sj-pdf-1-tai-10.1177_2049936121998562 – Supplemental material for Personal protective equipment use by healthcare workers in intensive care unit during the early phase of COVID-19 pandemic in Italy: a secondary analysis of the PPE-SAFE survey

Supplemental material, sj-pdf-1-tai-10.1177_2049936121998562 for Personal protective equipment use by healthcare workers in intensive care unit during the early phase of COVID-19 pandemic in Italy: a secondary analysis of the PPE-SAFE survey by Mariachiara Ippolito, Mahesh Ramanan, Davide Bellina, Giulia Catalisano, Pasquale Iozzo, Andrea Di Guardo, Alessandra Moscarelli, Giacomo Grasselli, Antonino Giarratano, Matteo Bassetti, Alexis Tabah and Andrea Cortegiani in Therapeutic Advances in Infectious Disease

sj-pdf-2-tai-10.1177_2049936121998562 – Supplemental material for Personal protective equipment use by healthcare workers in intensive care unit during the early phase of COVID-19 pandemic in Italy: a secondary analysis of the PPE-SAFE survey

Supplemental material, sj-pdf-2-tai-10.1177_2049936121998562 for Personal protective equipment use by healthcare workers in intensive care unit during the early phase of COVID-19 pandemic in Italy: a secondary analysis of the PPE-SAFE survey by Mariachiara Ippolito, Mahesh Ramanan, Davide Bellina, Giulia Catalisano, Pasquale Iozzo, Andrea Di Guardo, Alessandra Moscarelli, Giacomo Grasselli, Antonino Giarratano, Matteo Bassetti, Alexis Tabah and Andrea Cortegiani in Therapeutic Advances in Infectious Disease

Two episodes of Taravana syndrome in a breath-hold diver with hyperhomocysteinemia

Key Clinical Message Taravana syndrome is a rare dysbaric disease characterized by neurologic signs and symptoms. Differently from others decompression illness, it has unspecified pathophysiology and unclear predisposing factors. Our cases suggest that thrombophilic state due to hyperhomocysteinemia could increase the risk to develop Taravana syndrome.

Cardiopulmonary resuscitation in prone position: A scoping review.

Introduction The ongoing pandemic of COVID-19 brought to the fore prone positioning as treatment for patients with acute respiratory failure. With the increasing number of patients in prone position, both spontaneously breathing and mechanically ventilated, cardiac arrest in this position is more likely to occur. This scoping review aimed to summarize the available evidence on cardiopulmonary resuscitation in prone position (‘reverse CPR’) and knowledge or research gaps to be further evaluated. The protocol of this scoping review was prospectively registered on 10th May 2020 in Open Science Framework (https://osf.io/nfuh9). Methods We searched PubMed, EMBASE, MEDLINE and pre-print repositor…

Counterfeit filtering facepiece respirators are posing an additional risk to health care workers during COVID-19 pandemic.

Medical masks and Respirators for the Protection of Healthcare Workers from SARS-CoV-2 and other viruses

The use of medical masks and respirators as personal protective equipment is pivotal to reducing the level of biological hazard to which healthcare workers are exposed during the outbreak of highly diffusible pathogens, such as the recent novel coronavirus SARS-CoV-2. Unfortunately, during this pandemic, supplies are rapidly running out worldwide, with potential consequences for the rate of occupational infections. Also, knowledge about specific characteristics of respirators is of utmost importance to select the proper type according to the clinical setting. A wide variety of literature is available on the topic, but mostly based on Influenza viruses infection models. Clinical evidence on …

What Is the Most Recent Evidence on the Prevention and Early Treatment of Invasive Fungal Infections in Nonneutropenic Critically Ill Patients?

: Invasive fungal infections (IFIs) are associated with high morbidity and mortality in intensive care units. Candida species are the most important fungal pathogens and among the most frequent causes of infection in critically ill patients. Studies have evaluated the correlation between the onset of antifungal treatment and survival. However, definitive diagnosis of IFI is time-consuming in clinical practice. Antifungal prophylaxis and preemptive or empirical treatments are among therapeutic strategies to prevent or treat early fungal infections in selected patients. Recently, new evidence from randomized controlled trials and systematic reviews has been published. Moreover, new clinical p…

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study (Intensive Care Medicine, (2021), 47, 2, (160-169), 10.1007/s00134-020-06234-9)

The original version of this article unfortunately contained a mistake. The members of the ESICM Trials Group Collaborators were not shown in the article but only in the ESM. The full list of collaborators is shown below. The original article has been corrected.

