Therapeutic hyperbaric chambers require continuous monitoring and maintenance, including periodic requalification. The primary aim is to verify the suitability for continued safe service. Maintenance is regulated in Europe, and in France requalification is mandatory where a hyperbaric chamber operates above pressures equal to or greater than 4 bar gauge. French requalification requires a hydraulic (hydrostatic) pressure test to determine the absence of deformation and leaks during the test. However, in such cases, it is often necessary to move the chamber if the combined mass of the chamber and water may exceed the allowable floor loading strength. In 2009, an innovative alternative to a hydraulic pressure testing was authorised in France. It consists of carrying out a pneumatic pressure test simultaneously with a non-destructive monitoring technique called ‘acoustic emission’. This can be compared to a microseismology technique, where sensors are applied to the pressure retaining boundary of the hyperbaric chamber, and signals emitted by the vessel under load are captured. These signals are analysed, prioritised, and classified, to determine the physical position of any sources (artifacts) through triangulation calculations. This technique makes it possible to assess the behaviour of the vessel very accurately in real time and, a posteriori, to assess its fitness for continued service. This technique reduces the unavailability time of the chamber to two days, compared to potentially several weeks when a hydraulic test is performed. Over and above financial considerations and availability of facilities, this technique provides a baseline of the integrity of pressure vessels and allows monitoring over time of any potential deterioration.

Background: Acute respiratory distress syndrome (ARDS) is a life-threatening condition resulting from acute pulmonary inflammation. However, no specific treatment for ARDS has yet been developed. Previous findings suggest that lung injuries related to ARDS could be regulated by endocan (Esm-1). The aim of this study was to evaluate the potential efficiency of endocan in the treatment of ARDS. Methods: We first compared the features of acute pulmonary inflammation and the severity of hypoxemia in a tracheal LPS-induced acute lung injury (ALI) model performed in knockout (Esm1−/−) and wild type (WT) littermate C57Bl/6 mice. Next, we assessed the effects of a continuous infusion of glycosylated murine endocan in our ALI model in Esm1−/− mice. Results: In our ALI model, we report higher alveolar leukocytes (p < 0.001), neutrophils (p < 0.001), and MPO (p < 0.001), and lower blood oxygenation (p < 0.001) in Esm1−/− mice compared to WT mice. Continuous delivery of glycosylated murine endocan after LPS-induced ALI resulted in decreased alveolar leukocytes (p = 0.012) and neutrophils (p = 0.012), higher blood oxygenation levels (p < 0.001), and reduced histological lung injury (p = 0.04), compared to mice treated with PBS. Conclusions: Endocan appears to be an effective treatment in an ARDS-like model in C57Bl/6 mice.

INTRODUCTION:Previous studies have highlighted hyperoxia-induced microcirculation modifications, but few have focused on hyperbaric oxygen (HBO) effects. Our primary objective was to explore hyperbaric hyperoxia effects on the microcirculation of healthy volunteers and investigate whether these modifications are adaptative or not.METHODS:This single centre, open-label study included 15 healthy volunteers. Measurements were performed under five conditions: T0) baseline value (normobaric normoxia); T1) hyperbaric normoxia; T2) hyperbaric hyperoxia; T3) normobaric hyperoxia; T4) return to normobaric normoxia. Microcirculatory data were gathered via laser Doppler, near-infrared spectroscopy and transcutaneous oximetry (PtcO₂). Vascular-occlusion tests were performed at each step. We used transthoracic echocardiography and standard monitoring for haemodynamic investigation.RESULTS:Maximal alterations were observed under hyperbaric hyperoxia which led, in comparison with baseline, to arterial hypertension (mean arterial pressure 105 (SD 12) mmHg vs 95 (11), P < 0.001) and bradycardia (55 (7) beats·min⁻¹ vs 66 (8), P < 0.001) while cardiac output remained unchanged. Hyperbaric hyperoxia also led to microcirculatory vasoconstriction (rest flow 63 (74) vs 143 (73) perfusion units, P < 0.05) in response to increased PtcO₂ (104.0 (45.9) kPa vs 6.3 (2.4), P < 0.0001); and a decrease in laser Doppler parameters indicating vascular reserve (peak flow 125 (89) vs 233 (79) perfusion units, P < 0.05). Microvascular reactivity was preserved in every condition.CONCLUSIONS:Hyperoxia significantly modifies healthy volunteer microcirculation especially during HBO exposure. The rise in PtcO₂ promotes an adaptative vasoconstrictive response to protect cellular integrity. Microvascular reactivity remains unaltered and vascular reserve is mobilised in proportion to the extent of the ischaemic stimulus.

