Anesthesiology

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Anesthesia management in cesarean section for a patient with coronavirus disease 2019
Kang X.;  Zhang R.;  He H.;  Yao Y.;  Zheng Y.;  Wen X.;  Zhu S.
Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences (2020) 49:1 (0). Date of Publication: 25 May 2020

ABSTRACT
Since the corona virus disease 2019 (COVID-19) affects the cardio-pulmonary function of pregnant women, the anesthetic management in the cesarean section for the patients, as well as the protection for medical staff is significantly different from that in ordinary surgical operation. This paper reports a pregnant woman with COVID-19, for whom a cesarean section was successfully performed in our hospital on February 8, 2020. Anesthetic management, protection of medical staff and psychological intervention for the patients during the operation are discussed. Importance should be attached to the preoperative evaluation of pregnant women with COVID-19 and the implementation of anesthesia plan. For ordinary COVID-19 patients intraspinal anesthesia is preferred in cesarean section, and the influence on respiration and circulation in both maternal and infant should be reduced; while for severe or critically ill patients general anesthesia with endotracheal intubation should be adopted. The safety of medical environment should be ensured, and level-Ⅲ standard protection should be taken for anesthetists. Special attention and support should be given to maternal psychology. It is important to give full explanation before operation to reduce anxiety; to relieve the discomfort during operation to reduce tension; to avoid the bad mood of patients due to pain after operation.


Sex difference and smoking predisposition in patients with COVID-19
Cai H.
The Lancet Respiratory Medicine (2020) 8:4 (e20). Date of Publication: 1 Apr 2020


Anesthesia Procedure of Emergency Operation for Patients with Suspected or Confirmed COVID-19
Wen X.;  Li Y.
Surgical infections (2020) 21:3 (299). Date of Publication: 1 Apr 2020


Elevated plasmin(ogen) as a common risk factor for COVID-19 susceptibility
Ji H.-L.;  Zhao R.;  Matalon S.;  Matthay M.A.
Physiological reviews (2020). Date of Publication: 27 Mar 2020

ABSTRACT
Patients with hypertension, diabetes, coronary heart disease, cerebrovascular illness, COPD, and kidney dysfunction have worse clinical outcomes when infected with SARS-CoV-2, for unknown reasons. The purpose of this review is to summarize the evidence for the existence of elevated plasmin(ogen) in COVID-19 patients with these comorbid conditions. Plasmin, and other proteases, may cleave a newly inserted furin site in the S protein of SARS-CoV-2, extracellularly, which increases its infectivity and virulence. Hyper-fibrinolysis associated with plasmin leads to elevated D-dimer in severe patients. The plasmin(ogen) system may prove a promising therapeutic target for combating COVID-19.


Simulation as a tool for assessing and evolving your current personal protective equipment: lessons learned during the coronavirus disease (COVID-19) pandemic
Lockhart S.L.;  Naidu J.J.;  Badh C.S.;  Duggan L.V.
Canadian journal of anaesthesia = Journal canadien d’anesthesie (2020). Date of Publication: 27 Mar 2020


Neuraxial procedures in COVID-19 positive parturients: a review of current reports
Bauer M.E.;  Chiware R.;  Pancaro C.
Anesthesia and analgesia (2020). Date of Publication: 26 Mar 2020


Considérations pratiques pour laréalisation de l’anesthésie régionale: les leçons tirées de la pandémie de COVID-19
Lie S.A.;  Wong S.W.;  Wong L.T.;  Wong T.G.L.;  Chong S.Y.
Canadian journal of anaesthesia = Journal canadien d’anesthesie (2020). Date of Publication: 24 Mar 2020


Coronavirus disease 2019“ (COVID-19): update für Anästhesisten und Intensivmediziner März 2020
Thomas-Rüddel D.;  Winning J.;  Dickmann P.;  Ouart D.;  Kortgen A.;  Janssens U.;  Bauer M.
Der Anaesthesist (2020). Date of Publication: 24 Mar 2020


