Programme Hospitalier Recherche Clinique, Institut Pasteur, Inserm, French Public Health Agency.

We report a difficult intubation rate of 15.5% in obese patients and 2.2% in lean patients. None of the risk factors for difficult intubation described in the lean population was satisfactory in the obese patients. We also report a high risk of desaturation in obese patients with difficult intubation.

Background Coronavirus disease-2019 (COVID-19), a respiratory disease has been associated with ischemic complications, coagulation disorders, and an endotheliitis. Objectives To explore endothelial damage and activation-related biomarkers in COVID-19 patients with criteria of hospitalization for referral to intensive care unit (ICU) and/or respiratory worsening. Methods Analysis of endothelial and angiogenic soluble markers in plasma from patients at admission. Results Study enrolled 40 consecutive COVID-19 patients admitted to emergency department that fulfilled criteria for hospitalization. Half of them were admitted in conventional wards without any ICU transfer during hospitalization; whereas the 20 others were directly transferred to ICU. Patients transferred in ICU were more likely to have lymphopenia, decreased SpO2 and increased D-dimer, CRP and creatinine levels. In those patients, soluble E-selectin and angiopoietin-2 were significantly increased (p value at 0.009 and 0.003, respectively). Increase in SELE gene expression (gene coding for E-selectin protein) was confirmed in an independent cohort of 32 patients using a whole blood gene expression profile analysis. In plasma, we found a strong association between angiopoetin-2 and CRP, creatinine and D-dimers (with p value at 0.001, 0.001 and 0.003, respectively). ROC curve analysis identified an Angiopoietin-2 cut-off of 5000 pg/mL as the best predictor for ICU outcome (Se = 80.1%, Sp = 70%, PPV = 72.7%, NPV = 77%), further confirmed in multivariate analysis after adjustment for creatinine, CRP or D-dimers. Conclusion Angiopoietin-2 is a relevant predictive factor for ICU direct admission in COVID-19 patients. This result showing an endothelial activation reinforces the hypothesis of a COVID-19-associated microvascular dysfunction.

Background Coronavirus disease‐2019 (COVID‐19) has been associated with cardiovascular complications and coagulation disorders. Objectives To explore the coagulopathy and endothelial dysfunction in COVID‐19 patients. Methods The study analyzed clinical and biological profiles of patients with suspected COVID‐19 infection at admission, including hemostasis tests and quantification of circulating endothelial cells (CECs). Results Among 96 consecutive COVID‐19‐suspected patients fulfilling criteria for hospitalization, 66 were tested positive for SARS‐CoV‐2. COVID‐19‐positive patients were more likely to present with fever (P = .02), cough (P = .03), and pneumonia at computed tomography (CT) scan (P = .002) at admission. Prevalence of D‐dimer >500 ng/mL was higher in COVID‐19‐positive patients (74.2% versus 43.3%; P = .007). No sign of disseminated intravascular coagulation were identified. Adding D‐dimers >500 ng/mL to gender and pneumonia at CT scan in receiver operating characteristic curve analysis significantly increased area under the curve for COVID‐19 diagnosis. COVID‐19‐positive patients had significantly more CECs at admission (P = .008) than COVID‐19‐negative ones. COVID‐19‐positive patients treated with curative anticoagulant prior to admission had fewer CECs (P = .02) than those without. Interestingly, patients treated with curative anticoagulation and angiotensin‐converting‐enzyme inhibitors or angiotensin receptor blockers had even fewer CECs (P = .007). Conclusion Curative anticoagulation could prevent COVID‐19‐associated coagulopathy and endothelial lesion.

In morbidly obese patients, postoperative immediate and intermediate recoveries are more rapid and consistent after desflurane than after propofol or isoflurane anesthesia.

Background COVID‐19 is a respiratory disease associated to thrombotic outcomes with coagulation and endothelial disorders. Based on that, several anticoagulation (AC) guidelines have been proposed. We aimed to identify if AC therapy modifies the risk of developing severe COVID‐19. Methods and Results COVID‐19 patients initially admitted in medical wards of 24 French hospitals were included prospectively from February 26th to April 20th, 2020. We used Poisson regression model, Cox proportional hazard model and matched propensity score to assess the effect of AC on outcomes (intensive care unit (ICU) admission and/or in‐hospital mortality). Study enrolled 2878 COVID‐19 patients, among whom 382 (13.2%) were treated with oral AC therapy prior to hospitalization. After adjustment, AC therapy prior to hospitalization was associated with a better prognosis with an adjusted Hazard Ratio (aHR) 0.70 (95% CI 0.55‐0.88). Analyses performed using propensity score matching confirmed that AC therapy prior to hospitalization was associated with a better prognosis with an aHR of 0.43 (95% CI 0.29–0.63) for ICU admission and aHR of 0.76 (95% CI 0.61–0.98) for composite criteria ICU admission and/or death. In contrast, therapeutic or prophylactic low or high dose AC started during hospitalization were not associated with any of the outcomes. Conclusions AC therapy used prior to hospitalization in medical wards was associated with a better prognosis in contrast to AC initiated during hospitalization. AC therapy introduced in early step of disease could better prevent COVID‐19‐associated coagulopathy, endotheliopathy and prognosis.

This work shows that the insertion of a peripheral venous line is more difficult in obese than in lean patients. The usual recommendation, that a central venous line should be inserted routinely in obese patients to perform anesthesia, is not valid.

This study aimed to evaluate whether patient's wishes were respected by prehospital emergency medical teams after implementing collaboration and a standardized process between a community-based palliative network and the Emergency Medical Service system. Forty patients were included. In 75% of cases, the doctor of the prehospital emergency team decided in collaboration with the network's doctor according to the established procedure. This has enabled a respect of the care plan in 83% of cases. Without collaboration with the palliative care network, through the ignorance of its existence or through the wish of the prehospital emergency medical teams for taking decisions alone, the care plan was only respected in 40% of cases, P=0.025. Collaboration between prehospital emergency medical teams and community-based palliative care networks seems to enable a better respect of the care plan in the event of emergency situations affecting the patient in a palliative situation.