Background: The COVID-19 pandemic has, by necessity, contributed to rapid advancements in medicine. Owing to the necessity of following strict anti-epidemic sanitary measures when taking care of infected patients, the accessibility of standard diagnostic methods may be limited. Consequently, the significance and potential of bedside diagnostic modalities increase, including lung ultrasound (LUS). Method: Multicenter registry study involving adult patients with confirmed COVID-19, for whom LUS was performed. Results: A total of 228 patients (61% males) qualified for the study. The average age was 60 years (±14), 40% were older than 65 years of age. In 130 from 173 hospitalized patients, HRCT (high-resolution computed tomography) was performed. In 80% of patients, LUS findings indicated interstitial pneumonia. In hospitalized patients multifocally located single B-lines, symmetrical B-lines, and areas of white lung were significantly more frequent as compared to ambulatory patients. LUS findings, both those indicating interstitial syndrome and consolidations, were positively correlated with HRCT images. As compared to HRCT, the sensitivity and specificity of LUS in detecting interstitial pneumonia were 97% and 100%, respectively. Conclusions: As compared to HRCT, LUS is characterized by a very high sensitivity and specificity in detecting interstitial pneumonia in COVID-19 patients. Potentially, LUS can be a particularly useful diagnostic modality for COVID-19 patients pneumonia.

Bronchofiberoscopy (FOB) is a procedure routinely performed for: lung cancer, obstruction, interstitial diseases, foreign bodies' removal, airway clearance, and hemoptysis. It causes acute airway narrowing leading to respiratory and cardiovascular stress. Due to increasing number of ill patients with respiratory failure (RF), conventional oxygen therapy (COT) is frequently insufficient to assure accurate oxygenation and prevent RF in patients requiring FOB. In this clinical scenario, patients may be intubated and supported with invasive mechanical ventilation (IMV) with the specific aim of allowing a safe FOB. However, this invasive strategy is associated with an increased risk of IMV-associated complications. Our study is a planned prospective multicenter three-arm randomized controlled trial (RCT). The target number of 300 patients was calculated based on the intubation risk in RF patients, which is 0.2-2%. The patients will be assigned to each arm based on Horowitz index. In each arm, the patients will be randomly assigned to one out of two dedicated respiratory support methods in each group i.e. COT/high flow nasal cannula (HFNC), HFNC/non-invasive ventilation (NIV) and NIV/IMV. In the manuscript the current state of art in the area of respiratory support is discussed. We have underlined knowledge gaps in medical evidence which we are planning to reveal with our results. The results of our study are clinically crucial, because they address current gaps concerning COT/HFNC/NIV/IMV. The expected findings of this study would allow for careful selection of respiratory support method to safely perform FOB in patients with hypoxemic RF.

Objective. An accurate identification of patients at the need for prioritized diagnostics and care are crucial in the emergency department (ED). Blood gas (BG) analysis is a widely available laboratory test, which allows to measure vital parameters, including markers of ventilation and perfusion. The aim of our analysis was to assess whether blood gas parameters in patients with dyspnea at an increased risk of respiratory failure admitted to the ED can predict short-term outcomes. Methods. The study group eventually consisted of 108 patients, with available BG analysis. The clinical and laboratory parameters were retrospectively evaluated, and three groups were distinguishedarterial blood gas (ABG), venous blood gas (VBG), and mixed blood gas. The primary endpoint was short-term, all-cause mortality during the follow-up of median (quartile 1quartile 3) 2 (14) months. The independent risk factors for mortality that could be obtained from blood gas sampling were evaluated. Results. The short-term mortality was 35.2 (38/108). Patients who died were more frequently initially assigned to the red triage risk group, more burdened with comorbidities, and the median SpO₂ on admission was significantly lower than in patients who survived the follow-up period. In the multivariable analysis, lactate was the strongest independent predictor of death, with 1mmol/L increasing all-cause mortality by 58 in ABG (95 CI: 1.012.47), by 80 in VBG (95 CI: 1.132.88), and by 68 in the mixed blood gas analysis (95 CI: 1.222.31), what remained significant in VBG and mixed group after correction for base excess. In each group, pH, pO₂, and pCO₂ did not predict short-term mortality. Conclusions. In patients admitted to the ED due to dyspnea, at risk of respiratory failure, lactate levels in arterial, venous, and mixed blood samples are independent predictors of short-term mortality.

