Not just a matter of weight: A case report of ECMO treatment in a severely obese patient.

The ELSO Guidelines list a BMI ≥ 40 kg/m2 among the relative contraindications to give ECMO treatment in SARS - COV2 patients. We describe a case of a 52-year-old with BMI 50.21 kg/m2, admitted to the intensive care unit (ICU) with severe respiratory conditions and successfully treated with extracorporeal membrane oxygenation (ECMO). The application of veno-venous (VV) ECMO will evolve as far as we understand the pathophysiology of the COVID-19 disease and will probably have a determinant role in management of patient with refractory hypoxemia, whose ventilation management is difficult, even in case of severe obesity.

A monocentric retrospective analysis about the effects of COVID-19 pandemic on emergency general surgery consultations.

OBJECTIVE: The pandemic effects due to the coronavirus SARS-CoV-2 caused a health emergency. We decided to carry out a study with the aim to investigate the changes in patients' tendencies for admission to the emergency department for surgical diseases, and the related hospitalizations and urgent surgery rates. PATIENTS AND METHODS: We carried out a retrospective, observational study on patients who received emergency general surgery consultation at our University Hospital during the two COVID-19 pandemic periods and on the same dates one year before. The patients' demographic characteristics, their hospitalization in surgical department and the data about those who underwent urgent surgery were retrospectively recorded. RESULTS: In the period March-April 2020 there were 95 surgical visits recorded; among these patients, 25% required hospitalization and 12.63% underwent urgent surgery. In the period November-December-January 2020-2021 there were 156 surgical consultations, of which 35.26% required hospitalization and 21.15% underwent urgent surgery. In both considered periods we found that the number of surgical consultations decreased compared to the same periods of the previous year. Moreover, we found a higher rate of hospitalization and need for urgent surgery. CONCLUSIONS: We documented a significant reduction in the overall number of surgical consultations and an increase of hospitalization and urgent surgery rates.

[Working modes and evaluation of perceived stress during the Covid-19 pandemic]

SUMMARY: Introduction. The global sanitary crisis due to covid 19 has had an unprecedent impact on human health and on the global economy creating unexpected challenges on work life. In Italy in order to limit the velocity of virus transmission, measures aimed towards social distancing were adopted by suspending all non essential working activities, with the recommendation of the maximum use of smart working (DPCM 01 MARCH 2020). Literature regarding precedent experiences worldwide on the impact of epidemic or pandemic flu viruses on the working enviroment report of a strong presence of correlated work stress.

High-resolution chest CT angiography of patients with COVID-19 pneumonia: A longitudinal prospective study

Background: Vascular findings in coronavirus disease 2019 (COVID-19) are not systematically described using 384-row state-of-the-art chest CT angiography (CTA). The relationship between CT-CTA features and arterial blood gas (ABG) parameters is not fully understood. Methods: Chest CT images were acquired with Dual Source 384-slice (2×192) CT (Siemens SOMATOM Force). Quantitative volumetric assessment of lung lesions and the CT severity score were calculated by using a deep learning algorithm trained on COVID-19 pneumonia and correlated with ABG parameters. Assessment of pulmonary vascular tree was performed on CTA images. Statistical analysis included Mann-Whitney U test and non-parametric Spearman’s Rho test, with significance threshold at P<0.05. Results: Out of the 36 patients referred to the Covid Center, 30.6% (11/36) were admitted to the intensive care unit (ICU) and 69.4% (25/36) to the non-ICU low-cure Covid Medicine. We found a significant inverse relationship between the P/F ratio and lung lesion volume relative percentages (r=–0.52;95% CI: –0.72, –0.23;P=0.001), absolute volume (r=–0.58;95% CI: –0.76, –0.31;P<0.001) and the CT severity score (r=–0.60;95% CI: –0.77, –0.34;P<0.001) at day 0. At day 7, CTA showed pulmonary embolism in 2/10 patients (20%). In 9/10 patients (90%) CTA detected vascular wall thickening/irregularity and stenoses of segmental and/or subsegmental branches of pulmonary artery. CTA demonstrated subsegmental tubular vessel dilation in all cases (100%) and the presence of subsegmental focal vessel dilations in 6/10 patients (60%). Conclusions: In conclusion, 384-row Chest CTA is able to capture the full spectrum of vascular pathology in COVID-19, comprising pulmonary embolism and stenoses together with tubular and focal dilations of segmental and/or subsegmental branches of pulmonary artery. © Journal of Xiangya Medicine. All rights reserved.

Effectiveness and safety of a new helmet CPAP configuration allowing tidal volume monitoring in patients with COVID-19.

