Significant burden of post-COVID exertional dyspnoea in a South-Italy region: knowledge of risk factors might prevent further critical overload on the healthcare system.

Background: Exertional dyspnoea in post-COVID syndrome is a debilitating manifestation, requiring appropriate comprehensive management. However, limited-resources healthcare systems might be unable to expand their healthcare-providing capacity and are expected to be overwhelmed by increasing healthcare demand. Furthermore, since post-COVID exertional dyspnoea is regarded to represent an umbrella term, encompassing several clinical conditions, stratification of patients with post-COVID exertional dyspnoea, depending on risk factors and underlying aetiologies might provide useful for healthcare optimization and potentially help relieve healthcare service from overload. Hence, we aimed to investigate the frequency, functional characterization, and predictors of post-COVID exertional dyspnoea in a large cohort of post-COVID patients in Apulia, Italy, at 3-month post-acute SARS-CoV-2 infection. Methods: A cohort of laboratory-confirmed 318 patients, both domiciliary or hospitalized, was evaluated in a post-COVID Unit outpatient setting. Post-COVID exertional dyspnoea and other post-COVID syndrome manifestations were collected by medical history. Functional characterization of post-COVID exertional dyspnoea was performed through a 6-min walking test (6-mwt). The association of post-COVID exertional dyspnoea with possible risk factors was investigated through univariate and multivariate logistic regression analysis. Results: At medical evaluation, post-COVID exertional dyspnoea was reported by as many as 190/318 patients (59.7%), showing relatively high prevalence also in domiciliary-course patients. However, functional characterization disclosed a 6-mwt-based desaturation walking drop in only 24.1% of instrumental post-COVID exertional dyspnoea patients. Multivariate analysis identified five independent predictors significantly contributing to PCED, namely post-COVID-fatigue, pre-existing respiratory co-morbidities, non-asthmatic allergy history, age, and acute-phase-dyspnoea. Sex-restricted multivariate analysis identified a differential risk pattern for males (pre-existing respiratory co-morbidities, age, acute-phase-dyspnoea) and females (post-COVID-fatigue and acute-phase-dyspnoea). Conclusion: Our findings revealed that post-COVID exertional dyspnoea is characterized by relevant clinical burden, with potential further strain on healthcare systems, already weakened by pandemic waves. Sex-based subgroup analysis reveals sex-specific dyspnoea-underlying risk profiles and pathogenic mechanisms. Knowledge of sex-specific risk-determining factors might help optimize personalized care management and healthcare resources.

[Nursing role in prevention of Ventilator Associated Pneumonia: Spanish project "Neumonìa Zero"]. / Ruolo dell'infermiere nella prevenzione della Polmonite Associata a Ventilazione Meccanica Invasiva: il progetto spagnolo "Neumonìa Zero".

The incidence of Ventilator Associated Pneumonia (VAP) varies between 8 and 28% on patients with invasive mechanical ventilation, and it is associated with high mortality rates. The international literature indicates that the VAP has some risk factors that cannot be changed and some other that are closely related to nursing care procedures. The aim of this study is to analyze compliance level to the protocol of nursing prevention of the VAP in the ICU of "General Hospital" in Castellon de la Plana (Spain) within the project "Neumonía Zero". The data were collected during the months of May and June 2012 through direct observation which lasted 33 days. 5 check lists based on international recommendations were used for the objective evaluation on the adoption of preventive treatments. 58 patients in invasive mechanical ventilation and 43 ICU nurses were enrolled. Compliance procedure showed no significant differences among each other with an average adhesion of 78% of the observations. The observations trend shows a tendency of improvement in accordance with the checklists of cuff pressure and of the inclination of the bed head. An incidence rate of VAP 13,37/1000 was observed. In conclusion, direct observation showed good compliance to the protocols used in the ward. The obtained data allows to re-direct educational choices and assume a systematic application of this methodology with an important contribution to nursing.