. Two patients with respiratory failure due to confirmed COVID-19 were examined using bedside lung ultrasound (LUS) shortly after intubation and start of invasive ventilation. In the first patient, LUS revealed extensive atelectatic areas. A recruitment maneuver was applied, resulting in some reaeration of areas that showed atelectasis, and some improvement in oxygenation was observed. Oxygenation improved further with the use of prone positioning. In the second patient, LUS showed diffuse abnormalities without atelectatic areas, and ventilation proceeded without a recruitment maneuver but with prone positioning. These two cases illustrate how LUS could be useful in identifying different lung morphologies early after the start of invasive ventilation and help decide on adjunctive therapies. This has possible implications for ventilator management in resource-limited settings, with limited availability of chest computed tomography and blood gas analyzers. Tailoring invasive ventilation based on LUS findings early after the start of invasive ventilation is feasible, but this should be further evaluated in future studies.
Introduction: Oocyte retrieval is a fundamental step in vitro fertilization (IVF). To date, no anesthetic technique has demonstrated superiority in terms of efficacy. The Virtual Reality (VR) distraction technique has been researched for its clinical applications. The main objective of this study was to reduce the need for sedation with the VR distraction during oocyte retrieval while maintaining satisfaction with the quality of care.Materials and Method: We included 44 patients scheduled for oocyte retrieval in 2 groups: 22 patients in the distraction group via virtual reality (VR) and 22 patients in the control group. In the VR group, patients benefited from VR distraction with rescue sedation if necessary. In the control group, the patients benefited from routine sedation (propofol and remifentanil). The primary endpoint was propofol and remifentanil dose reductions with virtual reality distraction. The secondary endpoints were patient satisfaction, comfort, pain, and anxiety using validated questionnaires. Patient pain was measured using a visual analog scale (VAS). Patient comfort was measured using the Gloucester comfort scale. Patient satisfaction was evaluated with a Net Promoter Score (NPS). The State-Trait Anxiety Inventory (STAI) was used the measurement of patient anxiety.Results: We observed a significant decrease in propofol (50.9 mg for the VR group versus 118.6 mg for the control group, P = 0.0013) and remifentanil (90.5 µg in the VR group versus 135.65 µg in the control group, P = 0.0047) with VR distraction. Both groups had similar comfort, pain, anxiety, and patient satisfaction with the procedure.Conclusion: In our study, distraction by virtual reality reduced the need for sedation during oocyte retrieval while maintaining satisfaction with the quality of care with earlier recovery.
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