Haemostatic devices in parotid surgery: a systematic review.

OBJECTIVE: The Harmonic Scalpel and Ligasure (Covidien) devices are commonly used in head and neck surgery. Parotidectomy is a complex and intricate surgery that requires careful dissection of the facial nerve. This study aimed to compare surgical outcomes in parotidectomy using these haemostatic devices with traditional scalpel and cautery. METHOD: A systematic review of the literature was performed with subsequent meta-analysis of seven studies that compared the use of haemostatic devices to traditional scalpel and cautery in parotidectomy. Outcome measures included: temporary facial paresis, operating time, intra-operative blood loss, post-operative drain output and length of hospital stay. RESULTS: A total of 7 studies representing 675 patients were identified: 372 patients were treated with haemostatic devices, and 303 patients were treated with scalpel and cautery. Statistically significant outcomes favouring the use of haemostatic devices included operating time, intra-operative blood loss and post-operative drain output. Outcome measures that did not favour either treatment included facial nerve paresis and length of hospital stay. CONCLUSION: Overall, haemostatic devices were found to reduce operating time, intra-operative blood loss and post-operative drain output.

Patient blood management and blood conservation - Complimentary concepts and solutions for blood establishments and clinical services in South Africa and beyond.

Blood transfusions come with risks and high costs, and should be utilized only when clinically indicated. Decisions to transfuse are however not always well informed, and lack of clinician knowledge and education on good clinical transfusion practices contribute to the inappropriate use of blood. Low and middle-income countries in particular take much strain in their efforts to address blood safety challenges, demand-supply imbalances, high blood costs as well as high disease burdens, all of which impact blood usage and blood collections. Patient blood management (PBM), which is a patient-focused approach aimed at improving patient outcomes by preemptively diagnosing and correcting anaemia and limiting blood loss by cell salvage, coagulation optimization and other measures, has become a major approach to addressing many of the challenges mentioned. The associated decrease in the use of blood and blood products may be perceived as being in competition with blood conservation measures, which is the more traditional, but primarily product-focused approach. In this article, we hope to convey the message that PBM and blood conservation should not be seen as competing concepts, but rather complimentary strategies with the common goal of improving patient care. This offers opportunity to improve the culture of transfusion practices with relief to blood establishments and clinical services, not only in South Africa and LMICs, but everywhere. With the COVID-19 pandemic impacting blood supplies worldwide, this is an ideal time to call for educational interventions and awareness as an active strategy to improve transfusion practices, immediately and beyond.

Speech therapy and tracheostomy rehabilitation in COVID 19: five preliminary case reports (preprint)

Studies addressing the hospitalization of patients affected by COVID-19 have reported that length of hospital stay in intensive care unit varies between 12 and 22 days. Part of these patients require orotracheal intubation (OTI) and, in cases where OTI is prolonged and/or with complications, they consequently end up undergoing open surgical tracheostomy (OST). In most hospitals, a multidisciplinary team composed of physicians, nurses, physiotherapists and speech-language therapists is responsible for this process, which allows early removal of the tracheal cannula, making it safer for patients, with reduced risk of failure and complications. Although safety recommendations and procedures support the most diverse protocols of weaning from mechanical ventilation and tracheostomy, there is no universally accepted protocol for this transition. This is a complex issue that is necessary in the current scenario, because studies establishing weaning and decannulation criteria in patients with COVID-19 are urgent at this moment. Purpose: To describe the process of weaning from the tracheostomy in COVID-19 patients. Methods: This is a descriptive study presenting a series of case reports. It describes the decannulation process in five tracheostomized patients with COVID-19 (3 men and 2 women) aged 41 and 74 years who agreed to participate in the study and remained hospitalized in a private hospital in the city of XXXX. Results: The decannulation process of the five COVID-19 patients lasted up to 10 days (mean duration of 6.4 days).

Study protocol for a multicentre, 2×2 factorial, randomised, controlled trial evaluating the interest of intravenous iron and tranexamic acid to reduce blood transfusion in hip fracture patients (the HiFIT study).

INTRODUCTION: Blood transfusion and anaemia are frequent and are associated with poor outcomes in patients with hip fracture (HF). We hypothesised that preoperative intravenous iron and tranexamic acid (TXA) may reduce the transfusion rate in these patients. METHODS AND ANALYSIS: The HiFIT study is a multicentre, 2×2 factorial, randomised, double-blinded, controlled trial evaluating the effect of iron isomaltoside (IIM) (20 mg/kg) vs placebo and of TXA (intravenously at inclusion and topically during surgery) versus placebo on transfusion rate during hospitalisation, in patients undergoing emergency surgery for HF and having a preoperative haemoglobin between 95 and 130 g/L. 780 patients are expected. The primary endpoint is the proportion of patients receiving an allogenic blood transfusion of packed red blood cells from the day of surgery until hospital discharge (or until D30 if patient is still hospitalised). Enrolment started on March 2017 in 11 French hospitals. The study was stopped between July 2017 and August 2018 (because of investigation of serious AEs with IIM in Spain) and slowed down since March 2020 (COVID-19 crisis). The expected date of final follow-up is May 2022. Analyses of the intent-to-treat and per-protocol populations are planned. ETHICS AND DISSEMINATION: The HiFIT trial protocol has been approved by the Ethics Committee of Comité de Protection des Personnes Ouest II and the French authorities (ANSM). It will be carried out according to the principles of the Declaration of Helsinki and the Good Clinical Practice guidelines. The results will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals. The HiFIT trial will be the largest study evaluating iron and TXA in patients with HF. TRIAL REGISTRATION NUMBER: clinicalTrials.gov identifier: NCT02972294; EudraCT Number 2016-003087-40.