Purpose: Cervical cellulitis is an infrequent but serious infection. The management of the upper airways is dif-ficult, at the actual time of intubation but also regarding the necessity of maintaining mechanical ventilation. The objective of this study is to identify risk factors on admission to the intensive care unit for difficult venti-latory weaning in patients with cervical cellulitis.Methods: Between January 2013 and December 2018, this retrospective observational study was performed in an intensive care unit with 10 beds in a university hospital recognized as a reference center for the man-agement of cellulitis. All intensive care patients receiving mechanical ventilation after surgery for cervical cellulitis were eligible. Difficult ventilatory weaning was defined as mechanical ventilation lasting more than 7 days or failure of extubation as established by the WIND 2017 study.Results: We included 120 patients with severe cervical cellulitis. The median age was 43 years. Eighteen patients (16%) presented mediastinal extension. The risk factor for difficult ventilatory weaning (n = 49) in multivariate analysis was a high level of procalcitonin on admission (OR at 1.14[1.005-1.29]; p<0.042) and the protective factor was surgery in an expert center (OR at 0.11[0.026-0.47]; p<0.003). Eight patients required a tracheotomy in our study: 3 patients during surgery and at a later time for the other 5 of our 8 patients. Conclusion: No intensive care studies have investigated ventilatory weaning risk factors in patients with cer-vical cellulitis. Yet simple criteria seem to predict this risk. It is now necessary to confirm them by a multicen-ter prospective study.(c) 2022 Elsevier Masson SAS. All rights reserved.

Gas embolism is a potential and often life-threatening complication of central venous catheters. We report a case of air embolism after tearing of the central catheter associated with severe acute respiratory distress syndrome. The severity of the clinical situation meant choices had to be made regarding the order of treatments. This clinical case provided useful eye-openers for patient management regarding the prioritization of treatments as well as the possibilities offered by hyperbaric oxygen therapy.

Various skin manifestations have been reported during the coronavirus disease 2019 (COVID-19) pandemic. Among these are acral vascular skin lesions in non-severe patients, but few studies have focused specifically on patients with severe COVID-19 admitted to the intensive care unit (ICU). We aimed to assess the frequency of acral vascular skin manifestations (AVSM) in patients admitted to the ICU based on systematic dermatological examination. We conducted a clinical, observational and prospective study in the ICU of Lille University Hospital (France). All adult patients with RT-PCR-confirmed severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) infection were included on May 5th and 6th, 2020. A total of 39 patients with severe COVID-19 were examined (34 males and five females; median age: 61 [55–59]). We observed AVSM in 11/39 patients (28%) including five with acral necrotic lesions, three with haemorrhagic blisters, one with acral live-doid rash, and one with erosive distal lesions. Chilblain or chilblain-like lesions were not seen, unlike ambulatory or non-severe patients described in the literature. There was no difference regarding the median length of stay in the ICU, initial symptoms of COVID-19 or baseline characteristics, except for a lower BMI in patients with AVSM. All patients had biological coagulation abnormalities (e.g. higher levels of fibrinogen or D-dimers), but there was no difference between patients with and without AVSM. AVSM are infrequent and heterogenous and seem to be non-specific to patients with severe SARS-CoV-2, and possibly unrelated to COVID-19. The pathophysiology of AVSM described during the COVID-19 pandemic is not fully elucidated.

ObjectiveTo describe EEG patterns of critical Coronavirus Disease 2019 (COVID-19) patients with suspicion of encephalopathy and test their association with clinical outcome.MethodsEEG after discontinuation of sedation in all patients, and somesthesic evoked potentials and brainstem auditive evoked potentials when EEG did not show reactivity, were performed. Clinical outcome was assessed at day 7 and 14 after neurophysiological explorations.Results33 patients were included for analysis. We found slowed background activity in 85% of cases, unreactive activity in 42% of cases, low-voltage activity in 21% of cases and rhythmic or periodic delta waves in 61% of cases. EEG epileptic events were never recorded. Clinical outcome at day 14 was associated with unreactive background activity and tended to be associated with rhythmic or periodic delta waves and with low-voltage activity. Results of multimodal evoked potentials were in favor of a preservation of central nervous system somatosensory and auditory functions.ConclusionsAmong critical COVID-19 patients with abnormal arousal at discontinuation of sedation, EEG patterns consistent with encephalopathy are found and are predictive for short term clinical outcome.SignificanceThe abnormal EEG with presence of periodic discharges and lack of reactivity could be related to encephalopathy linked to COVID-19.