Angiotensin II for the Treatment of COVID-19-Related Vasodilatory Shock
Chow J.H.;  Mazzeffi M.A.;  McCurdy M.T.
Anesthesia and analgesia (2020). Date of Publication: 23 Mar 2020


Recommendations for Endotracheal Intubation of COVID-19 Patient  Orser B.A.
Anesthesia and analgesia (2020). Date of Publication: 23 Mar 2020


COVID-19 Infection: Implications for Perioperative and Critical Care Physicians
Greenland J.R.;  Michelow M.D.;  Wang L.;  London M.J.
Anesthesiology (2020). Date of Publication: 19 Mar 2020

ABSTRACT
Healthcare systems worldwide are responding to Coronavirus Disease 2019 (COVID-19), an emerging infectious syndrome caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus. Patients with COVID-19 can progress from asymptomatic or mild illness to hypoxemic respiratory failure or multisystem organ failure, necessitating intubation and intensive care management. Healthcare providers, and particularly anesthesiologists, are at the frontline of this epidemic, and they need to be aware of the best available evidence to guide therapeutic management of patients with COVID-19 and to keep themselves safe while doing so. Here, the authors review COVID-19 pathogenesis, presentation, diagnosis, and potential therapeutics, with a focus on management of COVID-19-associated respiratory failure. The authors draw on literature from other viral epidemics, treatment of acute respiratory distress syndrome, and recent publications on COVID-19, as well as guidelines from major health organizations. This review provides a comprehensive summary of the evidence currently available to guide management of critically ill patients with COVID-19.


Precautions for Intubating Patients with COVID-19
Luo M.;  Cao S.;  Wei L.;  Tang R.;  Hong S.;  Liu R.;  Wang Y.
Anesthesiology (2020). Date of Publication: 19 Mar 2020


Intubation and Ventilation amid the COVID-19 Outbreak: Wuhan’s Experience
Meng L.;  Qiu H.;  Wan L.;  Ai Y.;  Xue Z.;  Guo Q.;  Deshpande R.;  Zhang L.;  Meng J.;  Tong C.;  Liu H.;  Xiong L.
Anesthesiology (2020). Date of Publication: 19 Mar 2020

ABSTRACT
The COVID-19 outbreak has led to 80,409 diagnosed cases and 3,012 deaths in mainland China based on the data released on March 4, 2020. Approximately 3.2% of patients with COVID-19 required intubation and invasive ventilation at some point in the disease course. Providing best practices regarding intubation and ventilation for an overwhelming number of patients with COVID-19 amid an enhanced risk of cross-infection is a daunting undertaking. The authors presented the experience of caring for the critically ill patients with COVID-19 in Wuhan. It is extremely important to follow strict self-protection precautions. Timely, but not premature, intubation is crucial to counter a progressively enlarging oxygen debt despite high-flow oxygen therapy and bilevel positive airway pressure ventilation. Thorough preparation, satisfactory preoxygenation, modified rapid sequence induction, and rapid intubation using a video laryngoscope are widely used intubation strategies in Wuhan. Lung-protective ventilation, prone position ventilation, and adequate sedation and analgesia are essential components of ventilation management.


Perioperative Management of Patients Infected with the Novel Coronavirus: Recommendation from the Joint Task Force of the Chinese Society of Anesthesiology and the Chinese Association of Anesthesiologists
Chen X.;  Liu Y.;  Gong Y.;  Guo X.;  Zuo M.;  Li J.;  Shi W.;  Li H.;  Xu X.;  Mi W.;  Huang Y.
Anesthesiology (2020). Date of Publication: 19 Mar 2020

