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A 61-year-old male patient diagnosed with Coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) was managed with tracheostomy and intermittent prone positioning in the intensive care unit. After a sudden deterioration, examination of tracheostomy tube (TT) and X-ray of the chest revealed that he had aspirated the fractured TT. The fractured tube was removed through the tracheostomy stoma using a rigid ventilating bronchoscope and forceps. Prone positioning is a beneficial postural therapy capable of improving patient oxygenation. However, it has some complications, like unplanned extubation and facial tissue injury. Percutaneous tracheostomy is also a valuable and safe procedure and has been increasingly performed in critical care patients, including those who suffer from COVID-19 ARDS. Fractures and aspiration of a tracheostomy tube can occur anytime after tracheostomy. We think prone positioning may contribute to the rupture and aspiration of the tracheostomy tube in this study. [ABSTRACT FROM AUTHOR]

Introduction: Hospital-acquired anemia (HAA) is common, especially in the most intensive care patients (ICP). Several literature series suggest that patients who develop HAA have increased mortality and morbidity compared with those who do not. The cause of HAA is likely multifactorial; iatrogenic blood loss,impaired erythropoiesis, bleeding episodes all can lead to HAA in ICP. Little research has focused on HAA, which develops during ICU admission of ARDS patients. The objective of this study was to investigate the incidence HAA, as well as its relationship with mortality, in COVID-19 associated ARDS patients admitted to ICU. Materials and Methods: We retrospectively analyzed all adult COVID-19 ARDS patients admitted to our ICU between January 2020 and December 2021 (n=1,007). Patients with missing data (n=7) or who have a length of ICU stay of less than 24 hours (n=10) were excluded. In addition, patients with chronic anemia at admission (n=445) were also excluded, because main focus of the study was development of HAA. Anemia is defined as a hemoglobin (Hgb) value <12 g/dL in women and <13 g/dL in men by WHO. HAA was defined as a nadir Hgb value during the course of ICU stay meeting WHO criteria. We further grouped Hgb by degree into mild anemia (Hgb >11 and <12 g/dL in women, >11 and<13 g/dL in men), moderate anemia (Hgb >9 and ≤11 g/dL) and severe anemia (Hgb ≤9 g/dL). COVID-19 ARDS is diagnosed when the patient with confirmed COVID-19 infection meets the Berlin 2012 ARDS diagnostic criteria. Baseline patient characteristics, admission Hgb and lactate levels, lengths of ICU stay and in-hospital mortality of patients who developed HAA were compared with those who did not develop HAA. We further stratified the patients based on the severity of HAA. Results: HAA developed in 373 (68.4%) patients. Characteristics and mortality rates of patients with and without HAA are presents in Table 1. Table 2 shows the data of the patients by presence and severity of HAA. Conclusion: Development of HAA is common and associated with higher in-hospital mortality. Patients who developed severe HAA has the highest mortality rates (73.1%). Hospitals must raise awareness of HAA. [ABSTRACT FROM AUTHOR]

Introduction: Low hemoglobin levels are associated with an increased risk of mortality in intensive care (ICU) patients. The underlying reason is due to the limitation in oxygen delivery to the tissues caused by a reduction in the number of oxygen carrying erythrocytes. This study aimed to examine the relationship between hemoglobin drop (DHgb= admission hemoglobin-nadir hemoglobin), nadir hemoglobin levels (NdrHgb; the lowest hemoglobin value during ICU stay) and mortality in COVID ARDS patients admitted to intensive care. Materials and Methods: This was a prospective non-randomized study of consecutive COVID ARDS patients who had at least two determinations of hemoglobin level (the first on admission) separated by 24 hours and an ICU stay <14 days. Admission hemoglobin (AdmHgb), NdrHgb and DHgb levels were analyzed. Data on blood transfusions were also collected. Results: Although high DHgb and low NdrHgb levels were significantly associated with mortality in univariate analysis of patients, this was not sustained in multivariate analysis. The area under the ROC curve (AUC) of DHgb was 0.577, with a cut-off value of 1.9 g/dL, sensitivity and specificity were 50.7%, and 65.2%, respectively. NdrHgb had a cut-off value of 10.7 g/ dL, with an AUC of 0.423, sensitivity and specificity of 50%. Conclusion: Our results showed that DHgb and low NdrHgb levels are both predictive markers for mortality with moderate sensitivity and specifity. We recommend further studies evaluating a simple scoring model based on DHgb and NdrHgb for predicting mortality. [ABSTRACT FROM AUTHOR]

Neuromuscular blocking agents can be used for purposes such as eliminating ventilator-patient dyssynchrony, facilitating gas exchange by reducing intra-abdominal pressure and improving chest wall compliance, reducing risk of lung barotrauma, decreasing contribution of muscles to oxygen consumption by preventing shivering and limiting elevations in intracranial pressure caused by airway stimulation in patients supported with mechanical ventilation in intensive care units. Adult Respiratory Distress Syndrome (ARDS), status asthmaticus, increased intracranial pressure and therapeutic hypothermia following ventricular fibrillation--associated cardiac arrest are some of clinical conditions that can be sustained by neuromuscular blockade. Appropriate indication and clinical practice have gained importance considering side effects such as ICU-acquired weakness, masking seizure activity and longer durations of hospital and ICU stays. We mainly aimed to review the current literature regarding neuromuscular blockade in up-to-date clinical conditions such as improving oxygenation in early ARDS and preventing shivering in the therapeutic hypothermia along with summarising the clinical practice in adult ICU in this report. [ABSTRACT FROM AUTHOR]

Neuromuscular blocking agents can be used for purposes such as eliminating ventilator-patient dyssynchrony, facilitating gas exchange by reducing intra-abdominal pressure and improving chest wall compliance, reducing risk of lung barotrauma, decreasing contribution of muscles to oxygen consumption by preventing shivering and limiting elevations in intracranial pressure caused by airway stimulation in patients supported with mechanical ventilation in intensive care units. Adult Respiratory Distress Syndrome (ARDS), status asthmaticus, increased intracranial pressure and therapeutic hypothermia following ventricular fibrillation--associated cardiac arrest are some of clinical conditions that can be sustained by neuromuscular blockade. Appropriate indication and clinical practice have gained importance considering side effects such as ICU-acquired weakness, masking seizure activity and longer durations of hospital and ICU stays. We mainly aimed to review the current literature regarding neuromuscular blockade in up-to-date clinical conditions such as improving oxygenation in early ARDS and preventing shivering in the therapeutic hypothermia along with summarising the clinical practice in adult ICU in this report. [ABSTRACT FROM AUTHOR]