Ventilatory associated barotrauma in COVID-19 patients: A multicenter observational case control study (COVI-MIX-study)

BACKGROUND

The risk of barotrauma associated with different types of ventilatory support is unclear in COVID-19 patients. The primary aim of this study was to evaluate the effect of the different respiratory support strategies on barotrauma occurrence; we also sought to determine the frequency of barotrauma and the clinical characteristics of the patients who experienced this complication.

METHODS

This multicentre retrospective case-control study from 1 March 2020 to 28 February 2021 included COVID-19 patients who experienced barotrauma during hospital stay. They were matched with controls in a 1:1 ratio for the same admission period in the same ward of treatment. Univariable and multivariable logistic regression (OR) were performed to explore which factors were associated with barotrauma and in-hospital death.

RESULTS

We included 200 cases and 200 controls. Invasive mechanical ventilation was used in 39.3% of patients in the barotrauma group, and in 20.1% of controls (p<0.001). Receiving non-invasive ventilation (C-PAP/PSV) instead of conventional oxygen therapy (COT) increased the risk of barotrauma (OR 5.04, 95% CI 2.30 - 11.08, p<0.001), similarly for invasive mechanical ventilation (OR 6.24, 95% CI 2.86-13.60, p<0.001). High Flow Nasal Oxygen (HFNO), compared with COT, did not significantly increase the risk of barotrauma. Barotrauma frequency occurred in 1.00% [95% CI 0.88-1.16] of patients; these were older (p=0.022) and more frequently immunosuppressed (p=0.013). Barotrauma was shown to be an independent risk for death (OR 5.32, 95% CI 2.82-10.03, p<0.001).

CONCLUSIONS

C-PAP/PSV compared with COT or HFNO increased the risk of barotrauma; otherwise HFNO did not. Barotrauma was recorded in 1.00% of patients, affecting mainly patients with more severe COVID-19 disease. Barotrauma was independently associated with mortality.

TRIAL REGISTRATION

this case-control study was prospectively registered in clinicaltrial.gov as NCT04897152 (on 21 May 2021).

Is estimated cardiovascular risk higher in HIV-infected patients than in the general population?

Cardiovascular disease (CVD) is an increasing concern for human immunodeficiency virus (HIV)-infected patients, and risk assessment is recommended in routine HIV care. The absolute cardiovascular risk in an individual is determined by several factors, and various algorithms may be applied. To date, few comparisons of HIV patients with persons of the same age from the general population have been conducted. We hypothesized that the calculated risk of CVD may be increased in HIV patients. The probability for acute coronary events within 10 y (Framingham Risk Score) and the probability for fatal cardiovascular disease (SCORE algorithm) were assessed in 403 consecutive HIV-positive subjects free from overt cardiovascular disease, as well as in 96 age- and gender-matched control subjects drawn from the general population living in the same geographical area. The average 10-y risk for acute coronary events (Framingham Risk Score) was 7.0%+/-5% in HIV subjects and 6.3%+/-5% in the control group (p =0.32). The 10-y estimated risk for cardiovascular mortality (SCORE algorithm) was 1.23%+/-2.3% and 0.83%+/-0.9%, respectively (p =0.01). The main contributor to the increased CVD risk was the high proportion of smokers, but not an increase in cholesterol level. In conclusion, a limited increase in estimated risk of CVD was found in HIV-infected patients compared to the general population. In HIV-infected individuals other factors of less value in the general population and not included in any cardiovascular algorithm might be important. In our patients intervention to modify traditional risk factors should be addressed primarily towards modifying smoking habits.

Nosocomial post-traumatic Rhizomucor soft tissue and bone infection treated with liposomial amphotericin B: case report

Mucornycosis is a rare fungal infection most commonly occuring in patients with severe immunocompromise, diabetes, uremia or trauma. Only a few cases of non axial skeletal bone osteomyelitis have been reported. We report a case of nosocomial cellulitis and osteomyelitis complicating a posttraumatic bacterial infection, successfully treated with liposomial amphotericin B and surgical debridement. Traumatized patients with extensive tissue loss, receiving broad-spectrum antibiotics, can develop impaired immune responses and are at risk for fungal infections.

Fatal haemolytic uraemic syndrome in an AIDS patient with disseminated adenovirus and cytomegalovirus co-infection

We describe a fatal case of haemolytic uraemic syndrome in a young woman with AIDS, and disseminated adenovirus (ADV) and cytomegalovirus (CMV) co-infection. We hypothesize that ADV/CMV co-infection may have a causative role in this clinical picture.

A case of rhombencephalitis caused by Listeria monocytogenes successfully treated with linezolid

Infection of the central nervous system due to Listeria monocytogenes is uncommon. The treatment of choice is ampicillin. We describe in this report a case of rhombencephalitis caused by Listeria monocytogenes successfully treated with linezolid. To the best of our knowledge, this is the first case in which linezolid was used to treat infection of the central nervous system caused by this organism.