ABSTRACT
  The outbreak of the new Coronavirus disease, COVID-19, has been involved in 77,262 cases in China as well as in 27 other countries as of February 24, 2020. Because the virus is novel to human beings, and there is no vaccine yet available, every individual is susceptible and can become infected. Healthcare workers are at high risk, and unfortunately, more than 3,000 healthcare workers in China have been infected. Anesthesiologists are among healthcare workers who are at an even higher risk of becoming infected because of their close contact with infected patients and high potential of exposure to respiratory droplets or aerosol from their patients’ airways. In order to provide healthcare workers with updated recommendations on the management of patients in the perioperative setting as well as for emergency airway management outside of the operating room, the two largest anesthesia societies, the Chinese Society of Anesthesiology (CSA) and the Chinese Association of Anesthesiologists (CAA) have formed a task force to produce the recommendations. The task force hopes to help healthcare workers, particularly anesthesiologists, optimize the care of their patients and protect patients, healthcare workers, and the public from becoming infected. The recommendations were created mainly based on the practice and experience of anesthesiologists who provide care to patients in China. Therefore, adoption of these recommendations outside of China must be done with caution, and the local environment, culture, uniqueness of the healthcare system, and patients’ needs should be considered. The task force will continuously update the recommendations and incorporate new information in future versions.


Response of Chinese Anesthesiologists to the COVID-19 Outbreak
Zhang H.-F.;  Bo L.-L.;  Lin Y.;  Li F.-X.;  Sun S.-J.;  Lin H.-B.;  Xu S.-Y.;  Bian J.-J.;  Yao S.-L.;  Chen X.-D.;  Meng L.;  Deng X.-M.
Anesthesiology (2020). Date of Publication: 19 Mar 2020

ABSTRACT
The coronavirus disease 2019, named COVID-19 officially by the World Health Organization (Geneva, Switzerland) on February 12, 2020, has spread at unprecedented speed. After the first outbreak in Wuhan, China, Chinese anesthesiologists encountered increasing numbers of infected patients since December 2019. Because the main route of transmission is via respiratory droplets and close contact, anesthesia providers are at a high risk when responding to the devastating mass emergency. So far, actions have been taken including but not limited to nationwide actions and online education regarding special procedures of airway management, oxygen therapy, ventilation support, hemodynamic management, sedation, and analgesia. As the epidemic situation has lasted for months (thus far), special platforms have also been set up to provide free mental health care to all anesthesia providers participating in acute and critical caring for COVID-19 patients. The current article documents the actions taken, lesson learned, and future work needed.


Hypothesis: angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may increase the risk of severe COVID-19
Diaz J.H.
Journal of travel medicine (2020). Date of Publication: 18 Mar 2020

ABSTRACT
  Intravenous infusions of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in experimental animals increase the numbers of angiotensin-converting enzyme 2 (ACE2) receptors in the cardiopulmonary circulation. ACE2 receptors serve as binding sites for SARS-CoV-2 virions in the lungs. Patients who take ACEIs and ARBS may be at increased risk of severe disease outcomes due to SARS-CoV-2 infections.


Coronavirus disease 2019 (COVID-19): update for anesthesiologists and intensivists March 2020
Thomas-Rüddel D.;  Winning J.;  Dickmann P.;  Ouart D.;  Kortgen A.;  Janssens U.;  Bauer M.
Der Anaesthesist (2020). Date of Publication: 18 Mar 2020


Expert Recommendations for Tracheal Intubation in Critically ill Patients with Noval Coronavirus Disease 2019
Zuo M.-Z.;  Huang Y.-G.;  Ma W.-H.;  Xue Z.-G.;  Zhang J.-Q.;  Gong Y.-H.;  Che L.
Chinese medical sciences journal = Chung-kuo i hsueh k’o hsueh tsa chih (2020). Date of Publication: 27 Feb 2020

