Lung ultrasound-guided PEEP titration in COVID-19 patients treated with CPAP.

OBJECTIVES: An increasing number of COVID-19 patients were treated with continuous positive airways pressure (CPAP). To evaluate the clinical effects of personalized positive end-expiratory pressure (PEEP) compared to standard fixed PEEP in COVID-19 patients requiring CPAP. METHODS: This is a single center, prospective, randomized clinical study. Sixty-three COVID-19 patients with hypoxemic respiratory failure and bilateral pneumonia were randomized in two Groups: Group A received CPAP with fixed PEEP of 10 cm H2O, Group B performed the "PEEP trial", that consists in the evaluation of best PEEP defined as the PEEP value that precedes the echographic appearance of "lung pulse" determining a PaO2/FiO2 increase. Primary outcome was composite in-hospital mortality + intubation, secondary outcome was the percentage increase of PaO2/FiO2. As safety indicator, the incidence of pneumothorax was collected. RESULTS: Thirty-two patients were enrolled in Group A and 31 in Group B. The two groups were comparable for clinical characteristics and laboratory parameters. The primary outcome occurred in 36 (57.1 %) patients: 23 (71.8 %) in Group A and 13 (41.9 %) in Group B (p<0.01). Mortality was higher in Group A (53.1 vs. 19.3 %, p<0.01), while intubation rate was comparable between groups. Group B showed a higher PaO2/FiO2 increase than Group A (34.9 vs. 13.1 %, p<0.01). Five cases of pneumothorax were reported in Group A, none in Group B. CONCLUSIONS: Lung ultrasound-guided PEEP trial is associated with lower mortality in COVID-19 patients treated with CPAP. Identifying the best PEEP is useful to increase oxygenation and reduce the incidence of complications.

Three-Dimensional (3D) Printing: Implications for Risk Assessment and Management in Occupational Settings.

The widespread application of additive manufacturing (AM) technologies, commonly known as three-dimensional (3D) printing, in industrial and home-business sectors, and the expected increase in the number of workers and consumers that use these devices, have raised concerns regarding the possible health implications of 3D printing emissions. To inform the risk assessment and management processes, this review evaluates available data concerning exposure assessment in AM workplaces and possible effects of 3D printing emissions on humans identified through in vivo and in vitro models in order to inform risk assessment and management processes. Peer-reviewed literature was identified in Pubmed, Scopus, and ISI Web of Science databases. The literature demonstrated that a significant fraction of the particles released during 3D printing could be in the ultrafine size range. Depending upon the additive material composition, increased levels of metals and volatile organic compounds could be detected during AM operations, compared with background levels. AM phases, specific job tasks performed, and preventive measures adopted may all affect exposure levels. Regarding possible health effects, printer emissions were preliminary reported to affect the respiratory system of involved workers. The limited number of workplace studies, together with the great variety of AM techniques and additive materials employed, limit generalizability of exposure features. Therefore, greater scientific efforts should be focused at understanding sources, magnitudes, and possible health effects of exposures to develop suitable processes for occupational risk assessment and management of AM technologies.

The use of chest ultrasonography in suspected cases of COVID-19 in the emergency department.

AIM: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus-specific reverse transcriptase-polymerase chain reaction (RT-PCR) represents the diagnostic gold standard. We explored the value of chest ultrasonography to predict positivity to SARS-CoV-2 on RT-PCR in suspected COVID-19 cases. PATIENTS & METHODS: Consecutive patients with suspect COVID-19 were included if they had fever and/or history of cough and/or dyspnea. Lung ultrasound score (LUSS) was computed according to published methods. RESULTS: A total of 76 patients were included. A 3-variable model based on aspartate transaminase (AST) > upper limit of normal, LUSS >12 and body temperature >37.5°C yielded an overall accuracy of 91%. CONCLUSION: A simple LUSS-based model may represent a powerful tool for initial assessment in suspected cases of COVID-19.