Neutrophil CD64 as a marker of infection in patients admitted to the emergency department with acute respiratory failure

Andrea Cortegiani, Vincenzo Russotto, Francesca Montalto, Grazia Foresta, Pasquale Iozzo, Santi Maurizio Raineri, Antonino Giarratano Department of Biopathology and Medical and Forensic Biotechnologies (DIBIMEF), Section of Anesthesiology, Analgesia, Emergency and Intensive Care, Policlinico “P Giaccone”, University of Palermo, Palermo, Italy Introduction: Cluster of differentiation 64 (CD64) is expressed on neutrophils during bacterial infections and sepsis. The aim of our study was to assess the CD64 expression in patients admitted to the emergency department (ED) with a triage diagnosis of acute respiratory failure (ARF) and/or dyspnea and to verify a relationship bet…

Protocol of a multicenter international randomized controlled manikin study on different protocols of cardiopulmonary resuscitation for laypeople (MANI-CPR)

IntroductionOut-of-hospital cardiac arrest is one of the leading causes of death in industrialised countries. Survival depends on prompt identification of cardiac arrest and on the quality and timing of cardiopulmonary resuscitation (CPR) and defibrillation. For laypeople, there has been a growing interest on hands-only CPR, meaning continuous chest compression without interruption to perform ventilations. It has been demonstrated that intentional interruptions in hands-only CPR can increase its quality. The aim of this randomised trial is to compare three CPR protocols performed with different intentional interruptions with hands-only CPR.Methods and analysisThis is a prospective randomise…

Regional anticoagulation with heparin of an extracorporeal CO2 removal circuit: a case report

Abstract Background Extracorporeal carbon dioxide removal is an increasingly used respiratory support technique. As is true of all extracorporeal techniques, extracorporeal carbon dioxide removal needs proper anticoagulation. We report a case of a patient at risk of bleeding complications who was treated with extracorporeal carbon dioxide removal and anticoagulated with a regional technique. Case presentation A 56-year-old Caucasian man with a history of chronic obstructive pulmonary disease exacerbation required extracorporeal carbon dioxide removal for severe hypercapnia and acidosis despite mechanical ventilation. The extracorporeal circuit was anticoagulated using a regional heparin tec…

Procalcitonin for the diagnosis of invasive candidiasis: what is the evidence?

Abstracts Procalcitonin is a widely used marker for the evaluation of infection and sepsis and to guide antibiotic therapy. During the last decade, several studies evaluated its role and diagnostic performance as a surrogate marker for the identification of Candida spp. in suspected invasive candidiasis. A low serum level and a favorable negative predictive value are the main findings for procalcitonin in this setting. The aim of this report is to provide an updated brief summary of the evidence supporting the use of PCT for the management of invasive candidiasis.

Update I. A systematic review on the efficacy and safety of chloroquine/hydroxychloroquine for COVID-19

Purpose To assess efficacy and safety of chloroquine (CQ)/hydroxychloroquine (HCQ) for treatment or prophylaxis of COVID-19 in adult humans. Materials and methods MEDLINE, PubMed, EMBASE and two pre-print repositories (bioRxiv, medRxiv) were searched from inception to 8th June 2020 for RCTs and nonrandomized studies (retrospective and prospective, including single-arm, studies) addressing the use of CQ/HCQ in any dose or combination for COVID-19. Results Thirty-two studies were included (6 RCTs, 26 nonrandomized, 29,192 participants). Two RCTs had high risk, two ‘some concerns’ and two low risk of bias (Rob2). Among nonrandomized studies with comparators, nine had high risk and five moderat…

Personal protective equipment use by healthcare workers in intensive care unit during the early phase of COVID-19 pandemic in Italy: a secondary analysis of the PPE-SAFE survey.

Background: Italy was the first Western country to be heavily affected by COVID-19. Healthcare workers (HCWs) were exposed to a high risk of occupational infection, partially due to insufficient personal protective equipment (PPE) supplies. This study aimed to describe the practices, availability, training, confidence in PPE use and the adverse effects due to extended PPE use, as reported by HCWs in Italy. We also aimed to provide a comparison between Italian data and those from other countries. Methods: This study was a secondary analysis of a previously published international study, the PPE-SAFE Survey, conducted in April 2020. Data were analysed from the original study database. Results…

Association between night-time extubation and clinical outcomes in adult patients

Background: Whether night-time extubation is associated with clinical outcomes is unclear. Objective: The aim of this systematic review and meta-analysis was to evaluate the association between night-time extubation and the reintubation rate, mortality, ICU and in-hospital LOS in adult patients, compared with daytime extubation. Design: A systematic review and meta-analysis. Data sources: PubMed, EMBASE, CINAHL and Web of Science from inception to 2 January 2021 (PROSPERO registration - CRD42020222812). Eligibility criteria: Randomised, quasi and cluster randomised, and nonrandomised studies describing associations between adult patients' outcomes and time of extubation (daytime/night-time)…

Use of low dose of rFVIIa (recombinant Factor VII activated) to control late bleeding after percutaneous dilational tracheostomy

Key Clinical Message In our case, the use of a low intravenous bolus dose of rFVIIa (recombinant factor VII activated; 15‐20 mcg/kg) was effective and uneventful in controlling late postprocedural PDT bleeding associated with thrombocytopenia that cannot be corrected and after all other treatments failed.

