Patients with a diagnosed fracture and surgical indication were evaluated by our anaesthesiology team, after obtaining history, chest radiography, blood exams, ECG, and PCR SARS-CoV-2 RNA swab test. In order to assess risk related to surgery, correct timing, and adequate anaesthetic procedure, we based patient’s staging upon clinical conditions, as described by the Italian Society of Anesthesiology and Intensive Care (SIAARTI) [14] (Table 1).
Table 1 Adapted SIAARTI staging for COVID-19 clinical presentation in adults [15]
Stage Description
Stage 1 Mild disease Patients with uncomplicated upper respiratory tract viral infection, unspecific symptoms as fever, cough (productive or unproductive), fatigue, anorexia, sore throat, nasal congestion, headache, muscle pain, discomfort; rarely diarrhea, nausea or vomiting.
Stage 2 Pneumonia Patients with pneumonia, no signs of severe pneumonia, no need for oxygen therapy.
Stage 3 Severe Pneumonia Fever or suspected respiratory tract infection associated to at least one of the following:
respiratory rate > 30/min, severe dyspnea, SpO2 < 93% in air.
The diagnosis is clinical; chest imaging can exclude complications.
Stage 4 ARDS Outbreak or worsening of respiratory symptoms within 1 week after first clinical manifestation.
Imaging: bilateral radiopacity not related to effusion, atelectasis or consolidations.
Origin of edema: respiratory failure not related to heart failure or fluid overload.
Oxygenation:
- mild ARDS: 200 mmHg < PaO2 / FiO2 ≤ 300 mmHg
- moderated ARDS: 100 mmHg < PaO2/FiO2 ≤ 200 mmHg
- severe ARDS: PaO2/FiO2 ≤ 100 mmHg
- When PaO2 is not available, SpO2/FiO2 ≤ 315 suggests ARDS
Stage 5 Sepsis Organ failure caused by deregulated host response to infection. Signs of organ failure include altered mental status, difficult or superficial respiration, increased respiratory rate, low O2 peripheral saturation, oliguria/anuria, tachycardia, cold extremities, hypotension, and cutaneous alterations, and laboratory findings including altered coagulation, thrombocytopenia, acidosis, hyperbilirubinemia, and increased lactates.
Stage 6 Septic shock Hypotension not responsive to volume expansion; need for vasopressors to keep MAP ≥ 65 mmHg and lactates ≥ 2 mmol/l