Objectives: Treating acute respiratory failure in patients with coronavirus disease 2019 is challenging due to the lack of knowledge of the underlying pathophysiology. Hypoxemia may be explained in part by the loss of hypoxic pulmonary vasoconstriction. The present study assessed the effect of almitrine, a selective pulmonary vasoconstrictor, on arterial oxygenation in severe acute respiratory syndrome coronavirus 2-induced acute respiratory distress syndrome. Design: Single-center retrospective observational study. Setting: ICU of Lille Teaching Hospital, France, from February 27, 2020, to April 14, 2020. Patients: Patients with coronavirus disease 2019 pneumonia confirmed by positive reverse transcriptase-polymerase chain reaction for severe acute respiratory syndrome-coronavirus 2 and acute respiratory distress syndrome according to Berlin definition. Data focused on clinicobiological features, ventilator settings, therapeutics, outcomes, and almitrine-related adverse events. Interventions: Almitrine was considered in patients with severe hypoxemia (Pao 2/Fio 2 ratio < 150 mm Hg) in addition to the recommended therapies, at an hourly IV delivery of 10 μg/kg/min. Comparative blood gases were done before starting almitrine trial and immediately after the end of the infusion. A positive response to almitrine was defined by an increase of Pao 2/Fio 2 ratio greater than or equal to 20% at the end of the infusion. Measurements and Main Results: A total of 169 patients were enrolled. Thirty-two patients with acute respiratory distress syndrome received an almitrine infusion trial. In most cases, almitrine was infused in combination with inhaled nitric oxide (75%). Twenty-one patients (66%) were responders. The median Pao 2/Fio 2 ratio improvement was 39% (9–93%) and differs significantly between the responders and nonresponders (67% [39–131%] vs 6% [9–16%], respectively; p < 0.0001). The 28-day mortality rates were 47.6% and 63.6% (p = 0.39) for the responders and nonresponders, respectively. Hemodynamic parameters remained similar before and after the trial, not suggesting acute cor pulmonale. Conclusions: Almitrine infusion improved oxygenation in severe acute respiratory syndrome coronavirus 2-induced acute respiratory distress syndrome without adverse effects. In a multistep clinical approach to manage severe hypoxemia in this population, almitrine could be an interesting therapeutic option to counteract the loss of hypoxic pulmonary vasoconstriction and redistribute blood flow away from shunting zones.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently a major worldwide concern. Guidelines have been issued regarding precautions for healthcare workers caring for SARS-CoV-2-infected patients. Despite accurate observance of infection control measures, including contact precautions, we encountered an OXA-23-producing Acinetobacter baumannii outbreak in 5 intensive care units of 10 beds each in our tertiary care teaching hospital.

Dysregulated leukocyte diapedesis is a major contributor to acute severe inflammatory states like sepsis and acute respiratory distress syndrome, which are common conditions in critically ill subjects. Endocan is a circulating proteoglycan that binds to the leukocyte integrin LFA-1 and blocks its interaction with its endothelial ligand ICAM-1, subsequently leading to the inhibition of leukocyte recruitment. Recent data have highlighted the hypothetic role of p14, endocan's major catabolite found in the bloodstream of septic patients, as a potential antagonist of endocan, thus participating in the regulation of acute inflammation. We hereby characterize the role of p14 as a biologic competitor of endocan, through assessment of its molecular interactions with LFA-1, endocan, and ICAM-1, as well as its effects on human leukocyte trafficking. Using immunodetection assay, we report that p14 can bind to LFA-1, thus inhibiting the interaction between LFA-1 and endocan, which in turn leads to the restoration of the ICAM-1/LFA-1 interaction. In primary human T cells trafficking assays, we underline the absence of effect of p14 on ICAM-1-dependent adhesion and migration, as well as on transendothelial migration. However, in those models, p14 reverses the antimigratory effect of endocan. To conclude, our study supports the hypothesis of an antagonistic role of p14 versus endocan in its effect on the LFA-1/ICAM-1-dependent human leukocyte recruitment.

