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4.
Ann Thorac Surg ; 110(4): e333-e334, 2020 10.
Article in English | MEDLINE | ID: covidwho-1023473

ABSTRACT

The outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic pointed out that the need to ensure emergent surgery in patients positive for infection is no longer hypothetical. Among emergency procedures, thoracic surgical operations are frequent. A standardized surgical pathway is mandatory to achieve effective and safe management of this subset of patients. We briefly present the protocol adopted by our thoracic surgery division.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Disease Transmission, Infectious/prevention & control , Guidelines as Topic , Health Facilities/standards , Pandemics , Pneumonia, Viral/epidemiology , Thoracic Surgical Procedures/standards , COVID-19 , Coronavirus Infections/transmission , Humans , Italy/epidemiology , Pneumonia, Viral/transmission , SARS-CoV-2
5.
Surgeon ; 19(1): e1-e8, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-696084

ABSTRACT

INTRODUCTION: COVID-19 presented an unprecedented challenge for healthcare workers and systems around the world. Healthcare systems have adapted differently in terms of pandemic planning of regular services, adopting infection control measures and prioritising essential hospital services in the context of a burgeoning COVID-19 patient load and inevitable surge. METHODS: We performed a review on current evidence and share our practices at a teaching hospital in Singapore. RESULTS: We outline principles and make recommendations for continuity of delivering essential thoracic surgical services during this current outbreak. CONCLUSIONS: The maintenance and provision of thoracic surgery services in this context requires good preplanning and vigilance to infection control measures across all levels.


Subject(s)
COVID-19/epidemiology , Continuity of Patient Care/standards , Infection Control/standards , Thoracic Surgical Procedures/standards , Humans , Pandemics , SARS-CoV-2
6.
J Cardiothorac Vasc Anesth ; 34(12): 3211-3217, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-665472

ABSTRACT

Anesthesia for thoracic surgery requires specialist intervention to provide adequate operating conditions and one-lung ventilation. The pandemic caused by severe acute respiratory syndrome-associated coronavirus 2 (SARS-CoV-2) is transmitted by aerosol and droplet spread. Because of its virulence, there is a risk of transmission to healthcare workers if appropriate preventive measures are not taken. Coronavirus disease 2019 (COVID-19) patients may show no clinical signs at the early stages of the disease or even remain asymptomatic for the whole course of the disease. Despite the lack of symptoms, they may be able to transfer the virus. Unfortunately, during current COVID-19 testing procedures, about 30% of tests are associated with a false-negative result. For these reasons, standard practice is to assume all patients are COVID-19 positive regardless of swab results. Here, the authors present the recommendations produced by the Israeli Society of Anesthesiologists for use in thoracic anesthesia for elective surgery during the COVID-19 pandemic for both the general population and COVID-19-confirmed patients. The objective of these recommendations is to make changes to some routine techniques in thoracic anesthesia to augment patients' and the medical staff's safety.


Subject(s)
Anesthesia/standards , Anesthesiologists/standards , COVID-19/epidemiology , Elective Surgical Procedures/standards , Pandemics , Thoracic Surgical Procedures/standards , Anesthesia/methods , COVID-19/prevention & control , Consensus , Elective Surgical Procedures/methods , Humans , Israel/epidemiology , Pandemics/prevention & control , Societies, Medical/standards , Thoracic Surgical Procedures/methods
8.
Eur J Cardiothorac Surg ; 58(2): 319-327, 2020 08 01.
Article in English | MEDLINE | ID: covidwho-614141

ABSTRACT

OBJECTIVES: During the Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) pandemic, Northern Italy had to completely reorganize its hospital activity. In Lombardy, the hub-and-spoke system was introduced to guarantee emergency and urgent cardiovascular surgery, whereas most hospitals were dedicated to patients with coronavirus disease 2019 (COVID-19). The aim of this study was to analyse the results of the hub-and-spoke organization system. METHODS: Centro Cardiologico Monzino (Monzino) became one of the four hubs for cardiovascular surgery, with a total of eight spokes. SARS-CoV-2 screening became mandatory for all patients. New flow charts were designed to allow separated pathways based on infection status. A reorganization of spaces guaranteed COVID-19-free and COVID-19-dedicated areas. Patients were also classified into groups according to their pathological and clinical status: emergency, urgent and non-deferrable (ND). RESULTS: A total of 70 patients were referred to the Monzino hub-and-spoke network. We performed 41 operations, 28 (68.3%) of which were emergency/urgent and 13 of which were ND. The screening allowed the identification of COVID-19 (three patients, 7.3%) and non-COVID-19 patients (38 patients, 92.7%). The newly designed and shared protocols guaranteed that the cardiac patients would be divided into emergency, urgent and ND groups. The involvement of the telematic management heart team allowed constant updates and clinical discussions. CONCLUSIONS: The hub-and-spoke organization system efficiently safeguards access to heart and vascular surgical services for patients who require ND, urgent and emergency treatment. Further reorganization will be needed at the end of this pandemic when elective cases will again be scheduled, with a daily increase in the number of operations.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Thoracic Surgery/organization & administration , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Emergencies , Health Care Reform/organization & administration , Health Priorities , Humans , Infection Control/organization & administration , Intersectoral Collaboration , Italy/epidemiology , Pandemics/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , SARS-CoV-2 , Surgery Department, Hospital/organization & administration , Thoracic Surgical Procedures/standards
11.
Respir Med Res ; 78: 100769, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-343140

ABSTRACT

The objective of this document is to formalize a degraded mode management for patients with thoracic cancers in the context of the COVID-19 pandemic. The proposals are based on those of the French High Council for Public Health, on published data outside the context of COVID-19, and on a concerted analysis of the risk-benefit ratio for our patients by a panel of experts specialized on thoracic oncology under the aegis of the French-Language Society of Pulmonology (SPLF)/French-language oncology group. These proposals are evolving (10 April 2020) according to the situations encountered, which will enrich it, and are to be adapted to our institutional organisations and to the evolution of resources during the COVID-19 epidemic. Patients with symptoms and/or COVID-19+ are not discussed in this document and are managed within the framework of specific channels.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Pandemics , Thoracic Neoplasms/therapy , Antineoplastic Agents/therapeutic use , COVID-19/complications , Chemoradiotherapy/methods , Chemoradiotherapy/standards , Clinical Trials as Topic/methods , Clinical Trials as Topic/organization & administration , Clinical Trials as Topic/standards , Humans , Mutation , Neoadjuvant Therapy/methods , Neoadjuvant Therapy/standards , Neoplasm Metastasis , Pulmonary Medicine/methods , Pulmonary Medicine/organization & administration , Pulmonary Medicine/standards , Risk Factors , Risk Reduction Behavior , SARS-CoV-2 , Thoracic Neoplasms/epidemiology , Thoracic Neoplasms/genetics , Thoracic Neoplasms/pathology , Thoracic Surgical Procedures/methods , Thoracic Surgical Procedures/standards
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