COVID-19 IN PATIENTS RECOVERING FROM CARDIAC SURGERY: A SURPRISING MILD DISEASE COURSE (preprint)

Cardiac surgical patients are often discharged to a rehabilitation facility to complete the convalescence in a protected setting. This care pathway is usually reserved for elderly and fragile patients, with severe and invalidating comorbid conditions. Between March and April 2020, nineteen patients were discharged from our unit to a rehabilitation clinic where a hotbed of SARS-CoV-2 infection was documented on April 17. After the outbreak, all patients underwent screening with real-time PCR on nasal swabs, and 18/19 patients were found positive. Diversely from other observations on perioperative COVID-19 reporting mortality rates of 30-40%, the COVID-19 had a benign course in our cohort: six patients were completely asymptomatic, and only seven patients required hospitalization (no deaths). We describe the baseline, operative and postoperative features of these patients, and present some potential explanations for the surprisingly benign course of the COVID-19 in this cohort.

Blood use and transfusion needs at a large health care system in Washington state during the SARS-CoV-2 pandemic.

BACKGROUND: This report evaluates hospital blood use trends during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, and identifies factors associated with the need for transfusion and risk of death in patients with coronavirus 2019 (COVID-19). METHODS: Overall hospital blood use and medical records of adult patients with COVID-19 were extracted for two institutions. Multivariate logistic regression models were conducted to estimate associations between the outcomes transfusion and mortality and patient factors. RESULTS: Daily blood use decreased compared to pre-COVID-19 levels; the effect was more significant for platelets (29% and 34%) compared to red blood cells (25% and 20%) at the two institutions, respectively. Surgical and oncologic services had a decrease in average daily use of platelets of 52% and 30%, and red blood cells of 39% and 25%, respectively. A total of 128 patients with COVID-19 were hospitalized, and 13 (10%) received at least one transfusion due to anemia secondary to chronic illness (n = 7), recent surgery (n = 3), and extracorporeal membrane oxygenation (n = 3). Lower baseline platelet count and admission to the intensive care unit were associated with increased risk of transfusion. The blood group distribution in patients with COVID-19 was 37% group O, 40% group A, 18% group B, and 5% group AB. Non-type O was not associated with increased risk of mortality. CONCLUSION: The response to the SARS-CoV-2 pandemic included changes in routine hospital operations that allowed for the provision of a sufficient level of care for patients with and without COVID-19. Although blood type may play a role in COVID-19 susceptibility, it did not seem to be associated with patient mortality.

Intraoperative coagulopathy during cesarean section as an unsuspected initial presentation of COVID-19: a case report.

BACKGROUND: The world's understanding of COVID-19 continues to evolve as the scientific community discovers unique presentations of this disease. This case report depicts an unexpected intraoperative coagulopathy during a cesarean section in an otherwise asymptomatic patient who was later found to have COVID-19. This case suggests that there may be a higher risk for intrapartum bleeding in the pregnant, largely asymptomatic COVID-positive patient with more abnormal COVID laboratory values. CASE: The case patient displayed D-Dimer elevations beyond what is typically observed among this hospital's COVID-positive peripartum population and displayed significantly more oozing than expected intraoperatively, despite normal prothrombin time, international normalized ratio, fibrinogen, and platelets. CONCLUSION: There is little published evidence on the association between D-Dimer and coagulopathy among the pregnant population infected with SARS-CoV-2. This case report contributes to the growing body of evidence on the effects of COVID-19 in pregnancy. A clinical picture concerning for intraoperative coagulopathy may be associated with SARS-CoV-2 infection during cesarean sections, and abnormal COVID laboratory tests, particularly D-Dimer, may help identify the patients in which this presentation occurs.

A Scalable Method for Ultraviolet C Disinfection of Surgical Facemasks Type IIR and Filtering Facepiece Particle Respirators 1 and 2 (preprint)

Due to the SARS-CoV-2 pandemic a shortage of personal protective equipment, including surgical facemasks and Filtering Facepiece Particle Respirators has occurred. SARS-CoV-2 has a 79,5-82% homology to SARS-CoV-2. The SARS-CoV UVC sensitivity is described in literature. We have performed UVC transmission measurements of surgical facemasks and respirators. In addition, we performed UVC disinfection experiments of S. aureus with surgical facemasks and respirators. Results show that we can achieve an 8-log reduction of S. aureus in the inner layers of FFP1 respirators and the exterior of surgical facemasks. Furthermore, we showed a 7-log reduction of S. aureus in the inner layers of FFP2 respirators. We conclude that UVC disinfection is an effective, safe and scalable method for reuse of surgical facemask and respirators.