Bedside tracheostomy for a COVID-19 cohort.

The use of tracheostomy in ventilator dependent COVID-19 patients is novel because of the recent and rapid spread of this pandemic with risk of transmission of infection to healthcare workers. This case-series of mechanically ventilated COVID-19 patients indicates that percutaneous tracheostomy performed at bedside with careful precautions and limited modification of standard technique was effective in promoting weaning from mechanical ventilation with few complications and no transmission of COVID-19 infection to the procedural healthcare workers.

Extracorporeal Membrane Oxygenation for COVID-19 Treatment in a Community Hospital.

Description Coronavirus disease 2019 (COVID-19) may result in severe acute respiratory disease syndrome (ARDS) and death. For COVID-19 patients failing mechanical ventilation, extra corporeal membrane oxygenation (ECMO) has been used with varying efficacy in academic medical centers and quaternary referral centers. We report the successful use of veno-venous (VV) ECMO to treat refractory ARDS due to COVID-19 in a community hospital setting with a survival to discharge rate of 71% over a 3 month period. In a community hospital with adequate resources, VV ECMO can be an effective rescue therapy for selected COVID-19 patients who fail all other available treatments.

Utility of brain natriuretic peptide as a predictor of atrial fibrillation after cardiac operations.

BACKGROUND: Atrial fibrillation (AF) occurs frequently after coronary bypass grafting and valve operations. Brain natriuretic peptide (BNP) has been shown to predict recurrence of AF in congestive heart failure. It is a potential biomarker for preoperative risk stratification for development of AF in at-risk patients. METHODS: A total of 398 consecutive patients were prospectively evaluated for new-onset AF after heart operations. Patients with a history of AF and presence of permanent pacemaker were excluded. BNP levels were measured before and immediately after the operation. RESULTS: AF occurred in 20%. AF was more likely to develop in patients who were older, who underwent valve operations, had a lower ejection fraction, and a larger left atrial size. Preoperative exposure to statins (62% vs 43%, p < 0.01) and angiotensin inhibitors (60% vs 45%, p = 0.02) was more common in patients without AF. BNP values were insignificantly higher preoperatively (361 vs 302 mg/dL, p = 0.3) and postoperatively (312 vs. 229 mg/dL, p = 0.15) in patients with AF. Multivariate logistic analysis showed that older age (odds ratio [OR], 3.1, 95% confidence interval [CI], 1.7 to 5.6), lower ejection fraction (OR, 2.0; 95% CI, 1.2 to 3.3), larger left atrial size (OR, 3.1; 95% CI, 1.9 to 4.9), and nonuse of angiotensin inhibitors (OR, 2.3; 95% CI, 1.1 to 4.8) were independently associated with AF. CONCLUSIONS: This study does not support use of BNP for prediction of AF. Age, low ejection fraction, large left atrial size, and nonuse of angiotensin blocking agents were found to be significant predictors of AF development.

ICU admissions after actual or planned hospital discharge: incidence, clinical characteristics, and outcomes in patients with cancer.

BACKGROUND: Unexpected ICU admissions may result from early or premature discharge from the hospital. We sought to determine the incidence, clinical characteristics, and outcomes of patients admitted to the ICU after actual or planned hospital discharge and to analyze whether the need for ICU admission was related or unrelated to the associated hospitalization. METHODS: We retrospectively reviewed all adult ICU admissions between January 2004 and December 2006 at a tertiary care cancer center and identified the following two groups of patients: those patients admitted directly to the ICU within 48 h of actual hospital discharge (group A); and those patients admitted to the ICU within 48 h of planned hospital discharge (group B). RESULTS: Of 60,462 patients discharged from the hospital during the study period, 826 patients (1.4%) required readmission to the hospital within 48 h of discharge; of these, 13 patients (1.5%) were admitted directly to the ICU (group A). An additional 12 patients were admitted to the ICU within 48 h of a planned hospital discharge (group B). The majority of these 25 patients (68%) [groups A and B] required ICU admission for a condition that was related to the previous or current hospitalization. The overall hospital mortality rate for both groups was 16%. CONCLUSIONS: A small, but unique group of patients is admitted to the ICU within 48 h of actual or planned hospital discharge. Worsening of the underlying condition that necessitated the previous or current hospitalization often is the reason for ICU admission. Whether ICU admission could have been prevented by continued hospital care or improved diagnostic evaluation during the prior or current hospitalization requires further study.