C oronavirus disease 2019 (COVID-19) has a 3.1% fatality rate and is spread primarily through droplets and contact. Anesthetists working in hospitals may perform procedures and provide care involving the respiratory system [eg, cardiopulmonary resuscitation (CPR), airway management, intubation, chest compression, and face mask ventilation], which increases their risk of viral infection and death. To help mitigate these adverse outcomes, the European Resuscitation Council has prioritized staff safety and recommends that personal protective equipment (PPE) is worn by rescuers performing CPR. The minimum PPE recommendation includes a respirator mask (FFP2 or N95 respirator mask if FFP3 is not available).While the N95 mask has met safety guidelines in the past, there are downsides to the N95 mask design: it is only 95% effective against aerosol particle penetration compared with the 99% of FFP3 masks, it does not have a face-tight seal, and the shape and movement may compromise its efficacy (a study found 61% of those wearing N95 masks failed at least one third of chest compression sessions, and 18% experienced mask failures). Value and cup-type N95 mask efficacy was especially low.Powered air-purifying respirators, while not being perfectly protective and though they are more cumbersome and time consuming to put on, are shown to be more protective than N95 masks while providing CPR.Health care workers should consider the risk and benefits of available PPE when approaching situations involving CPR for optimal safety.
T o include a more comprehensive pool of women and babies at increased risk of adverse outcomes, a more comprehensive definition of preeclampsia (PE) has been largely adopted. This study aimed to identify how varying definitions of PE at term gestation determine maternal and perinatal adverse outcomes.This prospective cohort study at 2 large hospitals in the United Kingdom between October 2016 and September 2018 included women between 35 0/7 and 36 6/7 weeks of gestation. During a routine visit the following were collected: maternal demographics, maternal history, fetal anatomy ultrasound, estimated fetal weight (EFW), Doppler measurements, maternal serum placental growth factor (PIGF) measurement, maternal soluble fms-like tyrosine kinase-1 (sFlt-1) measurement, and gestational age. Women with singleton pregnancies who delivered a nonmalformed live-born or still-born baby were included in the study. Women with aneuploid or major fetal abnormalities were excluded. Hospital records were collected to determine the presence of PE and gestational hypertension. Five definitions of PE were analyzed: (1) the established traditional clinical standard definition with onset proteinuria; (2) the maternal-criteria American College of Obstetricians and Gynecologists (ACOG) 2013 definition; (3) the International Society for the Study of Hypertension in Pregnancy maternal factors (ISSHP-M) definition; (4) the International Society for the Study of Hypertension in Pregnancy maternal-fetal factors [ISSHP-MF; EFW <3rd percentile or EFW at the 3rd to 10th percentile in combination with uterine artery pulsatility index (UtA-PI) > 95th percentile, umbilical artery pulsatility index (UAPI) > 95th percentile, or middle cerebral artery pulsatility index [MCA PI] <5th percentile); and (5) the maternal-fetal criteria plus angiogenic imbalance ISSHP definition (ISSHP-MF-AI; PGF <5th percentile or soluble fms-like tyrosine kinase-1etoeserum PGF > 95th percentile). Primary outcomes included severe maternal hypertension (160 mm Hg systolic BP or 110 mm Hg diastolic BP), perinatal mortality (neonatal death up to 28 d following birth), major maternal or neonatal morbidity (one or more severe adverse outcomes), <10th percentile neonatal birthweight, and neonatal unit admission ≥ 48 hours.Of the 15,248 women included in the study, <2% had elevated BP, and <10% had abnormal UtA readings, UA readings, MCA PI readings, PlGF ratio, or sFlt-1-to-PlGF ratio at the routine hospital visit. Analyses identified the following PE rates for the five definitions: traditional, 1.8% (15 of 281); ACOG, 2.1% (15 of 326); ISSHP-MF 2.6% (15 of 400); ISSHP-MF, 2.8% (15 of 434); ISSHP-MF-AI, 3.3% (15 of 500). For all five definitions, <20% of women presented with severe hypertension and maternal morbidity was around 5%. Perinatal mortality or major morbidity occurred in approximately 9% and 11% of gestational hypertension (GH) and PE pregnancies, respectively. Birthweight <10th percentile occurred in <20% and 20% of GH and PE pregnancies, respectively. Neonatal unit a...
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