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the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic has caused a major health crisis. Between March 1 and April 30, SARS-CoV-2 led to an excess daily mortality of 33% compared with average values for the years 2000 to 2019. 1 As of 17th December 2020, a report published by the French National Public Health Agency indicates a cumulative number of 2 427 316 COVID-19 infected patients, with 59 619 deaths, 41 200 of these in hospital. 2 The purpose of this critical commentary is to describe the COVID-19 crisis from the perspective of French intensive care unit (ICU) nurses and to discuss how the pandemic has finally facilitated appropriate recognition for French critical care nurses. This major crisis was managed nationally by the Ministry ofHealth, but every hospital had to locally manage the increased activity due to the admissions of COVID-19 patients with its own means. Decades of political decisions to decrease health costs has led to equipment and staff deficiencies for hospitals. To cope with these limited resources, health care professionals had to create new organizations and set up new collaborations. In the first days of the pandemic in France, health authorities expected that many patients would need intensive care, and an important gap between ICU capacity and demand was feared. Before the pandemic, French ICUs were already under pressure: with only 2.4 ICU beds for 10 000 citizens, half of

BackgroundThe clinical interest of using bubble humidification of oxygen remains controversial. This study was designed to further explore whether delivering dry oxygen instead of bubble-moistened oxygen had an impact on discomfort of ICU patients.MethodsThis randomized multicenter non-inferiority open trial included patients admitted in intensive care unit and receiving oxygen. Any patient receiving non-humidified oxygen (between 0 and 15 L/min) for less than 2 h could participate in the study. Randomization was stratified based on the flow rate at inclusion (less or more than 4 L/min). Discomfort was assessed 6–8 and 24 h after inclusion using a dedicated 15-item scale (quoted from 0 to 150).ResultsThree hundred and fifty-four ICU patients receiving non-humidified oxygen were randomized either in the humidified (HO) (n = 172), using bubble humidifiers, or in the non-humidified (NHO) (n = 182) arms. In modified intention-to-treat analysis at H6–H8, the 15-item score was 26.6 ± 19.4 and 29.8 ± 23.4 in the HO and NHO groups, respectively. The absolute difference between scores in both groups was 3.2 [90% CI 0.0; + 6.5] for a non-inferiority margin of 5.3, meaning that the non-inferiority analysis was not conclusive. This was also true for the subgroups of patients receiving either less or more than 4 L/min of oxygen. At H24, using NHO was not inferior compared to HO in the general population and in the subgroup of patients receiving 4 L/min or less of oxygen. However, for patients receiving more than 4 L/min, a post hoc superiority analysis suggested that patients receiving dry oxygen were less comfortable.ConclusionsOxygen therapy-related discomfort was low. Dry oxygen could not be demonstrated as non-inferior compared to bubble-moistened oxygen after 6–8 h of oxygen administration. At 24 h, dry oxygen was non-inferior compared to bubble-humidified oxygen for flows below 4 L/min.Electronic supplementary materialThe online version of this article (10.1186/s13613-018-0472-9) contains supplementary material, which is available to authorized users.

Background: Arterial pressure lability is common during the process of replacing syringes used for norepinephrine infusions in critically ill patients. It is unclear if there is an optimal approach to minimise arterial pressure instability during this procedures. We investigated whether 'double pumping' changeover (DPC) or automated changeover (AC) reduced blood pressure lability in critically ill adults compared with quick syringe changeover (QC). Methods: Patients requiring a norepinephrine infusion syringe change were randomised in a non-blinded trial undertaken in six ICUs. Randomisation was minimised by norepinephrine flow rate at inclusion and centre. The primary outcome was the frequency of increased/decreased mean arterial pressure (defined by 15 mm Hg from baseline measurements) within 15 min of switching the syringe compared with QC. Results: Patients (mean age: 64 (range:18e88)) yr were randomly assigned to QC (n¼95), DPC (n¼95), or AC (n¼96). Increased MAP was the commonest consequence of syringe changeovers. MAP variability was most frequent after DPC (89/224 changeovers; 39.7%) compared with 57/223 (25.6%) changeovers after quick syringe switch and 46/181 (25.4%) in patients randomised to receive automated changeover (P¼0.001). Fewer events occurred with QC compared with DPC (P¼0.002). Sensitivity analysis based on mixed models showed that performing several changeovers on a single patient had no impact. Both type of changeover and norepinephrine dose before syringe changeover were independently associated with MAP variations >15 mm Hg. Conclusions: Quick changeover of norepinephrine syringes was associated with less blood pressure lability compared with DPC. The prevalence of MAP variations was the same between AC and QC. Clinical trial registration: NCT02304939.