Circulation. 2020;142:184–186. DOI: 10.1161/CIRCULATIONAHA.120.047430 184

Most people who develop COVID-19 after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection present with paucisymptomatic and non-severe disease.1Zhu N Zhang D Wang W et al.A novel coronavirus from patients with pneumonia in China, 2019.N Engl J Med. 2020; 382: 727-733Google Scholar However, approximately 20% of patients develop severe COVID-19 requiring hospitalisation, including 5% who are admitted to the intensive care unit (ICU).2Chen N Zhou M Dong X et al.Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study.Lancet. 2020; 395: 507-513Google Scholar The ongoing COVID-19 outbreak has led to an unprecedented health crisis. Hence, it is crucial to identify individuals who are susceptible to developing severe COVID-19 and could require hospitalisation, especially in the ICU. Evidence is emerging that obesity-related conditions seem to worsen the effect of the virus. Studies from Chinese cohorts of patients with COVID-19 have identified several risk factors of severe COVID-19 including age, cardiomyopathy, and obesity-related complications such as type 2 diabetes and hypertension.3Shi Y Yu X Zhao H Wang H Zhao R Sheng J Host susceptibility to severe COVID-19 and establishment of a host risk score: findings of 487 cases outside Wuhan.Crit Care. 2020; 24: 108Google Scholar However, to our knowledge, only few studies so far have included information regarding the BMI of patients with COVID-19, which suggest a high prevalence of obesity in patients with severe COVID-19.4Chen Q Zheng Z Zhang C et al.Clinical characteristics of 145 patients with corona virus disease 2019 (COVID-19) in Taizhou, Zhejiang, China.Infection. 2020; (published online April 28.)DOI:10.1007/S15010-020-01432-5Google Scholar, 5Mahase E Covid-19: most patients require mechanical ventilation in first 24 hours of critical care.BMJ. 2020; 368m1201Google Scholar, 6Bhatraju PK Ghassemieh BJ Nichols M et al.Covid-19 in critically ill patients in the Seattle region—case series.N Engl J Med. 2020; (published online March 30.)DOI:10.1056/NEJMoa2004500Google Scholar, 7Simonnet A Chetboun M Poissy J et al.High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation.Obesity (Silver Spring). 2020; (published online April 9.)DOI:10.1002/oby.22831Google Scholar Data from New York City suggest that obesity, as defined by BMI of at least 30 kg/m2, might be a risk factor for ICU admission among patients with COVID-19, especially among those younger than 60 years.8Lighter J Phillips M Hochman S et al.Obesity in patients younger than 60 years is a risk factor for COVID-19 hospital admission.Clin Infect Dis. 2020; (published online April 9.)DOI:10.1093/cid/ciaa415Google Scholar Additionally, preliminary analyses from Lille University Hospital have reported differences in BMI distribution in ICU patients with COVID-19 compared with ICU patients without COVID-19.7Simonnet A Chetboun M Poissy J et al.High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation.Obesity (Silver Spring). 2020; (published online April 9.)DOI:10.1002/oby.22831Google Scholar Given the growing epidemic of COVID-19 in countries such as the USA, UK, and Mexico that have a high prevalence of obesity, there is an urgent need to clarify the relationship between obesity and severity of COVID-19. Therefore, we aimed to assess the prevalence of obesity, as defined by BMI of at least 30 kg/m2, among patients requiring hospitalisation for severe COVID-19, including those with critical COVID-19 admitted to an ICU. On March 27, 2020, 357 patients were hospitalised in Lyon University Hospital with COVID-19, of whom 17 patients had no data on BMI (appendix p 5). We found no relevant differences in clinical features between patients with and without BMI (data not shown). 340 patients with confirmed, severe COVID-19 were included in our population, including 230 (68%) patients with non-critical COVID-19 and 110 (32%) patients with critical COVID-19 (appendix p 5). Our retrospective non-COVID-19 ICU comparison group included 1210 patients with BMI values admitted to ICU units in Lyon University Hospital on March 27 each year between 2007 and 2019 (appendix p 5). 85 (25%) of 340 patients with severe COVID-19 had obesity, compared with 15·3% in the French adult population in 2014 (appendix p 8). After standardisation on age and sex, the prevalence of obesity was 1·35 times (95% CI 1·08–1·66) higher in patients with severe COVID-19 than in the general French population (p=0·0034; figure 1; appendix pp 6–8). Likewise, in ICU, the prevalence of obesity was 1·89 times (1·33–2·53) higher than in the general French population (p=0·0011) after standardisation on age and sex (figure 1). In multivariable logistic regression adjusted for age and sex, the prevalence of obesity remained higher in patients with critical COVID-19 than in those with non-critical COVID-19 (OR 1·96 [95% CI 1·13–3·42]; p=0·018; appendix pp 7–8). Among the 1210 patients in our retrospective ICU non-COVID-19 comparison group, 314 (26%) patients had obesity (appendix p 9). The prevalence of obesity was numerically higher in patients with critical COVID-19 than in ICU patients without COVID-19 (p=0·066; appendix p 9). After adjustment for age and sex, odds of obesity were significantly higher in patients with critical COVID-19 (OR 1·69 [95% CI 1·10–2·56]; p=0·017; figure 2A). Our findings are in agreement with preliminary findings from a population comprising 124 patients with critical COVID-19 and 306 ICU patients without COVID-19 from Lille University Hospital (appendix p 5).7Simonnet A Chetboun M Poissy J et al.High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation.Obesity (Silver Spring). 