Early detection and assessment of intensive care unit-acquired weakness: a comprehensive review.

Intensive care unit-acquired weakness (ICU-AW) is a serious complication in critically ill patients. Therefore, timely and accurate diagnosis and monitoring of ICU-AW are crucial for effectively preventing its associated morbidity and mortality. This article provides a comprehensive review of ICU-AW, focusing on the different methods used for its diagnosis and monitoring. Additionally, it highlights the role of bedside ultrasound in muscle assessment and early detection of ICU-AW. Furthermore, the article explores potential strategies for preventing ICU-AW. Healthcare providers who manage critically ill patients utilize diagnostic approaches such as physical exams, imaging, and assessment tools to identify ICU-AW. However, each method has its own limitations. The diagnosis of ICU-AW needs improvement due to the lack of a consensus on the appropriate approach for its detection. Nevertheless, bedside ultrasound has proven to be the most reliable and cost-effective tool for muscle assessment in the ICU. Combining the Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score assessment, and ultrasound can be a convenient approach for the early detection of ICU-AW. This approach can facilitate timely intervention and prevent catastrophic consequences. However, further studies are needed to strengthen the evidence.

Continuous Negative Pressure Operative Field Barrier for Combined Open Tracheostomy and Percutaneous Endoscopic Gastrostomy Tube Placement During Coronavirus Disease 2019.

Respiratory failure in coronavirus disease 2019 (COVID-19) patients with prolonged endotracheal intubation may require a tracheostomy and percutaneous endoscopic gastrostomy (PEG) tube placement to facilitate recovery. Both techniques are considered high-risk aerosol-generating procedures and present a heightened risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for operating room personnel. We designed, simulated, and implemented a portable, continuous negative pressure, operative field barrier system using standard equipment available in hospitals to enhance health care provider safety during high-risk aerosol-generating procedures.

Portable negative pressure environment to protect staff during aerosol-generating procedures in patients with COVID-19.

Patients with COVID-19 often need therapeutic interventions that are considered high aerosol-generating procedures. These are either being performed by healthcare providers with potentially inadequate personal protective equipment or the procedures are being delayed until patients clear their viral load. Both scenarios are suboptimal. We present a simple, cost-effective method of creating a portable negative pressure environment using equipment that is found in most hospitals to better protect healthcare providers and to facilitate more timely care for patients with COVID-19.

Reducing transmission of COVID-19 using a continuous negative pressure operative field barrier during oral maxillofacial surgery.

Oral and maxillofacial surgery in patients with suspected or confirmed COVID-19, presents a high risk of exposure and cross contamination to the operative room personnel. We designed, simulated and implemented a continue negative pressure operative field barrier to provide an additional layer of protection, using standard equipment readily available in most operative rooms during oral and maxillofacial procedures.

Paraplegia after mastoidectomy under general anesthesia.

We report a case of complete paraplegia after general anesthesia for a right tympanomastoidectomy without any apparent predisposing factors related to the surgical procedure or the anesthetic. The case raises the possibility that the combination of neck rotation and relative hypotension may precipitate paraplegia in patients with preexisting spinal chord pathology.