Objective: Patients with severe COVID-19 admitted to Intensive Care Units (ICU) are often challenging because of the complications related to co-existing diseases. Among these hypertension is highly ...prevalent and blockers of renin-angiotensin system (RAS-B) are frequently reported as home drug therapy. However the influence of these medications on renal function and mortality is matter of debate. Design and method: We retrospectively analyzed clinical data and drug treatment of 90 patients (F/M 25/65) admitted in our ICU for severe COVID-19, with lung disease severity expressed as pO2/fractional inspired oxygen (P/F) below 300 mmHg. In normotensive (n = 35) and hypertensive patients previously treated with (n = 35) or without (n = 20) RAS-B, we compared systolic and diastolic blood pressure (SBP and DBP, mmHg), serum creatinine (SC, mg/dl) and potassium (SK, mEq/L) baseline and SC peak values reached during the admission in ICU. Rate of renal replacement therapy (RRT) and mortality were also recorded. Results: Baseline mean SBP and DBP were within the normal limits and similar in normotensive and in both groups of hypertensive patients while P/F was 157 ± 71 in normotensives and 137 ± 64 vs. 94 ± 30 respectively in hypertensives with and without RAS-B. In the latter two groups, baseline, SC and SK were similar (respectively 1 ± 0.5 vs. 1 ± 0.8 and 4 ± 0.6 vs. 4 ± 0.6) and peak SC values were similar as well (respectively 1.74 ± 1.3 vs. 1.71 ± 1.7). Among the seven patients who needed RRT three and four respectively were on and off treatment with RAS-B. Overall mortality was slightly but not significantly higher in hypertensive than in normotensive patients (31/55, 56% and 15/35, 43%) but similar in those with and without RAS-B (19/35, 54% and 12/20, 60%). Conclusions: These preliminary data suggest that in patients with severe COVID-19 admitted to ICU, the use of RAS blockers for the treatment of hypertension prior to the infection does not affect renal function, the need of RRT and mortality.
Abstract
In patients intubated for hypoxemic acute respiratory failure (ARF) related to novel coronavirus disease (COVID-19), we retrospectively compared two weaning strategies, early extubation with ...immediate non-invasive ventilation (NIV) versus standard weaning encompassing spontaneous breathing trial (SBT), with respect to IMV duration (primary endpoint), extubation failures and reintubations, rate of tracheostomy, intensive care unit (ICU) length of stay and mortality (additional endpoints). All COVID-19 adult patients, intubated for hypoxemic ARF and subsequently extubated, were enrolled. Patients were included in two groups, early extubation followed by immediate NIV application, and conventionally weaning after passing SBT. 121 patients were enrolled and analyzed, 66 early extubated and 55 conventionally weaned after passing an SBT. IMV duration was 9 6–11 days in early extubated patients versus 11 6–15 days in standard weaning group (
p
= 0.034). Extubation failures 12 (18.2%) vs. 25 (45.5%),
p
= 0.002 and reintubations 12 (18.2%) vs. 22 (40.0%)
p
= 0.009 were fewer in early extubation compared to the standard weaning groups, respectively. Rate of tracheostomy, ICU mortality, and ICU length of stay were no different between groups. Compared to standard weaning, early extubation followed by immediate NIV shortened IMV duration and reduced the rate of extubation failure and reintubation.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
There is increasing burnout incidence among medical disciplines, and physicians working in emergency settings seem at higher risk. Cardiac anesthesiology is a stressful anesthesiology subspecialty ...dealing with high-risk patients. The authors hypothesized a high risk of burnout in cardiac anesthesiologists.
National survey conducted on burnout.
Italian cardiac centers.
Cardiac anesthesiologists.
The authors administered via email an anonymous questionnaire divided into 3 parts. The first 2 parts evaluated workload and private life. The third part consisted of the Maslach Burnout Inventory test with its 3 constituents: high emotional exhaustion, high depersonalization, and low personal accomplishment.