Rapid detection of carbapenem resistance: Targeting a zero level of inadequate empiric antibiotic exposure

Resistance to carbapenems is an increasingly encountered phenomenon in the ICU, complicating empiric and targeted antimicrobial therapy. Infections due to carbapenem-resistant microorganisms are characterized by high morbidity and mortality [1, 2]. Recently, there has been an increasing interest in rapid detection techniques, based on real time on-demand easy-to-use PCR, to detect genes responsible for carbapenem resistance. One of these techniques is the Cepheid Xpert Carba-R assay, which is able to detect and differentiate five of the most frequent genes associated with non-susceptibility to carbapenems in Gram-negative bacteria (bla KPC, bla VIM, bla OXA-48, bla IMP-1, bla NDM). The diag…

Real-time feedback systems for cardiopulmonary resuscitation training: time for a paradigm shift.

Among the new tools to improve the quality of cardiopulmonary resuscitation (CPR), real-time feedback systems (FS) have been largely studied during the last decade (1). These systems permit the real-time analysis of CPR.

No-touch methods of terminal cleaning in the intensive care unit: results from the first large randomized trial with patient-centred outcomes

N/A

What is the risk of acquiring bacteria from prior intensive care unit bed occupants?

Effect of High-Fidelity Simulation on Medical Students' Knowledge about Advanced Life Support: A Randomized Study

High-fidelity simulation (HFS) is a learning method which has proven effective in medical education for technical and non-technical skills. However, its effectiveness for knowledge acquisition is less validated. We performed a randomized study with the primary aim of investigating whether HFS, in association with frontal lessons, would improve knowledge about advanced life support (ALS), in comparison to frontal lessons only among medical students. The secondary aims were to evaluate the effect of HFS on knowledge acquisition of different sections of ALS and personal knowledge perception. Participants answered a pre-test questionnaire consisting of a subjective (evaluating personal percepti…

Variation in communication and family visiting policies in intensive care within and between countries during the Covid-19 pandemic: The COVISIT international survey

Background: During the COVID-19 pandemic, intensive care units (ICU) introduced restrictions to in-person family visiting to safeguard patients, healthcare personnel, and visitors. Methods: We conducted a web-based survey (March– July 2021) investigating ICU visiting practices before the pandemic, at peak COVID-19 ICU admissions, and at the time of survey response. We sought data on visiting pol icies and communication modes including use of virtual visiting (videoconferencing). Results: We obtained 667 valid responses representing ICUs in all continents. Before the pandemic, 20% (106/ 525) had unrestricted visiting hours ; 6% (30/525) did not allow in-person visiting. At peak, 84% (558/667…

Material and Technology: Back to the Future for the Choice of Interface for Non-Invasive Ventilation – A Concise Review

Non-invasive ventilation (NIV) has dramatically changed the treatment of both acute and chronic respiratory failure in the last 2 decades. The success of NIV is correlated to the application of the “best ingredients” of a patient’s “tailored recipe,” including the appropriate choice of the selected candidate, the ventilator setting, the interface, the expertise of the team, and the education of the caregiver. The choice of the interface is crucial for the success of NIV. Type (oral, nasal, nasal pillows, oronasal, hybrid mask, helmet), size, design, material and headgears may affect the patient’s comfort with respect to many aspects, such as air leaks, claustrophobia, skin erythema, eye irr…

What Healthcare Workers Should Know about Environmental Bacterial Contamination in the Intensive Care Unit

Intensive care unit- (ICU-) acquired infections are a major health problem worldwide. Inanimate surfaces and equipment contamination may play a role in cross-transmission of pathogens and subsequent patient colonization or infection. Bacteria contaminate inanimate surfaces and equipment of the patient zone and healthcare area, generating a reservoir of potential pathogens, including multidrug resistant species. Traditional terminal cleaning methods have limitations. Indeed patients who receive a bed from prior patient carrying bacteria are exposed to an increased risk (odds ratio 2.13, 95% confidence intervals 1.62–2.81) of being colonized and potentially infected by the same bacterial spec…

Use of a real-Time training software (Laerdal QCPR®) compared to instructor-based feedback for high-quality chest compressions acquisition in secondary school students: A randomized trial

High-quality chest compressions are pivotal to improve survival from cardiac arrest. Basic life support training of school students is an international priority. The aim of this trial was to assess the effectiveness of a real-time training software (Laerdal QCPR®) compared to a standard instructor-based feedback for chest compressions acquisition in secondary school students. After an interactive frontal lesson about basic life support and high quality chest compressions, 144 students were randomized to two types of chest compressions training: 1) using Laerdal QCPR® (QCPR group– 72 students) for real-time feedback during chest compressions with the guide of an instructor who considered sof…

Facepiece filtering respirators with exhalation valve should not be used in the community to limit SARS-CoV-2 diffusion.