Timing, Complications, and Safety of Tracheotomy in Critically Ill Patients With COVID-19.

IMPORTANCE: The current coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented needs for invasive ventilation, with 10% to 15% of intubated patients subsequently requiring tracheotomy. OBJECTIVE: To assess the complications, safety, and timing of tracheotomy performed for critically ill patients with COVID-19. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study assessed consecutive patients admitted to the intensive care unit (ICU) who had COVID-19 that required tracheotomy. Patients were recruited from March 16 to April 10, 2020, at a tertiary referral center. EXPOSURES: A surgical tracheotomy was performed for all patients following recommended criteria for use of personal protective equipment (PPE). MAIN OUTCOMES AND MEASURES: The number of subthyroid operations, the tracheal entrance protocol, and use of PPE. Infections among the surgeons were monitored weekly by reverse-transcriptase polymerase chain reaction of nasopharyngeal swab samples. Short-term complications, weaning, and the association of timing of tracheotomy (early [≤10 days] vs late [>10 days]) with total required days of invasive ventilation were assessed. RESULTS: A total of 50 patients (mean [SD] age, 63.8 [9.2] years; 33 [66%] male) participated in the study. All tracheotomies were performed at the bedside. The median time from intubation to tracheotomy was 9 days (interquartile range, 2-24 days). A subthyroid approach was completed for 46 patients (92%), and the tracheal protocol was adequately achieved for 40 patients (80%). Adequate PPE was used, with no infection among surgeons identified 4 weeks after the last tracheotomy. Postoperative complications were rare, with minor bleeding (in 6 patients [12%]) being the most common complication. The successful weaning rate was higher in the early tracheotomy group than in the late tracheotomy group (adjusted hazard ratio, 2.55; 95% CI, 0.96-6.75), but the difference was not statistically significant. There was less time of invasive mechanical ventilatory support with early tracheotomy compared with late tracheotomy (mean [SD], 18 [5.4] vs 22.3 [5.7] days). The reduction of invasive ventilatory support was achieved at the expense of the pretracheotomy period. CONCLUSIONS AND RELEVANCE: In this cohort study, with the use of a standardized protocol aimed at minimizing COVID-19 risks, bedside open tracheotomy was a safe procedure for patients and surgeons, with minimal complications. Timing of tracheotomy may be important in reducing time of invasive mechanical ventilation, with potential implications to intensive care unit availability during the COVID-19 pandemic.

Acid blue 29 decolorization and mineralization by anodic oxidation with a cold gas spray synthesized Sn-Cu-Sb alloy anode.

The elevated cost of anodic materials used in the anodic oxidation for water treatment of effluents undermines the real application of these technologies. The study of novel alternative materials more affordable is required. In this work, we report the application of Sn-Cu-Sb alloys as cheap anodic material to decolorize azo dye Acid Blue 29 solutions. These anodes have been synthesized by cold gas spray technologies. Almost complete decolorization and COD abatement were attained after 300 and 600 min of electrochemical treatment, respectively. The influence of several variables such as supporting electrolyte, pH, current density and initial pollutant concentration has been investigated. Furthermore, the release and evolution of by-products was followed by HPLC to better understand the oxidative power of Sn-Cu-Sb electrodes.

Prognostic significance and association of Helicobacter pylori infection in pharyngolaryngeal cancer.

The aim of this study is to assess the correlation between the Helicobacter pylori (H. pylori) serologic status of patients who underwent for curative resection for squamous cell carcinoma of the larynx and hypopharynx and their prognosis. From April 2004 to March 2005, we included eighty patients with laryngeal and hypopharyngeal cancer. Control group consisted of 20 healthy patients and 10 patients with Reinke's edema. Serologic status was assessed using an enzyme-linked immunosorbent assay kit for immunoglobulin G. Patients were followed for 5 years. H. pylori-positive serologic status was statistically significant for the case subjects (70.6 v/s 29.4 %; p < 0.001). Mean overall and disease-free survival were 50.7 months (range 46.9-54.5) and 52.1 months (range 48.3-55.7), respectively. H. pylori-positive serologic status was not associated with a poor prognosis in the Cox regression model (p = 0.77). We observed a positive association between H. pylori infection and laryngeal and hypopharyngeal cancer. But we fail to confirm that the presence of H. pylori infection is associated with poor outcome or a higher recurrence rate.