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      Diagnostik und Therapie schlafbezogener Atmungsstörungen im Zusammenhang mit der Corona‑Pandemie : Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V. (DGP), Deutsche Gesellschaft für Schlafforschung und Schlafmedizin (DGSM) Translated title: Management of diagnostic procedures and treatment of sleep related breathing disorders in the context of the coronavirus pandemic

      , 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V. (DGP), Deutsche Gesellschaft für Schlafforschung und Schlafmedizin (DGSM)

      Somnologie

      Springer Medizin

      Coronavirus-Pandemie, SARS-CoV2, Schlaflabor, Schlafapnoe, Schlafbezogene Atmungsstörungen, Coronavirs pandemic, SARS-CoV2, Sleep laboratory, Sleep apnea, Sleep related breathing disorders

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          Abstract

          Bei der Erbringung schlafmedizinischer Leistungen im Zusammenhang mit der Corona-Pandemie sind besondere Aspekte zu berücksichtigen. Trotz aller vorbeugender Maßnahmen muss aufgrund der hohen Dunkelziffer mit SARS-CoV2-Kontakten im Schlaflabor gerechnet und entsprechende Vorkehrungen getroffen werden. Die Fortführung bzw. Wiederaufnahme schlafmedizinischer Leistungen unter den gebotenen Hygienemaßnahmen ist dennoch dringend anzustreben zur Vermeidung medizinischer und psychosozialer Komplikationen. Es gibt keine gesicherten Hinweise für eine Verschlechterung der COVID-19 durch eine CPAP-Therapie. Grundsätzlich kann die Anwendung einer Überdrucktherapie über verschiedene Maskensysteme mit der Bildung einer infektiösen Aerosolwolke einhergehen. Bei bestätigter Infektion mit SARS-CoV-2 sollte im ambulanten Umfeld eine vorbestehende Maskentherapie unter Einhaltung der Vorgaben des RKI zur häuslichen Isolierung fortgeführt werden, da eine Therapiebeendigung mit einer zusätzlichen kardiopulmonalen Belastung durch die unbehandelte schlafbezogene Atmungsstörung einhergeht. Mit geeigneter persönlicher Schutzausrüstung (Augenschutz, FFP2/FFP3-Maske, Kittel) kann eine PAP-Therapie nach jetzigem Kenntnisstand vom Personal ohne erhöhtes Infektionsrisiko durchgeführt werden.

          Dieses gemeinsame Positionspapier der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin (DGP) und der Deutschen Gesellschaft für Schlafmedizin (DGSM) beinhaltet konkrete Empfehlungen zur Durchführung schlafmedizinischer Diagnostik und Therapie im Umfeld der Corona-Pandemie.

          Translated abstract

          When providing sleep medical services special aspects must be taken into account in the context of the coronavirus pandemic. Despite all prevention, due to the high number of unrecognized cases, SARS-CoV2 contacts in the sleep laboratory must be expected and appropriate precautions are necessary. Nevertheless, the continuation or resumption of sleep medical services under the appropriate hygiene measures is strongly recommended to avoid medical and psychosocial complications. There is no evidence for a deterioration of COVID-19 through CPAP therapy. In principle, the application of positive pressure therapy via various mask systems can be accompanied by the formation of infectious aerosols. In the case of confirmed infection with SARS-CoV2, a pre-existing PAP therapy should be continued in an outpatient setting in accordance with the local guidelines for home isolation, since discontinuation of PAP therapy is associated with additional cardiopulmonary complications due to the untreated sleep-related breathing disorder. According to the current state of knowledge inhalation therapy, nasal high-flow (NHF), and PAP therapy can be carried out without increased risk of infection for health care workers (HCW) as long as appropriate personal protective equipment (eye protection, FFP2 or FFP-3 mask, gown) is being used.

          This position paper of the German Society for Pneumology and Respiratory Medicine (DGP) and the German Society for Sleep Medicine (DGSM) offers detailed recommendations for the implementation of sleep medicine diagnostics and therapy in the context of the coronavirus pandemic.

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          Most cited references 15

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          Factors involved in the aerosol transmission of infection and control of ventilation in healthcare premises

           J.W. Tang,  Y. Li,  I Eames (2006)
          Summary The epidemics of severe acute respiratory syndrome (SARS) in 2003 highlighted both short- and long-range transmission routes, i.e. between infected patients and healthcare workers, and between distant locations. With other infections such as tuberculosis, measles and chickenpox, the concept of aerosol transmission is so well accepted that isolation of such patients is the norm. With current concerns about a possible approaching influenza pandemic, the control of transmission via infectious air has become more important. Therefore, the aim of this review is to describe the factors involved in: (1) the generation of an infectious aerosol, (2) the transmission of infectious droplets or droplet nuclei from this aerosol, and (3) the potential for inhalation of such droplets or droplet nuclei by a susceptible host. On this basis, recommendations are made to improve the control of aerosol-transmitted infections in hospitals as well as in the design and construction of future isolation facilities.
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            Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID ‐19 adult patient group

