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1.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-307196

ABSTRACT

Background: ascertaining whether respiratory system static compliance (Crs), driving pressure (DP), and tidal volume normalized for ideal body weight (VT/kg IBW) at the 1 st day of controlled mechanical ventilation (CMV) are associated with intensive care unit (ICU) mortality in COVID-19 acute respiratory distress syndrome (ARDS). Methods: : observational multicenter cohort study. All consecutive COVID-19 adult patients admitted to 25 ICUs belonging to the COVID-19 VENETO ICU network (February 28 th -April 28 th , 2020), who received CMV, were screened. Only patients fulfilling ARDS criteria and with complete records of Crs, DP and VT/kg IBW within the 1 st day of CMV were included. Crs, DP and VT/kg IBW were collected in sedated, paralyzed and supine patients. Results: : 704 COVID-19 patients were screened and 241 enrolled. Seventy-one patients (29%) died in ICU. The logistic regression analysis showed that: i) Crs was not linearly associated with ICU mortality (p-value for non-linearity=0.01), with a greater risk of death for values <48 ml/cmH 2 O;ii) the association between DP and ICU mortality was linear (p-value for non-linearity=0.68), and increasing DP from 10 to 14 cmH 2 O caused significant higher odds of in-ICU death (OR 1.45, 95%CI 1.06-1.99);iii) VT/kg IBW was not associated with a significant increase of the risk of death (OR 0.92, 95%CI 0.55-1.52). Multivariable analysis confirmed these findings. Conclusions: : Crs <48 ml/cmH 2 O was associated with ICU mortality, while DP was linearly associated with mortality. DP should be kept as low as possible, even in the case of relatively preserved Crs, irrespective of VT/kg IBW, to reduce the risk of death.

2.
Lorenzoni, Giulia, Sella, Nicolò, Boscolo, Annalisa, Azzolina, Danila, Bartolotta, Patrizia, Pasin, Laura, Pettenuzzo, Tommaso, De Cassai, Alessandro, Baratto, Fabio, Toffoletto, Fabio, De Rosa, Silvia, Fullin, Giorgio, Peta, Mario, Rosi, Paolo, Polati, Enrico, Zanella, Alberto, Grasselli, Giacomo, Pesenti, Antonio, Navalesi, Paolo, Gregori, Dario, Tocco, Martina, Pretto, Chiara, Tamburini, Enrico, Fregolent, Davide, Pirelli, Pier Francesco, Marchesin, Davide, Perona, Matteo, Franchetti, Nicola, Paolera, Michele Della, Simoni, Caterina, Falcioni, Tatiana, Tresin, Alessandra, Schiavolin, Chiara, Schiavi, Aldo, Vathi, Sonila, Sartori, Daria, Sorgato, Alice, Pistollato, Elisa, Linassi, Federico, Gianoli, Sara, Gaspari, Silvia, Gruppo, Francesco, Maggiolo, Alessandra, Giurisato, Elena, Furlani, Elisa, Calore, Alvise, Serra, Eugenio, Pittarello, Demetrio, Tiberio, Ivo, Bond, Ottavia, Michieletto, Elisa, Muraro, Luisa, Peralta, Arianna, Persona, Paolo, Petranzan, Enrico, Zarantonello, Francesco, Graziano, Alessandro, Piasentini, Eleonora, Bernardi, Lorenzo, Pianon, Roberto, Mazzon, Davide, Poole, Daniele, Badii, Flavio, Bosco, Enrico, Agostini, Moreno, Trevisiol, Paride, Farnia, Antonio, Altafini, Lorella, Calò, Mauro Antonio, Meggiolaro, Marco, Lazzari, Francesco, Martinello, Ivan, Papaccio, Francesco, di Gregorio, Guido, Bonato, Alfeo, Sgarabotto, Camilla, Montacciani, Francesco, Alessandra, Parnigotto, Gagliardi, Giuseppe, Ferraro, Gioconda, Ongaro, Luigi, Baiocchi, Marco, Danzi, Vinicio, Zanatta, Paolo, Donadello, Katia, Gottin, Leonardo, Sinigaglia, Ezio, da Ros, Alessandra, Marchiotto, Simonetta, Bassanini, Silvia, Zamperini, Massimo, Daroui, Ivan, Mosaner, Walter.
Journal of Anesthesia, Analgesia and Critical Care ; 1(1):3-3, 2021.
Article in English | BioMed Central | ID: covidwho-1388853
3.
Crit Care ; 25(1): 263, 2021 07 28.
Article in English | MEDLINE | ID: covidwho-1331949

ABSTRACT

BACKGROUND: Pathophysiological features of coronavirus disease 2019-associated acute respiratory distress syndrome (COVID-19 ARDS) were indicated to be somewhat different from those described in nonCOVID-19 ARDS, because of relatively preserved compliance of the respiratory system despite marked hypoxemia. We aim ascertaining whether respiratory system static compliance (Crs), driving pressure (DP), and tidal volume normalized for ideal body weight (VT/kg IBW) at the 1st day of controlled mechanical ventilation are associated with intensive care unit (ICU) mortality in COVID-19 ARDS. METHODS: Observational multicenter cohort study. All consecutive COVID-19 adult patients admitted to 25 ICUs belonging to the COVID-19 VENETO ICU network (February 28th-April 28th, 2020), who received controlled mechanical ventilation, were screened. Only patients fulfilling ARDS criteria and with complete records of Crs, DP and VT/kg IBW within the 1st day of controlled mechanical ventilation were included. Crs, DP and VT/kg IBW were collected in sedated, paralyzed and supine patients. RESULTS: A total of 704 COVID-19 patients were screened and 241 enrolled. Seventy-one patients (29%) died in ICU. The logistic regression analysis showed that: (1) Crs was not linearly associated with ICU mortality (p value for nonlinearity = 0.01), with a greater risk of death for values < 48 ml/cmH2O; (2) the association between DP and ICU mortality was linear (p value for nonlinearity = 0.68), and increasing DP from 10 to 14 cmH2O caused significant higher odds of in-ICU death (OR 1.45, 95% CI 1.06-1.99); (3) VT/kg IBW was not associated with a significant increase of the risk of death (OR 0.92, 95% CI 0.55-1.52). Multivariable analysis confirmed these findings. CONCLUSIONS: Crs < 48 ml/cmH2O was associated with ICU mortality, while DP was linearly associated with mortality. DP should be kept as low as possible, even in the case of relatively preserved Crs, irrespective of VT/kg IBW, to reduce the risk of death.


