A Modified Technique for Percutaneous Dilatational Tracheostomy

Purpose: Percutaneous dilatational tracheostomy (PDT) is widely used in mechanical ventilation patients to facilitate weaning. This modified technique aims to reduce accidental intraprocedural airway loss and desaturation associated with current PDT techniques. Materials and Methods: This is a single-center, prospective cohort study of 100 patients who underwent a modified technique between September 8, 2022, and January 18, 2023. The procedure was performed at Shiraz University of medical science at the tertiary center, Namazi teaching hospital. In this method instead of withdrawing the endotracheal tube (ETT) up close to the vocal cord and subglottic area at the beginning of the procedure, which is a common theme in PDT techniques with accidental extubation risk, we kept the ETT and gradually withdraw it. Results: Of the 100 patients, the average age was 53.5 years, and 66% were males. On average, the procedure lasted 255 (67) seconds. All patients successfully underwent PDT with no life-threatening complications, accidental intraprocedural airway loss, or desaturation. Conclusions: As a result of this modified technique, PDT for airway management can be a safe and low-complication procedure without the risk of accidental intraprocedural airway loss. Moreover, omitting bronchoscopy and sonography during these procedures is cost-effective and secure.

Cerebral Vasomotor Reactivity in COVID-19: A Narrative Review

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily affects the respiratory system but can also lead to neurological complications. Among COVID-19 patients, the endothelium is considered the Achilles heel. A variety of endothelial dysfunctions may result from SARS-CoV-2 infection and subsequent endotheliitis, such as altered vascular tone, oxidative stress, and cytokine storms. The cerebral hemodynamic impairment that is caused is associated with a higher probability of severe disease and poor outcomes in patients with COVID-19. This review summarizes the most relevant literature on the role of vasomotor reactivity (VMR) in COVID-19 patients. An overview of the research articles is presented. Most of the studies have supported the hypothesis that endothelial dysfunction and cerebral VMR impairment occur in COVID-19 patients. Researchers believe these alterations may be due to direct viral invasion of the brain or indirect effects, such as inflammation and cytokines. Recently, researchers have concluded that viruses such as the Human Herpes Virus 8 and the Hantavirus predominantly affect endothelial cells and, therefore, affect cerebral hemodynamics. Especially in COVID-19 patients, impaired VMR is associated with a higher risk of severe disease and poor outcomes. Using VMR, one can gain valuable insight into a patient's disease progression and make more informed decisions regarding appropriate treatment options. A new pandemic may develop with the COVID-19 virus or other viruses, making it essential that healthcare providers and researchers remain focused on developing new strategies for improving survival in such patients, particularly those with cerebrovascular risk factors.

The hospitalization rate and clinical characteristics of mucormycosis prior and during COVID-19 pandemic: A single-center study

INTRODUCTION

There have been some reports of the association between SARS-CoV-2 infection and mucormycosis. This study aims to compare the hospitalization rates and clinical characteristics of mucormycosis before and during the COVID-19 pandemic.

METHODOLOGY

In this retrospective study, we compared the hospitalization rate of mucormycosis patients in Namazi hospital in Southern Iran for two periods of 40 months. We defined July 1st, 2018 to February 17th, 2020, as the pre-COVID-19 period and February 18th, 2020, to September 30th, 2021, as the COVID-19 period. In addition, a quadrupled group of hospitalized patients with age and sex-matched SARS-COV-2 infection without any sign of mucormycosis was selected as the control group for COVID-associated mucormycosis.

RESULT

In the total of 72 mucormycosis patients in the COVID period, 54 patients had a clinical history and a positive RT-PCR, which confirms the diagnosis of SARS-COV2 infection. The hospitalization rate of mucormycosis showed an increase of + 306% (95% CI: + 259%, + 353%) from a monthly average value of 0.26 (95% confidence interval (CI): 0.14, 0.38) in the pre-COVID period to 1.06 in the COVID period. The use of corticosteroids prior to the initiation of hospitalization (p ≤ 0.01), diabetes (DM) (p = 0.04), brain involvement (p = 0.03), orbit involvement (p = 0.04), and sphenoid sinus invasion (p ≤ 0.01) were more common in patients with mucormycosis during the COVID period.

CONCLUSIONS

In high-risk patients, especially diabetics, special care to avoid the development of mucormycosis must be taken into account in patients with SARS-COV-2 infection considered for treatment with corticosteroids.