机对照试验提前终止，并发现：体外生命支持与标准医疗处置方案（包括俯卧式换气和神经肌肉阻滞）相比，两者 60 天病死率（主要结局指标）无统计学差异 45。

en-us	However, ECLS was associated with a reduced risk of the composite outcome of mortality and crossover to ECLS, 45 and a post hoc Bayesian analysis of this RCT showed that ECLS is very likely to reduce mortality across a range of prior assumptions. 46
zh-cn	但是，体外生命支持可降低其交叉使用以及死亡组合结局和风险 45，对该试验进行事后贝叶斯分析表明：在一系列预设的前提下，体外生命支持极有可能降低病死率 46。

en-us	In patients with MERS-CoV infection, ECLS vs. conventional treatment was associated with reduced mortality in a cohort study. 47
zh-cn	在一项队列研究中，体外生命支持与常规治疗可降低中东呼吸综合征冠状病毒感染的病死率 47。

en-us	ECLS should Clinical management of severe acute respiratory infection when Novel coronavirus (nCoV) infection is suspected: Interim Guidance 7 only be offered in expert centres with a sufficient case volume to maintain expertise and that can apply the IPC measures required for nCoV patients. 48 
zh-cn	能够实施体外生命支持的专业医疗中心应具备以下条件：病例数足够以保证具备相应的专业水平、能够对新型冠状病毒患者实施感染防控措施 48。 

en-us	×Avoid disconnecting the patient from the ventilator, which results in loss of PEEP and atelectasis.
zh-cn	×避免断开患者与呼吸机的连接，否则会导致呼吸末正压丧失和肺不张。

en-us	 Use in-line catheters for airway suctioning and clamp endotracheal tube when disconnection is required (for example, transfer to a transport ventilator). 
zh-cn	当需要断开连接时（如转移到转运呼吸机上），请使用直插式导管进行气道抽吸并夹住气管导管。 

en-us	6. Management of septic shock 
zh-cn	6. 感染性休克的处理 

en-us	√Recognize septic shock in adults when infection is suspected or confirmed AND vasopressors are needed to maintain mean arterial pressure (MAP) ≥65 mmHg AND lactate is ≥2 mmol/L, in absence of hypovolemia. 
zh-cn	√成人感染性休克：怀疑或确诊感染，需要使用血管加压药维持平均动脉压≥65mmHg 和乳酸≥2 mmol / L，且无血容量不足。

en-us	Recognize septic shock in children with any hypotension (systolic blood pressure [SBP] <5th centile or >2 SD below normal for age) or 2-3 of the following:  
zh-cn	儿童感染性休克：存在低血压（收缩压<该年龄组第 5 百分位，或低于正常值 2 个标准差）或符合 2-3 条以下情况：

en-us	altered mental state;
zh-cn	意识改变；

en-us	tachycardia or bradycardia (HR <90 bpm or >160 bpm in infants and HR <70 bpm or >150 bpm in children);
zh-cn	心动过速或心动过缓（婴儿心率<90 bpm 或> 160 bpm，儿童心率<70 bpm 或> 150 bpm）；

en-us	 prolonged capillary refill (>2 sec) or warm vasodilation with bounding pulses;
zh-cn	毛细血管再充盈时间延长（>2 秒）或伴有洪脉的热性血管舒张；

en-us	tachypnea; 
zh-cn	呼吸急促； 

en-us	mottled skin or petechial or purpuric rash;
zh-cn	皮肤花斑、皮疹或紫癜；

en-us	increased lactate;
zh-cn	乳酸增加；

en-us	oliguria; 
zh-cn	少尿；

en-us	hyperthermia or hypothermia.
zh-cn	体温过高或过低。

en-us	Remarks: In the absence of a lactate measurement, use MAP and clinical signs of perfusion to define shock.
zh-cn	备注：如不能测量乳酸水平，可用平均动脉压和血流灌注的临床体征来识别休克。

