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Graphical Objective Few studies have reported the implications and adverse events of performing endotracheal intubation for critically ill COVID-19 patients admitted to intensive care units. The aim of the present study was to determine the adverse events related to tracheal intubation in COVID-19 patients, defined as the onset of hemodynamic instability, severe hypoxemia, and cardiac arrest. Setting Tertiary care medical hospitals, dual-centre study performed in Northern Italy from November 2020 to May 2021. Patients Adult patients with positive SARS-CoV-2 PCR test, admitted for respiratory failure and need of advanced invasive airways management. Interventions Endotracheal Intubation Adverse Events. Main variables of interests The primary endpoint was to determine the occurrence of at least 1 of the following events within 30 minutes from the start of the intubation procedure and to describe the types of major adverse peri-intubation events: severe hypoxemia defined as an oxygen saturation as measured by pulse-oximetry <80%;hemodynamic instability defined as a SBP 65 mmHg recoded at least once or SBP < 90 mmHg for 30 minutes, a new requirement or increase of vasopressors, fluid bolus >15 mL/kg to maintain the target blood pressure;cardiac arrest. Results Among 142 patients, 73.94% experienced at least one major adverse peri-intubation event. The predominant event was cardiovascular instability, observed in 65.49% of all patients undergoing emergency intubation, followed by severe hypoxemia (43.54%). 2.82% of the patients had a cardiac arrest. Conclusion In this study of intubation practices in critically ill patients with COVID-19, major adverse peri-intubation events were frequent. Clinical Trial registration www.clinicaltrials.gov identifier: NCT04909476
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Objective: Few studies have reported the implications and adverse events of performing endotracheal intubation for critically ill COVID-19 patients admitted to intensive care units. The aim of the present study was to determine the adverse events related to tracheal intubation in COVID-19 patients, defined as the onset of hemodynamic instability, severe hypoxemia, and cardiac arrest. Setting: Tertiary care medical hospitals, dual-centre study performed in Northern Italy from November 2020 to May 2021. Patients: Adult patients with positive SARS-CoV-2 PCR test, admitted for respiratory failure and need of advanced invasive airways management. Interventions: Endotracheal Intubation Adverse Events. Main variables of interests: The primary endpoint was to determine the occurrence of at least 1 of the following events within 30â¯minutes from the start of the intubation procedure and to describe the types of major adverse peri-intubation events: severe hypoxemia defined as an oxygen saturation as measured by pulse-oximetry <80%; hemodynamic instability defined as a SBP 65â¯mmHg recoded at least once or SBPâ¯<â¯90â¯mmHg for 30â¯minutes, a new requirement or increase of vasopressors, fluid bolus >15â¯mL/kg to maintain the target blood pressure; cardiac arrest. Results: Among 142 patients, 73.94% experienced at least one major adverse peri-intubation event. The predominant event was cardiovascular instability, observed in 65.49% of all patients undergoing emergency intubation, followed by severe hypoxemia (43.54%). 2.82% of the patients had a cardiac arrest. Conclusion: In this study of intubation practices in critically ill patients with COVID-19, major adverse peri-intubation events were frequent. Clinical Trial registration: www.clinicaltrials.gov identifier: NCT04909476.
Objetivo: Pocos estudios han informado las implicaciones y los eventos adversos de realizar una intubación endotraqueal para pacientes críticos con COVID-19 ingresados ââen unidades de cuidados intensivos. El objetivo del presente estudio fue determinar los eventos adversos relacionados con la intubación traqueal en pacientes con COVID-19, definidos como la aparición de inestabilidad hemodinámica, hipoxemia severa y paro cardíaco. Ámbito: Hospitales médicos de atención terciaria, estudio de doble centro realizado en el norte de Italia desde noviembre de 2020 hasta mayo de 2021. Pacientes: Pacientes adultos con prueba PCR SARS-CoV-2 positiva, ingresados por insuficiencia respiratoria y necesidad de manejo avanzado de vías aéreas invasivas. Intervenciones: Eventos adversos de la intubación endotraqueal. Principales variables de interés: El punto final primario fue determinar la ocurrencia de al menos 1 de los siguientes eventos dentro de los 30 minutos posteriores al inicio del procedimiento de intubación y describir los tipos de eventos adversos periintubación mayores. : hipoxemia severa definida como una saturación de oxígeno medida por pulsioximetría <80%; inestabilidad hemodinámica definida como PAS 65â¯mmHg registrada al menos una vez o PASâ¯<â¯90â¯mmHg durante 30 minutos, nuevo requerimiento o aumento de vasopresores, bolo de líquidos > 15â¯mL/kg para mantener la presión arterial objetivo; paro cardiaco. Resultados: Entre 142 pacientes, el 73,94% experimentó al menos un evento periintubación adverso importante. El evento predominante fue la inestabilidad cardiovascular, observada en el 65,49% de todos los pacientes sometidos a intubación de urgencia, seguido de la hipoxemia severa (43,54%). El 2,82% de los pacientes tuvo un paro cardíaco. Conclusión: En este estudio de prácticas de intubación en pacientes críticos con COVID-19, los eventos adversos periintubación mayores fueron frecuentes. Registro de ensayos clínicos: www.clinicaltrials.gov identificador: NCT04909476.