[Nosocomial post-neurosurgery meningitis due to Corynebacterium jeikeium]

Among the post neurosurgery infections the meningitis due to Corynebacterium jeikeium are rare, particularly without central nervous system devices. We report a case of a 78 year-old patient with chronic myeloproliferative syndrome, who developed an acute meningeal syndrome by Corynebacterium jeikeium post hypophyseal macroadenoma resection.

Pulsed field gel electrophoresis and random amplified polymorphic DNA molecular characterization of Ralstonia pickettii isolates from patients with nosocomial central venous catheter related bacteremia

Over a period of 18 months 3 clusters of central venous catheter-related Ralstonia pickettii bacteremia occurred in 3 different units of the same hospital. In order to investigate the relatedness of the clinical isolates we studied 15 strains using pulsed-field gel electrophoresis (PFGE) and randomly amplified polymorphic DNA (RAPD) techniques. The combined analysis of the results obtained by these two methods led us to conclude that all the patients except one were infected by a single clone comprising two variants circulating in the units. Only one case was due to a different strain, probably originating outside the ward. PFGE and RAPD appear to be discriminatory techniques to study the clonal relationship among the isolates and can represent a good tool to perform the epidemiological investigation of an outbreak.

Nosocomial Aspergillus flavus wound infections following cardiac surgery

In this report we describe three cases of Aspergillus flavus sternal wound infection following cardiac surgery. All three cases occurred in a 3-month period coinciding with hospital renovation activities. The patients were successfully treated with combined surgical and medical therapy.

Late onset opportunistic infections in a renal allograft recipient: a case report

In renal allograft recipients, infection disease complications remain an important cause of morbidity and mortality during the post-transplant period. This complication occurs more frequently from 1 to 6 months after transplant. The epidemiology of infection during the postoperative period is less well characterized, because recipients routinely reside at home. We describe a case of late onset Candida albicans and HSV-1 esophagitis, and Pneumocystis carinii pneumonia, that occurs 9 years after renal transplantation in a patient with severe CD4+ T-lymphocytopenia and hypogammaglobulinaemia. We underline the importance of monitoring immunosuppressive therapy in these patients and the usefulness of prophylaxis against P. carinii pneumonia

Evidence of Toscana virus circulation in Umbria: first report

To evaluate, for the first time, circulation and clinical expression of Toscana virus (ToSv) in Umbria region we studied: (1) 93 cases of aseptic meningitis and meningoencephalitis admitted to our Department from 1989 to 2001 with negative results for common neurotropic virus; (2) 50 healthy subjects. Specific antibodies (IgM and IgG) anti-TOSv were found in 36.6% of aseptic meningitis, in 6.06% of meningoencephalitis and (IgG) in 16% of healthy subjects.

Evidence of Toscana virus circulation in Umbria: first report

To evaluate, for the first time, circulation and clinical expression of Toscana virus (ToSv) in Umbria region we studied: (1) 93 cases of aseptic meningitis and meningoencephalitis admitted to our Department from 1989 to 2001 with negative results for common neurotropic virus; (2) 50 healthy subjects. Specific antibodies (IgM and IgG) anti-TOSv were found in 36.6% of aseptic meningitis, in 6.06% of meningoencephalitis and (IgG) in 16% of healthy subjects.

[Nosocomial infections in vascular surgery: 1-year surveillance]

Among the hospital related complications the nosocomial infections are a major source of problems, especially in the Intensive Care and in the Surgery Units. It has been clearly demonstrated that infection control programs, in Surgery Units, have a large benefit in the reduction of surgical site infections (SSIs) rates. The surveillance method, sponsored by the Centers for Diseases Control of Atlanta, is the most consolidated system and it is active since '70 years. We used this method in the Vascular Surgery Unit of Perugia Hospital. During a 12-month period, 668 consecutive patients were enrolled and followed, after surgery, for 30 days (without implantable devices) or 1 year (with prosthesis). A total of 14 (2.1%) patients had SSIs: 4 superficial, 4 deep, 6 organ-space. We isolated 13 pathogens: 8 gram-positive, 4 gram-negative, and one Candida albicians. The most prevalent pathogen isolated was Staphylococcus aureus methicillin-susceptible. This first positive experience will be used for further more generalized work involving the principal surgical Unit of the Umbria Region.

Novel unstable resonator configuration with a self-filtering aperture: experimental characterization of the Nd:YAG loaded cavity

A novel cavity design based on a confocal negative branch unstable resonator configuration is presented. A proper choice for the size of the field limiting aperture, set at the common focal plane of the mirrors, results in removal of the hot spot inside the cavity and in the smoothing of the spatial profile of the oscillating mode. Application of this scheme to a pulsed Nd:YAG oscillator is thoroughly characterized in a variety of operational modes (fixed-Q, Q-switching, mode-locking). The main results are a high efficiency of energy extraction and excellent phase and amplitude profiles of the output beam, which shows real transform-limited performances.