Highlights-Thoracic anesthesiologists might be involved in the perioperative care of patients suspected to have or diagnosed COVID-19 who might undergo thoracic surgery during the acute or convalescence phases of the disease.-Caution should be exercised when securing the airway and performing lung separation (if required), through vigilant donning/doffing of personal protection equipment (PPE), planning ahead, team briefing, proper preparations, systematic approach, and debriefing.-Lung separation / isolation should be individualized using either bronchial blockers or double lumen tubes according to the patient"s status and postoperative care plan.-Optimum PPE donning should be maintained during surgery and anesthesia. One lung ventilation could be challenging in this group of patients.-The anesthesiologists should discuss the feasibility of extubating the patient following thoracic surgery, and procedures for postoperative care andtransferring the patient to the isolation wards or intensive care unit.Abstract 110 words, Manuscript 4935 words Running

clinicaltrials.gov Identifier: NCT00621790.

Objective This systematic review and meta-analysis aimed to describe the features of right ventricular impairment and pulmonary hypertension in COVID-19 and assess its effect on mortality. Design We carried out a systematic review and meta-analysis of observational studies. Setting We performed a search through Pubmed, the International Clinical Trials Registry Platform, and the Cochrane Library for studies reporting right ventricular dysfunction in COVID-19 patients and outcomes. Participants The search yielded 9 studies in which the appropriate data were available. Interventions Pooled odds ratio were calculated according to the random effects model. Measurements and Main Results Overall, 1450 patients were analyzed, half of them invasively ventilated. Primary outcome was mortality at the longest follow-up available. Mortality was 48.5% versus 24.7% in patients with or without right ventricular impairment, (n = 7, OR = 3.10; 95% CI 1.72 – 5.58; p = 0.0002), 56.3% versus 30.6%, in patients with or without right ventricular dilatation (n = 6; OR = 2.43; 95% CI 1.41 – 4.18; p = 0.001), and 52.9% versus 14.8% in patients with or without pulmonary hypertension, (n = 3; OR = 5.75; 95% confidence intervals 2.67 – 12.38; p < 0.001). Conclusion Mortality of COVID-19 patients requiring respiratory support and with a diagnosis of right ventricular dysfunction, dilatation or pulmonary hypertension, is high. Future studies should highlight the mechanisms of right ventricular derangement in COVID-19 while early detection of right ventricular impairment using ultrasound might be important to individualize therapies and improve outcomes.

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Objective: Continuous positive airway pressure (CPAP) is an important therapeutic tool in COVID-19 acute respiratory distress syndrome (ARDS) since it improves oxygenation, reduces respiratory rate and can prevent intubation and intensive care unit (ICU) admission. CPAP during pronation has seldom been described and never during sedation. Design: Case series. Setting: High dependency unit of San Carlo University Hospital (Potenza, Italy). Patients: Eleven consecutive patients with COVID-19 ARDS. Intervention. Helmet CPAP in prone position after failing a CPAP trial in the supine position. Main variable of interest: Data collection at baseline and then after 24, 48 and 72 hours of pronation. We measured PaO2/FIO2, pH, lactate, PaCO2, SpO2, respiratory rate and the status of the patients at 28-day follow up. Results: Patients were treated with helmet CPAP for a mean +SD of 7+2.7 days. Prone positioning was feasible in all patients, but in 7 of them dexmedetomidine improved comfort. PaO2/FIO2 improved from 107.5±20.8 before starting pronation to 244.4±106.2 after 72 hours (p<.001). We also observed a significantly increase in Sp02 from 90.6±2.3 to 96±3.1 (p<.001) and a decrease in respiratory rate from 27.6±4.3 to 20.1±4.7 (p=.004). No difference was observed in PaCO2 or pH. At 28 days two patients died after ICU admission, one was discharged in the main ward after ICU admission and eight were discharged home after being successfully managed outside the ICU. Conclusions: Helmet CPAP during pronation was feasible and safe in COVID-19 ARDS managed outside the ICU and sedation with dexmedetomidine safely improved comfort. We recorded an increase in PaO2/FIO2, SpO2 and a reduction in respiratory rate.

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Our results suggest that both PV and KP offer therapeutic benefit significantly reducing pain and improving mobility in patients with vertebral fracture without significant differences between groups in term of quality. The leakage of cement has been observed only during PV.