Controversies in Tracheostomy for Patients With COVID-19: The When, Where, and How.

COVID-19 has impacted how we deliver care to patients, and much remains unknown regarding optimal management of respiratory failure in this patient population. There are significant controversies regarding tracheostomy in patients with COVID-19 related to timing, location of procedure, and technique. In this narrative review, we explore the recent literature, publicly available guidelines, protocols from different institutions, and clinical reports to provide critical insights on how to deliver the most benefit to our patients while safeguarding the health care force. Consensus can be reached that patients with COVID-19 should be managed in a negative-pressure environment with proper personal protective equipment, and that performing tracheostomy is a complex decision that should be made through multidisciplinary discussions considering patient prognosis, institutional resources, staff experience, and risks to essential health care workers. A broad range of practices exist because there is no conclusive guidance regarding the optimal timing or technique for tracheostomy.

Clinical outcome analysis of male and female genital burn injuries: a 15-year experience at a level-1 burn center.

OBJECTIVES: The American Burn Association classifies a burn to the genitalia as a major injury. Isolated burns to the penis, scrotum or vulva are rare as a result of protection provided by the thighs and abdomen. Thus, burned genitalia represent an ominous sign of a more extensive total body surface area burn. METHODS: A retrospective analysis of consecutive patients admitted to a Level-1 Burn Unit with a burn involving the genitalia from January 1995 to December 2009 comprised the study population. RESULTS: A total of 393 patients of 5878 patients (6.7%) admitted to the Burn Unit suffered a burn involving the genitalia, including 253 males (64.4%) and 140 females (35.6%). The median total body surface area was 12% (range 1-100%), the most common cause of genital burn was scald (n = 246, 62.9%) and median length of stay was 9 days (range 1-472 days). A total of 269 patients (68.4%) were discharged to home from the hospital, and in-hospital mortality was 20.9%. CONCLUSIONS: The typical profile for those sustaining a genital burn include younger patients (≤30 years-of-age), sustaining a median total body surface area burn of 12% from a scald injury, with extensive genitalia involvement. Length of stay for genital burns is usually extended and, as a result of concomitant injuries, is associated with a 20% in-hospital death rate.

Pediatric genital burns: a 15-year retrospective analysis of outcomes at a level 1 burn center.

BACKGROUND/PURPOSE: Burns involving the genitalia and perineum are commonly seen in the context of extensive total body surface area (TBSA) burns and rarely as isolated injuries because of protection provided by the thighs and the abdomen. Genital burns usually result in extended hospital stays and are accompanied by severe morbidity and increased mortality. METHODS: A retrospective analysis of consecutive pediatric (<18 years) patients with burns involving the genitalia admitted to the Saint Barnabas Medical Center Level 1 Burn Unit from January 1, 1995, to December 31, 2009, was performed. RESULTS: One hundred sixty pediatric patients (8.3%) had a genital burn, including 105 patients younger than 5 years (65.6%) and 55 patients between 5 and 18 years (34.4%). Overall mean TBSA was 13.8% ± 16.8%, mean TBSA (genitalia) was 0.84% ± 0.25%, mean length of stay (LOS) was 11.9 ± 11.9 days, and mean burn intensive care unit LOS was 4.9 ± 9.7 days. CONCLUSIONS: In patients younger than 5 years, a TBSA burn more than 10% with extensive genitalia involvement is almost always the result of a scald injury. Younger patients (<5 years) are more often the victims of abuse, and prolonged LOS is the norm (>2 weeks). Patients 5 years or older are more often male and usually have a TBSA burn more than 15%.