en-us	Standard care includes early recognition and the following treatments within 1 hour of recognition: antimicrobial therapy and fluid loading and vasopressors for hypotension.49 
zh-cn	标准医疗措施包括及早识别并在 1 小时内进行的以下治疗：抗菌治疗、补液、使用血管加压药治疗低血压 49。

en-us	The use of central venous and arterial catheters should be based on resource availability and individual patient needs.
zh-cn	应根据资源的可及性和患者的个人需求使用中央静脉和动脉导管。

en-us	Detailed guidelines are available for the management of septic shock in adults17 and children. 2,3,12 
zh-cn	更多关于成人 17和儿童 2,3,12感染性休克的信息详见相关指南。 

en-us	√In resuscitation from septic shock in adults, give at least 30 ml/kg of isotonic crystalloid in adults in the first 3 hours. 
zh-cn	√成人感染性休克进行复苏时，应在前 3 小时内至少输注 30 ml/kg 的等渗晶体液。

en-us	In resuscitation from septic shock in children in well-resourced settings, give 20 ml/kg as a rapid bolus and up to 40-60 ml/kg in the first 1 hr. 
zh-cn	儿童感染性休克进行复苏时，如果资源充足，应按照 20 ml/kg 的剂量快速输注，前 1 小时内应达 40-60 ml/kg。 

en-us	×Do not use hypotonic crystalloids, starches, or gelatins for resuscitation. 
zh-cn	×请勿使用低渗晶体、淀粉或明胶进行复苏。 

en-us	！Fluid resuscitation may lead to volume overload, including respiratory failure.
zh-cn	！液体复苏可能导致容量超负荷，包括呼吸衰竭。

en-us	 If there is no response to fluid loading and signs of volume overload appear (for example, jugular venous distension, crackles on lung auscultation, pulmonary oedema on imaging, or hepatomegaly in children), then reduce or discontinue fluid administration.  
zh-cn	如果对补液无反应并且出现容量超负荷的迹象（例如，颈静脉扩张、肺部啰音、影像学显示肺水肿或儿童肝肿大），则应减少或停止输液。

en-us	This step is particularly important where mechanical ventilation is not available.
zh-cn	该步骤在机械通气的情况下特别重要。

en-us	Alternate fluid regimens are suggested when caring for children in resource-limited settings50 
zh-cn	如资源有限，儿童可采取其他补液方案 50。 

en-us	Remarks: Crystalloids include normal saline and Ringer’s lactate. Determine need for additional fluid boluses (250-1000 ml in adults or 10-20 ml/kg in children) based on clinical response and improvement of perfusion targets.
zh-cn	备注：晶体液包括生理盐水和乳酸林格氏液。根据临床反应和灌注的改善情况，确定是否需要额外快速补液（成人 250-1000 ml，儿童 10-20 ml/kg）。

en-us	Perfusion targets include MAP (>65 mmHg or age-appropriate targets in children), urine output (>0.5 ml/kg/hr in adults, 1 ml/kg/hr in children), and improvement of skin mottling, capillary refill, level of consciousness, and lactate. Consider dynamic indices of volume responsiveness to guide volume administration beyond initial resuscitation based on local resources and experience.17 
zh-cn	灌注的目标包括：平均动脉压（>65 mmHg 或儿童达到相应年龄标准）、尿量（成人>0.5 ml/kg /小时，儿童 1 ml /kg /小时）、皮肤花斑、毛细血管再充盈、意识和乳酸水平的改善。根据当地资源和经验，在初始复苏后，考虑使用容量反应性的动态指标来指导容量管理 17。

en-us	These indices include passive leg raises, fluid challenges with serial stroke volume measurements, or variations in systolic pressure, pulse pressure, inferior vena cava size, or stroke volume in response to changes in intrathoracic pressure during mechanical ventilation. 
zh-cn	这些指标包括：被动抬腿、连续测量心搏量进行液体输注，或收缩压、脉压、下腔静脉大小的变化，或机械通气期间胸内压变化对心搏量的影响。 

