Spontaneous pneumomediastinum in patients with COVID-19 pneumonia.

INTRODUCTION: Spontaneous pneumomediastinum (SPM) is a rare affection in general population. Only few cases have been reported during this ongoing global pandemic of Coronavirus-2019 (COVID-19). The ethipathogeny of this complication is poorly understood. OBSERVATIONS: we reported ten cases of SPM complicating coronavirus pneumonia. There were six me and four women. Age varies from 32 to 66 years. Pneumonia was severe for all cases defined by a bloo oxygen saturation < 90% on admission. All patients were hospitalized in intensive care unit and treated by high-flow oxygen for nine patients and non-rebreather masks for one patient. Repeated chest computed tomography (CT) scan showed resolution of the pneumomediastinum and appearance of signs of pulmonary fibrosis for four cases. CONCLUSIONS: Chest CT scan must be performed in front of any sudden deterioration in respiratory status of patients with COVID-19 pneumonia to not miss mechanical complication such as SPM. This complication seems to be associated with severe forms of COVID-19.

C-reactive protein in the early diagnosis of pneumonia complicating severe blunt chest trauma.

INTRODUCTION: The early diagnosis of pneumonia following severe blunt chest trauma (SBCT) allows the early prescription of antibiotics and initiation of adequate supportive care. AIM: To assess the usefulness of C-reactive protein (CRP) in the early diagnosis of pneumonia complicating SBCT. METHODS: We conducted a prospective study of patients admitted to trauma intensive care unit for SBCT between January 2020 and February 2023. Patients were divided into two groups according to whether or not they developed pneumonia. The CRP levels were monitored daily. RESULTS: One hundred sixty-seven patients were included. Pneumonia occurred in 40.1% of patients within a median of 5 days. We found statistically significant difference in mean CRP levels between groups from day 3 to day 9 following trauma. The increase in CRP level on the 4th day from a value greater than or equal to 192 mg/L was a marker of early diagnosis of pneumonia (sensitivity 80.6%; specificity 80.8%). CONCLUSION: Daily CRP measurement from the 3rd day following SBCT may be useful for early diagnosis of pneumonia complicating SBCT.

Systematic preoperative tests prescription in elective surgery: it's high time to appraise!

BACKGROUND: The prescription of preoperative complementary tests aims to decrease morbidity and mortality associated to the perioperative period. AIM: To assess the practice and the financial cost of the systematic prescription of preoperative tests. METHODS: This was a retrospective study including all patients older than three years, scheduled for elective surgery from November 2018 to January 2019. Two attendings analyzed the data collected during the pre-anesthetic assessment and evaluated the usefulness of the ordered preoperative tests. The overall cost of prescribed preoperative tests and the cost generated by inappropriate prescriptions were also estimated. RESULTS: This study included 1006 patients. The average age was 46.9 ± 22.05 years old. Five hundred and twenty three of them (51.98%) have no medical history. Among the planned procedures, 6.46% had an intermediate or major bleeding risk. Preoperative prescriptions were ordered by surgeons in 99% of cases. Prescriptions were justifiable in only 9.42% of cases. Abnormal findings were noted in 4.98% of the patients. The total cost was almost 80992 Dinars (≈ 24543 €). Complying the guidelines would save 70245 Dinars (≈ 21286 €) during the three months' study. CONCLUSION: The routine prescription of preoperative complementary tests results in a significant additional economic cost. Developing national guidelines would change this attitude of unnecessary prescription.

Negative-pressure pulmonary edema following maxillofacial surgery: recognize to prevent further complications.

Negative-pressure pulmonary edema (NPPE) is a rare respiratory complication due to acute upper airway obstruction occurring shortly after extubation. We report a case of NPPE in young adult patient who underwent an eventful general anesthesia. The patient presented laryngospasm followed by acute respiratory distress with pink frothy sputum. The NPPE was initially misdiagnosed, and a preventable tracheostomy was performed. NPPE was managed with mechanical ventilation and diuretics, and the patient had full recovery. Every anesthesiologist should be aware of the diagnosis of NPPE. Early recognition and management are essential to prevent the morbidity associated with NPPE in young healthy patients.

Comparison of ultrasound-guided internal jugular vein and supraclavicular subclavian vein catheterization in critically ill patients: a prospective, randomized clinical trial.

BACKGROUND: The aim of this study was to compare the effectiveness and safety of ultrasound-guided out-of-plane internal jugular vein (OOP-IJV) and in-plane supraclavicular subclavian vein (IP-SSCV) catheterization in adult intensive care unit. METHODS: A total of 250 consecutive patients requiring central venous catheterization, were randomly assigned to undergo either ultrasound-guided OOP-IJV or IP-SSCV cannulation. All catheterizations were carried out by three physicians. The primary outcome was the first attempt success rate. Ultrasound scanning time, venous puncture time, insertion time, overall access time, number of puncture attempts, number of needle redirections, success rate, guidewire advancing difficulties, venous collapse and adverse events were also documented. RESULTS: The first attempt success rate was significantly higher in IP-SSCV group (83.2%) compared to OOP-IJV group (63.2%) (p = 0.001). The IP-SSCV group was associated with a longer ultrasound scanning time (16.54 ± 13.51 vs. 5.26 ± 4.05 s; p < 0.001) and a shorter insertion time (43.98 ± 26.77 vs. 53.12 ± 40.21 s; p = 0.038). In the IP-SCCV group, we recorded a fewer number of puncture attempts (1.16 ± 0.39 vs. 1.47 ± 0.71; p < 0.001), needle redirections (0.69 ± 0.58 vs. 1.17 ± 0.95; p < 0.001), difficulties in guidewire advancement (2.4% vs. 27.4%; p < 0.001), venous collapse (2.4%, vs. 18.4%; p < 0.001) and adverse events (8.8% vs. 13.6%; p = 0.22). CONCLUSIONS: The IP-SSCV approach is an effective and a safe alternative to the classic OOP-IJV catheterization in critical adult patients. TRIAL REGISTRATION: Clinicaltrials.gov, NCT03879954. Registered March 19, 2019-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03879954 .

Intussusception caused by an inverted Meckel's diverticulum: a rare cause of small bowel obstruction in adults.

Adult intussusception due to Meckel's diverticulum is an uncommon cause of intestinal obstruction. However, the surgeon should still be suspicious of this condition since the non specific symptoms and the rarity of it make a preoperative diagnosis uncertain. Considering the secondary nature of adult intussusception and the necessity of early surgical intervention to avoid morbidity and mortality, we report one case of intussusception due to Meckel's diverticulum in an adult. A 22-year-old patient was admitted to our hospital with vomiting and abdominal pain. The abdomen was hard with tenderness. We diagnosed an acute small bowel obstruction and performed emergency surgery. The intra operative findings were distention of the small bowel and intussusception of ileus due to an inverted Meckel's diverticulum located 70 cm from the ileocecal valve. 30 cm ischemic loop was identified. A segmental small bowel resection and hand-sewn anastomosis was performed. Histopathology distinguished Meckel's diverticulum measuring 5 cm x 3.5 cm x 1 cm and no signs of malignancy.