The authors measured the prevalence and risk of burnout through the Maslach Burnout Inventory questionnaire and analyzed factors influencing burnout. Among 670 contacts from 71 centers, 382 cardiac anesthesiologists completed the survey (57%). The authors found the following mean Maslach Burnout Inventory values: 14.5 ± 9.7 (emotional exhaustion), 9.1 ± 7.1 (depersonalization), and 33.7 ± 8.9 (personal accomplishment). A rate of 34%, 54%, and 66% of respondents scored in “high” or “moderate-high” risk of burnout (emotional exhaustion, depersonalization, and personal accomplishment, respectively). The authors found that, if offered to change subspecialty, 76% of respondents would prefer to remain in cardiac anesthesiology. This preference and parenthood were the only 2 investigated factors with a protective effect against all components of burnout. Significantly lower burnout scores were found in more experienced anesthesiologists.
A relatively high incidence of burnout was found in cardiac anesthesiologists, especially regarding high depersonalization and low personal accomplishment. Nonetheless, most of the respondents would choose to remain in cardiac anesthesiology.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Arterial thromboembolism in patients with an unknown source of embolization is associated with significant morbidity and mortality. Once the acute process has been treated, a search of the offending ...embolic source must be conducted to prevent additional episodes. The most common sources of peripheral embolism include intracardiac thrombi (>85%), thrombus within arterial aneurysm, thrombus overlying complex atherosclerotic plaques, and paradoxical embolization from deep venous thrombus. A strong association has been shown between protruding, noncalcified plaques>4 cm in the aorta detected by transesophageal echocardiography and the risk of embolism. Moreover, as many as 25-50% of protruding plaques may have superimposed mobile thrombi ranging from one to several centimeters, and this imparts a high embolic risk. The formation of thrombi in morphologically normal aorta is a rare event. We report a case of peripheral embolization in a young man caused by a thrombus in the descending aorta detected by transesophageal echocardiography.
Fragmented data exist on the emotional and psychological distress generated by hospital admission during the pandemic in specific populations of patients, and no data exists on patients scheduled for ...surgery. The aim of this multicentre nationwide prospective cross-sectional survey was to evaluate the impact of pandemic on emotional status and fear of SARS-CoV-2 contagion in a cohort of elective surgical patients in Italy, scheduled for surgery during the COVID-19 pandemic.
Twenty-nine Italian centres were involved in the study, for a total of 2376 patients surveyed (mean age of 58 years ± 16.61; 49.6% males). The survey consisted of 28 total closed questions, including four study outcome questions. More than half of patients had at least one chronic disease (54%), among which cardiovascular diseases were the commonest (58%). The most frequent type of surgery was abdominal (20%), under general anaesthesia (64%). Almost half of the patients (46%) declared to be frightened of going to the hospital for routine checkups; 55% to be afraid of getting SARS-CoV-2 infection during hospitalization and 62% were feared of being hospitalised without seeing family members. Having an oncological disease and other patient-related, centre-related or perioperative factors were independently associated with an increased risk of fear of SARS-CoV-2 infection during hospitalization and of being hospitalised without seeing family members. A previous infection due to SARS-COV-2 was associated with a reduced risk of worse emotional outcomes and fear of SARS-CoV-2 infection during hospitalization. Patients who showed the most emotionally vulnerable profile (e.g. use of sleep-inducing drugs, higher fear of surgery or anaesthesia) were at higher risk of worse emotional status towards the hospitalization during COVID-19 pandemic. Being operated in hospitals with lower surgical volume and with COVID-19 wards was associated with worse emotional status and fear of contagion.
Additional fear and worse emotional status may be frequent in patients scheduled for elective surgery during COVID-19 pandemic. More than half of the participants to the survey were worried about not being able to receive family visits. Psychological support may be considered for patients at higher risk of psychological distress to improve perioperative wellbeing during the pandemic.
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