en-us	Starches are associated with an increased risk of death and acute kidney injury vs. crystalloids.
zh-cn	与晶体液相比，淀粉可增加死亡和急性肾损伤的风险。

en-us	The effects of gelatins are less clear, but they are more expensive than cyrstalloids.51,52
zh-cn	明胶的作用尚不清楚，但比晶体液昂贵 51,52。

en-us	Hypotonic (vs. isotonic) solutions are less effective at increasing intravascular volume.
zh-cn	低渗溶液（相对于等渗溶液）增加血容量的效果较差。

en-us	Surviving Sepsis also suggests albumin for resuscitation when patients require substantial amounts of crystalloids, but this conditional recommendation is based on low-quality evidence.17 
zh-cn	根据拯救败血症患者指南，如果患者需要补充大量晶体液，可使用白蛋白进行复苏，但其证据等级较低，只作条件性推荐 17。 

en-us	√Administer vasopressors when shock persists during or after fluid resuscitation.
zh-cn	√如果液体复苏期间或之后仍存在休克，应使用血管加压药。

en-us	 The initial blood pressure target is MAP ≥65 mmHg in adults and age-appropriate targets in children. 
zh-cn	成人的初始血压目标为平均动脉压≥65 mmHg，儿童依年龄而定。 

en-us	！If central venous catheters are not available, vasopressors can be given through a peripheral IV, but use a large vein and closely monitor for signs of extravasation and local tissue necrosis.
zh-cn	！如果没有条件放置中心静脉导管，可通过外周静脉给予血管加压药，但应使用大静脉并密切监测是否有渗出或出现局部组织坏死。

en-us	If extravasation occurs, stop infusion.
zh-cn	如果发生渗出，应停止输液。

en-us	Vasopressors can also be administered through intraosseous needles. 
zh-cn	还可通过骨内针给予血管加压药。 

en-us	！If signs of poor perfusion and cardiac dysfunction persist despite achieving MAP target with fluids and vasopressors, consider an inotrope such as dobutamine.
zh-cn	！如果尽管通过补液和使用血管加压药达到目标平均动脉压，但仍然存在灌注不良和心脏功能障碍的迹象，请考虑使用正性肌力药物，例如多巴酚丁胺。 

en-us	Remarks: Vasopressors (i.e. norepinephrine, epinephrine, vasopressin, and dopamine) are most safely given through a central venous catheter at a strictly controlled rate, but it is also possible to safely administer them via peripheral vein53 and intraosseous needle.
zh-cn	备注：血管加压药物（如去甲肾上腺素、肾上腺素、血管加压素和多巴胺）最安全的给药方式是通过中央静脉导管、严格控制速率给药，但也可通过外周静脉 53和骨内针安全给药。

en-us	 Monitor blood pressure frequently and titrate the vasopressor to the minimum dose necessary to maintain perfusion and prevent side effects.
zh-cn	频繁监测血压，并将血管加压药调定至维持灌注和预防副作用所需的最小剂量。

en-us	Norepinephrine is considered first-line in adult patients; epinephrine or vasopressin can be added to achieve the MAP target.
zh-cn	去甲肾上腺素被认为是成年患者的一线药物；可以添加肾上腺素或血管加压素来达到平均动脉压目标值。

en-us	 Because of the risk of tachyarrhythmia, reserve dopamine for selected patients with low risk of tachyarrhythmia or those with bradycardia.
zh-cn	由于存在快速心律失常的风险，多巴胺只保守用于那些快速心律失常风险较低或心动过缓的患者。

en-us	 In children with cold shock (more common), epinephrine is considered first-line, while norepinephrine is used in patients with warm shock (less common).  
zh-cn	对于冷休克（较常见）的儿童，肾上腺素被认为是一线药物，而去甲肾上腺素用于热休克（较不常见）。

