Background SARS-CoV-2 aerosolization during noninvasive positive pressure ventilation may endanger healthcare professionals. Various circuit setups have been described in order to reduce virus aerosolization. However, these setups may alter ventilator performances. Research question What are the consequences of the different suggested circuit setups on ventilator’s efficacy during continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV)? Study Design and Method Eight circuit setups were evaluated on a bench made of a 3-D printed head and an artificial lung. Setups were a dual-limb circuit with an oro-nasal mask, a dual-limb circuit with a helmet interface, a single-limb circuit with a passive exhalation valve, three single-limb circuits with custom-made additional leaks and two single-limb circuits with active exhalation valves. All setups were evaluated during NIV and CPAP. The following variables were recorded: the inspiratory flow preceding trigger of the ventilator, the inspiratory effort required to trigger the ventilator, the triggering delay, the maximal inspiratory pressure delivered by the ventilator, the tidal volume (V t ) generated to the artificial lung, the total work of breathing (WOB) and the pressure time product to trigger the ventilator (PTPt). Results With NIV, the type of circuit setup had a significant impact on inspiratory flow preceding the trigger of the ventilator (p<0.0001), the inspiratory effort required to trigger the ventilator (p<0.0001), the triggering delay (p<0.0001); the maximal inspiratory pressure (p<0.0001), the V t (p:0.0008), the WOB (p<0.0001), the PTPt (p<0.0001). Similar differences and consequences were seen with CPAP as well as with the addition of bacterial filters. Best performance was achieved using a dual limb circuit with an oro-nasal mask. Worst performance was achieved using a dual-limb circuit with a helmet interface. Interpretation Ventilator performance is significantly impacted by the circuit setup. The use of dual-limb circuit with oro-nasal masks should be used preferentially.

El presente estudio retrospectivo observacional tiene como objetivo analizar la utilidad de las escalas Sequential Organ Failure Assessment (SOFA), Quick SOFA (qSOFA), National Early Warning Score (NEWS) y Quick NEWS para predecir el fallo respiratorio y la muerte en pacientes con COVID-19 atendidos fuera de la Unidad de Cuidados Intensivos (UCI). Se incluyeron 237 adultos con COVID-19 hospitalizados seguidos durante un mes o hasta su fallecimiento. El fallo respiratorio se definió como un cociente PaO2/FiO2 ≤200 mm Hg o la necesidad de ventilación mecánica. Setenta y siete pacientes (32,5%) desarrollaron fallo ventilatorio; 29 (12%) precisaron ingreso en UCI, y 49 fallecieron (20,7%). La discriminación del fallo ventilatorio fue algo mayor con la puntuación NEWS, seguida de la SOFA. En cuanto a la mortalidad, la puntuación SOFA fue más exacta que las otras escalas. En conclusión, las escalas de sepsis son útiles para predecir el fallo respiratorio y la muerte en COVID-19. Una puntuación ≥4 en la escala NEWS sería el mejor punto de corte para predecir fallo respiratorio.

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This observational retrospective study aimed to investigate the usefulness of Sequential Organ Failure Assessment (SOFA), Quick SOFA (qSOFA), National Early Warning Score (NEWS), and quick NEWS in predicting respiratory failure and death among patients with COVID-19 hospitalized outside of intensive care units (ICU). We included 237 adults hospitalized with COVID-19 who were followed-up on for one month or until death. Respiratory failure was defined as a PaO 2 /FiO 2 ratio ≤ 200 mmHg or the need for mechanical ventilation. Respiratory failure occurred in 77 patients (32.5%), 29 patients (12%) were admitted to the ICU, and 49 patients (20.7%) died. Discrimination of respiratory failure was slightly higher in NEWS, followed by SOFA. Regarding mortality, SOFA was more accurate than the other scores. In conclusion, sepsis scores are useful for predicting respiratory failure and mortality in COVID-19 patients. A NEWS score ≥ 4 was found to be the best cutoff point for predicting respiratory failure.

BackgroundGastrointestinal complications after lung transplatation are associated with an increased risk of morbidity and mortality. This study aims to describe severe gastrointestinal complications (SGC) after lung transplantation.MethodsWe performed a prospective, observational study that included 136 lung transplant patients during a seven year period in a tertiary care universitary hospital. SGC were defined as any diagnosis related to the gastrointestinal or biliary tract leading to lower survival rates or an invasive therapeutic procedure. Early and late complications were defined as those occurring < 30 days and ≥ 30 days post-transplant. The survival function was calculated through the Kaplan-Meier estimator. Variables were analyzed using univariate and multivariate analysis. Statistical significance was defined as p < 0.05.ResultsThere were 17 (12.5%) SGC in 17 patients. Five were defined as early. Twelve patients (70.6%) required surgical treatment. Mortality was 52.9% (n = 9). Patients with SGC had a lower overall survival rate compared to those who did not (14 vs 28 months, p = 0.0099). The development of arrhythmias in the first 48 h of transplantation was a risk factor for gastrointestinal complications (p = 0.0326).ConclusionsSGC are common after lung transplantation and are associated with a considerable increase in morbidity-mortality. Early recognition is necessary to avoid delays in treatment, since a clear predictor has not been found in order to forecast this relevant comorbidity.