ABSTRACT
Coronavirus Disease 2019 (COVID-19), caused by a novel coronavirus (SARS-CoV-2), is a highly contagious disease. It firstly appeared in Wuhan, Hubei province of China in December 2019. During the next two months, it moved rapidly throughout China and spread to multiple countries through infected persons travelling by air. Most of the infected patients have mild symptoms including fever, fatigue and cough. But in severe cases, patients can progress rapidly and develop to the acute respiratory distress syndrome, septic shock, metabolic acidosis and coagulopathy. The new coronavirus was reported to spread via droplets, contact and natural aerosols from human-to-human. Therefore, high-risk aerosol-producing procedures such as endotracheal intubation may put the anesthesiologists at high risk of nosocomial infections. In fact, SARS-CoV-2 infection of anesthesiologists after endotracheal intubation for confirmed COVID-19 patients have been reported in hospitals in Wuhan. The expert panel of airway management in Chinese Society of Anaesthesiology has deliberated and drafted this recommendation, by which we hope to guide the performance of endotracheal intubation by frontline anesthesiologists and critical care physicians. During the airway management, enhanced droplet/airborne PPE should be applied to the health care providers. A good airway assessment before airway intervention is of vital importance. For patients with normal airway, awake intubation should be avoided and modified rapid sequence induction is strongly recommended. Sufficient muscle relaxant should be assured before intubation. For patients with difficult airway, good preparation of airway devices and detailed intubation plans should be made.


Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients
Wax R.S.;  Christian M.D.
Canadian Journal of Anesthesia (2020). Date of Publication: 2020

ABSTRACT
A global health emergency has been declared by the World Health Organization as the 2019-nCoV outbreak spreads across the world, with confirmed patients in Canada. Patients infected with 2019-nCoV are at risk for developing respiratory failure and requiring admission to critical care units. While providing optimal treatment for these patients, careful execution of infection control measures is necessary to prevent nosocomial transmission to other patients and to healthcare workers providing care. Although the exact mechanisms of transmission are currently unclear, human-to-human transmission can occur, and the risk of airborne spread during aerosol-generating medical procedures remains a concern in specific circumstances. This paper summarizes important considerations regarding patient screening, environmental controls, personal protective equipment, resuscitation measures (including intubation), and critical care unit operations planning as we prepare for the possibility of new imported cases or local outbreaks of 2019-nCoV. Although understanding of the 2019-nCoV virus is evolving, lessons learned from prior infectious disease challenges such as Severe Acute Respiratory Syndrome will hopefully improve our state of readiness regardless of the number of cases we eventually manage in Canada.


How to balance acute myocardial infarction and COVID-19: the protocols from Sichuan Provincial People’s Hospital
Zeng J.;  Huang J.;  Pan L.
Intensive Care Medicine (2020). Date of Publication: 2020


Lidocaine during intubation and extubation in patients with coronavirus disease (COVID-19)
Aminnejad R.;  Salimi A.;  Saeidi M.
Canadian Journal of Anesthesia (2020). Date of Publication: 2020


Safety and efficacy of different anesthetic regimens for parturients with COVID-19 undergoing Cesarean delivery: a case series of 17 patients
Chen R.;  Zhang Y.;  Huang L.;  Cheng B.-H.;  Xia Z.-Y.;  Meng Q.-T.
Canadian Journal of Anesthesia (2020). Date of Publication: 2020