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OBJECTIVE: Few studies have reported the implications and adverse events of performing endotracheal intubation for critically ill COVID-19 patients admitted to intensive care units. The aim of the present study was to determine the adverse events related to tracheal intubation in COVID-19 patients, defined as the onset of hemodynamic instability, severe hypoxemia, and cardiac arrest. SETTING: Tertiary care medical hospitals, dual-centre study performed in Northern Italy from November 2020 to May 2021. PATIENTS: Adult patients with positive SARS-CoV-2 PCR test, admitted for respiratory failure and need of advanced invasive airways management. INTERVENTIONS: Endotracheal Intubation Adverse Events. MAIN VARIABLES OF INTERESTS: The primary endpoint was to determine the occurrence of at least 1 of the following events within 30â¯minutes from the start of the intubation procedure and to describe the types of major adverse peri-intubation events: severe hypoxemia defined as an oxygen saturation as measured by pulse-oximetry <80%; hemodynamic instability defined as a SBP 65â¯mmHg recoded at least once or SBPâ¯<â¯90â¯mmHg for 30â¯minutes, a new requirement or increase of vasopressors, fluid bolus >15â¯mL/kg to maintain the target blood pressure; cardiac arrest. RESULTS: Among 142 patients, 73.94% experienced at least one major adverse peri-intubation event. The predominant event was cardiovascular instability, observed in 65.49% of all patients undergoing emergency intubation, followed by severe hypoxemia (43.54%). 2.82% of the patients had a cardiac arrest. CONCLUSION: In this study of intubation practices in critically ill patients with COVID-19, major adverse peri-intubation events were frequent. CLINICAL TRIAL REGISTRATION: www. CLINICALTRIALS: gov identifier: NCT04909476.
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Graphical Objective Few studies have reported the implications and adverse events of performing endotracheal intubation for critically ill COVID-19 patients admitted to intensive care units. The aim of the present study was to determine the adverse events related to tracheal intubation in COVID-19 patients, defined as the onset of hemodynamic instability, severe hypoxemia, and cardiac arrest. Setting Tertiary care medical hospitals, dual-centre study performed in Northern Italy from November 2020 to May 2021. Patients Adult patients with positive SARS-CoV-2 PCR test, admitted for respiratory failure and need of advanced invasive airways management. Interventions Endotracheal Intubation Adverse Events. Main variables of interests The primary endpoint was to determine the occurrence of at least 1 of the following events within 30 minutes from the start of the intubation procedure and to describe the types of major adverse peri-intubation events: severe hypoxemia defined as an oxygen saturation as measured by pulse-oximetry <80%;hemodynamic instability defined as a SBP 65 mmHg recoded at least once or SBP < 90 mmHg for 30 minutes, a new requirement or increase of vasopressors, fluid bolus >15 mL/kg to maintain the target blood pressure;cardiac arrest. Results Among 142 patients, 73.94% experienced at least one major adverse peri-intubation event. The predominant event was cardiovascular instability, observed in 65.49% of all patients undergoing emergency intubation, followed by severe hypoxemia (43.54%). 2.82% of the patients had a cardiac arrest. Conclusion In this study of intubation practices in critically ill patients with COVID-19, major adverse peri-intubation events were frequent. Clinical Trial registration www.clinicaltrials.gov identifier: NCT04909476
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Introduction: Emergency intubation of COVID-19 patients is a highrisk procedure and a challenge to intensivists [1,2]. The aim was to determine major adverse events related to tracheal intubation in COVID-19 patients: severe hypoxemia, hemodynamic instability and cardiac arrest. Methods: This is a prospective, observational, dual-center study of COVID-19 patients undergoing advanced airway management for respiratory failure and admitted in ICU from November 2020 to May 2021. We reported data about demographics, comorbidities and parameters related to the intubation and expertise. Within 30 min from the intubation, we recorded the occurrence of severe hypoxia, cardiac arrest, hemodynamic instability. We collected data about difficult airways, the need of front of neck airways position, death within 30 min from the intubation, arrhythmia, esophageal intubation, pneumomediastinum and pneumothorax recognized within 6 h from the intubation. Results: Within 142 patients considered for our analysis, 73.94% experienced at least 1 major adverse peri-intubation event. The predominant event was cardiovascular instability in 65.49% of patients, followed by severe hypoxemia (43.54%) and cardiac arrest (2.82%). First-pass success was achieved for 90.84% of patients. The rate of major adverse events was significantly lower with first-pass intubation success than for 2 attempts. No difference was found in ICU LOS between patients with a major adverse periintubation event and patients without events. Conclusions: In this observational study of intubation practices in critically ill patients with COVID-19, major adverse peri-intubation events were observed frequently.
