The Italian coronavirus disease 2019 outbreak: recommendations from clinical practice.

Novel coronavirus 2019 is a single-stranded, ribonucleic acid virus that has led to an international pandemic of coronavirus disease 2019. Clinical data from the Chinese outbreak have been reported, but experiences and recommendations from clinical practice during the Italian outbreak have not. We report the impact of the coronavirus disease 2019 outbreak on regional and national healthcare infrastructure. We also report on recommendations based on clinical experiences of managing patients throughout Italy. In particular, we describe key elements of clinical management, including: safe oxygen therapy; airway management; personal protective equipment; and non-technical aspects of caring for patients diagnosed with coronavirus disease 2019. Only through planning, training and team working will clinicians and healthcare systems be best placed to deal with the many complex implications of this new pandemic.

The Bonfils fiberscope: a clinical evaluation of its learning curve and efficacy in difficult airway management.

BACKGROUND: This study evaluated the use of the Bonfils fiberscope by analyzing its learning curve, efficacy and safety during airway management. METHODS: This was a prospective observational study where five anesthetists, with differing levels of experience, were asked to use the Bonfils rigid fiberscope (Karl Storz) for a six-month period. They used the scope when performing endotracheal intubations in patients undergoing general anesthesia. The patients were excluded if various clinical indicators predicted that they might be difficult to intubate. The patient's head was kept in the neutral position to simulate the intubation of a trauma patient. Direct laryngoscopy with a Macintosh blade was performed to assign a Cormack and Lehane grade prior to attempting laryngoscopy with the Bonfils fiberscope. After intubating the patient with the Bonfils fiberscope, intubation time and any complications or failures noted after the procedure were recorded. RESULTS: The study included 216 patients, three of which were failed intubations. No complications occurred during the study period. The median intubation time was 21.4 s. The learning curve improved significantly after 20 intubations (P<0.05) and was affected by the operator's experience and aptitude with endoscopic viewing. Seventeen patients were deemed to have "unpredicted" difficult airways: 15 subjects with a Cormack grade 3 (6.9%) and two subjects with a Cormack 4 (0.9%). Median time to intubation in subjects with a Cormack <3 was 16 s (95% CI=10-29 s), and in subjects with a Cormack ≥3, it was 15 s (CI 95%=15-18 s) with P=0.703. CONCLUSION: The Bonfils fiberscope is an efficient, easy to use and safe device for endotracheal intubation.