Right ventricular dysfunction in patients with COVID-19 pneumonitis whose lungs are mechanically ventilated: a multicentre prospective cohort study.

Cardiovascular complications due to COVID-19, such as right ventricular dysfunction, are common. The combination of acute respiratory distress syndrome, invasive mechanical ventilation, thromboembolic disease and direct myocardial injury creates conditions where right ventricular dysfunction is likely to occur. We undertook a prospective, multicentre cohort study in 10 Scottish intensive care units of patients with COVID-19 pneumonitis whose lungs were mechanically ventilated. Right ventricular dysfunction was defined as the presence of severe right ventricular dilation and interventricular septal flattening. To explore the role of myocardial injury, high-sensitivity troponin and N-terminal pro B-type natriuretic peptide plasma levels were measured in all patients. We recruited 121 patients and 118 (98%) underwent imaging. It was possible to determine the primary outcome in 112 (91%). Severe right ventricular dilation was present in 31 (28%), with interventricular septal flattening present in nine (8%). Right ventricular dysfunction (the combination of these two parameters) was present in seven (6%, 95%CI 3-13%). Thirty-day mortality was 86% in those with right ventricular dysfunction as compared with 45% in those without (p = 0.051). Patients with right ventricular dysfunction were more likely to have: pulmonary thromboembolism (p < 0.001); higher plateau airway pressure (p = 0.048); lower dynamic compliance (p = 0.031); higher plasma N-terminal pro B-type natriuretic peptide levels (p = 0.006); and raised plasma troponin levels (p = 0.048). Our results demonstrate a prevalence of right ventricular dysfunction of 6%, which was associated with increased mortality (86%). Associations were also observed between right ventricular dysfunction and aetiological domains of: acute respiratory distress syndrome; ventilation; thromboembolic disease; and direct myocardial injury, implying a complex multifactorial pathophysiology.

Anesthetic Management for Thoracic Surgery During the COVID-19 Pandemic.

PURPOSE OF REVIEW: This review explores recent international guidance on the anesthetic management of patients undergoing thoracic surgery during the COVID-19 pandemic: those with suspected or confirmed COVID-19 requiring urgent thoracic surgery and those presenting for elective procedures. RECENT FINDINGS: A significant mortality risk is associated with patients with COVID-19 undergoing thoracic surgery; therefore, where possible, it should be avoided. Thoracic surgery also carries a significant risk of viral transmission to healthcare workers due to the necessarily high frequency of intraoperative aerosol-generating procedures involved, such as lung isolation, one-lung ventilation, and flexible bronchoscopy. SUMMARY: Guidelines recommend appropriate personal protective equipment and numerous procedural modifications to prevent viral transmission to staff and other patients. With appropriate disease mitigation strategies in place, elective thoracic surgery, in particular for lung cancer, has been able to continue safely in many centres.

Statistical power in COVID-19 case-control host genomic study design.

The identification of genetic variation that directly impacts infection susceptibility to SARS-CoV-2 and disease severity of COVID-19 is an important step towards risk stratification, personalized treatment plans, therapeutic, and vaccine development and deployment. Given the importance of study design in infectious disease genetic epidemiology, we use simulation and draw on current estimates of exposure, infectivity, and test accuracy of COVID-19 to demonstrate the feasibility of detecting host genetic factors associated with susceptibility and severity in published COVID-19 study designs. We demonstrate that limited phenotypic data and exposure/infection information in the early stages of the pandemic significantly impact the ability to detect most genetic variants with moderate effect sizes, especially when studying susceptibility to SARS-CoV-2 infection. Our insights can aid in the interpretation of genetic findings emerging in the literature and guide the design of future host genetic studies.

Management of the airway and lung isolation for thoracic surgery during the COVID-19 pandemic: Recommendations for clinical practice endorsed by the Association for Cardiothoracic Anaesthesia and Critical Care and the Society for Cardiothoracic Surgery in Great Britain and Ireland.

Intra-operative aerosol-generating procedures are arguably unavoidable in the routine provision of thoracic anaesthesia. Airway management for such patients during the COVID-19 pandemic including tracheal intubation, lung isolation, one-lung ventilation and flexible bronchoscopy may pose a significant risk to healthcare professionals and patients. That said, there remains a need for timely thoracic surgery for patients with lung cancer or thoracic trauma. The thoracic anaesthetic community has been confronted with the need to modify existing techniques to maximise safety for patients and healthcare professionals. With appropriate modification, aerosol generation may be mitigated against in most circumstances. We developed a set of practice-based recommendations for airway management in thoracic surgical patients, which have been endorsed by the Association for Cardiothoracic Anaesthesia and Critical Care and the Society for Cardiothoracic Surgery in Great Britain and Ireland.

On Statistical Power for Case-Control Host Genomic Studies of COVID-19 (preprint)

The identification of genetic variation that directly impacts infection susceptibility and disease severity of COVID-19 is an important step towards risk stratification, personalized treatment plans, therapeutic and vaccine development and deployment. Given the importance of study design in infectious disease genetic epidemiology, we use simulation and draw on current estimates of exposure, infectivity and test accuracy of COVID-19 to demonstrate the feasibility of detecting host genetic factors associated with susceptibility and severity with published COVID-19 study designs. We demonstrate why studying susceptibility to SARS-CoV-2 infection could be futile at the early stages of the pandemic. Our insights can aid in the interpretation of genetic findings emerging in the literature and guide the design of future host genetic studies.