Summary Background & Aims Little is known about cholestasis including its most severe variant secondary sclerosing cholangitis (SSC), in critically ill patients with coronavirus disease 19 (COVID‐19). In this study we analyzed the occurrence of cholestatic liver injury and SSC, including clinical, serological, radiological and histopathological findings. Methods We conducted a retrospective single‐center analysis of all consecutive patients admitted to the intensive care unit (ICU) due to severe COVID‐19 at the University Hospital Zurich to describe cholestatic injury in these patients. The findings were compared to a retrospective cohort of patients with severe influenza A Results 34 patients with severe COVID‐19 admitted to the ICU were included. 14 patients (41%) had no cholestasis (group 0), 11 patients (32%, group 1) developed mild and 9 patients (27%, group 2) severe cholestasis. Patients in group 2 had a more complicated disease course indicated by significantly longer ICU stay (median 51 days IQR 25‐86.5) than the other groups (group 0 median 9.5 days IQR 3.8‐18.3 p =0.001 and group 1 median 16 days IQR 8‐30 p < 0.05 respectively). Four patients in group 2 developed SSC compared to none in the influenza A cohort. The available histopathological findings suggest an ischemic damage to the perihilar bile ducts. Conclusions The development of SSC represents an important complication of critically ill COVID‐19 patients and needs to be considered in the diagnostic work up in prolonged cholestasis. The occurrence of SSC is of interest in the ongoing pandemic since it is associated with considerable morbidity and mortality.

Background: Portable respiratory inductive plethysmography (RIP) is promising for noninvasive monitoring of breathing patterns in unrestrained subjects. However, its use has been hampered by requiring recalibration after changes in body position. Objectives: To facilitate RIP application in unrestrained subjects, we developed a technique for adjustment of RIP calibration using position sensor feedback. Methods: Five healthy subjects and 12 patients with lung disease were monitored by portable RIP with sensors incorporated within a body garment. Unrestrained individuals were studied during 40–60 min while supine, sitting and upright/walking. Position was changed repeatedly every 5–10 min. Initial qualitative diagnostic calibration followed by volume scaling in absolute units during 20 breaths in different positions by flow meter provided position-specific volume-motion coefficients for RIP. These were applied during subsequent monitoring in corresponding positions according to feedback from 4 accelerometers placed at the chest and thigh. Accuracy of RIP was evaluated by face mask pneumotachography. Results: Position sensor feedback allowed accurate adjustment of RIP calibration during repeated position changes in subjects and patients as reflected in a minor mean difference (bias) in breath-by-breath tidal volumes estimated by RIP and flow meter of 0.02 liters (not significant) and limits of agreement (±2 SD) of ±19% (2,917 comparisons). An average of 10 breaths improved precision of RIP (limits of agreement ±14%). Conclusions: RIP calibration incorporating position sensor feedback greatly enhances the application of RIP as a valuable, unobtrusive tool to investigate respiratory physiology and ventilatory limitation in unrestrained healthy subjects and patients with lung disease during everyday activities including position changes.

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Zusammenfassung. Die akute Rechtsherzinsuffizenz ist ein kritischer Zustand, der anhand der klinischen Präsentation kombiniert mit Echokardiografie diagnostiziert wird. Zusatzdiagnostik inkl. Labor, EKG, Rechtsherzkatheter und weitere bildgebende Verfahren werden zur Ursachenabklärung benötigt. Therapeutisch spielen die Identifikation und Behandlung der zu Grunde liegenden Pathologie, die Reduktion der rechtsventrikulären Nachlast (sofern möglich), eine Optimierung der Vorlast (häufig Diuretika, selten Volumen) und eine Kreislaufunterstützung mittels Vasopressoren und/oder Inodilatatoren eine zentrale Rolle. In schweren Fällen kommen spezielle Therapien und mechanische Kreislaufunterstützungssysteme ins Spiel.