2020; (published online April 9.)DOI:10.1002/oby.22831Google Scholar As observed in the Lyon population, the prevalence of obesity in patients with critical COVID-19 in the Lille population was 2·88 times (95% CI 2·19–3·66) higher than in the French general population after standardisation on age and sex (p<0·0001; figure 1; appendix p 6). Among the 306 ICU patients in the Lille population without COVID-19, 79 (26%) had obesity. The prevalence of obesity was higher in patients with critical COVID-19 than in ICU patients without COVID-19 (p<0·0001; appendix p 9). The prevalence of obesity in patients with critical COVID-19 was higher than in ICU patients without COVID-19 in the Lille population (OR 2·86 [95% CI 1·78–4·61]; p=0·017; figure 2B) after standardisation on age and sex. Finally, in exploratory analyses, we looked at whether specific risk factors other than obesity were associated with critical COVID-19 versus non-critical COVID-19 in univariable analyses (appendix pp 9–10). In multivariable analyses, odds of critical COVID-19 versus non-critical COVID-19 were higher in patients with obesity than in patients without obesity when adjusted for age and sex (appendix p 9). The association remained significant after adjustment for the other potential specific risk factors, with age-sex-adjusted ORs ranging between 1·80 and 2·03 (appendix p 9). This study reports a significant association between the prevalence of obesity and severe COVID-19, including critical COVID-19, and suggests that obesity might be a risk factor of pejorative evolution of COVID-19, increasing the risk of ICU admission. Preliminary analyses from Lille University Hospital, using the same cohort of patients, have also reported a higher prevalence of invasive mechanical intubation in male patients and those with higher BMI, especially at least 35 kg/m2 in ICU patients with COVID-19.7Simonnet A Chetboun M Poissy J et al.High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation.Obesity (Silver Spring). 2020; (published online April 9.)DOI:10.1002/oby.22831Google Scholar However, whether these observations were influenced by a higher prevalence of obesity in these populations or important confounding factors such age and sex was not clear.9Caussy C Wallet F Laville M Disse E Obesity is associated with severe forms of COVID-19.Obesity (Silver Spring). 2020; (published online April 21.)DOI:10.1002/oby.22842Google Scholar Our study helps to fill this gap in knowledge by providing evidence of a higher prevalence of obesity among patients with severe COVID-19, especially those admitted to the ICU. However, this cross-sectional study did not capture other possible confounding factors such as viral load, biological data, socioeconomic factors, or other obesity-related comorbidities such as non-alcoholic fatty liver disease. Additionally, this study does not include any longitudinal follow-up as several patients are still hospitalised. Some patients in the non-ICU group might yet require ICU admission. We acknowledge that the findings in our study might not be generalised to other centres depending on the clinical algorithm implemented for ICU admission and ICU capacity and recommendations for the intensive care management of COVID-19 should be considered in future research.10Phua J Weng L Ling L et al.Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations.Lancet Respir Med. 2020; (published online April 6.)DOI:10.1016/S2213-2600(20)30161-2Google Scholar Finally, the comparison of the prevalence of obesity with the general population is based only on our sample of patients with COVID-19, and a population-based study would be needed to precisely assess the demographics of patients with COVID-19 with respect to the general population. Given the dual pandemics of COVID-19 and obesity in high-income countries, our findings have major implications for the clinical care of patients with obesity and COVID-19, as well as for public health interest. Further independent multicentre studies including longitudinal assessment of outcomes such as duration of hospitalisation and mortality are needed to confirm that obesity is a risk factor for severe COVID-19, and further analyses are planned on our datasets once follow-up is complete. These findings can help clinicians to better identify specific populations with higher risk of severe disease, which could lead to an increase in protective measures, proposal of serological screening for immunisation, and recommendation of a vaccination once available for people with obesity. We declare no competing interests. This work was partially supported by grants from the European Commission (FEDER 12003944), Agence National de la Recherche (European Genomic Institute for Diabetes ANR-10-LABX-46), and Foundation Coeur et Arteres (FCA number R15112EE). Download .pdf (.45 MB) Help with pdf files Supplementary appendix

