Mechanical Ventilation Associated Pneumomediastinum - A Rising Incidence of Cases in an Emergency Hospital During the COVID-19 Pandemics.

Introduction: Mechanical ventilation is a last resort solution for patients presenting with acute respiratory distress syndrome produced by SARS-CoV-2. Spontaneous pneumomediastinum is a rare pathology associated with invasive mechanical ventilation. The objective of our research was to highlight the increased incidence of spontaneous pneumomediastinum during the COVID-19 pandemics in our hospital. Material and method: A retrospective review of the cases in our hospital requiring surgical evaluation was performed. Electronic health records from our institution were searched for nontraumatic pneumomediastinum from October to November 2021. All patients that were identified with pneumomediastinum were included in the review. Results: We identified 12 mechanical ventilated patients that presented with free air in the mediastinum on a computed tomography during the study period. All of the patients had SARS-CoV-2 bronchopneumonia with extensive pulmonary involvement. The mortality rate among these patients was 58.33%. Conclusions: The main take-home message of our study is that the incidence of mechanically ventilation-associated pneumomediastinum was exponentially higher during the fourth wave of COVID-19. There is a need for multicenter data in this pathology for a better approach and to define surgical management options for these patients.

Surgical Stasis: Anomalies Scarcities in Surgical Residents Training in the Covid-19 Period.

Introduction: The COVID-19 pandemic has led to a marked decrease in surgical procedures performed worldwide and to numerous other changes in medical practice. We investigated the effect of these changes on surgical trainees. Method: We searched medical records and asked a total of 67 surgical residents from different specialities (general surgery, obstetrics-gynecology, orthopedics-traumatology, neurosurgery) to answer a questionnaire investigating how the total number of surgical procedures and operative role varied for each respondent during the pandemic, the number of medical congresses and handson courses they attended during this time, how much study time was available to them and how the changes in their training modules affected them. Results: Most respondents reported a marked decrease in the number of surgical procedures performed, performing key operative steps with a lower frequency. Most of them believed that their training stagnated or suffered a setback. However, most residents consider the changes in their training during the pandemic a useful experience. Conclusion: The real effect of the COVID-19 pandemic on surgical training should be further studied. Future prospective studies should identify threshold values for each surgical procedure and the most effective compensatory strategies.

Current Management of Colon Trauma at a Level II Trauma Center - A Single Center Review of Cases from the Last Two Decades.

Introduction: The large bowel is the second most commonly injured hollow viscus in penetrating abdominal trauma following the small bowel. Injuries to the colon are fairly common in times of war and the lessons learned in these instances have historically guided management. The objective of our research is to highlight current management principles as they are applied in a single trauma centre during the last two decades. Material and Method: retrospective review of our clinical experience was performed. Electronic health records from our institution were searched for injuries caused by external forces from January 2003 - October 2021. All patients that were identified with colon injuries were included in the review. Results: We identified 11 male patients with colon injuries during the study period. Repair options used were primary suture or colostomy formation with no anastomoses and no damage control procedures. Mortality was 27.2%, relatively high when compared with contemporaneous studies. Conclusions: The main take home message of our research is that the epidemiology of colon trauma is very different in a civilian environment that has a low caseload of penetrating injury compared to wartime injuries. There is a clear need of prospective multicentre data in this type of trauma cohorts to better define management options and not base our approach on wartime data or data from communities where the rate of penetrating injuries is high.