Preoperative virtual video visits only:a convenient option that should be offered to caregivers beyond the pandemic

Objective During the COVID-19 pandemic,our group implemented preoperative video visits(VVs)to limit physical contact.The aim of this study was to determine caregivers’and providers’perceptions of this practice and to determine feasibility for continuation.Methods All patients who had only a preoperative VV prior to an elective surgery were identified from March-October 2020.Caregivers,surgeons,and clinic staff were surveyed about their experiences.Results Thirty-four preoperative VVs were followed by an elective surgery without a preceding in-person visit.Of the 31 caregiver surveys completed,the majority strongly agreed that the VV was more convenient(87%,n=27).Eighty-one percent(n=25)strongly agreed or agreed that the VV saved them money.Ninety-four percent(n=29)strongly agreed or agreed that they would choose the VV option again.Caregivers saved an average travel distance of 60.3 miles one way(range 6.1-480).Of the 13/17 providers who responded,77%(n=10)expressed that the practice should continue.Conclusions Virtual health became a necessity during the pandemic,and caregivers were overwhelmingly satisfied.Continuing VVs as an option beyond the pandemic may be a reasonable and effective way to help eliminate some of the hurdles that impede healthcare-seeking behavior and should be offered.

Neonatal pneumothorax in congenital diaphragmatic hernia:Be wary of high ventilatory pressures

Background Patients with congenital diaphragmatic hernia(CDH)require invasive respiratory support and higher ventilator pressures may be associated with barotrauma.We sought to evaluate the risk factors associated with pneumothorax in CDH neonates prior to repair.Methods Weretrospectivelyreviewednewborns born withCDHbetween 2014and 2019who developeda pneumothorax,and we matched these cases to patients with CDH without pneumothorax.Results Twenty-sixpatientswere included(n=13per group).The pneumothorax group required extracorporeal life support(ECLS)more frequently(85%vs 54%,p=0.04),particularly among type A/B defects(31%vs 7%,p=0.01).The pneumothorax group had higher positive end-expiratory pressure(PEEP)within 1 hour of birth(p=0.02),at pneumothorax diagnosis(p=0.003),and at ECLS(p=0.02).The pneumothorax group had a higher mean airway pressure(Paw)at birth(p=0.01),within 1 hour of birth(p=0.01),and at pneumothorax diagnosis(p=0.04).Using multiple logistic regression with cluster robust SEs,higher Paw(OR 2.2,95%Cl 1.08 to 3.72,p=0.03)and PEEP(OR 1.8,95%CI 1.15 to 3.14,p=0.007)were associated with an increased risk of developing pneumothorax.There was no difference in survival(p=0.09).Conclusions Development of a pneumothorax in CDH neonates is independently associated with higher Paw and higher PEEP.A pneumothorax increases the likelihood of treated with ECLS,even with smaller defect.