Amount and distribution of parenchymal abnormalities at CT-scan do not predict awake prone position outcome in Covid-19

Background: Even if definitive evidence is still missing, prone position in non-intubated hypoxemic patients with Covid-19 is largely used. The aim of the present study was to investigate whether the amount and distribution of lung abnormalities evaluated by CT-scan can predict the improvement of oxygenation when Covid-19 patients undergoing non-invasive ventilation (NIV) are turned prone. Method(s): Retrospective monocentric study of severe Covid-19 patients who underwent NIV and prone position, evaluated with a basal chest CT-scan. Result(s): Forty-five severe Covid-19 patients were considered. On average 50% of the overall lung volume was involved by pneumonia at CT-scan, with ground glass, and consolidation accounting for 44, and 4%, respectively. The parenchymal abnormalities were predominantly posterior, as demonstrated by a posterior/anterior ratio of ground glass and consolidation of 1.5, and 4.4, respectively. PaO2/FiO2, whose basal value under NIV in supine position was 140 [IQR 108;169] improved on average by 67% (+98) during prone position. Once supine position was resumed, improvement in oxygenation was maintained in 28 patients (62% of the overall population, categorized as "responders"). We did not find significant difference between responders and non-responders in terms of the amount and distribution of parenchymal abnormalities. No correlation emerged between the distribution of parenchymal abnormalies and changes in oxygenation in supine position before and after prone position (R2 = 0.009, p= 0.526). Conclusion(s): the amount and distribution of lung abnormalities evaluated by CT-scan do not predict the response to awake prone position in patients with severe Covid-19 pneumonia undergoing non-invasive ventilation.

Shunt fraction in Covid-19 related Acute Respiratory Failure

Background: Failing autoregulation of pulmonary vessels and higher shunt have been described in Covid-19 related Acute respiratory failure (ARF). The aim was to investigate shunt fraction in patients with Covid-19-ARF compared to patients with other causes of ARF. Method(s): Observational study of hospitalized patients with Covid-19-ARF and other causes of ARF at Papa Giovanni XXIII Hospital, Bergamo, Italy between June 2020 and November 2021. Shunt fraction was measured by a non-invasive system during spontaneous breathing (BeaconCaresystem). Result(s): We enrolled 51 adult patients (8 female), mean age (+/-SD) 65+/-13 years and mean BMI 28,3+/-5,3 Kg/m2. Covid-19-ARF patients represented 71% (36/51). Community acquired pneumonia was the most common cause of other ARF (11/15). No differences in terms of age and BMI were described between the two groups. Pulmonary gas exchange impairment was similar, median PaO2/FIO2 ratio was 254 [IQR 162,297] in Covid-19-ARF and 269 [IQR 201,296] in other causes of ARF patients (p=0.41). Nevertheless, mean shunt fraction resulted significantly increased in Covid-19-ARF (18+/-6%) than other causes of ARF patients (12+/-9%;p=0.03) Fig. 1. Conclusion(s): Shunt fraction appears to be increased in Covid-19-ARF if compared to patients with other causes of ARF. However, this is the first study proposing this non-invasive method to measure shunt fraction in ARF and further investigations are needed to validate this technique.

Caregiving during COVID19 pandemic: the new challenge in oncology assistance?

Introduction: Coronavirus disease 2019 (COVID-19) outbreak has been declared a pandemic unprecedented. Italy has been one of the first and heavily affected countries. The hematologic toxicity due to chemotherapy is the main reason why cancer patients are considered fragile patients, due to the high risk of infection. This led to important restrictions and recommendations during first and even more during second peak of COVID-19 pandemic with the prohibition of caregivers admission. In the above scenario, our study has the aim of evaluating the impact of COVID19 pandemic in caregiving in oncology. Materials and Methods: Between 02/09 and 04/02 2021 our team conducted a cross-sectional study by submitting a survey to caregivers of patients with solid cancer undergoing active treatments in Oncologic Departments of Marche region. An anonymous, paper questionnaire regarding perception of patient safety and continuity of care was submitted. Results: A total of 112 caregivers responded to our survey. The majority of them were between 46 and 65 years old (46.4%), female (57%), declared to take care of the patient for 0-2 hours/day (36.6%) and declared to have increased assistance time during the pandemic (59.3%). Half of the participants declared there were no economic difficulties in assistance of their relatives and more than half (55.4 %, n=62) did not report major change in this setting. Almost all caregivers (99.1%) declared that the Oncology Departments has complied with the safety recommendations to limit virus spread. Although 86 (76.8%) of them confirmed that access has been restricted due to pandemic, only 10 caregivers (8.9%) perceived these precautions too restrictive, while 107 ( 95.5%) of the all sample defined them effective. Despite these constraints, approximately all respondents declared that they had the chance to dialogue with health care providers and had the possibility to access the oncologic department if necessary (respectively 106 subjects, 94.6% and 101, 90.1%). Moreover, more than half of caregivers (n=57, 50.9%) perceived that the quality of care has not been affected by the pandemic. Conclusions: Despite the COVID-19 pandemic has overwhelmed the Italian National Health System, maybe more than in other countries, Oncology Departments was considered worthy of the emergency care in terms of safety and care management by caregivers. Caregivers perceived and believed in an adequate quality of care for their relatives without economic implications.

