Current Surgery Reports最新文献

Purpose of review: This review focuses on the challenges faced by acute care healthcare workers in the management of the normal and difficult pediatric airway during the COVID-19 pandemic and how these protocols and practices evolved during the pandemic. The current state of knowledge on timing of surgery and anesthesia is also discussed.

Recent findings: In the early days of the pandemic, information about the SARS-CoV-2 virus and disease process was scarce. Governmental, healthcare, and professional organizations created several guidelines to protect invaluable healthcare workers from the contagious virus while also delivering appropriate care to children with COVID-19. With the emergence of new studies and the deployment of new life-saving COVID-19 vaccines and other therapies, these guidelines evolved. The use of aerosol containment devices such as aerosol boxes and flexible barrier techniques was found to be ineffective in reliably containing virus particles while posing potential harm to both healthcare workers and patients. Also, the definition of aerosol-generating and dispersing medical procedures was vastly broadened. To date, use of appropriate personal protection equipment and COVID-19 vaccination are the most effective ways to protect healthcare workers and safely manage children infected with SARS-CoV-2 who require airway intervention.

Summary: Evidence-based public health measures and appropriate personal protective equipment remain the best way to protect both healthcare workers and patients. As the virus and population evolve and COVID-19 vaccines become more widely available, clinicians must be willing to adapt to the emerging evidence of their impact on how safe pediatric perioperative care is delivered.

Purpose of the review: The COVID-19 pandemic has had an unprecedented challenge to the critical care providers caring for those patients, including the delivery of nutrition. This review will address the challenges of gastric versus post gastric feeding in patients in COVID-19 disease.

Recent recommendations: Many societies, including American, British, and Australian recommend initiating of enteral feeding in COVID-19 patients as soon as 24 h of ICU admission or within 12 h after intubation. Consideration for post-pyloric feeding if there is evidence of intolerance to gastric feeding.

Summary: The same principle for non-COVID-19 critically ill patients applies to COVID-19 patients when it comes to the route of nutritional delivery. Gastric feeding should be initiated as soon as 24 h of admission to the ICU, and post gastric feeding should be reserved to patients who demonstrate gastric feeding intolerance.

Purpose of review: The purpose of this review is to provide an overview of the current literature, recommendations, and practice guidelines on the nutritional management of and implications associated with COVID-19 infection.

Recent findings: Particular attention should be paid to the screening, prevention, and treatment of malnutrition in critically ill individuals with COVID-19 infection given the significant risk for complications and poor outcomes. Extrapolation of existing literature for the nutritional support in the critically ill patient has demonstrated early enteral nutrition is safe and well-tolerated in patients with severe COVID-19 infection.

Summary: Futures studies should focus on the long-term nutritional outcomes for patients who have suffered COVID-19 infection, nutritional outcomes/recommendations for special populations with COVID-19, nutritional outcomes based on the current recommendations and guidelines for nutrition therapy, and the role for micronutrient supplementation in COVID-19 infection.