ABSTRACT
Purpose: To assess the management and safety of epidural or general anesthesia for Cesarean delivery in parturients with coronavirus disease (COVID-19) and their newborns, and to evaluate the standardized procedures for protecting medical staff. Methods: We retrospectively reviewed the cases of parturients diagnosed with severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection disease (COVID-19). Their epidemiologic history, chest computed tomography scans, laboratory measurements, and SARS-CoV-2 nucleic acid positivity were evaluated. We also recorded the patients’ demographic and clinical characteristics, anesthesia and surgery-related data, maternal and neonatal complications, as well as the health status of the involved medical staff. Results: The clinical characteristics of 17 pregnant women infected with SARS-CoV-2 were similar to those previously reported in non-pregnant adult patients. All of the 17 patients underwent Cesarean delivery with anesthesia performed according to standardized anesthesia/surgery procedures. Fourteen of the patients underwent continuous epidural anesthesia with 12 experiencing significant intraoperative hypotension. Three patients received general anesthesia with tracheal intubation because emergency surgery was needed. Three of the parturients are still recovering from their Cesarean delivery and are receiving in-hospital treatment for COVID-19. Three neonates were born prematurely. There were no deaths or serious neonatal asphyxia events. All neonatal SARS-CoV-2 nucleic acid tests were negative. No medical staff were infected throughout the patient care period. Conclusions: Both epidural and general anesthesia were safely used for Cesarean delivery in the parturients with COVID-19. Nevertheless, the incidence of hypotension during epidural anesthesia appeared excessive. Proper patient transfer, medical staff access procedures, and effective biosafety precautions are important to protect medical staff from COVID-19.


Chest computed tomography images of early coronavirus disease (COVID-19)
Chen R.;  Chen J.;  Meng Q.-T.
Canadian Journal of Anesthesia (2020). Date of Publication: 2020


Outbreak of a new coronavirus: what anaesthetists should know
Peng P.W.H.;  Ho P.-L.;  Hota S.S.
British Journal of Anaesthesia (2020). Date of Publication: 2020


Vicarious traumatization in the general public, members, and non-members of medical teams aiding in COVID-19 control
Li Z.;  Ge J.;  Yang M.;  Feng J.;  Qiao M.;  Jiang R.;  Bi J.;  Zhan G.;  Xu X.;  Wang L.;  Zhou Q.;  Zhou C.;  Pan Y.;  Liu S.;  Zhang H.;  Yang J.;  Zhu B.;  Hu Y.;  Hashimoto K.;  Jia Y.;  Wang H.;  Wang R.;  Liu C.;  Yang C.
Brain, Behavior, and Immunity (2020). Date of Publication: 2020

ABSTRACT
Since December 2019, more than 79,000 people have been diagnosed with infection of the Corona Virus Disease 2019 (COVID-19). A large number of medical staff was sent to Wuhan city and Hubei province to aid COVID-19 control. Psychological stress, especially vicarious traumatization caused by the COVID-19 pandemic, should not be ignored. To address this concern, the study employed a total of 214 general public and 526 nurses (i.e., 234 front-line nurses and 292 non-front-line nurses) to evaluate vicarious traumatization scores via a mobile app-based questionnaire. Front-line nurses are engaged in the process of providing care for patients with COVID-19. The results showed that the vicarious traumatization scores for front-line nurses including scores for physiological and psychological responses, were significantly lower than those of non-front-line nurses (P < 0.001). Interestingly, the vicarious traumatization scores of the general public were significantly higher than those of the front-line nurses (P < 0.001); however, no statistical difference was observed compared to the scores of non-front-line nurses (P > 0.05). Therefore, increased attention should be paid to the psychological problems of the medical staff, especially non-front-line nurses, and general public under the situation of the spread and control of COVID-19. Early strategies that aim to prevent and treat vicarious traumatization in medical staff and general public are extremely necessary.


Anesthetic Management of Patients With Suspected or Confirmed 2019 Novel Coronavirus Infection During Emergency Procedures
Zhao S.;  Ling K.;  Yan H.;  Zhong L.;  Peng X.;  Yao S.;  Huang J.;  Chen X.
Journal of Cardiothoracic and Vascular Anesthesia (2020). Date of Publication: 2020

