BACKGROUND The exponential rise in Coronavirus disease 2019(COVID-19)cases has resulted in an increased number of patients requiring prolonged ventilatory support and subsequent tracheostomy.With the limited availabil...BACKGROUND The exponential rise in Coronavirus disease 2019(COVID-19)cases has resulted in an increased number of patients requiring prolonged ventilatory support and subsequent tracheostomy.With the limited availability of literature regarding the outcomes of COVID-19 patients with tracheostomy,we attempted to study the clinical characteristics and multiple parameters affecting the outcomes in these patients.AIM To determine all-cause mortality following tracheostomy and its association with various risk factors in COVID-19 patients.METHODS This retrospective study included 73 adult COVID-19 patients admitted to the ICU between 1 April,2020 and 30 September,2021 who underwent tracheostomy as a result of acute respiratory failure due to COVID-19.The data collected included demographics(age,sex),comorbidities,type of oxygen support at admission,severity of COVID-19,complications,and other parameters such as admission to tracheostomy,intubation to tracheostomy,ICU stay,hospital stay,and outcome.RESULTS This study included 73 adult patients with an average age of 52±16.67 years,of which 52%were men.The average time for admission to tracheostomy was 18.12±12.98 days while intubation to tracheostomy was 11.97±9 days.The mortality rate was 71.2%and 28.8%of patients were discharged alive.The mean duration of ICU and hospital stay was 25±11 days and 28.21±11.60 days,respectively.Greater age,severe COVID-19,mechanical ventilation,shock and acute kidney injury were associated with poor prognosis;however,early tracheostomy in intubated patients resulted in better outcomes.CONCLUSION Patients with severe COVID-19 requiring mechanical ventilation have a poor prognosis but patients with early tracheostomy may benefit with no added risk.We recommend that the timing of tracheostomy be decided on a case-by-case basis and a well-designed randomised controlled trial should be performed to elucidate the potential benefit of early tracheostomy in such patients.展开更多
Purpose: Fat embolism syndrome (FES) is systemic manifestation of fat emboli in the circulation seen mostly after long bone fractures. FES is considered a lethal complication of trauma. There are various case reports ...Purpose: Fat embolism syndrome (FES) is systemic manifestation of fat emboli in the circulation seen mostly after long bone fractures. FES is considered a lethal complication of trauma. There are various case reports and series describing FES. Here we describe the clinical characteristics, management in ICU and outcome of these patients in level I trauma center in a span of 6 months. Methods: In this prospective study, analysis of all the patients with FES admitted in our polytrauma intensive care unit (ICU) of level I trauma center over a period of 6 months (from August 2017 to January 2018) was done. Demographic data, clinical features, management in ICU and outcome were analyzed. Results: We admitted 10 cases of FES. The mean age of patients was 31.2 years. The mean duration from time of injury to onset of symptoms was 56 h. All patients presented with hypoxemia and petechiae but central nervous system symptoms were present in 70% of patients. The mean duration of mechanical ventilation was 11.7 days and the mean length of ICU stay was 14.7 days. There was excellent recovery among patients with no neurological deficit. Conclusion: FES is considered a lethal complication of trauma but timely management can result in favorable outcome. FES can occur even after fixation of the fracture. Hypoxia is the most common and earliest feature of FES followed by CNS manifestations. Any patient presenting with such symptoms should raise the suspicion of FES and mandate early ICU referral.展开更多
Early diagnosis of cerebral fat embolism in a patient with contradiction to MRI is challenging.Here we report an interesting case,where the raised optic nerve sheath diameter helped us to predict the early cerebral in...Early diagnosis of cerebral fat embolism in a patient with contradiction to MRI is challenging.Here we report an interesting case,where the raised optic nerve sheath diameter helped us to predict the early cerebral involvement with fat emboli in a left femoral shaft fracture patient.MRI scan could not be performed due to the presence of a metallic implant in the patient from a previous surgery.He was later diagnosed as an atypical presentation of fat embolism syndrome.Optic nerve sheath monitoring also helped us to guide further management of the patient.展开更多
Background:Road traffic accident accounts for 70%to 80%of the blunt cardiac injury.The true incidence varies in the literature due to non-uniform criteria for diagnosis.Case Presentation:Here,we describe the case of a...Background:Road traffic accident accounts for 70%to 80%of the blunt cardiac injury.The true incidence varies in the literature due to non-uniform criteria for diagnosis.Case Presentation:Here,we describe the case of a young male presenting after blunt chest injury and hemodynamic instability.Initially,the patient had frequent episodes of arrhythmias and hypotension due to cardiac injury per se.However,he was stabilized by day 2.Subsequently,patient developed cellulitis followed by septic shock and succumbed to cellulitis on day 5 of injury.Conclusion:Sepsis is difficult to be diagnosed and treated in the presence of cardiac injury.Myocardial depression has been found in sepsis,which contributes as an added comorbidity in an already compromised heart function.Sepsis also interferes with the diagnosis and follow-up of progress of blunt cardiac injury.展开更多
