Zusammenfassung Hintergrund Seit dem Auftreten des neuen Coronavirus im Dezember 2019 in China haben viele Länder Schwierigkeiten, die ansteigende Zahl der Infektionen, auch innerhalb des medizinischen Personals, zu kontrollieren. Es hat sich mittlerweile deutlich gezeigt, dass das neue SARS-CoV-2-Virus insbesondere über Aerosole und Tröpfchen der oberen Atemwege übertragen wird und die Infektionsgefahr bei oberen Atemwegsprozeduren deutlich erhöht ist. Ein Anteil der schwererkrankten beatmungspflichtigen Patienten benötigt ab einem gewissen Zeitpunkt eine Tracheotomie zur langfristigen Beatmung und einfacheren Entwöhnung von der Beatmungsmaschine. Diese Patienten erfordern jedoch im Anschluss eine nicht unerhebliche Betreuung durch medizinisches Pflegepersonal, und es ist bislang unklar, inwieweit die Tracheostomapflege ein Risiko für sekundäre Infektionen darstellt. Fragestellung Evaluierung der Gefahr der Tröpfchenbildung bei Trachealkanülenwechsel, Überblick zum Kanülenwechsel bei COVID-19-Patienten. Material und Methoden Literaturrecherche, quantitative und qualitative Analyse der Tröpfchenfreisetzung bei Kanülenwechsel an n = 8 Patienten, Übersicht und Checkliste für Kanülenwechsel. Ergebnisse Diese Studie demonstriert, dass beim Kanülenwechsel, insbesondere bei Einführen der neuen Kanüle, eine nicht unbeträchtliche Menge an Tröpfchen entstehen kann. Eine Aerosolbildung von Partikeln kleiner als 5 µm wurde nicht untersucht. Schlussfolgerung Unsere Ergebnisse im Zusammenhang mit der aktuellen Literatur verdeutlichen, dass die Pflege nach Tracheotomie eine hoch risikoreiche Prozedur darstellt und nur von einer kleinen Gruppe von geschultem und gut geschütztem Personal durchgeführt werden sollte.

BackgroundThe VEGF Inhibition Study In Ocular Neovascularisation (VISION) reported the efficacy of intravitreal (ITV) vascular endothelial growth factor (VEGF) inhibition with pegaptanib sodium (Macugen®) for the treatment of neovascular age-related macular degeneration (AMD). This paper reports clinical experience with pegaptanib sodium for the treatment of occult or minimally classic choroidal neovascularization (CNV) due to AMD.Material and methodsThe study included 50 eyes (in 49 patients) with either occult CNV or minimally classic CNV secondary to neovascular AMD who were not eligible for photodynamic therapy (PDT). Study data were analyzed retrospectively. During the 6-month study, patients were administered an average 2.74 injections of 0.3 mg ITV pegaptanib sodium. Angiography and optical coherence tomography (OCT) examinations were carried out and intraocular pressure (IOP) and visual acuity (VA) were measured at baseline, at 3 months and at 6 months. An eye examination was performed and VA was measured the 2 days following treatment and then again at weeks 4–6, and at 3 and 6 months. OCT, VA, and IOP were also assessed at 1 month.ResultsITV pegaptanib sodium was well tolerated and no treatment complications arose. Mean VA was measured as: 0.37 ± 0.24 at baseline; 0.37 ± 0.25 at 1 month; 0.37 ± 0.25 at 3 months and 0.40 ± 0.26 at 6 months. VA was stabilized in approximately 90% of eyes treated with pegaptanib sodium. OCT examination showed a minimal change in central retinal thickness (CRT) during the course of the study, from 251.19 μm at baseline to 251.63 μm at 6 months. No elevation in IOP was measured during treatment at 4–6 months in patients receiving pegaptanib sodium.ConclusionsITV therapy with pegaptanib sodium for occult and minimally classic CNV secondary to neovascular AMD offered good efficacy with a favorable adverse events profile. The majority of patients showed stabilization in all assessed parameters. In clinical practice, careful consideration should be given to the use of nonselective VEGF inhibition in patients with a high cardiovascular risk profile or in those with a history of thromboembolic events.

Introduction: During the COVID-19 pandemic, worldwide over 600,000 human beings died due to the cause of the disease. In order to deescalate the transmission rate and to avoid crush loading the countries medical health systems social distancing, face masks, and lockdowns have been considered essential by the majority of governments. Whereas some countries have highly reduced or completely stopped otorhinolaryngological procedures, other countries have continued selected surgeries. The objective of this study was to analyze procedures and outcomes of continuing semielective and emergency surgeries during the COVID-19 pandemic. Methods: Retrospective analysis of n = 750 patients who received semi-elective or emergency surgery between March 26 and June 16, 2020, in the Otolaryngology Department of the Friedrich-Alexander-University of Erlangen-Nürnberg. All patients were screened for COVID symptoms and swabbed for SARS-CoV-2 prior to surgery. Results: Of the n = 750 patients, n = 699 patients received semielective surgery and n = 51 emergency surgery. For 27 patients, the swab result could not be awaited due to a life-threatening condition. In these cases, surgery was performed in full protective equipment. No patient was tested positive during or after the surgery (follow-up 45 to 127 days). No member of the medical personnel showed symptoms or was tested positive after contact with patients. Due to the continuation of surgeries, patients’ lives were saved and improvement of long-term quality-of-life and outcomes is anticipated. Conclusions: Continuing selected otorhinolaryngological surgeries is crucial for patients’ health, survival, and long-time quality of life, yet, the protection of the medical personnel has to be granted.

During the COVID-19 pandemic, a significant number of healthcare workers have been infected with SARS-CoV-2. However, there remains little knowledge regarding large droplet dissemination during airway management procedures in real life settings. 12 different airway management procedures were investigated during routine clinical care. A high-speed video camera (1000 frames/second) was for imaging. Quantitative droplet characteristics as size, distance traveled, and velocity were computed. Droplets were detected in 8/12 procedures. The droplet trajectories could be divided into two distinctive patterns (type 1/2). Type 1 represented a ballistic trajectory with higher speed large droplets whereas type 2 represented a random trajectory of slower particles that persisted longer in air. The use of tracheal cannula filters reduced the amount of droplets. Respiratory droplet patterns generated during airway management procedures follow two distinctive trajectories based on the influence of aerodynamic forces. Speaking and coughing produce more droplets than non-invasive ventilation therapy confirming these behaviors as exposure risks. Even large droplets may exhibit patterns resembling the fluid dynamics smaller airborne aerosols that follow the airflow convectively and may place the healthcare provider at risk.