Scientia potentia est: How the Italian world of oncology changes in the covid19 pandemic

Background: After COVID-19 was declared a pandemic by the World Health Organization, a response from the Italian Health System to react to an unprecedented condition became necessary and sudden. COVID-19 pandemic required oncologists to redefine clinical organization and management of cancer patients. The aim of our study was to take a picture of the situation of Italian oncologies and to evaluate the difficulties in patients management. Methods: Between 18th March and 9th April 2020 we conducted an online survey (Google Forms). It consisted of 45 questions ranging from individual perception of pandemic management by oncological centers to physicians and nurses psychological distress and patient care. The survey was anonymous and broadcasted to oncology health workers by mailing contacts, word of mouth and social networks. Results: A total of 383 oncology health workers participated in the survey. The majority was female (72%) and from central Italy (46%). Impressively, a total of 357 (93%) participants declared the Oncologic Department reorganized routine clinical activity, but only 41% was adequately trained about the required procedures. 20% of the survey attendees think they have not received adequate and timely protective devices with respect to clinical needs and according to 58% the supply of these devices was only partial. 34% of professionals declared they do not have or know a defined common guideline to reschedule patients' treatments. More than 80% of interviewees declared to feel worry about being at greater risk of contagion than the general population, 92% feared to transmit virus to family members. Deferring treatments has caused fear / anxiety in 228 of the interviewed (60%). Symptoms of stressful situations emerged with a deterioration in sleep quality in 62% of professionals, worsening of mood (69%) and lower concentration ability (49%). Conclusions: Our survey demonstrated the flexibility of oncologic teams. However, the emergency response quality has been heterogeneous, and several drawbacks emerged from this first analyses. Information, protection, testing and training of healthcare professionals are keywords that should be kept in mind to encourage recovery after this tragedy and to be ready to face a similar emergency in the next future.

Scientia potentia est: How the Italianworld of oncology changes in the COVID19 pandemic

Background: After COVID-19 was declared a pandemic by the World Health Organization, a response from theItalian Health System to react to an unprecedented condition became necessary and sudden. COVID- 19 pandemicrequired oncologists to redefine clinical organization and management of cancer patients. The aim of our study wasto take a picture of the situation of Italian oncologies and to evaluate the difficulties in patients' management. Methods: Between 18th March and 9th April 2020 we conducted an online survey (Google Forms). It consisted of45 questions ranging from individual perception of pandemic management by oncologic centers to physicians' andnurses' psychological distress and patient care. The survey was anonymous and broadcast to oncology healthworkers by mailing contacts, word of mouth, and social networks. Results: A total of 383 oncology health workers participated in the survey. The majority was female (72%) and fromcentral Italy (46%). Impressively, a total of 357 (93%) participants declared the Oncologic Department reorganizedroutine clinical activity, but only 41% were adequately trained about the required procedures. 20% of the surveyattendees thought they had not received adequate and timely protective devices with respect to clinical needs, andaccording to 58% the supply of these devices was only partial. 34% of professionals declared that they did not haveor know a defined common guideline to reschedule patients' treatments. More than 80% of interviewees declaredfeeling worried about being at greater risk of contagion than the general population, and 92% feared to transmitvirus to family members. Deferring treatments has caused fear/anxiety in 228 of the interviewed (60%). Symptomsof stressful situations emerged with a deterioration in sleep quality in 62% of professionals, worsening of mood(69%), and lower concentration ability (49%). Conclusions: Our survey demonstrated the flexibility of oncologic teams. However, the emergency response qualityhas been heterogeneous, and several drawbacks emerged from this first analysis. Information, protection, testing, and training of health care professionals are keywords that should be kept in mind to encourage recovery after thistragedy and to be ready to face a similar emergency in the near future.