ABSTRACT
Objectives: The aim of the present study was to prevent cross-infection in the operating room during emergency procedures for patients with confirmed or suspected 2019 novel coronavirus (2019-nCoV) by following anesthesia management protocols, and to document clinical- and anesthesia-related characteristics of these patients. Design: This was a retrospective, multicenter clinical study. Setting: This study used a multicenter dataset from 4 hospitals in Wuhan, China. Participants: Patients and health care providers with confirmed or suspected 2019-nCoV from January 23 to 31, 2020, at the Wuhan Union Hospital, the Wuhan Children’s Hospital, The Central Hospital of Wuhan, and the Wuhan Fourth Hospital in Wuhan, China. Interventions: Anesthetic management and infection control guidelines for emergency procedures for patients with suspected 2019-nCoV were drafted and applied in 4 hospitals in Wuhan. Measurements and Main Results: Cross-infection in the operating rooms of the 4 hospitals was effectively reduced by implementing the new measures and procedures. The majority of patients with laboratory-confirmed 2019-nCoV infection or suspected infection were female (23 [62%] of 37), and the mean age was 41.0 years old (standard deviation 19.6; range 4-78). 10 (27%) patients had chronic medical illnesses, including 4 (11%) with diabetes, 8 (22%) with hypertension, and 8 (22%) with digestive system disease. Twenty-five (68%) patients presented with lymphopenia, and 23 (62%) patients exhibited multiple mottling and ground-glass opacity on computed tomography scanning. Conclusions: The present study indicates that COVID 19–specific guidelines for emergency procedures for patients with confirmed or suspected 2019-nCoV may effectively prevent cross-infection in the operating room. Most patients with confirmed or suspected COVID 19 presented with fever and dry cough and demonstrated bilateral multiple mottling and ground-glass opacity on chest computed tomography scans.


Anesthetic Management of Patients Undergoing Aortic Dissection Repair With Suspected Severe Acute Respiratory Syndrome Coronavirus-2 Infection
He H.;  Zhao S.;  Han L.;  Wang Q.;  Xia H.;  Huang X.;  Yao S.;  Huang J.;  Chen X.
Journal of Cardiothoracic and Vascular Anesthesia (2020). Date of Publication: 2020

ABSTRACT
Severe acute respiratory syndrome coronavirus-2 is still active in Wuhan, China, and is spreading to the rest of the world. Recently, perioperative anesthetic management in patients with suspected or confirmed coronavirus-2 has been reported. However, little has been reported on the anesthetic management of patients undergoing aortic dissection repair in patients with suspected severe acute respiratory syndrome coronavirus-2 infection. During the outbreak in Wuhan, the authors’ team completed 4 cases of aortic dissection repair successfully in patients with suspected severe acute respiratory syndrome coronavirus-2 infection. The purpose of the present report is to summarize current knowledge and experiences on anesthetic management in this patient population and to provide clinical practice guidelines on anesthetic management and infection prevention and control in these critically ill patients.


Risk Factors Associated with Acute Respiratory Distress Syndrome and Death in Patients with Coronavirus Disease 2019 Pneumonia in Wuhan, China
Wu C.;  Chen X.;  Cai Y.;  Xia J.;  Zhou X.;  Xu S.;  Huang H.;  Zhang L.;  Zhou X.;  Du C.;  Zhang Y.;  Song J.;  Wang S.;  Chao Y.;  Yang Z.;  Xu J.;  Zhou X.;  Chen D.;  Xiong W.;  Xu L.;  Zhou F.;  Jiang J.;  Bai C.;  Zheng J.;  Song Y.
JAMA Internal Medicine (2020). Date of Publication: 2020

