Respiratory Mechanics and Association With Inflammation in COVID-19-Related ARDS.

BACKGROUND: The novel coronavirus-associated ARDS (COVID-19 ARDS) often requires invasive mechanical ventilation. A spectrum of atypical ARDS with different phenotypes (high vs low static compliance) has been hypothesized in COVID-19. METHODS: We conducted a retrospective analysis to identify respiratory mechanics in COVID-19 ARDS. Berlin definition was used to categorize severity of ARDS. Correlational analysis using t test, chi-square test, ANOVA test, and Pearson correlation was used to identify relationship between subject variables and respiratory mechanics. The primary outcome was duration of mechanical ventilation. Secondary outcomes were correlation between fluid status, C- reactive protein, PEEP, and D-dimer with respiratory and ventilatory parameters. RESULTS: Median age in our cohort was 60.5 y with predominantly male subjects. Up to 53% subjects were classified as severe ARDS (median [Formula: see text] = 86) with predominantly low static compliance (median Cst- 25.5 mL/cm H2O). The overall mortality in our cohort was 61%. The total duration of mechanical ventilation was 35 d in survivors and 14 d in nonsurvivors. High PEEP (r = 0.45, P < .001) and D-dimer > 2,000 ng/dL (P = .009) correlated with significant increase in physiologic dead space without significant correlation with [Formula: see text]. Higher net fluid balance was inversely related to static compliance (r = -0.24, P = .045), and elevation in C- reactive protein was inversely related to [Formula: see text] (r = -0.32, P = .02). CONCLUSIONS: In our cohort of mechanically ventilated COVID-19 ARDS subjects, high PEEP and D-dimer were associated with increase in physiologic dead space without significant effect on oxygenation, raising the question of potential microvascular dysfunction.

Preferences of Lebanese adults for the gender of their surgeons: a cross-sectional study.

BACKGROUND: More females are specializing in surgery in Lebanon, but it is not known if a gender bias exists among Lebanese people in their preference of their surgeons. AIMS: This study investigated the preference of Lebanese men and women for the gender of surgeons and explored reasons for their preferences. METHODS: A convenience sample of 1000 Lebanese adults were asked about their preferences for the gender of surgeons of different specialties (paediatrics, cardiology, neurology, orthopaedics, ophthalmology, ear nose and throat, plastic surgery and obstetrics/gynaecology). The association between the participants' sociodemographic characteristics and gender preference for surgeons was examined in bivariate and multivariable regression analyses. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. RESULTS: Half of the respondents had no gender preference for their surgeons whatever their speciality. Male surgeons were preferred over females for cardiac (44.2% versus 3.7% respectively), neurological (43.4% versus 4.1%) and orthopaedic procedures (41.9% versus 3.5%) whereas male and female obstetricians/gynaecologists were equally preferred (23.6% and 25.0% respectively). Being male (OR = 0.74, 95% CI: 0.57-0.97) or single (OR = 0.65, 95% CI: 0.44-0.96) decreased the likelihood of choosing a male heart surgeon whereas employment increased that likelihood (OR = 1.37, 95% CI: 1.03-1.83). Perceived competence, reputation and trustworthiness of male surgeons influenced participants' choices whereas the choice of an obstetrician/gynaecologist was related to privacy and comfort. CONCLUSIONS: The preference for female surgeons in Lebanon varies by the type of surgical specialty. Qualitative studies exploring the social determinants of patients' preferences are needed.

Clinical Outcomes in Critically Ill Coronavirus Disease 2019 Patients: A Unique New York City Public Hospital Experience.

To explore demographics, comorbidities, transfers, and mortality in critically ill patients with confirmed severe acute respiratory syndrome coronavirus 2. DESIGN: Retrospective cohort study. SETTING: Data were collected from a large tertiary care public hospital ICU that is part of the largest public healthcare network in the United States. PATIENTS: One-hundred thirty-seven adult (≥ 18 yr old) ICU patients admitted between March 10, 2020, and April 7, 2020, with follow-up collected through May 18, 2020. INTERVENTIONS: None. MEASUREMENTS: Demographic, clinical, laboratory, treatment, and outcome data extracted from electronic medical records. MAIN RESULTS: The majority of patients were male (99/137; 72.3%) and older than 50 years old (108/137; 78.9%). The most reported ethnicity and race were Hispanic (61/137; 44.5%) and Black (23/137; 16.7%). One-hundred six of 137 patients had at least one comorbidity (77.4%). One-hundred twenty-one of 137 (78.1%) required mechanical ventilation of whom 30 (24.8%) moved to tracheostomy and 46 of 137 (33.6%) required new onset renal replacement therapy. Eighty-two of 137 patients (59.9%) died after a median of 8 days (interquartile range 5-15 d) in the ICU. Male sex had a trend toward a higher hazard of death (hazard ratio, 2.1 [1.1-4.0]) in the multivariable Cox model. CONCLUSIONS: We report a mortality rate of 59.9% in a predominantly Hispanic and Black patient population. A significant association between comorbidities and mortality was not found in multivariable regression, and further research is needed to study factors that impact mortality in critical coronavirus disease 2019 patients. We also describe how a public hospital developed innovative approaches to safely manage a large volume of interhospital transfers and admitted patients.