Implications of early respiratory support strategies on disease progression in critical COVID-19: a matched subanalysis of the prospective RISC-19-ICU cohort.

Uncertainty about the optimal respiratory support strategies in critically ill COVID-19 patients is widespread. While the risks and benefits of noninvasive techniques versus early invasive mechanical ventilation (IMV) are intensely debated, actual evidence is lacking. We sought to assess the risks and benefits of different respiratory support strategies, employed in intensive care units during the first months of the COVID-19 pandemic on intubation and intensive care unit (ICU) mortality rates. Subanalysis of a prospective, multinational registry of critically ill COVID-19 patients. Patients were subclassified into standard oxygen therapy ≥10 L/min (SOT), high-flow oxygen therapy (HFNC), noninvasive positive-pressure ventilation (NIV), and early IMV, according to the respiratory support strategy employed at the day of admission to ICU. Propensity score matching was performed to ensure comparability between groups. Initially, 1421 patients were assessed for possible study inclusion. Of these, 351 patients (85 SOT, 87 HFNC, 87 NIV, and 92 IMV) remained eligible for full analysis after propensity score matching. 55% of patients initially receiving noninvasive respiratory support required IMV. The intubation rate was lower in patients initially ventilated with HFNC and NIV compared to those who received SOT (SOT: 64%, HFNC: 52%, NIV: 49%, p = 0.025). Compared to the other respiratory support strategies, NIV was associated with a higher overall ICU mortality (SOT: 18%, HFNC: 20%, NIV: 37%, IMV: 25%, p = 0.016). In this cohort of critically ill patients with COVID-19, a trial of HFNC appeared to be the most balanced initial respiratory support strategy, given the reduced intubation rate and comparable ICU mortality rate. Nonetheless, considering the uncertainty and stress associated with the COVID-19 pandemic, SOT and early IMV represented safe initial respiratory support strategies. The presented findings, in agreement with classic ARDS literature, suggest that NIV should be avoided whenever possible due to the elevated ICU mortality risk

Long-term outcome of COVID-19 patients treated with helmet noninvasive ventilation vs. high-flow nasal oxygen: a randomized trial

Background: Long-term outcomes of patients treated with helmet noninvasive ventilation (NIV) are unknown: safety concerns regarding the risk of patient self-inflicted lung injury and delayed intubation exist when NIV is applied in hypoxemic patients. We assessed the 6-month outcome of patients who received helmet NIV or high-flow nasal oxygen for COVID-19 hypoxemic respiratory failure. Methods: In this prespecified analysis of a randomized trial of helmet NIV versus high-flow nasal oxygen (HENIVOT), clinical status, physical performance (6-min-walking-test and 30-s chair stand test), respiratory function and quality of life (EuroQoL five dimensions five levels questionnaire, EuroQoL VAS, SF36 and Post-Traumatic Stress Disorder Checklist for the DSM) were evaluated 6 months after the enrollment. Results: Among 80 patients who were alive, 71 (89%) completed the follow-up: 35 had received helmet NIV, 36 high-flow oxygen. There was no inter-group difference in any item concerning vital signs (N = 4), physical performance (N = 18), respiratory function (N = 27), quality of life (N = 21) and laboratory tests (N = 15). Arthralgia was significantly lower in the helmet group (16% vs. 55%, p = 0.002). Fifty-two percent of patients in helmet group vs. 63% of patients in high-flow group had diffusing capacity of the lungs for carbon monoxide < 80% of predicted (p = 0.44); 13% vs. 22% had forced vital capacity < 80% of predicted (p = 0.51). Both groups reported similar degree of pain (p = 0.81) and anxiety (p = 0.81) at the EQ-5D-5L test; the EQ-VAS score was similar in the two groups (p = 0.27). Compared to patients who successfully avoided invasive mechanical ventilation (54/71, 76%), intubated patients (17/71, 24%) had significantly worse pulmonary function (median diffusing capacity of the lungs for carbon monoxide 66% [Interquartile range: 47–77] of predicted vs. 80% [71–88], p = 0.005) and decreased quality of life (EQ-VAS: 70 [53–70] vs. 80 [70–83], p = 0.01). Conclusions: In patients with COVID-19 hypoxemic respiratory failure, treatment with helmet NIV or high-flow oxygen yielded similar quality of life and functional outcome at 6 months. The need for invasive mechanical ventilation was associated with worse outcomes. These data indicate that helmet NIV, as applied in the HENIVOT trial, can be safely used in hypoxemic patients. Trial registration Registered on clinicaltrials.gov NCT04502576 on August 6, 202