BACKGROUND: High generated tidal volumes (Vt) have been correlated with higher risk of self-induced lung injury and worse clinical outcome. This study aimed to evaluate the effectiveness and safety of a new helmet continuous positive airway pressure delivered (h-CPAP) configuration allowing Vt monitoring in patients affected by COVID-19. METHODS: This prospective observational study was performed in the respiratory intermediate care unit of University Hospital in Turin, Italy, between March 24th, and June 15th, 2020. Included patients were treated with CPAP via a single-limb intentional leak configuration by a turbine-driven ventilator, provided with a dedicated patch. Effectiveness and safety of the configuration and healthcare workers safety were the outcomes of the study. MAIN FINDINGS: Thirty-five patients were included in this study. Median age was 67 years (IQR 57-76 years), and 30 patients (85.7%) were men. Median value of overall leaks (intentional plus unintentional) was 68 L/min (IQR 63-75). Reliability of Vt measurements was 100%. An out of scale of Vt (above 50% compared to the previous values) was never recorded. Six patients (17.1%) needed more than two helmet replacements, due to leak test >10 l/min. Arm oedema and skin breakdowns were reported in sixteen (45.7%) and seven (20%) patients respectively. Among the 63 healthcare workers involved in the care of COVID-19 patients during the study only one was positive at RT-PCR nasopharyngeal swab testing. CONCLUSIONS: The use of h-CPAP for treating COVID-19 in this configuration allowed for reliable Vt monitoring. Further studies evaluating this configuration in larger patients' cohorts are needed.

Workers health in pandemic and the Statute’s mark

The contribution aims to examine workers health regulations at the time of the pandemic. With reference to some protocols, in particular the “Protocol for the regulation of measures to contrast and contain the spread of the Covid-19 in the workplace” signed in 2020, it focuses on a threefold profile. First, it compares these protocols with a regulatory precedent represented by Article 9 of the Workers’ Statute. Second, it examines the relationship with the system of sources, since these protocols are collective autonomy agreements signed to implement the measures contained in some Prime Minister Decrees. Third, it analyzes the legal and trade-union nature of these protocols, signed upon invitation of the Government, which promoted the agreement between the social partners. In conclusion, this contribution provides an assessment of the integration between the individual and the collective dimensions, which had its significant legitimacy in Art. 9 of the Workers’ Statute. © 2021 Societa Editrice il Mulino. All rights reserved.

Guidelines of clinical practice for the management of swallowing disorders and recent dysphonia in the context of the COVID-19 pandemic.

Procedures putting healthcare workers in close contact with the airway are particularly at risk of contamination by the SARS-Cov-2 virus, especially when exposed to sputum, coughing, or a tracheostomy. In the current pandemic phase, all patients should be considered as potentially infected. Thus, the level of precaution recommended for the caregivers depends more on the type of procedure than on the patient's proved or suspected COVID-19 status. Procedures that are particularly at high risk of contamination are clinical and flexible endoscopic pharyngo-laryngological evaluation, and probably also video fluoroscopic swallowing exams. Voice rehabilitation should not be considered urgent at this time. Therefore, recommendations presented here mainly concern the management of swallowing disorders, which can sometimes be dangerous for the patient, and recent dysphonia. In cases where they are considered possible and useful, teleconsultations should be preferred to face-to-face assessments or rehabilitation sessions. The latter must be maintained only in few selected situations, after team discussions or in accordance with the guidelines provided by health authorities.

Conseils de bonnes pratiques pour les praticiens spécialisés en laryngologie et en phoniatrie en contexte d’épidémie COVID-19

RESUME Les gestes mettant le personnel soignant en contact étroit avec les voies aériennes sont particulièrement à risque de contamination par le virus SARS-Cov-2, en particulier en cas de crachats, toux, ou présence d’une trachéotomie. Dans la phase pandémique actuelle, tous les patients sont à considérer comme potentiellement infecté donc l’attitude du soignant est à adapter au statut COVID-19 du patient mais aussi et surtout au geste effectué. Ainsi, s’il s’agit d’un geste invasif comme une fibroscopie ou une pose de sonde naso-gastrique notamment, les précautions sont identiques pour tous les patients quel que soit leur statut COVID. Les rééducations vocales sont à considérer comme non urgentes dans ce contexte. Les recommandations présentaient ici en date du 9 avril 2020 sont donc surtout destinées à la prise en charge des troubles de la déglutition (ceci pouvant parfois être dangereux pour le patient) ou d’une dysphonie récente inquiétante. Dès qu’elles sont possibles techniquement et règlementairement, les téléconsultations seront à privilégier. Seules les urgences non différables seront réalisées en présentiel et ce après décision collégiale (ou en fonction des informations venues des autorités de santé) et en prenant les précautions adéquates détaillées ici.