en-us	No RCTs have compared dobutamine to placebo for clinical outcomes.17
zh-cn	目前尚无随机对照试验将多巴酚丁胺与安慰剂进行临床比较 17。

en-us	7. Prevention of complications 
zh-cn	7. 预防并发症

en-us	Implement the following interventions (Table 3) to prevent complications associated with critical illness.
zh-cn	可采取以下干预措施（表 4）预防重症相关的并发症。

en-us	These interventions are based on Surviving Sepsis17 or other guidelines, 54-57 and are generally limited to feasible recommendations based on high quality evidence. 
zh-cn	基于拯救败血症指南 17 或其他指南 54-57，这些干预措施均为源自高质量证据的可行措施。 

en-us	Table 3. Prevention of complications
zh-cn	表4 并发症的预防措施

en-us	 Anticipated Outcome
zh-cn	预期效果

en-us	Interventions 
zh-cn	 干预措施 

en-us	Reduce days of invasive mechanical ventilation 
zh-cn	缩短有创通气的天数 

en-us	• Use weaning protocols that include daily assessment for readiness to breathe spontaneously 
zh-cn	• 撤机方案中包括每日评估是否能够自主呼吸

en-us	• Minimize continuous or intermittent sedation, targeting specific titration endpoints (light sedation unless contraindicated) or with daily interruption of continuous sedative infusions 
zh-cn	 • 减少持续或间歇镇静，指定目标滴定终点（轻度镇静，除非有禁忌）或持续镇静输液每日中断一次 

en-us	Reduce incidence of ventilatorassociated pneumonia
zh-cn	减少呼吸机相关肺炎发生率

en-us	 • Oral intubation is preferable to nasal intubation in adolescents and adults
zh-cn	 • 对于青少年和成人，经口插管优于经鼻插管 

en-us	• Keep patient in semi-recumbent position (head of bed elevation 30-45º) •
zh-cn	• 让患者保持半卧位（床头抬高 30-45 度）

en-us	Use a closed suctioning system; periodically drain and discard condensate in tubing
zh-cn	 • 使用封闭式吸痰装置；定期排空管道中的冷凝水

en-us	• Use a new ventilator circuit for each patient; once patient is ventilated, change circuit if it is soiled or damaged but not routinely
zh-cn	 • 每位患者使用一套新的通气管道，如发生污染或损坏应更换管道，但不用常规更换

en-us	• Change heat moisture exchanger when it malfunctions, when soiled, or every 5–7 days
zh-cn	 • 发生污染或故障时更换热湿气交换器，或每 5-7 天更换一次

en-us	Reduce incidence of venous thromboembolism
zh-cn	减少静脉血栓的发生率 

en-us	 • Use pharmacological prophylaxis (low molecular-weight heparin [preferred if available] or heparin 5000 units subcutaneously twice daily) in adolescents and adults without contraindications. For those with contraindications, use mechanical prophylaxis (intermittent pneumatic compression devices).
zh-cn	• 对于没有禁忌症的青少年和成人，使用药物预防（优先选择低分子肝素或肝素 5000U 皮下注射，每日两次）；对于有禁忌症的患者，使用机械预防（间歇充气加压装置）

en-us	 Reduce incidence of catheterrelated bloodstream infection
zh-cn	减少导管相关性血流感染的发生率

en-us	 • Use a checklist with completion verified by a real-time observer as reminder of each step needed for sterile insertion and as a daily reminder to remove catheter if no longer needed
zh-cn	 • 使用检查表并实时复核以提醒无菌插入的每一步操作，并每日提醒是否满足拔管条件

en-us	Reduce incidence of pressure ulcers
zh-cn	减少褥疮的发生率

en-us	• Turn patient every two hours
zh-cn	 • 每两小时给患者翻一次身

en-us	 Reduce incidence of stress ulcers and gastrointestinal bleeding
zh-cn	减少应激性溃疡和胃肠道出血的发生率 

