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  • 1
    Online Resource
    Online Resource
    The use of continuous positive airway pressure during the second and third waves of the COVID-19 pandemic
    European Respiratory Society (ERS) ; 2023
    In:  ERJ Open Research Vol. 9, No. 2 ( 2023-03), p. 00365-2022-
    Details
    In: ERJ Open Research, European Respiratory Society (ERS), Vol. 9, No. 2 ( 2023-03), p. 00365-2022-
    Abstract: In a preliminary study during the first COVID-19 pandemic wave, we reported a high rate of success with continuous positive airway pressure (CPAP) in preventing death and invasive mechanical ventilation (IMV). That study, however, was too small to identify risk factors for mortality, barotrauma and impact on subsequent IMV. Thus, we re-evaluated the efficacy of the same CPAP protocol in a larger series of patients during second and third pandemic waves. Methods 281 COVID-19 patients with moderate-to-severe acute hypoxaemic respiratory failure (158 full-code and 123 do-not-intubate (DNI)), were managed with high-flow CPAP early in their hospitalisation. IMV was considered after 4 days of unsuccessful CPAP. Results The overall recovery rate from respiratory failure was 50% in the DNI and 89% in the full-code group. Among the latter, 71% recovered with CPAP-only, 3% died under CPAP and 26% were intubated after a median CPAP time of 7 days (IQR: 5–12 days). Of the patients who were intubated, 68% recovered and were discharged from the hospital within 28 days. Barotrauma occurred during CPAP in 〈 4% of patients. Age (OR 1.128; p 〈 0.001) and tomographic severity score (OR 1.139; p=0.006) were the only independent predictors of mortality. Conclusions Early treatment with CPAP is a safe option for patients with acute hypoxaemic respiratory failure due to COVID-19.
    Type of Medium: Online Resource
    ISSN: 2312-0541
    URL: Article
    DOI: 10.1183/23120541.00365-2022
    Language: English
    Publisher: European Respiratory Society (ERS)
    Publication Date: 2023
    detail.hit.zdb_id: 2827830-6
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  • 2
    Online Resource
    Online Resource
    Postoperative pain management in non-traumatic emergency general surgery: WSES-GAIS-SIAARTI-AAST guidelines
    Springer Science and Business Media LLC ; 2022
    In:  World Journal of Emergency Surgery Vol. 17, No. 1 ( 2022-09-21)
    Details
    In: World Journal of Emergency Surgery, Springer Science and Business Media LLC, Vol. 17, No. 1 ( 2022-09-21)
    Abstract: Non-traumatic emergency general surgery involves a heterogeneous population that may present with several underlying diseases. Timeous emergency surgical treatment should be supplemented with high-quality perioperative care, ideally performed by multidisciplinary teams trained to identify and handle complex postoperative courses. Uncontrolled or poorly controlled acute postoperative pain may result in significant complications. While pain management after elective surgery has been standardized in perioperative pathways, the traditional perioperative treatment of patients undergoing emergency surgery is often a haphazard practice. The present recommended pain management guidelines are for pain management after non-traumatic emergency surgical intervention. It is meant to provide clinicians a list of indications to prescribe the optimal analgesics even in the absence of a multidisciplinary pain team. Material and methods An international expert panel discussed the different issues in subsequent rounds. Four international recognized scientific societies: World Society of Emergency Surgery (WSES), Global Alliance for Infection in Surgery (GAIS), Italian Society of Anesthesia, Analgesia Intensive Care (SIAARTI), and American Association for the Surgery of Trauma (AAST), endorsed the project and approved the final manuscript. Conclusion Dealing with acute postoperative pain in the emergency abdominal surgery setting is complex, requires special attention, and should be multidisciplinary. Several tools are available, and their combination is mandatory whenever is possible. Analgesic approach to the various situations and conditions should be patient based and tailored according to procedure, pathology, age, response, and available expertise. A better understanding of the patho-mechanisms of postoperative pain for short- and long-term outcomes is necessary to improve prophylactic and treatment strategies.
    Type of Medium: Online Resource
    ISSN: 1749-7922
    URL: Article
    DOI: 10.1186/s13017-022-00455-7
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2233734-9
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