Minimally-invasive tracheostomy (MIT): A care bundle for safety improvement in high-risk critically ill patients.

Background: Detailed reports are scarce on minimally-invasive tracheostomy (MIT) techniques for critically ill patients with challenging anatomy or complex coagulopathies. In such high-risk patients, conventional percutaneous dilatational tracheostomy (PDT) may lead to severe complications.

Methods: Aiming to broaden the scope of MIT for patients previously excluded due to high risks, we developed a new care bundle (MIT technique), specifically designed for intensive care specialists.

Beliefs, preferences, and acceptance of personal protective equipment for a shock room team in a tertiary care center.

Background: During coronavirus disease of 2019 pandemic a standard usage of personal protective equipment (PPE) in healthcare was mandatory, while actually the usage of PPE is currently decreasing. This raises the question about the further use of PPE in the clinical setting because healthcare workers (HCW) are at greater risk of being infected with SARS-CoV-2 than the general population. The primary objective of this study is to determine the proportion of shock room team members approving the further use of PPE including a FFP2 respirator in simulation training and reality.

Mechanisms of limitation of oxygen delivery during veno-venous extracorporal membrane oxygenation.

Delivery of oxygen to the mitochondrium is a process involving multiple steps. We here present the integration of the mechanisms of oxygen delivery (DO) during veno-venous (V-V) extracorporal membrane oxygenation (ECMO) into a holistic physiological model. The final steps of oxygen transport in this model are the convective transport of oxygen bound to hemoglobin in the arterial blood and the diffusion to the mitochondrium from the microcirculation.

Weaning assessment of veno-arteriovenous (V-AV) extracorporeal membrane oxygenation (ECMO).

Currently, there is a lack of methods for simultaneous assessment of readiness for decannulation of the veno-venous (V-V) and veno-arterial (V-A) components during veno-arteriovenous (V-AV) extracorporal membrane oxygenation (ECMO) support. We describe a novel approach using a simultaneous off-sweep and controlled backflow test to assess readiness for decannulation from V-AV ECMO. This method needs testing in future clinical trials.

Veno-arterial-venous extracorporal membrane oxygenation (V-AV ECMO) in a patient in ARDS and cardiac instability after severe polytrauma.

The role of extracorporeal life support (ECLS) in critically ill trauma patients is underutilized, mainly due to concerns of anticoagulation. However, short-term ECLS in these patients can be safely performed with no or minimal systemic anticoagulation. Case series show favorable outcomes in trauma patients with veno-venous (V-V) and veno-arterial (V-A) ECMO, respectively, but there are only a few case reports of successful veno-arterio-venous (V-AV) ECMO in polytrauma patients.

Simulation of Aerosol and Droplet Spread during Upper Airway and Gastrointestinal Endoscopy.

Background And Aims: Aerosols and droplets are the main vectors in transmission of highly contagious SARS-CoV-2. Invasive diagnostic procedures like upper airway and gastrointestinal endoscopy have been declared as aerosol-generating procedures. Protection of healthcare workers is crucial in times of the COVID-19 pandemic.

Leg-heel chest compression as an alternative for medical professionals in times of COVID-19.

Objective: To evaluate leg-heel chest compression without previous training as an alternative for medical professionals and its effects on distance to potential aerosol spread during chest compression.

Methods: 20 medical professionals performed standard manual chest compression followed by leg-heel chest compression after a brief instruction on a manikin. We compared percentage of correct chest compression position, percentage of full chest recoil, percentage of correct compression depth, average compression depth, percentage of correct compression rate and average compression rate between both methods.

Exploration of strategies to reduce aerosol-spread during chest compressions: A simulation and cadaver model.

Objective: To evaluate the effect of strategies to reduce the spread of simulated aerosol during chest compressions on manikin and cadaver experimental models.

Methods: To evaluate aerosol-spread we nebulized ultraviolet sensitive detergents into the artificial airway of a resuscitation dummy and performed CPR. The spread of the visualized aerosol was documented by a camera.

Extreme Metabolic Alkalosis and Acute Kidney Injury in a 38-Year-Old Male Patient.

Repeated vomiting may lead to profound loss of fluid and electrolytes. We describe a case with life-threatening acid-base disturbances due to vomiting. A 38-year-old man presented to an emergency department with weakness and decreased urine output after having vomited up to 20 times per day over a period of 7 days.

New echocardiographic findings correlate with intramyocardial inflammation in endomyocardial biopsies of patients with acute myocarditis and inflammatory cardiomyopathy.

Background: The diagnosis of acute myocarditis (AMC) and inflammatory cardiomyopathy (DCMi) can be difficult. Speckle tracking echocardiography with accurate assessments of regional contractility could have an outstanding importance for the diagnosis.

Methods And Results: N = 25 patients with clinically diagnosed AMC who underwent endomyocardial biopsies (EMBs) were studied prospectively.