            Abstract Introduction This statement was planned on 11 March 2020 to provide clinical guidance and aid staff preparation for the coronavirus disease 2019 (COVID‐19) pandemic in Australia and New Zealand. It has been widely endorsed by relevant specialty colleges and societies. Main recommendations Generic guidelines exist for the intubation of different patient groups, as do resources to facilitate airway rescue and transition to the “can't intubate, can't oxygenate” scenario. They should be followed where they do not contradict our specific recommendations for the COVID‐19 patient group. Consideration should be given to using a checklist that has been specifically modified for the COVID‐19 patient group. Early intubation should be considered to prevent the additional risk to staff of emergency intubation and to avoid prolonged use of high flow nasal oxygen or non‐invasive ventilation. Significant institutional preparation is required to optimise staff and patient safety in preparing for the airway management of the COVID‐19 patient group. The principles for airway management should be the same for all patients with COVID‐19 (asymptomatic, mild or critically unwell). Safe, simple, familiar, reliable and robust practices should be adopted for all episodes of airway management for patients with COVID‐19. Changes in management as a result of this statement Airway clinicians in Australia and New Zealand should now already be involved in regular intensive training for the airway management of the COVID‐19 patient group. This training should focus on the principles of early intervention, meticulous planning, vigilant infection control, efficient processes, clear communication and standardised practice.
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              Is Open Access

              Risk Factors for SARS Transmission from Patients Requiring Intubation: A Multicentre Investigation in Toronto, Canada

              Background In the 2003 Toronto SARS outbreak, SARS-CoV was transmitted in hospitals despite adherence to infection control procedures. Considerable controversy resulted regarding which procedures and behaviours were associated with the greatest risk of SARS-CoV transmission. Methods A retrospective cohort study was conducted to identify risk factors for transmission of SARS-CoV during intubation from laboratory confirmed SARS patients to HCWs involved in their care. All SARS patients requiring intubation during the Toronto outbreak were identified. All HCWs who provided care to intubated SARS patients during treatment or transportation and who entered a patient room or had direct patient contact from 24 hours before to 4 hours after intubation were eligible for this study. Data was collected on patients by chart review and on HCWs by interviewer-administered questionnaire. Generalized estimating equation (GEE) logistic regression models and classification and regression trees (CART) were used to identify risk factors for SARS transmission. Results 45 laboratory-confirmed intubated SARS patients were identified. Of the 697 HCWs involved in their care, 624 (90%) participated in the study. SARS-CoV was transmitted to 26 HCWs from 7 patients; 21 HCWs were infected by 3 patients. In multivariate GEE logistic regression models, presence in the room during fiberoptic intubation (OR = 2.79, p = .004) or ECG (OR = 3.52, p = .002), unprotected eye contact with secretions (OR = 7.34, p = .001), patient APACHE II score ≥20 (OR = 17.05, p = .009) and patient Pa02/Fi02 ratio ≤59 (OR = 8.65, p = .001) were associated with increased risk of transmission of SARS-CoV. In CART analyses, the four covariates which explained the greatest amount of variation in SARS-CoV transmission were covariates representing individual patients. Conclusion Close contact with the airway of severely ill patients and failure of infection control practices to prevent exposure to respiratory secretions were associated with transmission of SARS-CoV. Rates of transmission of SARS-CoV varied widely among patients.
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                Author and article information

                Contributors
                nikolaus.buechner@rub.de
                Journal
                Somnologie (Berl)
                Somnologie (Berl)
                Somnologie
                Springer Medizin (Heidelberg )
                1432-9123
                1439-054X
                22 June 2020
                : 1-11
                Affiliations
                [1 ]GRID grid.470892.0, Medizinischen Klinik I (Pneumologie, Schlaf- und Beatmungsmedizin), , Helios Klinikum Duisburg GmbH, ; An der Abtei 7–11, 47166 Duisburg, Deutschland
                [2 ]Lungenzentrum Ulm, Ulm, Deutschland
                [3 ]GRID grid.10253.35, ISNI 0000 0004 1936 9756, Fachkrankenhaus Kloster Grafschaft GmbH, Akademisches Lehrkrankenhaus, , Philipps-Universität Marburg, ; Schmallenberg Grafschaft, Deutschland
                [4 ]Deutsche Gesellschaft für Schlafforschung und Schlafmedizin, Schwalmstadt-Treysa, Deutschland
                [5 ]Neurologische Klinik Reithofpark, Medical Park, Bad Feilnbach, Deutschland
                [6 ]Praxis und Schlaflabor für Innere Medizin, Pneumologie, Allergologie, Schlafmedizin, Reinbek, Deutschland
                [7 ]GRID grid.489371.0, ISNI 0000 0004 0630 8065, Klinik für Pneumologie, , Krankenhaus Bethanien, ; Solingen, Deutschland
                [8 ]GRID grid.6190.e, ISNI 0000 0000 8580 3777, Institut für Pneumologie, , Universität zu Köln, ; Köln, Deutschland
                Article
                253
                10.1007/s11818-020-00253-w
                7306656
                © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2020

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

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