ABSTRACT
Importance: Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that was first reported in Wuhan, China, and has subsequently spread worldwide. Risk factors for the clinical outcomes of COVID-19 pneumonia have not yet been well delineated. Objective: To describe the clinical characteristics and outcomes in patients with COVID-19 pneumonia who developed acute respiratory distress syndrome (ARDS) or died. Design, Setting, and Participants: Retrospective cohort study of 201 patients with confirmed COVID-19 pneumonia admitted to Wuhan Jinyintan Hospital in China between December 25, 2019, and January 26, 2020. The final date of follow-up was February 13, 2020. Exposures: Confirmed COVID-19 pneumonia. Main Outcomes and Measures: The development of ARDS and death. Epidemiological, demographic, clinical, laboratory, management, treatment, and outcome data were also collected and analyzed. Results: Of 201 patients, the median age was 51 years (interquartile range, 43-60 years), and 128 (63.7%) patients were men. Eighty-four patients (41.8%) developed ARDS, and of those 84 patients, 44 (52.4%) died. In those who developed ARDS, compared with those who did not, more patients presented with dyspnea (50 of 84 [59.5%] patients and 30 of 117 [25.6%] patients, respectively [difference, 33.9%; 95% CI, 19.7%-48.1%]) and had comorbidities such as hypertension (23 of 84 [27.4%] patients and 16 of 117 [13.7%] patients, respectively [difference, 13.7%; 95% CI, 1.3%-26.1%]) and diabetes (16 of 84 [19.0%] patients and 6 of 117 [5.1%] patients, respectively [difference, 13.9%; 95% CI, 3.6%-24.2%]). In bivariate Cox regression analysis, risk factors associated with the development of ARDS and progression from ARDS to death included older age (hazard ratio [HR], 3.26; 95% CI 2.08-5.11; and HR, 6.17; 95% CI, 3.26-11.67, respectively), neutrophilia (HR, 1.14; 95% CI, 1.09-1.19; and HR, 1.08; 95% CI, 1.01-1.17, respectively), and organ and coagulation dysfunction (eg, higher lactate dehydrogenase [HR, 1.61; 95% CI, 1.44-1.79; and HR, 1.30; 95% CI, 1.11-1.52, respectively] and D-dimer [HR, 1.03; 95% CI, 1.01-1.04; and HR, 1.02; 95% CI, 1.01-1.04, respectively]). High fever (≥39 °C) was associated with higher likelihood of ARDS development (HR, 1.77; 95% CI, 1.11-2.84) and lower likelihood of death (HR, 0.41; 95% CI, 0.21-0.82). Among patients with ARDS, treatment with methylprednisolone decreased the risk of death (HR, 0.38; 95% CI, 0.20-0.72). Conclusions and Relevance: Older age was associated with greater risk of development of ARDS and death likely owing to less rigorous immune response. Although high fever was associated with the development of ARDS, it was also associated with better outcomes among patients with ARDS. Moreover, treatment with methylprednisolone may be beneficial for patients who develop ARDS.


COVID-19 – what should anaethesiologists and intensivists know about it?
Wujtewicz M.;  Dylczyk-Sommer A.;  Aszkiełowicz A.;  Zdanowski S.;  Piwowarczyk S.;  Owczuk R.
Anaesthesiology intensive therapy (2020) 52:1 (34-41). Date of Publication: 2020

ABSTRACT
Over the past three months, the world has faced an unprecedented health hazard. The World Health Organization has announced a pandemic infection with an unknown species of coronavirus called SARS-CoV-2. Spreading mainly through the droplet route, the virus causes mild symptoms in the majority of cases, the most common being: fever (80%), dry cough (56%), fatigue (22%) and muscle pain (7%); less common symptoms include a sore throat, a runny nose, diarrhea, hemoptysis and chills. A life-threatening complication of SARS-CoV-2 infection is an acute respiratory distress syndrome (ARDS), which occurs more often in older adults, those with immune disorders and co-morbidities. Severe forms of the infection, being an indication for treatment in the intensive care unit, comprise acute lung inflammation, ARDS, sepsis and septic shock. The article presents basic information about etiology, pathogenesis and diagnostics (with particular emphasis on the importance of tomocomputer imaging), clinical picture, treatment and prevention of the infection. It goes on to emphasize the specific risks of providing anesthesiology and intensive care services. Due to the fact that effective causal treatment is not yet available and the number of infections and deaths increases day by day, infection prevention and strict adherence to recommendations of infection control organizations remain the basis for fighting the virus.