Tracheostomy in the COVID-19 pandemic

Purpose: The role of tracheostomy in COVID-19-related ARDS is unknown. Nowadays, there is no clear indication regarding the timing of tracheostomy in these patients. Methods: We describe our synergic experience between ENT and ICU Departments at University Hospital of Modena underlining some controversial aspects that would be worth discussing tracheostomies in these patients. During the last 2 weeks, we performed 28 tracheostomies on patients with ARDS due to COVID-19 infection who were treated with IMV. Results: No differences between percutaneous and surgical tracheostomy in terms of timing and no case of team virus infection. Conclusion: In our experience, tracheostomy should be performed only in selected patients within 7- and 14-day orotracheal intubation

Point-of-care pancreatic stone protein measurement in critically ill COVID-19 patients

Introduction Pancreatic stone protein (PSP) is a novel biomarker that is reported to be increased in pneumonia and acute conditions. The primary aim of this study was to prospectively study plasma levels of PSP in a COVID-19 intensive care unit (ICU) population to determine how well PSP performed as a marker of mortality in comparison to other plasma biomarkers, such as C reactive protein (CRP) and procalcitonin (PCT).Methods We collected clinical data and blood samples from COVID-19 ICU patients at the time of admission (T0), 72 h later ( T1), five days later (T2), and finally, seven days later. The PSP plasma level was measured with a point-of-care system; PCT and CRP levels were measured simultaneously with laboratory tests. The inclusion criteria were being a critical COVID-19 ICU patient requiring ventilatory mechanical assistance.Results We enrolled 21 patients and evaluated 80 blood samples; we found an increase in PSP plasma levels according to mixed model analysis over time (p < 0.001), with higher levels found in the nonsurvivor population (p < 0.001). Plasma PSP levels achieved a statistically significant result in terms of the AUROC, with a value higher than 0.7 at T0, T1, T2, and T3. The overall AUROC of PSP was 0.8271 (CI (0.73-0.93), p < 0.001). These results were not observed for CRP and PCT.Conclusion These first results suggest the potential advantages of monitoring PSP plasma levels through point-of-care technology, which could be useful in the absence of a specific COVID-19 biomarker. Additional data are needed to confirm these results

Case Report: Filling Defect in Posterior Semicircular Canal on MRI With Balanced Steady-State Gradient-Echo Sequences After Labyrinthine Ischemia in the Common Cochlear Artery Territory as an Early Sign of Fibrosis

We describe a rare case of posterior semicircular canal (PSC) fibrosis following acute labyrinthine ischemia in the territory supplied by the common cochlear artery (CCA) and review the relevant literature. A 71-year-old man with multiple vascular risk factors presented 12 days after the onset of acute vertigo and profound left-sided hearing loss. Right-beating spontaneous nystagmus with downbeat components elicited by mastoid vibrations and headshaking was detected. The video head impulse test (vHIT) revealed an isolated hypofunction of the left PSC, whereas vestibular evoked myogenic potentials (VEMPs) showed ipsilateral saccular loss. The clinical presentation and instrumental picture were consistent with acute ischemia in the territory supplied by left CCA. Compared to previous imaging, a new MRI of the brain with 3D-FIESTA sequences highlighted a filling defect in the left PSC, consistent with fibrosis. Hearing function exhibited mild improvement after steroid therapy and hyperbaric oxygen sessions, whereas vHIT abnormalities persisted over time. To the best of our knowledge, this is the only case in the literature reporting a filling defect on MRI, consistent with semicircular canal fibrosis following acute labyrinthine ischemia. Moreover, PSC fibrosis was related with poor functional outcome. We therefore suggest using balanced steady-state gradient-echo sequences a few weeks following an acute lesion of inner ear sensors to detect signal loss within membranous labyrinth consistent with post-ischemic fibrosis. Besides addressing the underlying etiology, signal loss might also offer clues on the functional behavior of the involved sensor over time. In cases of acute loss of inner ear function, a careful bedside examination supplemented by instrumental assessments, including vHIT and VEMPs, of vestibular receptors and afferents may be completed by MRI with balanced steady-state gradient-echo sequences at a later time to confirm the diagnosis and address both etiology and functional outcome

Guide-wire replacement of a mini-midline catheter with a central venous catheter: A retrospective study on 63 cases

Background: Achieving a reliable venous access in a particular subset of patients and/or in emergency settings can be challenging and time-consuming. Furthermore, many hospitalized patients do not meet the criteria for central venous catheter positioning, unless an upgrade of the treatment is further needed. The mini-midline catheter has already showed to be reliable and safe as a stand-alone device, since it is easily and rapidly inserted and can indwell up to 1 month. Methods: In this further case series, we retrospectively evaluated data from 63 patients where a previously inserted mini-midline catheter was upgraded to a central venous catheter (the devices inserted in the arm replaced by peripherally inserted central catheter and others inserted “off-label” in the internal jugular replaced by single lumen centrally inserted central catheter), being used as introducer for the Seldinger guidewire. Results: The guidewire replacement was been made even early (after 1 day) or late (more than 10 days), usually following a need for an upgrade in treatment. No early or late complications were reported. Conclusion: According to the preliminary data we collected, this converting procedure seems to be feasible and risk-free, since neither infectious nor thrombotic complications were reported

