Critical Care Surge Capacity to Respond to the COVID-19 Pandemic in Italy: A Rapid and Affordable Solution in the Novara Hospital.

The rapid insurgence and spread of coronavirus disease 2019 (COVID-19) exceeded the limit of the intensive care unit (ICU) contingency plan of the Maggiore della Carità University Hospital (Novara, Italy) generating a crisis management condition. This brief report describes how a prompt response to the sudden request of invasive mechanical ventilation (IMV) was provided by addressing the key elements of health care system surge capacity from contingency to crisis. In a short time and at a relatively low cost, a structural modification of a hospital aisle allowed to convert the general ICU into a COVID-19 unit, increasing the number of COVID-19 critical care beds by 107%.

Sampling and analyzing alveolar exhaled breath condensate in mechanically ventilated patients: a feasibility study.

Recent studies in spontaneously breathing subjects indicate the possibility of obtaining the alveolar fraction of exhaled breath condensate (aEBC). In critically ill mechanically ventilated patients, in whom microbial colonization of the upper airways is constant, collection of aEBC could considerably add to the ability of monitoring alveolar inflammation. We designed this study to test the feasibility of collecting aEBC in mechanically ventilated critically ill patients through a dedicated apparatus, i.e. a CO2 valve combined with a condenser placed in the expiratory limb of the ventilator circuit. We also aimed to assess the adequacy of the samples obtained by measuring different markers of oxidative stress and inflammation. We enrolled 40 mechanically ventilated patients, 20 with and 20 without acute respiratory distress syndrome (ARDS). Measurements of respiratory mechanics, gas exchange and hemodynamics were obtained with a standard ventilator circuit after 30 min of aEBC collection and after inserting the dedicated collecting apparatus. Data showed that intrinsic positive end-expiratory pressure, peak and plateau pressure, static compliance and airway resistance (Raw) were similar before and after adding the collecting apparatus in both ARDS and controls. Similarly, gas exchange and hemodynamic variables did not change and 30 min collection provided a median aEBC volume of 2.100 and 2.300 ml for ARDS and controls, respectively. aEBC pH showed a trend toward a slight reduction in the ARDS group of patients, as opposed to controls (7.83 (7.62-8.03) versus 7.98 (7.87-8.12), respectively, p = 0.055)). H2O2 was higher in patients with ARDS, compared to controls (0.09 (0.06-0.12) µM versus 0.03 (0.01-0.09) µM, p = 0.043), while no difference was found in proteins content, 8-isoprostane, 4-hydroxy-2-nonhenal. In conclusion, we demonstrate, in patients receiving controlled mechanical ventilation, that aEBC collection is feasible without detrimental effects on ventilator functioning, respiratory mechanics and gas exchange. In addition, we show that the sample obtained is appropriate for compounds analysis.

[Assessment of non-traumatic chest pain in emergency room: comparison between heart score and triage assessment of an Italian hospital]. / La valutazione del dolore toracico non traumatico in pronto soccorso: confronto tra heart score e il triage di un ospedale italiano.

INTRODUCTION: Triage for non-traumatic chest pain is a difficult issue for nurses in Emergency Department. AIM: To compare sensibility and specificity of usual triage and HEART score. METHODS: A retrospective cohort study was conducted in the Emergency Room of Città della Salute e della Scienza - Molinette Hospital of Turin (Italy). Data about triage of patients with non-traumatic chest pain were retrieved and HEART score was calculated by a nurse blind to the triage assessment. RESULTS: Data on 428 patients were collected. The assessment with the HEART score showed a significantly higher sensitivity and specificity, respect to usual triage (p-value for comparison: 0.01 and 0.0001, respectively). Moreover the HEART score better identified patients with delayed risk. CONCLUSIONS: HEART score can be considered a more effective tool for the assessment of patients with non-traumatic chest pain.