文摘BACKGROUND The exponential rise in Coronavirus disease 2019(COVID-19)cases has resulted in an increased number of patients requiring prolonged ventilatory support and subsequent tracheostomy.With the limited availability of literature regarding the outcomes of COVID-19 patients with tracheostomy,we attempted to study the clinical characteristics and multiple parameters affecting the outcomes in these patients.AIM To determine all-cause mortality following tracheostomy and its association with various risk factors in COVID-19 patients.METHODS This retrospective study included 73 adult COVID-19 patients admitted to the ICU between 1 April,2020 and 30 September,2021 who underwent tracheostomy as a result of acute respiratory failure due to COVID-19.The data collected included demographics(age,sex),comorbidities,type of oxygen support at admission,severity of COVID-19,complications,and other parameters such as admission to tracheostomy,intubation to tracheostomy,ICU stay,hospital stay,and outcome.RESULTS This study included 73 adult patients with an average age of 52±16.67 years,of which 52%were men.The average time for admission to tracheostomy was 18.12±12.98 days while intubation to tracheostomy was 11.97±9 days.The mortality rate was 71.2%and 28.8%of patients were discharged alive.The mean duration of ICU and hospital stay was 25±11 days and 28.21±11.60 days,respectively.Greater age,severe COVID-19,mechanical ventilation,shock and acute kidney injury were associated with poor prognosis;however,early tracheostomy in intubated patients resulted in better outcomes.CONCLUSION Patients with severe COVID-19 requiring mechanical ventilation have a poor prognosis but patients with early tracheostomy may benefit with no added risk.We recommend that the timing of tracheostomy be decided on a case-by-case basis and a well-designed randomised controlled trial should be performed to elucidate the potential benefit of early tracheostomy in such patients.
文摘Purpose: Fat embolism syndrome (FES) is systemic manifestation of fat emboli in the circulation seen mostly after long bone fractures. FES is considered a lethal complication of trauma. There are various case reports and series describing FES. Here we describe the clinical characteristics, management in ICU and outcome of these patients in level I trauma center in a span of 6 months. Methods: In this prospective study, analysis of all the patients with FES admitted in our polytrauma intensive care unit (ICU) of level I trauma center over a period of 6 months (from August 2017 to January 2018) was done. Demographic data, clinical features, management in ICU and outcome were analyzed. Results: We admitted 10 cases of FES. The mean age of patients was 31.2 years. The mean duration from time of injury to onset of symptoms was 56 h. All patients presented with hypoxemia and petechiae but central nervous system symptoms were present in 70% of patients. The mean duration of mechanical ventilation was 11.7 days and the mean length of ICU stay was 14.7 days. There was excellent recovery among patients with no neurological deficit. Conclusion: FES is considered a lethal complication of trauma but timely management can result in favorable outcome. FES can occur even after fixation of the fracture. Hypoxia is the most common and earliest feature of FES followed by CNS manifestations. Any patient presenting with such symptoms should raise the suspicion of FES and mandate early ICU referral.
文摘Early diagnosis of cerebral fat embolism in a patient with contradiction to MRI is challenging.Here we report an interesting case,where the raised optic nerve sheath diameter helped us to predict the early cerebral involvement with fat emboli in a left femoral shaft fracture patient.MRI scan could not be performed due to the presence of a metallic implant in the patient from a previous surgery.He was later diagnosed as an atypical presentation of fat embolism syndrome.Optic nerve sheath monitoring also helped us to guide further management of the patient.
文摘Background:Road traffic accident accounts for 70%to 80%of the blunt cardiac injury.The true incidence varies in the literature due to non-uniform criteria for diagnosis.Case Presentation:Here,we describe the case of a young male presenting after blunt chest injury and hemodynamic instability.Initially,the patient had frequent episodes of arrhythmias and hypotension due to cardiac injury per se.However,he was stabilized by day 2.Subsequently,patient developed cellulitis followed by septic shock and succumbed to cellulitis on day 5 of injury.Conclusion:Sepsis is difficult to be diagnosed and treated in the presence of cardiac injury.Myocardial depression has been found in sepsis,which contributes as an added comorbidity in an already compromised heart function.Sepsis also interferes with the diagnosis and follow-up of progress of blunt cardiac injury.