en-us	 • Give early enteral nutrition (within 24–48 hours of admission)
zh-cn	• 尽早给与肠内营养（入院 24-48 小时内）

en-us	 • Administer histamine-2 receptor blockers or proton-pump inhibitors in patients with risk factors for GI bleeding. Risk factors for gastrointestinal bleeding include mechanical ventilation for ≥48 hours, coagulopathy, renal replacement therapy, liver disease, multiple comorbidities, and higher organ failure score Reduce incidence of ICU-related weakness 
zh-cn	 • 对于有胃肠道出血风险的患者，使用 H2 受体拮抗剂或质子泵抑制剂。胃肠道出血的危险因素包括：机械通气≥48 小时、凝血功能障碍、肾脏替代治疗、肝病、多重合并症、器官衰竭评分高减少重症监护室相关性衰弱的发生率

en-us	• Actively mobilize the patient early in the course of illness when safe to do so 
zh-cn	 • 在保证安全的前提下，尽早积极鼓励患者活动 

en-us	8. Specific anti-Novel-CoV treatments and clinical research 
zh-cn	8. 抗新型冠状病毒的特效治疗和临床研究 

en-us	！There is no current evidence from RCTs to recommend any specific anti-nCoV treatment for patients with suspected or confirmed nCoV. 
zh-cn	!对于新型冠状病毒疑似或确诊病例，目前尚无基于随机对照试验研究证据的特效抗病毒治疗方法。 

en-us	√Unlicensed treatments should be administered only in the context of ethically-approved clinical trials or the Monitored Emergency Use of Unregistered Interventions Framework (MEURI), with strict monitoring. 
zh-cn	√未获批的治疗方案只能在伦理委员会批准的临床试验中或遵守《未注册干预措施在监控之下紧急使用的框架》进行应用，且需严格监控。 

en-us	√Clinical characterization protocols are available, including the SPRINT-SARI https://isaric.tghn.org/sprint-sari/ and WHOISARIC forms available at https://isaric.tghn.org/protocols/severe-acute-respiratory-infection-data-tools/. Contact oubreak@who.int for additional questions. 
zh-cn	√临床特征手册可点击以下链接获得，包括：严重急性呼吸道感染短期发病率研究 https://isaric.tghn.org/sprintsari/和世卫组织-国际严重急性呼吸感染联盟的版本 https://isaric.tghn.org/protocols/severe-acute-respiratoryinfection-data-tools/。 

en-us	9. Special considerations for pregnant patients 
zh-cn	9. 针对孕妇患者的特别注意事项

en-us	√Pregnant women with suspected or confirmed nCoV should be treated with supportive therapies as described above, taking into account the physiologic adaptations of pregnancy. 
zh-cn	√对于疑似或确诊新型冠状病毒感染的孕妇，应按照上述辅助疗法进行治疗，同时兼顾妊娠的生理变化。

en-us	√The use of investigational therapeutic agents outside of a research study should be guided by individual risk-benefit analysis based on potential benefit for mother and safety to fetus, with consultation from an obstetric specialist and ethics committee. 
zh-cn	√在使用无研究结果支持的试验性治疗方案时，应基于母亲潜在获益和胎儿安全性，按个体权衡利弊，并咨询产科专家和伦理委员会。

en-us	√Emergency delivery and pregnancy termination decisions are challenging and based on many factors: gestational age, maternal condition, and fetal stability.
zh-cn	√紧急分娩和终止妊娠的决定非常具有挑战性，要根据诸多因素进行决策，包括：孕龄、母亲的状况、胎儿的稳定性。

en-us	Consultations with obstetric, neonatal, and intensive care specialists (depending on the condition of the mother) are essential. 
zh-cn	必须咨询产科、新生儿科和重症监护室的专家（视母亲情况而定）。 