The dramatic COVID-19 outbreak in italy is responsible of a huge drop in urological surgical activity: A multicenter observational study

OBJECTIVE: Italy is facing the COVID-19 outbreak with an abrupt reorganization of its national health-system, in order to augment care provision to symptomatic patients. The sudden shift of personnel and resources towards COVID-19 care has led to the reduction of surgery, with possible severe drawbacks. The aim of the study is to describe the trend in surgical volume in urology, in Italy. MATERIALS AND METHODS: Thirty-three urological units with physicians affiliated to the AGILE consortium were involved in a survey. Urologists were asked to report the amount of surgical elective procedures week-by-week, from the beginning of the emergency to the following month. RESULTS: The 33 hospitals involved in the study account, globally, for 22,945 beds and are distributed in 13/20 Italian regions. Before the outbreak, the involved urology units performed an overall amount of 1,213 procedures per week, half of which were oncological. One month later, the amount of surgery declined by 78%. Lombardy, the first region with positive-cases, experienced a 94% reduction. The decrease in oncological and non-oncological surgical activity was 35,9% and 89%, respectively. The trend of the decline showed a delay of roughly 2 weeks for the other regions. CONCLUSION: Italy, the country with the highest fatality rate from COVID-19, is experiencing a sudden decline in surgical activity. It is inversely related to the increase in COVID-19 care, with potential harm particularly in the oncological field. The Italian experience can be helpful for future surgical pre-planning in other countries not so hardly hit by the disease yet

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

PHYSIOLOGICAL-PARAMETERS AND PLASMA-LEVELS AFTER SHORT AND LONG-TERM PROPOFOL INFUSION

After IV bolus elimination of propofol is slower than previously reported. After prolonged i.v. infusion of propofol values of elimination half-life ranged widely from 12- to 40 h. , systemic clearance from 1.42 to 1.86 l h-1 and volume of distribution were similar to those obtained with bolus administration. The large volume of distribution is consistent with the high octanol/blood partition coefficient, which was found to be 72.0. Despite the long elimination half-life, blood propofol concentrations appeared to approach steady state within 30 min . This is because this drug displays multicompartment pharmacokinetics, whereas the long elimination half-life of propofol is probably of little significance in designing infusions regimen

Orto Botanico e Palinologia-Flora Pollinica dell'Orto Botanico di Modena: Cupressus sempervirens L., Juniperus x media Van Melle "Pfitzeriana, Taxus baccata L., Taxodium distichum (L.) Richard

Nell’ambito del progetto “Polline all’Orto Botanico” e del corrente programma di valorizzazione dell’Orto Botanico di Modena che prevede approfondimenti di carattere morfobiometrico sulle piante legnose, è iniziata la redazione della Flora Palinologica dell’Orto con strutturazione della Palinoteca relativa. Lo scopo è di ricercare eventuali particolarità morfopolliniche correlabili con parametri biologici/ambientali interessanti in termini ecologici (ad es. stato di salute, ambiente “Orto”, posizione dell’individuo, acclimatazione). Le piante legnose presenti in Orto, outdoors (censimento 2000), sono 702 appartenenti a 235 specie, 147 generi, 68 famiglie. Le Gimnosperme sono rappresentate da 95 individui (= 13.5%) e le Angiosperme da 607 (= 86.5%). Nella Palinoteca, la “sezione Orto” include (censimento 2007) 142 specie legnose che rappresentano il 60% degli Alberi/arbusti dell’Orto. L’acetolisi, i vetrini fissi con polline acetolizzato e i tubetti con polline in acqua + glicerina 50/50, materiale per le misure su polline mobile, sono disponibili per circa un terzo delle specie. I vetrini con polline “fresco”, cioè non trattato, sono disponibili per poche specie. Le specie legnose da cui è stato raccolto il polline sono state identificate e descritte con una scheda di screening preliminare e una scheda di approfondimento, che comprende indicazioni sulla valutazione delle condizioni sanitarie e di stabilità (a cura di E. Antonini). La Flora palinologica è iniziata secondo un ordine morfopalinologico, partendo da polline inaperturato (Juniperus type e Taxodiaceae). Da un primo studio, è emersa la necessità di procedere con criteri molto dettagliati. Ciò richiede tempi lunghi, ma è affrontabile all’Orto di Modena in cui la Flora legnosa, pur ragguardevole, è contenuta. In questa sede vengono presentati i dati inerenti 4 specie (Cupressus sempervirens L.; Juniperus x media “Pfitzeriana”, Taxus baccata L., Taxodium distichum (L.) Richard. Il polline è stato studiato utilizzando i metodi della Flora Palinologica Italiana, su polline acetolizzato e “fresco, per quanto riguarda le misure e la descrizione dei parametri di base. Per la ricerca delle particolarità o anomalie (ad esempio: papilla, poro, unità polliniche diverse dalla monade) è stato osservato un numero di granuli decisamente più alto, dell’ordine di molte migliaia di granuli, similmente a quanto fu effettuato in una indagine inerente il Cipresso in individui sani e individui ammalati colpiti da Seiridium cardinale. I dati ottenuti hanno mostrato larga concordanza con la letteratura nei parametri principali. Sono tuttavia emerse alcune particolarità degne di nota, inerenti ad es. qualche comparsa di papilla nelle Cupressaceae e la natura della papilla in Juniperus