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To report a descriptive analysis of the virological results of Influenza-like illness (ILI) surveillance, comparing the frequency of detection of respiratory viruses during the pre-pandemic (2018-2019) and SARS-CoV-2 pandemic (2020-2021) winter seasons in Lombardy (Northern Italy). From week 46 to week 17 of the following year, nasal-pharyngeal swabs (NPS) collected from ILIs were tested for influenza viruses (IV), RSV, rhinovirus and enterovirus with specific real-time RT-PCR assays. In 2020-2021, SARS-CoV-2 molecular detection was also included. 464 and 446 NPS were collected in 2018-2019 and 2020-2021, respectively. Sex distribution was similar between these two seasons (males: 51.5% vs 47%, P=0.165), while mean age was statistically higher in 2020-2021 (28.2 years [IQR: 40.5] vs. 43.6 years [IQR: 32.6], P<0.0001). ILI incidence was significantly higher in 2018/19 compared with 2020/21 season season (5.4/1,000 inhabitants vs. 1.9/1,000 inhabitants, P< 0.0001.ILI cases <15 years were less reported in 2020-2021 than in 2018-2019 season (P<0.0001). Contrary, those >15 years were more reported in 2020-2021 than in 2018-2019 (15-44 years, P=0.008;45-64 years, P=0.002;≥65 years, P<0.0001). In 2018-2019, IV and RSV accounted for 55% and 10% of ILIs, whereas in 2020-2021 no circulation of these viruses was observed. Enterovirus detections decreased from 3.4% in 2018-2019 to 0.4% in 2020-2021 (P=0.01), while rhinoviruses were detected at higher frequency in the latter season (8.6% vs. 11.9%, P=0.07). SARS-CoV-2 was detected in 25.3% of NPS in 2020-2021. Since the beginning of the pandemic, non-pharmaceutical measures, including use of face-masks, was massively applied to contrast SARS-CoV-2 spread. This dramatically reduced the incidence of ILI, the circulation of SARS-CoV-2 and other respiratory viruses (such as IV and RSV) transmitted by droplets, but did not reduce rhinovirus detection, which continued to circulate in 2020-2021 season. ILIs surveillance has demonstrated to be able to capture changes in the epidemiology of respiratory viruses and it should be sustained and improved to increase the capture of ILI remained with unknown etiology. [ FROM AUTHOR] Copyright of International Journal of Infectious Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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Purpose The value of SARS-CoV-2 monitoring in urban wastewater samples (WWS) for surveillance of virus spread at a population-wide level has been largely demonstrated. Aim of this study was to optimize an analytical workflow to detect SARS-CoV-2 RNA in WWS and to monitor SARS-CoV-2 spread during the first wave of COVID-19 epidemic (March–June 2020) in Lombardy, northern Italy. Methods & Materials The workflow consisted in WWS concentration by using PEG-8000 precipitation, a modified RNA extraction (QIAamp MinElute Virus Spin Kit;QIAGEN) and a one-step real-time RT-PCR detecting two portions of the N gene of SARS-CoV-2. Composite 24-hour WWS were collected once a week at the inlet of 8 wastewater treatment plants (WWTPs) with an overall catchment of 2,276,000 inhabitants, located in representative COVID-19 hotspots in Lombardy, from the end of March to mid-June 2020. 107 WWS were obtained and analysed. SARS-CoV-2 RNA copies/L/WWS were multiplied by the flow rate of each WWTP (m3/day) and the obtained load (copies/day/1,000 people) was normalized to the number of inhabitants served by WWTPs. Results The optimized workflow allowed to identify 1E+3 copies/mL of SARS-CoV-2 in concentrated WWS with a turnaround time of 8 hours. Overall, the presence of SARS-CoV-2 RNA was identified in 65/107 WWS (61%). The highest rate of positive WWS (78.7%;26/33) was identified in the Bergamo province, that was the epicentre during the first wave of COVID-19 epidemic (March-June 2020) in Lombardy. The highest amount of SARS-CoV-2 RNA was identified in late March/early April, when the overall viral load reflecting the number of individuals shedding the virus ranged from 9.3E+10 copies/day/1,000 people to 8.2E+8 copies/day/1,000 people. Since the end of May, WWS tested negative to SARS-CoV-2 detection. Conclusion According to the epidemiological features of the first wave of SARS-CoV-2 epidemic in Lombardy, the highest amount of SARS-CoV-2 RNA was detected in WWS collected in the areas most affected by COVID-19 (i.e. Bergamo province). This optimized workflow of WWS surveillance can help assessing the real number of individuals – both symptomatic and asymptomatic – able to spread the virus and appraising the effect of preventive measures.
