Anesthesiology Articles Published in 2020: A Review and Characterization of COVID-19 Versus Non-COVID-19 Publications in Top Anesthesiology Journals.

The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on the practice of medicine worldwide, particularly in anesthesiology. As the clinical realm has rapidly adjusted to the realities of the pandemic, anesthesiology literature has also changed significantly to reflect this. The purpose of this study was to characterize the effects the COVID-19 pandemic has had on anesthesiology literature. Specifically, it was hypothesized that the COVID-19-related literature in the anesthesiology community would gain more interest than non-COVID-19-related articles. A total of 15 anesthesiology-related journals with the highest impact factor in 2019, according to the Journal Citation Reports (JCR), were selected for data collection. An advanced PubMed search identified 5,722 COVID-19-related articles published by these journals in 2020. Next, articles with titles including "corona," "COVID," "COVID-19," "pandemic," "SARS," or "SARS-CoV-2" were selected for inclusion in the study, which resulted in 676 (12%) articles. A Kruskal-Wallis test was used to assess the Altmetric score, which is a weighted calculation of the attention an article receives online, for COVID-19 versus non-COVID-19 articles. Articles were then further characterized across multiple different variables, including country of origin, month published, type of article, and subspecialty of anesthesiology it pertained to. Of the 15 journals investigated, 676 (12%) articles of the 5,722 total articles published were found to be COVID-19-related material. The majority of the articles were found to be published in April (18%), May (19.5%), and June (14%). The majority of these articles were related either to general anesthesia (operating room anesthesiology that is not tied to a particular subspecialty fellowship track) (48%) or critical care (39%). By article type, most were determined to be editorial (71%) in nature, followed by original research articles (21%), of which most were cross-sectional (55%) studies. When compared with non-COVID-19-related articles, COVID-19-related articles had a significantly greater Altmetric score (29.518 versus 8.6333, p < 0.001). Of the COVID-19-related articles, original articles had the greatest Altmetric score, when compared to editorials and guidelines (54.794 versus 20.777 versus 40.643, p < 0.002). The response of the academic anesthesiology community to the COVID-19 pandemic was strong and timely, with a particularly strong focus on critical care anesthesia. The impact of the pandemic was strongly felt by the anesthesiology community, and their timely response served to guide our country and world through an incredibly challenging time. The pandemic highlighted the value of anesthesiologists worldwide, not only in the operating room setting but particularly as critical care physicians.

COVID-19 and Long-Term Outcomes: Lessons from Other Critical Care Illnesses and Potential Mechanisms.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that is currently causing a pandemic and has been termed coronavirus disease (COVID-19). The elderly or those with preexisting conditions like diabetes, hypertension, coronary heart disease, chronic obstructive pulmonary disease, cerebrovascular disease, or kidney dysfunction are more likely to develop severe cases when infected. Patients with COVID-19 admitted to the ICU have higher mortality than non-ICU patients. Critical illness has consistently posed a challenge not only in terms of mortality but also in regard to long-term outcomes of survivors. Patients who survive acute critical illness including, but not limited to, pulmonary and systemic insults associated with acute respiratory distress syndrome, pneumonia, systemic inflammation, and mechanical ventilation, will likely suffer from post-ICU syndrome, a phenomenon of cognitive, psychiatric, and/or physical disability after treatment in the ICU. Post-ICU morbidity and mortality continue to be a cause for concern when considering large-scale studies showing 12-month mortality risks of 11.8-21%. Previous studies have demonstrated that multiple mechanisms, including cytokine release, mitochondrial dysfunction, and even amyloids, may lead to end-organ dysfunction in patients. We hypothesize that COVID-19 infection will lead to post-ICU syndrome via potentially similar mechanisms as other chronic critical illnesses and cause long-term morbidity and mortality in patients. We consider a variety of mechanisms and questions that not only consider the short-term impact of the COVID-19 pandemic but its long-term effects that may not yet be imagined.

Role of angiotensin-converting enzyme 2 and pericytes in cardiac complications of COVID-19 infection.

The prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) quickly reached pandemic proportions, and knowledge about this virus and coronavirus disease 2019 (COVID-19) has expanded rapidly. This review focuses primarily on mechanisms that contribute to acute cardiac injury and dysfunction, which are common in patients with severe disease. The etiology of cardiac injury is multifactorial, and the extent is likely enhanced by preexisting cardiovascular disease. Disruption of homeostatic mechanisms secondary to pulmonary pathology ranks high on the list, and there is growing evidence that direct infection of cardiac cells can occur. Angiotensin-converting enzyme 2 (ACE2) plays a central role in COVID-19 and is a necessary receptor for viral entry into human cells. ACE2 normally not only eliminates angiotensin II (Ang II) by converting it to Ang-(1-7) but also elicits a beneficial response profile counteracting that of Ang II. Molecular analyses of single nuclei from human hearts have shown that ACE2 is most highly expressed by pericytes. Given the important roles that pericytes have in the microvasculature, infection of these cells could compromise myocardial supply to meet metabolic demand. Furthermore, ACE2 activity is crucial for opposing adverse effects of locally generated Ang II, so virus-mediated internalization of ACE2 could exacerbate pathology by this mechanism. While the role of cardiac pericytes in acute heart injury by SARS-CoV-2 requires investigation, expression of ACE2 by these cells has broader implications for cardiac pathophysiology.