Ventilator management and risk of air leak syndrome for patients with COVID-19 pneumonia

Introduction: Coronavirus disease 2019 (COVID-19) pneumonia is reportedly associated with air leak syndrome (ALS), including mediastinal emphysema and pneumothorax, and has a high mortality rate. In this study, we compared values obtained every minute from the ventilator to clarify the relationship between ventilatory management and the risk of developing ALS. Method(s): This was a single-center, retrospective, observational study for a 21-months period. Patient background, ventilator data, and outcomes were collected from adult patients with COVID-19 pneumonia on ventilator-assisted respiratory management. The primary outcome was the development of ALS within 30 days of starting ventilator management. Result(s): Of the 105 patients, 14 (13%) developed ALS. The mean positive-end expiratory pressure (PEEP) difference was 0.33 cmH2O (95% confidence interval (CI) 0.31-0.33), and it was higher in the ALS than in the non-ALS group (9.18 +/- 2.20 versus 8.85 +/- 2.63, respectively). For peak pressure, the mean difference was -0.18 cmH2O (95% CI -0.20 to -0.15), (20.70 +/- 5.30 vs. 20.87 +/- 5.65) and the mean pressure difference of -0.05 cmH2O (95% CI -0.04 to -0.07) (12.80 +/- 3.13 vs. 12.85 +/- 3.55, respectively) was also higher in the non-ALS group. The difference in the single ventilation volume per ideal body weight was 0.65 ml/kg (95% CI 0.63-0.66) (7.83 +/- 3.16 vs. 7.18 +/- 2.96, respectively), and the difference in dynamic lung compliance was 8.57 mL/cmH2O (95% CI 8.43-8.70) (50.32 +/- 31.68 vs. 49.68 +/- 15.16, respectively), and both were higher in the ALS group. The percentage of times that the ventilation volume per body weight exceeded 8 was higher in the ALS group (53.7% vs. 38.6%, p < 0.001). Conclusion(s): There was no association between higher ventilator pressures and the development of ALS. The ALS group had higher dynamic lung compliance and higher tidal volumes, which may indicate a pulmonary contribution to ALS, and ventilatory management that limits tidal volume may prevent the development of ALS.

The effectiveness of COVID-19 infection control measures evaluated by SARS-CoV-2 antibody screening of staff members at a hospital designated as a treatment center for infectious diseases - efforts to eliminate nosocomial infections and verification of their effectiveness

The pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in major social and medical problems. As in other countries, Japan has seen community transfer and clusters in cities, long-term care facilities, and hospitals. SARS-CoV-2 infection can be transmitted both from and to healthcare workers and patients. Severe infection events greatly impact the functioning of the medical care system, and under extreme conditions, can lead to collapse of the system. The staff members at medical institutions who are assigned for the treatment of infectious diseases are at an especially high risk of contact with Coronavirus disease 2019 (COVID-19) patients, and it is quite important to evaluate the effectiveness of infection control measures taken at hospitals to prevent nosocomial infection by SARS-CoV-2. Towards this end, we tested serum samples collected from 375 consenting staff members of Fukuoka City Hospital, a medical institution designated as a treatment center for infectious diseases, for SARS-CoV-2 antibodies by three methods. The staff members were grouped by the risk according to their frequency of contact with COVID-19 patients, and by occupation. The effectiveness of the infection control measures adopted by us was evaluated by comparing the antibody-positive rates of the groups. Our analyses revealed that there was only one antibody-positive staff member who had no contact with COVID-19 patients. Our results suggest that the infection control measures adopted at our hospital have been effective. Our results suggest that nosocomial infection with SARS-CoV-2 infection is preventable with by the precautions that we have adopted at our hospital, even in areas of intensive medical intervention, and that the reuse of personal protective equipment (PPE) that had to be implemented during the study period did not have any adverse impact on the spread of the infection. Further improvements of the precautions are needed for continued prevention of infection, depending on the availability of PPE and the accurate route of transmission.