Changes in Mode of Oxygen Delivery and Physiological Parameters with Physiotherapy in COVID-19 Patients: A Retrospective Study.

Background: Coronavirus disease (COVID-19) is an infectious disease caused by SARS-CoV-2, clinically presenting with common symptoms of fever, dry cough, and breathlessness within 14 days of exposure. Its severity ranges from mild to severe, latter manifesting into severe acute respiratory syndrome. As a part of multidisciplinary team, physiotherapy along with medical management was administered to patients with COVID-19 in an acute care setup. This retrospective study aims to explore various patient characteristics and will aid in identifying the impairments associated with the disease, giving a direction to the physiotherapy community in planning future management strategy to improve quality of life. Patients and methods: The present study is a unicentric study wherein prospective analysis of retrospective data of patients referred for physiotherapy from May 13 to July 31, 2020, was performed. (i) Characteristics of patients, (ii) associated comorbidities, (iii) hospital course since the time of admission to discharge, (iv) mode of oxygen delivery, (v) pre- and post-physiotherapy treatment values of oxygen saturation and heart rate, and (vi) physiotherapy treatment were recorded. The archived data were analyzed using the commercially available SPSS software version 24. Wilcoxon's matched pair test was used to compare pre- and post-treatment oxygen saturation and heart rate, and McNemar's test was used to compare mode of oxygen delivery and pre- and post-physiotherapy treatment. Results: Descriptive analysis of data showed a better outcome in terms of grade of dyspnea and rate of discharge on day 14 of physiotherapy treatment. Hence, a comparative analysis of day 1 and day 14 was performed for mode of oxygen delivery, oxygen saturation, and heart rate. A statistically significant improvement was observed in the heart rate (p = 0.001) and oxygen delivery (p = 0.000). However, no significant difference in the level of oxygen saturation was found (p = 0.6433). Conclusion: Physiotherapy treatment in conjunction with medical treatment can be effectively administered in patients with COVID-19 in acute care setup taking into consideration the health status and the hemodynamic stability of the patients. It emphasizes the role of physiotherapy in the alleviation of symptoms, facilitating early weaning and recovery enabling early discharge from the hospital. How to cite this article: Verma CV, Arora RD, Mistry HM, Kubal SV, Kolwankar NS, Patil PC, et al. Changes in Mode of Oxygen Delivery and Physiological Parameters with Physiotherapy in COVID-19 Patients: A Retrospective Study. Indian J Crit Care Med 2021;25(3):317-321.

Rupture of splenic artery pseudoaneurysm presenting with massive upper gastrointestinal bleed.

Splenic artery pseudoaneurysms develop in as many as 10% of patients with acute pancreatitis. The diagnosis should be suspected in patients with pancreatitis who develop either upper gastrointestinal bleeding without an obvious cause or in whom a contrast-enhanced lesion is demonstrated within or adjacent to a suspected pseudocyst as determined by computed tomography scan.

Treatment of Chronic Gastric Volvulus by Percutaneous Endoscopic Gastrostomy.

Five adult cases of chronic gastric volvulus were treated by percutaneous endoscopic Gastrostomy (PEG) between October 1992 and September 1997. Four cases were organoaxial volvulus and one was mesentericoaxial volvulus (Fig. 2). Diagnosis of volvulus was made by upper Gl barium examination. The volvulus was reduced endoscopically and fixed by PEG using an indigenous PEG catheter. The tube was kept for 6 to 8 weeks. All patients were found to be asymptomatic at 3 months after removal of their PEG catheter. Barium examination revealed no recurrence. There was no procedure-related mortality. PEG is a safe and effective method for treating chronic gastric volvulus.

Degloving injury of small intestine.

Self-inflicted stab wounds are seldom very grave. We report a 25-year-old man who inflicted stab wounds with a glass piece under the influence of alcohol. This led to evisceration and later degloving injury to the small bowel. He recovered following surgery.

Recurrent inflammatory pseudotumor of small bowel mesentery presenting as perforative peritonitis.

A 62-year-old man with recurrent inflammatory pseudotumor of the small bowel mesentery presented with perforative peritonitis; such a presentation has not been reported. The mass was excised successfully.