Cardiopulmonary resuscitation (CPR) in patients with severe acute respiratory syndrome coronavirus-2Àassociated disease (coronavirus disease 2019) poses a unique challenge to health-care providers due to the risk of viral aerosolization and disease transmission. This has caused some centers to modify existing CPR procedures, limit the duration of CPR, or consider avoiding CPR altogether. In this review, the authors propose a procedure for CPR in the intensive care unit that minimizes the number of personnel in the immediate vicinity of the patient and conserves the use of scarce personal protective equipment. Highlighting the low likelihood of successful resuscitation in high-risk patients may prompt patients to decline CPR. The authors recommend the preemptive placement of central venous lines in high-risk patients with intravenous tubing extensions that allow for medication delivery from outside the patients' rooms. During CPR, this practice can be used to deliver critical medications without delay. The use of a mechanical compression system for CPR further reduces the risk of infectious exposure to health-care providers. Extracorporeal membrane oxygenation should be reserved for patients with few comorbidities and a single failing organ system. Reliable teleconferencing tools are essential to facilitate communication between providers inside and outside the patients' rooms. General principles regarding the ethics and peri-resuscitative management of coronavirus 2019 patients also are discussed.

No abstract

Three patients underwent laryngeal and tracheal surgeries under apneic conditions using transnasal humidified rapid-insufflation ventilatory exchange. Transcutaneous carbon dioxide (CO2) levels were recorded throughout the apneic period to detect rates of CO2 rise. Conventional airway management was initiated after 15 minutes of apnea with either tracheal intubation or jet ventilation. No patient experienced oxygen desaturation <97%. The average rate of transcutaneous CO2 rise (1.7 mm Hg/min) was higher than previously reported using this technique. This suggests a need for further investigation into the utility of transnasal humidified rapid-insufflation ventilatory exchange for airway surgery and adequate ventilation during apnea.

Objective: To review the theoretical benefits of airway pressure release ventilation (APRV), summarize the evidence for its use in clinical practice, and discuss different titration strategies. Data Source: Published randomized controlled trials in humans, observational human studies, animal studies, review articles, ventilator textbooks, and editorials. Data Summary: Airway pressure release ventilation optimizes alveolar recruitment, reduces airway pressures, allows for spontaneous breathing, and offers many hemodynamic benefits. Despite these physiologic advantages, there are inconsistent data to support the use of APRV over other modes of ventilation. There is considerable heterogeneity in the application of APRV among providers and a shortage of information describing initiation and titration strategies. To date, no direct comparison studies of APRV strategies have been performed. This review describes 2 common management approaches that bedside providers can use to optimally tailor APRV to their patients. Conclusion: Airway pressure release ventilation remains a form of mechanical ventilation primarily used for refractory hypoxemia. It offers unique physiological advantages over other ventilatory modes, and providers must be familiar with different titration methods. Given its inconsistent outcome data and heterogeneous use in practice, future trials should directly compare APRV strategies to determine the optimal management approach.

Staphylococci, streptococci, and enterococci are frequently associated with endocarditis, but numerous complex and diverse species exist among the three groups and identification of specific pathogens can aid in treatment. One particular organism, Enterococcus hirae, is rarely described as a human pathogen and is more commonly identified among certain bird groups. We present the first documented case of human Enterococcus hirae infective endocarditis in the USA, representing only the fourth case worldwide.

No abstract

No abstract