Outcomes of delayed tracheostomy among intubated patients during the coronavirus disease pandemic.

BACKGROUND: Respiratory distress and failure is a complication of the coronavirus disease (COVID-19) and tracheostomy may be necessary in cases of prolonged intubation in order to reduce mechanical ventilation duration. However, according to the Canadian Society of Otolaryngology-Head and Neck Surgery guidelines, which our institution applies, patients should not undergo tracheostomy unless cleared of the virus to reduce its spread among healthcare workers because tracheostomy is an aerosolized procedure. This study aimed to identify the outcomes of prolonged intubation in patients with and without COVID-19 who underwent tracheostomy and to determine the morbidity and mortality rates in both groups. METHODS: This retrospective cohort study included adult patients admitted to the intensive care unit of King Fahad Hospital of the University, Alkhobar, Saudi Arabia, between March 1 and October 31, 2020. This study compared and analyzed the outcomes of delayed tracheostomy in patients with and without COVID-19 in terms of complication, morbidity, and mortality rates. RESULTS: Of the 228 study participants, 111 (48.68%) had COVID-19. The mean age of the study participants was 58.67 years (SD = 17.36, max.=93, min.=20), and the majority were males (n = 149, 65.35%). Regarding tracheostomy in patients with COVID-19, 11 (9.91%) patients underwent tracheostomy; however, four (36.36%) of them had prolonged intubation. The mean intensive care unit admission length of stay for tracheostomy patients was 37.17 days, while it was 12.09 days for patients without tracheostomy (t(226)=-9.32, p < 0.001). Regarding prolonged intubation among patients with COVID-19 (n = 7, 6.31%), the complications were as follows: six people (85.71%) had dysphonia, one (14.29%) had vocal cord granuloma, and two (28.57%) had subglottic tracheal stenosis. The mortality rate among our study participants was 51.32%, and the risk was significantly higher in older people (Odds ratio = 1.04, 95% Confidence Interval [CI] = 1.02-1.06) and in delayed tracheostomy cases (OR = 2.95, 95% CI = 1.31-6.63). However, COVID-19 status was not significantly related to the risk of mortality. CONCLUSIONS: Delaying tracheostomy increases the risk of mortality. Therefore, we recommend weighing the risks and benefits for each patient to benefit both healthcare workers and patients with COVID-19.

A Retrospective Analysis from A Single Center Perspective On Complications After Fixing Distal Radius Fracture In Pediatric Population.

Background: The Distal radius fractures in the pediatric age group have similar complications to any other fracture. One interpretation of the high fracture incidence in the distal third of the radius is the relative weakness of the metaphyseal part. Objective: The aim of this study is to provide an evaluation of Surgical complications of distal radius through satisfactory reduction and proper fixation by K-wires through bone growth plates. Methods: A retrospective single-center study in a tertiary hospital in Eastern Saudi Arabia from 2000 to 2021, using the hospital's electronic records system. The Inclusion criteria of this study involve all distal radius fracture cases who underwent surgical fixation by k-wire or plating system and are up to 14 years old. The exclusion criteria include loss of follow-up, incomplete data, and age of more than 14 years. Results: the study included 103 patients. The side of injury was almost equally distributed between the left and right sides. The odds of having at least one complication increase by 2.5 folds if the site of fracture is at the diaphysis. Further, if the distance of the fracture line to the epiphysis is more than 20 mm, the odds of reporting at least one complication post-procedure is 4.4 times higher than if it was at the level of the epiphysis. The majority of diaphyseal fractures required less than 6 weeks for radiological healing, which is significantly different from other sites which were evaluated. Conclusion: Complications of distal radius fracture due to Surgical intervention could be confounded by the complexity of the fracture itself. In our study, we found the distance of the fracture from the physis was inversely proportional to the likelihood of complications. For a comprehensive appreciation of physeal plate, we recommend extended follow-up for those who present with signs of severe distal radius fracture, especially in case of associated ulnar fracture.