Use of CPAP Failure Score to Predict the Risk of Helmet-CPAP Support Failure in COVID-19 Patients: A Retrospective Study.

(1) Background: the aim of this study was to create a score to predict the incidence of CPAP failure in COVID-19 patients early. (2) Methods: in this retrospective observational study, we included all consecutive adult patients admitted between February and April 2021. The main outcome was the failure of CPAP support (intubation or death). (3) Results: two-hundred and sixty-three COVID-19 patients were managed with CPAP. The population was divided in short-CPAP (CPAP days ≤ 10; 72.6%) and long-CPAP (>10; 27.4%) groups. After balancing the entire population using a stabilized IPTW method, we applied a multivariable logistic regression analysis to identify the risk factors for CPAP failure. We used the identified covariates to create a mathematical model, the CPAP Failure Score (CPAP-FS). The multivariable logistic regression analysis identified four variables: SpO2 (OR = 0.86; p-value = 0.001), P/F ratio (OR = 0.99; p-value = 0.008), the Call Score (OR = 1.44; p-value = 0.02), and a pre-existing chronic lung disease (OR = 3.08; p-value = 0.057). The beta-coefficients obtained were used to develop the CPAP-FS, whose diagnostic ability outperformed other relevant COVID-19-related parameters (AUC = 0.87; p-value < 0.0001). We validated the CPAP-FS using a 10-fold internal cross-validation method which confirmed the observed results (AUCs 0.76−0.80; p-values < 0.0001). (4) Conclusions: the CPAP-FS can early identify COVID-19 patients who are at risk of CPAP failure.

Further Hemodynamic Insight Into Patients Undergoing Liver Transplantation: A Preliminary Report on Cardiac Power Index.

INTRODUCTION: The aim of this retrospective study was to evaluate any relationship between cardiac power index (CPI) and preload indexes during liver transplantation (LT). METHODS: Thirty-three patients with normal preoperative cardiac evaluation undergoing LT were included. Anesthesia management was standardized. Monitoring included continuous cardiac output determination by pulmonary artery catheter. CPI was calculated throughout LT by using the following standard formula: Mean Arterial Pressure [mm Hg] × Cardiac Index [L/min/m2] × k, where k = 0.0022. A logistic regression to determine which preload indexes predicted an adequate CPI (≥ 0.4 watt/m2) was performed. Postregression analysis was carried out to calculate a cutoff of right ventricle end diastolic volume index (RVEDVI) able to guarantee an adequate CPI after establishing a sensitivity >0.9. The area under receiver operating characteristic curve (AUC) was also run separately for patients with a Model for End-Stage Liver Disease (MELD) score < or ≥ 25 to establish an accurate level of prediction in these subgroups (post-hoc analysis). RESULTS: Logistic regression showed that RVEDVI was the only predictor of CPI (AUC = 0.81). A cutoff value for RVEDVI of 105 mL/m2 was found (sensitivity = 90.5%; specificity = 50%). RVEDVI predicted CPI with moderate accuracy (AUC = 0.80) in patients with MELD < 25 (n = 25), whereas the prediction was highly accurate (AUC = 0.96) in patients with MELD ≥ 25 (n = 8). CONCLUSION: An RVEDVI = 105 mL/m2 can be considered a valid cutoff to perform a fluid challenge to optimize preload during LT. Sicker recipients (with MELD ≥ 25) could exhibit less tolerance to preload reduction, proven by a decrease of CPI below the minimum value considered safe (0.40 watt/m2).

Regional cerebral saturation versus transcranial Doppler during carotid endarterectomy under regional anaesthesia.

BACKGROUND AND OBJECTIVE: The aim of this study was to compare a cerebral oximeter with transcranial Doppler (TCD) as a neurological monitor in patients undergoing carotid endarterectomy under regional anaesthesia. METHODS: Forty patients were enrolled for this prospective study. We recorded every adverse neurological event after arterial clamping and variations in parameters evaluated by the two monitoring systems in order to determine whether there was any correlation between TCD data and those obtained by regional cerebral saturation, the timing of detection of the adverse event in both clinical examination and instrumental data and the presence of any false positives or negatives in any of the two monitoring systems. RESULTS: Shunting was necessary in eight patients, following clinical signs of a neurological deficit during clamping. In these patients, a significant reduction in TCD values and regional cerebral saturation values from baseline was recorded. We observed a drastic reduction in TCD values in four patients during clamping (6 +/- 5 versus 41 +/- 4 cm s) that was not associated with any neurological deficit or reduction in regional cerebral saturation values (51 +/- 4 versus 54 +/- 7%). Instrumental detection of a neurological deficit anticipated the clinical observation of about 5-10 s. CONCLUSION: We observed a greater reliability with the cerebral oximeter than with TCD in our patients.