Randomized Prospective Study on the Use of Eufiss in the Prevention of Infections in Patients Treated with External Fixation

Percutaneous synthesis using K-wires or external fixation in orthopedics and traumatology is extremely common. Postoperative management of external fixation includes frequent wound care which is demanding for both the patient and the healthcare professionals. In literature the most frequently reported complication is infection. The use of ionic silver goes back to the beginning of the last century and there are many articles describing its antimicrobial efficacy even for antibiotic-resistant bacteria. In this study we assess the reduction in both superficial and deep infections by using ionic silver in patients with external fixation for orthopedic diseases or traumatology. Furthermore, we show how this method could also contribute to reducing wound care costs. The data collected shows an overall infection incidence of 10%, concordant with data in literature. There appears to be no correlation between the probability of superficial infections and predisposing diseases, such as diabetes, nor the fracture site or position. The presence of loose pins increases the probability of infection. There appears to be no correlation between the clinical examination and the microbiological culture. The data analysis shows that wound care with ionic silver reduces the incidence of superficial infection of the pins. Furthermore, this method guarantees greater cleanliness of the skin and the external fixator which increases patient satisfaction in the management of the external fixation. To date, an insufficient number of patients have been studied to gather enough data to establish which wound care method is the most economical. Certainly, we can state that treatment with ionic silver reduces infection incidence and enables better management of the external fixators and percutaneous synthesis in orthopedics and traumatology

Anaerobic transformation of tetrachloroethane, perchloroethylene, and their mixtures by mixed-cultures enriched from contaminated soils and sediments

The focus of this research was to investigate the anaerobic transformation of tetrachloroethane (TeCA), perchloroethylene (PCE), and their mixtures by mixed cultures enriched from contaminated soils or sediments. Batch transformation studies were conducted using TeCA (60 mu M), PCE (60 mu M), or TeCA + PCE (each added at 60 RM) as electron acceptor(s) and H-2 + acetate (each added at 3 mM) or butyrate (3 mM) as electron donor(s). A Dehalococcoides spp.-containing, sediment-enrichment dechlorinated PCE rapidly to ethene (ETH) but slowly and incompletely dechlorinated TeCA. Moreover, when present in mixture with PCE, TeCA disrupted the ability of Dehalococcoides to dechlorinate vinyl chloride. In contrast, the soil-enrichment culture was able to completely dechlorinate TeCA and PCE to ETH, both when added as single contaminants and when added as a mixture

Severe Respiratory Distress in a Child with Pulmonary Idiopathic Hemosiderosis Initially Presenting with Iron-Deficiency Anemia

Idiopathic pulmonary hemosiderosis (IPH) is a rare cause of alveolar hemorrhage in children but should be considered in children with anemia of unknown origin who develop respiratory complications. It is commonly characterized by the triad of recurrent hemoptysis, diffuse parenchymal infiltrates, and iron-deficiency anemia. Pathogenesis is unclear and diagnosis may be difficult along with a variable clinical course. A 6-year-old boy was admitted to the hospital with a severe iron-deficiency anemia, but he later developed severe acute respiratory failure and hemoptysis requiring intubation and mechanical ventilation. The suspicion of IPH led to the use of immunosuppressive therapy with high dose of corticosteroids with rapid improvement in clinical condition and discharge from hospital