Subject(s)
COVID-19/mortality , Respiration, Artificial , Respiratory Distress Syndrome/mortality , Aged , Female , Humans , Intensive Care Units , Intubation , Italy , Male , Middle Aged , Respiratory Distress Syndrome/virology , Tidal Volume
4.
J Vasc Access ; : 11297298211005254, 2021 Apr 07.
Article in English | MEDLINE | ID: covidwho-1172818

ABSTRACT

BACKGROUND: On February 21 2020, in Schiavonia Hospital occurred the first death by COVID-19 in Italy and since this date SARS-CoV-2 caused more than 100,000 deaths in our country. Our hospital was immediately closed and re-opened after 15 days as a reference Covid Hospital. Among services involved in a process of destruction and rebirth there was also the Vascular Access Team. METHODS: We analyzed our Vascular Access Team activity comparing data from the first month (March) in which basically it did not work and data from the following month (April) in which we began to re-build the Team adapting it to the new reality. RESULTS: In all patients admitted to Intensive Care Unit a Centrally Inserted Central Catheter multilumen was placed, but in March only 5.5% of patients admitted to Medicine-Sub-intensive Unit had a catheter different from the short peripheral cannula while in April it was possible to guarantee a more suitable catheter 31.7% of patients admitted to Medicine-Sub-intensive Unit (p < 0.000). In April, compared to March, a significant higher number of Midline were implanted in Medicine-Sub-intensive Unit (36/139 vs 12/238 p < 0.000) where also a higher number of Centrally Inserted Central Catheter and Femoral Inserted Central Catheter were implanted (8/139 vs 1/238 p = 0.003). This change allowed us to implant more vascular accesses in Medicine-Sub-intensive Unit favoring Midline with a longer average duration. Only one patient with Midline developed a catheter vein thrombosis, and in only one patient the device was removed for suspected infection. CONCLUSIONS: The experience we gained will allow us to be more prepared in the future and our experience has highlighted that a structured Vascular Access Team is necessary to respond adequately to COVID-19 patients' needs, to ensure the effectiveness of the maneuver, to reduce complications and to avoid the waste of resources, always working in safe condition.

5.
J Arrhythm ; 37(1): 261-263, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-976979

ABSTRACT

COVID-19 patients may have cardiovascular complications requiring invasive treatment. Pacemaker implantation procedure may be challenging because of the necessity of personal protective equipment use. We report pacemaker implantation in a 78-year-old man with severe bilateral COVID-19 interstitial pneumonia, a second degree 2:1 atrioventricular block, and concomitant aortic stenosis.

6.
Eur Arch Otorhinolaryngol ; 277(8): 2403-2404, 2020 08.
Article in English | MEDLINE | ID: covidwho-378190

ABSTRACT

BACKGROUND: The indications and timing for tracheostomy in patients with SARS CoV2-related are controversial. PURPOSE: In a recent issue published in the European Archives of Otorhinolaryngology, Mattioli et al. published a short communication about tracheostomy timing in patients with COVID-19 (Coronavirus Disease 2019); they reported that the tracheostomy could allow early Intensive Care Units discharge and, in the context of prolonged Invasive Mechanical Ventilation, should be suggested within 7 and 14 days to avoid potential tracheal damages. In this Letter to the Editor we would like to present our experience with tracheostomy in a Hub Covid Hospital. METHODS: 8 patients underwent open tracheostomy in case of intubation prolonged over 14 days, bronchopulmonary overlap infections, and patients undergoing weaning. They were followed up and the number and timing of death were recorded. RESULTS: Two patients died after tracheostomy; the median time between tracheostomy and death was 3 days. A negative prognostic trend was observed for a shorter duration of intubation. CONCLUSION: In our experience, tracheostomy does not seem to influence the clinical course and prognosis of the disease, in the face of possible risks of contagion for healthcare workers. The indication for tracheostomy in COVID-19 patients should be carefully evaluated and reserved for selected patients. Although it is not possible to define an optimal timing, it is our opinion that tracheostomy in a stable or clinically improved COVID-19 patient should not be proposed before the 20th day after orotracheal intubation.


Subject(s)
Coronavirus Infections/diagnosis , Critical Care/methods , Intubation, Intratracheal/adverse effects , Minimally Invasive Surgical Procedures/methods , Pneumonia, Viral/diagnosis , Respiration, Artificial/adverse effects , Tracheostomy/adverse effects , Tracheostomy/methods , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Female , Humans , Intensive Care Units , Male , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Respiratory Insufficiency , SARS-CoV-2 , Severe Acute Respiratory Syndrome , Time Factors , Treatment Outcome
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