Despite high short-term mortality and morbidity rates for these critically ill patients, open abdomen treatment using VAWCM allows patients to recover to an acceptable long-term quality of life. The complex intensive care score can be used as a surrogate parameter for the global severity of illness and was the only predictor of physical functioning (SF-36).

Introduction Coronavirus Disease 2019 (COVID-19) is spreading all over the world. Health systems around the globe have to deal with decreased capabilities and exhausted resources because of the surge of patients. The need to identify COVID-19 patients to achieve a timely opportunity to treat and isolate them is an ongoing challenge for health care professionals everywhere. A lack of testing capabilities forces clinicians to make the crucial initial decision on the basis of clinical findings and routine diagnostic laboratory test. This article reviews the current literature and presents a new adapted protocol for diagnosing and triaging COVID-19 patients. A special emphasis lies on the stepwise approach guiding the medical provider to a triage decision that is suitable for the individual patient and the situation of the local medical treatment facility. Materials and Methods On March 30, 2020, a PubMed based literature research on COVID-19 following the preferred reporting items for systematic reviews and meta-analyses guidelines was performed. A diagnostic and triage tool for COVID-19 was designed based on the major findings in the reviewed literature. Results After a selection process, focusing on the topics “epidemiology,” “clinical characteristics,” and “diagnostic tools,” 119 out of a total amount of 1,241 publications were selected to get an overview of the growing evidence. Conclusions The designed Early Recognition and Triage Tool enables the medical provider to use the applicable modules of the protocol for capabilities of the local setting to get the most appropriate diagnostic and triage done. The tool should give guidance for the initial approach until specific testing for the COVID-19 virus is available.

Introduction The medical treatment facilities (MTF) represent the equivalent of the healthcare system in the home countries, but they face the limitations of an outpost at the end of the supply chain. The capabilities are limited, and the necessary effort to extend the treatment capacity is tremendous. Algorithms based on scientific evidence or at least profound medical expertise are a tool to facilitate the decision-making process in triage under difficult circumstances. The aim of this article is to present a protocol that regards the specific entities military MTF abroad have to deal with in context of the COVID-19 pandemic. Material and Methods To prepare our own health system within the Resolute Support mission, an interdisciplinary team of consultants and nurses located at the multinational role 2E, Camp Marmal, Mazar-e-Sharif, Afghanistan, individually reviewed medical databases and the current literature concerning triage on intensive care units. The identified literature was evaluated by all authors. In the next step, an adapted flow chart for triage on intensive care unit in MTF abroad was set up on the basis of existing triage tools found in the reviewed literature. Results The authors created the “Structured Approach for Intensive Care Unit Triage (SAINT)” protocol. It is an approach that fits to the specific entities (e.g., limited medical resources in the whole system, limited intensive care unit capabilities for long-term stay or organ replacement therapy, etc.) that determine the framework of the special military health system abroad. Conclusions The presented triage protocol may be a tool for medical personnel to facilitate the difficult task of triaging. It provides guidance along patient-centered criteria like individual medical, ethical, and legal issues while taking into account the available resources. Future studies are needed to investigate the effectiveness of the SAINT protocol.

Supraglottic airway devices appear to offer advantages in restricted-access situations.

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Zusammenfassung Hintergrund Die Fournier-Gangrän ist eine nekrotisierende Fasziitis Typ I der genitalen und perinealen Regionen, die insbesondere bei schweren Verläufen und systemischer Sepsis mit einer hohen Letalität vergesellschaftet ist. Der Schwerpunkt wurde auf die Evaluation der Risikofaktoren und Komorbiditäten, auf das bakteriologische Spektrum, laborchemische Analysen, Mortalität und den Verlauf nach dem algorithmischen Vorgehen gelegt. Material und Methoden Es wurden 10 Patienten am Bundeswehrzentralkrankenhaus Koblenz im Zeitraum von 2010 bis 2019 mit einer Fournier-Gangrän und Sepsis sowie einer mindestens 48-stündigen Intensivtherapie erfasst und deskriptiv analysiert. Ergebnisse Die Patientenkohorte bestand aus 6 männlichen und 4 weiblichen Patienten mit einem Durchschnittsalter von 62 Jahren (Range 42 – 78 Jahre). Der durchschnittliche Zeitpunkt zwischen Auftreten der Beschwerden und der Krankenhausaufnahme betrug 4 Tage (Range 3 – 5). Die häufigste Genese war ein Bagatelltrauma bei bestehender entgleister Diabeteserkrankung (30%). Diabetes mellitus (60%) und Adipositas (80% mit BMI > 25) waren führende Risikofaktoren. Bei 90% der Patienten bestand eine polymikrobielle Besiedlung. Alle Patienten wiesen eine Multiorgandysfunktion auf und hatten einen SOFA-Score zwischen 3 und 17 Punkten. Die Mortalitätsrate betrug in unserem Patientenkollektiv 40%. Signifikante Unterschiede zwischen überlebenden und verstorbenen Patienten zeigten PCT, INR und aPTT (p < 0,05). Schlussfolgerung Die Fournier-Gangrän ist insbesondere bei septischem Verlauf nach wie vor eine Erkrankung mit hoher Letalitätsrate. Bei foudroyantem Verlauf bedarf es einer unmittelbaren Diagnosestellung sowie eines aggressiven operativen Vorgehens, um die Letalität so gering wie möglich zu halten. Nach initialem radikalem Débridement sowie stabilisierenden intensivmedizinischen Maßnahmen folgen weitere operative Eingriffe. In der postakuten Phase hat sich die Anwendung der Vakuumtherapie zur Defektverkleinerung bewährt.

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IntroductionRapid sequence induction of anaesthesia is indicated in patients with an increased risk of pulmonary aspiration. The main objective of the technique is to reduce the critical time period between loss of airway protective reflexes and rapid inflation of the cuff of the endotracheal tube to minimise the chance of aspiration of gastric contents. The COVID-19 pandemic has reinforced the importance of first-pass intubation success to ensure patient and healthcare worker safety. The aim of this study is to compare the first-pass intubation success rate (FPS) using the videolaryngoscopy compared with conventional direct laryngoscopy in surgical patients with a high risk of pulmonary aspiration.Methods and analysisThe LARA trial is a multicentre, patient-blinded, randomised controlled trial. Consecutive patients requiring tracheal intubation are randomly allocated to either the McGrath MAC videolaryngoscope or direct laryngoscopy using the Macintosh laryngoscope. The expected rate of FPS is 92% in the McGrath group and 82% in the Macintosh group. Each group must include a total of 500 patients to achieve 90% power for detecting a difference at the 5% significance level. Successful intubation with the FPS is the primary endpoint. The secondary endpoints are the time to intubation, the number of intubation attempts, the necessity of airway management alternatives, the visualisation of the glottis using the Cormack and Lehane Score and the Percentage Of Glottic Opening Score and definite adverse events.Ethics and disseminationThe project is approved by the local ethics committee of the Medical Association of the Rhineland Palatine state (registration number: 2020–15502) and medical ethics committee of the University of Freiburg (registration number: 21–1303). The results of this study will be made available in form of manuscripts for publication and presentations at national and international meetings.Trial registrationNCT04794764.