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Background: The coronavirus-2019 (COVID-19) pandemic highlighted the unfortunate reality that many hospitals have insufficient intensive care unit (ICU) capacity to meet massive, unanticipated increases in demand. To drastically increase ICU capacity, NewYork-Presbyterian/Weill Cornell Medical Center modified its existing operating rooms and post-anaesthesia care units during the initial expansion phase to accommodate the surge of critically ill patients., Methods: This retrospective chart review examined patient care in non-standard Expansion ICUs as compared to standard ICUs. We compared clinical data between the two settings to determine whether the expeditious development and deployment of critical care resources during an evolving medical crisis could provide appropriate care., Results: Sixty-six patients were admitted to Expansion ICUs from March 1 st to April 30 th , 2020 and 343 were admitted to standard ICUs. Most patients were male (70%), White (30%), 45-64 years old (35%), non-smokers (73%), had hypertension (58%), and were hospitalized for a median of 40 days. For patients that died, there was no difference in treatment management, but the Expansion cohort had a higher median ICU length of stay (q = 0.037) and ventilatory length (q = 0.015). The cohorts had similar rates of discharge to home, but the Expansion ICU cohort had higher rates of discharge to a rehabilitation facility and overall lower mortality., Conclusions: We found no significantly worse outcomes for the Expansion ICU cohort compared to the standard ICU cohort at our institution during the COVID-19 pandemic, which demonstrates the feasibility of providing safe and effective care for patients in an Expansion ICU., (© 2022. The Author(s).)

Introduction: Spontaneously breathing patients undergoing procedures under regional anesthesia can expose operating room personnel to infectious agents. The use of localized negative pressure within proximity of a patient's airway is expected to reduce the amount of bioaerosols dispersed particularly for anesthesia staff who are frequently near the patient's airway., Methods: In the experiment, aerosols were produced using a polydisperse aerosol generator with nebulized saline. A portable negative pressure unit was set up at set distances of 10 cm and 30 cm with the aim of reducing aerosol particle counts detected by a laser-based particle counter., Results: Without the portable negative pressure unit, the median concentration of 0.5 µm aerosols detected was 3128 (1533, 22832) particles/ft 3 /min. With the portable negative pressure unit 10 cm and 30 cm from the site of aerosol emittance, the median concentration compared with background concentration was -0.5 (-8, 8) particles/ft 3 /min and 398 (89, 1749) particles/ft 3 /min, respectively., Conclusions: For particle concentrations of 0.5 µm, 0.7 µm, and 1.0 µm a significant amount of aerosol reduction was observed (p<0.001). Further experiments are warranted to assess the safety of staff when encountering a potentially infectious patient in the operating room., Competing Interests: Competing interests: None declared., (© American Society of Regional Anesthesia & Pain Medicine 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Competing interests: None declared.

Background: Concerns exist regarding exacerbation of existing disparities in health care access with the rapid implementation of telemedicine during the coronavirus disease 2019 (COVID-19) pandemic. However, data on pre-existing disparities in telemedicine utilization is currently lacking., Objective: We aimed to study: (1) the prevalence of outpatient telemedicine visits before the COVID-19 pandemic by patient subgroups based on age, comorbidity burden, residence rurality, and median household income; and (2) associated diagnosis categories., Research Design: This was a retrospective cohort study., Subject: Commercial claims data from the Truven MarketScan database (2014-2018) representing n=846,461,609 outpatient visits., Measures: We studied characteristics and utilization of outpatient telemedicine services before the COVID-19 pandemic by patient subgroups based on age, comorbidity burden, residence rurality, and median household income. Disparities were assessed in unadjusted and adjusted (regression) analyses., Results: With overall telemedicine uptake of 0.12% (n=1,018,092/846,461,609 outpatient visits) we found that pre-COVID-19 disparities in telemedicine use became more pronounced over time with lower use in patients who were older, had more comorbidities, were in rural areas, and had lower median household incomes (all trends and effect estimates P<0.001)., Conclusion: These results contextualize pre-existing disparities in telemedicine use and are crucial in the monitoring of potential disparities in telemedicine access and subsequent outcomes after the rapid expansion of telemedicine during the COVID-19 pandemic., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background and Aims: The onset of the coronavirus 2019 (COVID‐19) pandemic brought together the American Society of Regional Anesthesia and Pain Medicine (ASRA) and the European Society of Regional Anaesthesia and Pain Therapy (ESRA) to release a joint statement on anesthesia use. Their statement included a recommendation to use regional anesthesia whenever possible to mitigate the risk associated with aerosolizing procedures. We sought to examine the utilization of anesthesia in pediatric patients undergoing a surgical procedure for fractures or ligament repairs before and during COVID‐19. Methods: Using the Premier Health Database, we retrospectively analyzed pediatric patients undergoing a surgical intervention for fractures or ligament repair before and during COVID‐19. We sought to determine if there were differences in anesthesia use among this cohort during the two time periods. Fracture groups included shoulder and clavicle, humerus and elbow, forearm and wrist, hand and finger, pelvis and hip, femur and knee, leg and ankles, and foot and toes. Ligament procedures included surgical intervention for the anterior cruciate ligament and ulnar collateral ligament repair. Results: We identified a total of 5935 patients undergoing a surgical procedure for fractures or ligament repairs before and during COVID‐19. After exclusion for unknown anesthesia use, 2,807 patients were included in our cohort with 81.5% (n = 2288) of patients undergoing a procedure under general anesthesia, 6.4% (n = 181) under regional anesthesia, and 12.0% (n = 338) under combined general‐regional anesthesia. There did not appear to be a significant difference in the type of anesthesia used before and during COVID‐19 (p = 0.052). Conclusions: Our study did not identify a difference in anesthesia use before and during COVID‐19 among pediatric patients undergoing a surgical procedure. Further studies should estimate the change in anesthesia used during the time period when elective procedures were resumed. [ABSTRACT FROM AUTHOR]