Does socket liner material affect clinical outcomes in lower limb prosthesis users? Insights from a randomized control trial.

Among the noted disadvantages of prosthesis suspension by flexible liner is the increased rate of perspiration within the socket, which has the potential to cause discomfort, suspension issues, and tissue damage. In recent years, phase change material technology has been adopted for the use in prosthesis liners. These promise to improve temperature control and, consequently, reduce sweating. Previous work has demonstrated that this approach is effective in slowing the temperature increase at the limb-socket interface, but it was not clear how this would translate to clinical outcomes. This study had the aim to compare conventional and phase change material liners regarding prosthesis utilization, physical performance, and patient-reported outcome measures. A randomized double-blind cross-over study design with 6-month intervention periods was used. Of the 42 enrolled participants, only 50% completed the protocol. The high attrition was in large part because of the COVID-19 pandemic that started disrupting daily life and thereby the data collection midway through the study period. The findings indicate that the temperature control liners were, by trend, associated with better prosthesis utilization. The found effects did not reach the level of statistical significance, which is likely a result of the unduly reduced sample size.

PATIENT CHARACTERISTICS AND OUTCOMES OF SARS-COV-2 PATIENTS TREATED WITH PERCUTANEOUS TRACHEOSTOMY

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: To evaluate the safety and efficacy of percutaneous tracheostomy in patients with severe acute respiratory syndrome coronavirus (SARS-CoV-2) requiring prolonged intubation. METHODS: We retrospectively reviewed patients with confirmed SARS-CoV-2 infection between April 1st, 2020 to July 20, 2020 at Mount Sinai Medical Center who required endotracheal intubation. We identified 10 patients who underwent percutaneous tracheostomy due to prolonged intubation. The following baseline data was collected: age, sex, BMI, SARS-CoV-2 status, mechanical ventilation requirements and treatments administered. RESULTS: We reviewed over 200 patients admitted to ICU with SARS-COV2. Ten patients underwent percutaneous tracheostomy. The mean age was 64.2 ± 12.4, 90% were male, with mean BMI of 29 ± 5.3. Six patients underwent bedside tracheostomy, in an airborne isolation room and 4 patients underwent the procedure in an operating room (OR). Prior to tracheostomy, the mean days on ventilator were 26.5 ± 8.3 with 90% on deep sedation and/or paralysis. Four patients were positive for SARS-CoV-2 infection on the day of the procedure. Eight patients were treated with Hydroxychloroquine and Azithromycin, 90% treated with convalescent plasma, and 70% with IL-6 inhibitors. One returned to OR for excessive bleeding and one patient required a tracheostomy exchange. Currently, 5 patients (50%) have recovered to long-term facilities. Three patients were successfully decannulated, 2 patients remain hospitalized and 2 patients succumbed due to multiorgan failure. No staff involved in procedures developed SARS-CoV-2 infection. CONCLUSIONS: Percutaneous tracheostomy in SARS-CoV-2 critically ill patients is feasible, safe and can facilitate the weaning process from the ventilator. Adequate selection and appropriate timing are of utmost importance to obtain positive outcomes. Unfortunately, a vast number of patients suffering respiratory failure secondary to SARS-CoV-2 are not suitable candidates. Although, a small sample size, this cohort suggests that in adequately selected patients' early tracheostomy can facilitate recovery from respiratory failure due to SARS-CoV-2. CLINICAL IMPLICATIONS: In adequately selected patients, early tracheostomy may assist the weaning process of patients unable to come off the ventilator, facilitating mobilization and hasten recoveries. DISCLOSURES: No relevant relationships by Angel Porras, source=Web Response no disclosure on file for Fernando Safdie;No relevant relationships by Anita Singh, source=Web Response No relevant relationships by Francico Ujueta, source=Web Response

COVID-19 and waste management in Indian scenario: challenges and possible solutions.

The outbreak of COVID-19 pandemic has created havoc all across the globe causing exponential casualties and tremendous health and economic loss. With increasing COVID-19 cases, the amount of biomedical waste has increased manifolds making more people vulnerable to the pandemic. The developing and underdeveloped countries are already facing the challenges of waste management, and the waste generated during the pandemic scenario has added to the already existing challenges. The improper waste management practices need to be corrected; otherwise, the world will be facing a new disaster that could be termed as 'waste disaster'. The increase in COVID-19-associated waste (CAW) quantity and their availability in the environment will result in their easy approach to other organisms, which will possibly increase the potential risk of food chain contamination. Some of the countries have already started to make backup plans and are struggling to overcome the 'waste disaster'. In light of the limited knowledge available on the mutational properties and possible hosts of this newly emerged COVID-19, there is a great demand to have an efficient strategy to prevent the environment from further contamination in India. The necessity of the prevailing time is to create a more efficient, automatic, mechanized, and well-modified waste management system for handling the present situation and delaying the projected waste disaster in the near future in the era of COVID-19. The article aims to address the issues that originated from waste discharges, their potential sources along with possible sustainable solutions.

Bubble CPAP splitting: innovative strategy in resource-limited settings.

BACKGROUND: Non-invasive respiratory support for neonates using bubble continuous positive airway pressure (bCPAP) delivery systems is now widespread owing to its safety, cost effectiveness and easy applicability. Many innovative solutions have been suggested to deal with the possible shortage in desperate situations like disasters, pandemics and resource-limited settings. Although splitting of invasive ventilation has been reported previously, no attempts to split non-invasive respiratory support have been reported. OBJECTIVE: The primary objective was to test the feasibility of splitting the bCPAP assembly using a T-piece splitter in a simulation model. METHODS: A pilot simulation-based study was done to split a single bCPAP assembly using a T-piece. Other materials consisted of a heated humidification system, an air oxygen blender, corrugated inspiratory and expiratory tubing, nasal interfaces and two intercostal chest tube drainage bags. Two pressure manometers were used simultaneously to measure delivered pressures at different levels of set bCPAPs at the expiratory limb of nasal interfaces. RESULTS: Pressures measured at the expiratory end of two nasal interfaces were 5.1 and 5.2 cm H2O, respectively, at a flow of 6 L/min and a water level of 5 cm H2O in both chest bags. When tested across different levels of set continuous positive airway pressure (3-8 cmH2O) and fractional inspired oxygen concentration (0.30-1.0), measured parameters corresponded to set parameters. CONCLUSION: bCPAP splitting using a T-piece splitter is a technically simple, feasible and reliable strategy tested in a simulation model. Further testing is needed in a simulated lung model.

Neonatal COVID-19 Infection Management

AbstractCoronavirus disease 19 (COVID-19) infection pandemic has affected remarkable morbidity and mortality in a very short span of time. The overall disease profile and epidemiology is yet evolving but it seems to be highly infectious. Perinatal coronavirus infection is altogether a different perspective which has to be taken care of in a different way.