Luna Gargani, Nicolas Girerd, Elke Platz, Pierpaolo Pellicori, Ivan Stankovic, Alberto Palazzuoli, Emanuele Pivetta, Marcelo Haertel Miglioranza, Hatem Soliman-

Health care systems are belligerently responding to the new coronavirus disease 2019 (COVID-19). The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a specific condition, whose distinctive features are severe hypoxemia associated with (>50% of cases) normal respiratory system compliance. ¹ When a patient requires intubation and invasive ventilation, the outcome is poor, ^2–4 and the length of stay in the intensive care unit (ICU) is usually 2 or 3 weeks. ² In this article, the authors review several technological devices, which could support health care providers at the bedside to optimize the care for COVID-19 patients who are sedated, paralyzed, and ventilated. Particular attention is provided to the use of videolaryngoscopes (VL) because these can assist anesthetists to perform a successful intubation outside the ICU while protecting health care providers from this viral infection. Authors will also review processed electroencephalographic (EEG) monitors which are used to better titrate sedation and the train-of-four monitors which are utilized to better administer neuromuscular blocking agents in the view of sparing limited pharmacological resources. COVID-19 can rapidly exhaust human and technological resources too within the ICU. This review features a series of technological advancements that can significantly improve the care of patients requiring isolation. The working conditions in isolation could cause gaps or barriers in communication, fatigue, and poor documentation of provided care. The available technology has several advantages including (a) facilitating appropriate paperless documentation and communication between all health care givers working in isolation rooms or large isolation areas; (b) testing patients and staff at the bedside using smart point-of-care diagnostics (SPOCD) to confirm COVID-19 infection; (c) allowing diagnostics and treatment at the bedside through point-of-care ultrasound (POCUS) and thromboelastography (TEG); (d) adapting the use of anesthetic machines and the use of volatile anesthetics. Implementing technologies for safeguarding health care providers as well as monitoring the limited pharmacological resources are paramount. Only by leveraging new technologies, it will be possible to sustain and support health care systems during the expected long course of this pandemic.

The systemic venous side of the circulation has long been forgotten as an important component of the circulatory system. The concept of preload responsiveness justified administration of large volumes of intravenous fluids; however, little was known about the implications of excessive fluid administration on organ functions. As systemic venous pressure increases, the perfusion pressure [mean arterial pressure–right atrial pressure (RAP)] to the tissues can get compromised as it is the downstream pressure which the upstream pressure must overcome so that flow can be driven across the capillaries. Over the last years, a growing body of evidence showed that excessive fluid administration is linked to increased incidence of acute kidney injury, increased morbidity and mortality with multi-organ consequences.