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As SARS-CoV-2 swiftly spread globally becoming a pandemic, the urgent need to provide a laboratory diagnosis of the infection - to allow both the clinical management of individual patients and to monitor the outbreak in the community by health authorities - arose. This resulted in a rapid development of diagnostic tests - promptly available on the market - including methods for the direct detection of the virus in biological samples (molecular and antigenic tests) and for indirect detection by documenting a contact with SARS-CoV-2 (serological antibodies tests). To fast-track the availability of these tests, an "emergency" authorization was issued for their use in medical laboratories, which then resulted in the urge to verify their reliability and to monitor carefully their performances, in order to avoid the risk to provide inaccurate results. This document illustrates the main potential sources of error, which can be pre-pre-analytical (i.e. test utilization in an incorrect diagnostic window), pre-analytical (i.e. incorrect collection, manipulation, sample transport and storage), analytical (i.e. pipetting errors during manual sample dispensing, incorrect RNA extraction, cDNA synthesis and amplification) and post-analytical (i.e. incorrect test report and interpretation). Furthermore, the key elements for creating a system to keep continuously under control these potential sources of error are presented, both implementing an adequate control of the entire process and a system for monitoring the analytical quality, where Internal Quality Control plays a crucial role. © 2021 Biomedia. All rights reserved.
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This paper outlines the role of Lombardy's regional influenza reference laboratory (Northern Italy) in the surveillance of influenza-like illnesses (ILIs) in monitoring SARS-CoV-2 circulation by analyzing 631 consecutive nasopharyngeal swabs (NPSs) collected from ILI outpatients by sentinel physicians during the 2019-2020 season. The samples were tested by specific real-time RT-PCRs targeting SARS-CoV-2, influenza viruses, and RSVs.
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The clinical presentation of symptomatic SARS-CoV-2 not only includes viral pneumonia, but also milder illness overlapping with influenza-like illness (ILI), allowing a potential tracking of the infection in the framework of the national influenza surveillance system (SS). By comparing the data recorded by the influenza SS in 2019-20 season to those collected for the previous years, we want to evaluate whether the implementation of ILI SS could succeed in early detection and monitoring of Covid-19 diffusion. We analyzed the data recorded by the influenza SS and we compared the distribution of ILI incidence rate by week for 2017-18, 2018-19 and 2019-20 season in order to understand whether the SS detected any abnormality coinciding with Covid-19 outbreak. The distribution of ILI cases in the three seasons presented a similar pattern up to the 9th week;after then, a reduction in the ILI incidence rate was observed in the 2017-18 and the 2018-19 season while an increase was detected for 2019-20. During 2019-20 season, three major characteristics stand out: i) at the beginning of Covid-19 epidemic (7th-9th week) 9,17/1000 cases were reported;ii) during the recognition of the COVID-19 outbreak (9th-10th week) 6,36/1000 cases;iii) during the spread of Covid-19 (10th-11th week) an unexpected increase to 7,72/1000 cases. Additionally, their geographical distribution was concentrated in the areas known to be most affected by the epidemic. The influenza SS enabled us to detect the introduction and distribution of COVID-19. Implementation of the system should be prioritized in order to early identify new waves of Covid-19 but also any future novel respiratory pathogen. In order to empower the SS, it would be advisable to increase the population coverage about 2% which is the actual standard. Key messages The influenza surveillance system detected the first wave of Covid-19 in Lombardy Region, Italy. The influenza surveillance system should be implemented in order to bring a benefit both to the current situation and in sight of future public health challenges.