COVID-19

Publications and Guidelines

08.04.2020

Clear plastic drapes may be effective at limiting aerosolization and droplet spray during extubation: implications for COVID-19

The authors of this article propose the use of clear plastic drapes for extubation to reduce the spread of droplets during extubation

Comment Taskforce Knowledge-Management Covid-19

Dies ist eine mögliche Variante das Problem der Tröpfchenbildung beim Husten bei der Extubation zu reduzieren. Verschiedene Wege führen zu dem Ziel und sind legitim. Dies ist jedoch ein sehr einfacher Ansatz. Das verlinkte "supplemental video" ist interessant.

#prevention #treatment #anaesthesiology #ICU
08.04.2020

Aerosol-spread during chest compressions in a cadaver model

This CPR simulator model and cadaver study for chest-compressions during CPR showed that chest-compression only CPR has a high risk for aerosol spread. Endotracheal intubation itself however also has a high risk of aerosolization. Insertion of a laryngeal tube with HEPA-filter during CPR may lead to improved oxygenation and protect health care providers.

#treatment #prevention #emergency medicine #anaesthesiology
08.04.2020

PRAETORIAN-COVID: A Double-blind, Placebo-controlled Randomized Clinical Trial With Valsartan for PRevention of Acute rEspiraTORy dIstress Syndrome in hospitAlized patieNts With SARS-COV-2 (COVID-19) Infection Disease

Planned randomized controlled trial to evaluate the effect of RAS-Inhibition with AT1R blockage on ICU admission, mechanical ventilation and death in COVID19 infected patients.

Comment Taskforce Knowledge-Management Covid-19

RAS-Inhibitors: Friend or Foe in COVID19-Infections? Erst die prospektiven, randomisierten Trials werden es zeigen.

#general #prevention #cardiovascular #nephrology
08.04.2020

Extracorporeal membrane oxygenation (ECMO): does it have a role in the treatment of severe COVID-19?

This article suggests the use of extracorporal membrane oxygenation (ECMO) as a rescue therapy for acute respiratory distress syndrom (ARDS) in COVID-19 patients. This has also been suggested by WHO guideline and recent FDA approval.

Comment Taskforce Knowledge-Management Covid-19

Der Einsatz von ECMO beim schweren ARDS konnte das Outcome bei H1N1 Infektionen, sowie MERS in der Vergangenheit verbessern. Bei COVID-19 sind jedoch erst wenig Daten verügbar und diese zeigen eher einen bescheidenen oder gar keinen Vorteil auf die Patientenmortalität. WHO und FDA empfehlen dies derzeit als Rescue-Therapy. Weitere Studien sind notwendig für eine Bessere Beurteilung dieser Therapie bei COVID-19.

#review #therapy #ICU #anaesthesiology #pneumology
08.04.2020

Urinalysis, but not blood biochemistry, detects the early renal-impairment in patients with COVID-19

Abnormal urinary findings are prevalent in COVID infected patients irrespective of their Serum Creatinine Level. Pathological Urinalysis is associated with more severe disease course.

Comment Taskforce Knowledge-Management Covid-19

Retrospektive Studie über Urinbefunde bei COVID-19 infizierten Patienten. Rund die Hälfte hatten relevante pathologische Befunde, v.a. Proteinurie und/oder Leukozyt-/Erythrozyturie. Erhöhtes Kreatinin und eingeschränkte Nierenfunktion war in dieser Studie selten und nicht mit den Urinbefunden assoziiert. Die Befunde könnten Ausdruck einer direkten zytopathischen COVID-Infektion der Niere sein. Ob es strukturelle Nephropathien triggert und langfristig relevant ist, bleibt abzuwarten.

#nephrology
08.04.2020

Kidney diseases in the time of COVID-19: major challenges to patient care

Brief overview about the prevalence and outcome of COVID infection in dialysis patients and kidney transplant recipients.

Comment Taskforce Knowledge-Management Covid-19

Nicht nur die Immunsuppression, sondern die Komorbiditäten und der häufige Kontakt zu Gesundheitsinsitutionen scheinen relevant.

#nephrology
08.04.2020

Clinical Trial for the Prevention of SARS-CoV-2 Infection (COVID-19) in Healthcare Personnel (EPICOS) (EPICOS)

This study aims to assess the efficacy of a daily single dose of tenofovir disoproxil fumarate (TDF) (245 mg)/ Emtricitabine (FTC) (200 mg), a daily single dose of hydroxychloroquine (HC) (200 mg), a daily single dose of TDF (245 mg)/FTC (200 mg) plus HC (200 mg) versus placebo, during 12 weeks in: (1) reducing the incidence of symptomatic disease and (2) reducing clinical severity COVID-19 among hospital healthcare workers aged 18 to 65 years in public and private hospitals in Spain. The trial plans to enroll 4'000 participants.

Comment Taskforce Knowledge-Management Covid-19

Healthcare workers are particularly at risk of SARS-CoV-2. This is one of the first prevention trials to reduce SARS-CoV-2 transmission using a drug.

#prevention
08.04.2020

Facemasks and Similar Barriers to Prevent Respiratory Illness Such as Covid-19: A Rapid Systematic Review.

Based on only few RCTs authors conclude that wearing facemasks can be very slightly protective against primary infection from casual community contact, and modestly protective against household infections when both infected and uninfected members wear facemasks. However, authors think that there is enough evidence to support the use of facemasks for short periods of time by particularly vulnerable individuals when in transient higher risk situations.

Comment Taskforce Knowledge-Management Covid-19

Probably the first rapid systematic review on the question whether and how much widespread use of facemasks may help to prevent respiratory illness such as SARS-CoV-2. Not surprising, there are only few well-designed studies addressing this question.

#prevention
08.04.2020

Coronavirus Disease 2019 (COVID‐19): Do Angiotensin‐Converting Enzyme Inhibitors/Angiotensin Receptor Blockers Have a Biphasic Effect?

Cardiologists and infectiologists from the the Inselspital comment on the possible biphasic effect of Angiotensin‐Converting Enzyme Inhibitors/Angiotensin Receptor Blockers in Covid-19.

Comment Taskforce Knowledge-Management Covid-19

Die Autoren stellen eine Hypothese auf, welche besagt, dass ACE Hemmer und Angiotensin-Rezeptor Blocker einerseit den Eintritt des Virus in die Zellen via ACE2 up-regulation begünstigen könnten. Andererseits wäre eine up-regulation des ACE2 bei bereits infizierten Patienten mit diesen Medikamenten erwünscht um das lungenschädigende Angiotensin II tief zu halten. Sicherlich muss eine solche Hypothese mittels Studien genau untersucht werden und bis dahin sollte nichts an der Medikation verändert werden.

#general #clinical #cardiovascular #infectious diseases
08.04.2020

Angiotensin Converting Enzyme 2: A Double-Edged Sword

The authors describe the bifunctional role of ACE2 as a “double-edged sword”, which turns off the renin-angiotensin system and leads to beneficial effects but also mediates unique susceptibility to lung and cardiovascular disease in COVID-19 patients by serving as the SARS-CoV-2 receptor.

#cardiovascular #pneumology