ObjectiveThe COVID‐19 pandemic is rapidly spreading worldwide, notably in Europe and North America where obesity is highly prevalent. The relation between obesity and severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) has not been fully documented.MethodsThis retrospective cohort study analyzed the relationship between clinical characteristics, including BMI, and the requirement for invasive mechanical ventilation (IMV) in 124 consecutive patients admitted in intensive care for SARS‐CoV‐2 in a single French center.ResultsObesity (BMI > 30) and severe obesity (BMI > 35) were present in 47.6% and 28.2% of cases, respectively. Overall, 85 patients (68.6%) required IMV. The proportion of patients who required IMV increased with BMI categories (P < 0.01, χ2 test for trend), and it was greatest in patients with BMI > 35 (85.7%). In multivariate logistic regression, the need for IMV was significantly associated with male sex (P < 0.05) and BMI (P < 0.05), independent of age, diabetes, and hypertension. The odds ratio for IMV in patients with BMI > 35 versus patients with BMI < 25 was 7.36 (1.63‐33.14; P = 0.02).ConclusionsThe present study showed a high frequency of obesity among patients admitted in intensive care for SARS‐CoV‐2. Disease severity increased with BMI. Obesity is a risk factor for SARS‐CoV‐2 severity, requiring increased attention to preventive measures in susceptible individuals.

INTRODUCTION Inflating endotracheal tube cuffs using water instead of air before hyperbaric oxygen treatment (HBOT) is common. The objective of this study was to assess cuff pressure (Pcuff), when the cuff was inflated using water, in normobaric conditions and during HBOT. METHODS This was a prospective, observational study taking place in hyperbaric centre and intensive care unit of the University Hospital of Lille. Every patient who required tracheal intubation and HBOT at 253.3 kPa (2.5 atmospheres absolute [atm abs]) was included. Pcuff was measured using a pressure transductor connected to the cuff inflating port. Measurements were performed at 'normobaria' (1 atm abs) and during HBOT at 2.5 atm abs. RESULTS Thirty patients were included between February and April 2016. Recordings were analysable in 27 patients. Mean Pcuff at normobaria was 60.8 (SD 42) cmH2O. Nineteen (70%) of patients had an excessive Pcuff (higher than 30 cmH2O). Coefficient of variation was 69%. Mean Pcuff at 2.5 atm abs was 51.6 (40.7) cmH2O, significantly lower than at normobaria (P < 0.0001). Coefficient of variation was 79%. In only five (18%) patients was Pcuff < 20 cmH2O at 2.5 atm abs. CONCLUSIONS In normobaric conditions, when the cuff was inflated using water and not specifically controlled Pcuff was not predictable. The cuff was typically over-inflated exceeding safe pressure. During HBOT Pcuff decreased slightly.

AbstractAimsThe question of interactions between the renin angiotensin aldosterone system drugs and the incidence and prognosis of COVID-19 infection has been raised by the medical community. We hypothesised that if patients treated with ACE inhibitors (ACEI) or AT1 receptor blockers (ARB) were more prone to SARS-CoV2 infection and had a worse prognosis than untreated patients, the prevalence of consumption of these drugs would be higher in patients with COVID-19 compared to the general population.Methods and resultsWe used a clinical epidemiology approach based on the estimation of standardised prevalence ratio (SPR) of consumption of ACEI and ARB in four groups of patients (including 187 COVID-19 positive) with increasing severity referred to the University hospital of Lille and in three French reference samples (the exhaustive North population (n=1,569,968), a representative sample of the French population (n=414,046), a random sample of Lille area (n=1,584)).The SPRs of ACEI and ARB did not differ as the severity of the COVID-19 patients increased, being similar to the regular consumption of these drugs in the North of France population with the same non-significant increase for both treatment (1.17 [0.83–1.67]). A statistically significant increase in the SPR of ARB (1.56 [1.02–2.39]) was observed in intensive care unit patients only. After stratification on obesity, this increase was limited to the high risk subgroup of obese patients.ConclusionsOur results strongly support the recommendation that ACEI and ARB should be continued in the population and in COVID-19 positive patients, reinforcing the position of several scientific societies.

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