Background: COVID-19 is predominantly transmitted by droplets, being the risk of infection greatly increased in aerosol-generating procedures, such as intubation, extubation and aspiration of the orotracheal tube. Given the high transmission of this disease, it led to a reorganization of hospital teams and dynamics, with the implementation of additional protection measures. Medical innovation has taken an interesting role in the development of materials that provide protection when approaching the airway. Case: Male patient, 69 years old COVID-19 patient admitted to the Intensive Care Unit (ICU), that complicated with cardiopulmonary arrest. Advanced life support maneuvers with orotracheal intubation was immediately implemented, with recovery. The airway approach was performed using videolaryngoscope and placement of a plastic clamp in the orotracheal tube, only unclamped after connection to the closed circuit of the ventilator. For all these procedures, the aerosol box available at the ICU was used. Summary: The aerossol box and orotracheal tube clamp provided professionals decreases the dispersion of droplets and aerosols, reducing the exposure and consequently the risk of contagion of health professionals. Nevertheless, training and preparation of the staff is necessary in order to enhance the benefits and reduce the difficulties associated with the lack of experience in their use.

The pandemic we are facing has been devastating in some regions of the globe, not only because of the rapid spread, but also because of the unpredictability form of presentation and course of the disease. In fact, COVID-19 in its most severe form (SARS-CoV-2 pneumonia) and its systemic consequences have been described by several colleagues on the ground. The variety of multiorganic consequences, particularly cardiovascular, and the little expected response to therapeutic strategies as in the case of ventilation, makes us realize that knowledge about the virus is still scarce.

Background: Obesity has been a common factor in COVID-19 young patients who arrive at the hospital with advanced disease and high probability of invasive mechanical ventilation. The incidence of ARDS is increased in obese patients, although there are no studies that mention the association between the COVID-19 ventilatory phenotypes and obesity. These are two critical conditions that probably determine a hyper-inflammatory and hypercoagulable state. A correct ventilation and anticoagulation approach seems to be beneficial in these patients. Case: 32-year-old male, obese, with SARS-CoV-2 pneumonia. Clinically, with fever and cough and posterior respiratory failure, was hospitalized with severe disease, having bad prognosis markers, lymphopenia and negative septic screening. Admitted to the intensive care unit, needed invasive ventilation, with a “High-ARDS like” ventilatory phenotype. After unfavorable clinical evolution due to multiorgan dysfunction, antibiotic therapy was escaleted to cover nosocomial agents and low molecular weight heparin was adjusted. There was improvement of inflammatory parameters and ventilatory dysfunction since day tenth, was extubated at day fifteen and discharged after 22 days of hospitalization. Discussion: Obesity in COVID-19 seems a crucial factor, especially in young patients. COVID-19 infection may trigger a cytokine storm superimposed in a chronic hyper-inflammatory state as obesity. The patient presented with a “High-ARDS-like”. The relationship between COVID-19-obesity-ARDSLike phenotype can be suspected. Time to heal and anticoagulation with organ support until recovery (inflammatory-phase) could have been essential for the patient improvement. Conclusion: Obesity seems to be a crucial risk factor, especially in young patients. Anticoagulation with organ support until recovery of the inflammatory phase proved to be essential for the patient recovery.

Obesity has been recognized as an independent risk factor in other viral infections such as H1N1 (1). Although data are scarce at this stage, there is also an unexplained increased prevalence of obesity in patients infected with SARS-CoV-2 admitted to the intensive care units (ICU) (2).