Mallampati score has been identified and accepted worldwide as an independent predictor of difficult intubation and obstructive sleep apnea. We aimed to determine whether Mallampati score assessed on the first patient medical assessment allowed us to stratify the risk of worsening of conditions in patients hospitalized due to COVID-19. A total of 493 consecutive patients admitted between 13 November 2021 and 2 January 2022 to the temporary hospital in Pyrzowice were included in the analysis. The clinical data, chest CT scan, and major, clinically relevant laboratory parameters were assessed by patient-treating physicians, whereas the Mallampati score was assessed on admission by investigators blinded to further treatment. The primary endpoints were necessity of active oxygen therapy (AOT) during hospitalization and 60-day all-cause mortality. Of 493 patients included in the analysis, 69 (14.0%) were in Mallampati I, 57 (11.6%) were in Mallampati II, 78 (15.8%) were in Mallampati III, and 288 (58.9%) were in Mallampati IV. There were no differences in the baseline characteristics between the groups, except the prevalence of chronic kidney disease (p = 0.046). Patients with Mallampati IV were at the highest risk of AOT during the hospitalization (33.0%) and the highest risk of death due to any cause at 60 days (35.0%), which significantly differed from other scores (p = 0.005 and p = 0.03, respectively). Mallampati IV was identified as an independent predictor of need for AOT (OR 3.089, 95% confidence interval 1.65–5.77, p < 0.001) but not of all-cause mortality at 60 days. In conclusion, Mallampati IV was identified as an independent predictor of AOT during hospitalization. Mallampati score can serve as a prehospital tool allowing to identify patients at higher need for AOT.

Seria przypadków klinicznych ilustruje wyzwania związane z wykonaniem bronchofiberoskopii (fiberoptic bronchoscopy – FOB) u pacjentów obciążonych kardiologicznie i pulmonologicznie. Standardowe metody wsparcia oddechowego mogą być niewystarczające u tej grupy pacjentów. Pierwszy przypadek dotyczy pacjentki z wrodzoną wadą serca, niewydolnością oddechową i podejrzeniem zmian zapalnych w płucach, wymagającej diagnostycznej FOB z powodu krwioplucia. Zastosowanie wysokoprzepływowej tlenoterapii donosowej (high-flow nasal oxygen therapy – HFNOT) pozwoliło na bezpieczne wykonanie FOB, minimalizując ryzyko powikłań związanych np. z barotraumą. Drugi przypadek dotyczy pacjentki ze zdiagnozowanym zespołem Melnicka i Needlesa, przewlekłą niewydolnością oddechową i chondromalacją chrząstki oskrzelowej, co mogło stanowić przyczynę powikłań podczas standardowej FOB. W trakcie zabiegu również zastosowano HFNOT, co zapobiegło powikłaniom wynikającym z ograniczeń anatomicznych i ewentualnej barotraumy. Opisane przypadki kliniczne mogą sugerować, że zastosowanie HFNOT u pacjentów z wysokim ryzykiem powikłań, zwłaszcza z wrodzoną wadą serca i anomaliami dróg oddechowych, jest skuteczną alternatywą dla tradycyjnych metod wsparcia oddechowego.

Wprowadzenie: Bronchofiberoskopia (fiberoptic bronchoscopy – FOB) to małoinwazyjna procedura medyczna, powszechnie używana w diagnostyce i leczeniu chorób układu oddechowego. Zabieg jest na ogół dobrze tolerowany i istnieje niewiele przeciwwskazań do jego stosowania. Podczas FOB wprowadzany bronchofiberoskop powoduje ostre zwężenie dróg oddechowych, mogące skutkować rozwinięciem się lub zaostrzeniem niewydolności oddychania (respiratory failure – RF). Z tego powodu pacjenci z RF mogą zostać zdyskwalifikowani z zabiegu bronchoskopowego. Nieinwazyjne techniki wspomagania oddechu, takie jak donosowa terapia wysokoprzepływowa (high-flow nasal cannula – HFNC) oraz maska do wentylacji nieinwazyjnej (non-invasive ventilation – NIV), są cenionymi metodami wsparcia układu oddechowego u pacjentów z RF, jednak możliwości ich wykorzystania u pacjentów poddawanych FOB są wciąż niejasne.Opis przypadków: W opracowaniu opisano przypadki pięciu pacjentów poddanych bronchoskopii z różnych wskazań. W dwóch przypadkach rozpoznano guza krtani, w jednym obecność ciała obcego powikłanego nawracającymi zapaleniami płuc, u jednej pacjentki zapalenie płuc związane z przedłużoną intubacją, a w ostatnim przypadku RF po udarze niedokrwiennym mózgu. W każdym przypadku podczas FOB zastosowano wsparcie oddychania w postaci HFNC lub NIV z powodu wysokiego ryzyka rozwoju lub zaostrzenia RF. Parametry HFNC i NIV ustawiono zgodnie z założeniami dwóch trwających obecnie badań randomizowanych.Wnioski: Metody wsparcia oddechowego, takie jak HFNC oraz NIV, są obiecującymi metodami u pacjentów z wysokim ryzykiem rozwinięcia się RF podczas FOB.