Yudhyavir Singh

Objectives: Frailty in older adults is associated with more comorbid conditions, higher mortality, increased falls, and adverse discharge outcomes after hospitalization. While the Clinical Frailty Scale (CFS) and, more recently, the trauma-specific frailty index (TSFI) have been used to study adverse discharge outcomes, few studies have assessed their ability to predict hospital length of stay (LOS) in geriatric trauma patients. The objective of our study was to investigate the impact of frailty on hospital LOS and adverse discharge outcomes among elderly trauma patients. Material and Methods: A prospective observational study was conducted at a single center among geriatric trauma patients aged ≥65 years who were admitted for surgical interventions. Frailty was assessed using the CFS, and patients were categorized into two groups based on CFS scores of 1 -3 and 4 -7 for outcome analysis. The primary outcome was the effect of frailty on LOS. The secondary outcomes were the association of frailty with adverse discharge outcomes, i.e., mortality and correlation of CFS with TSFI. Results: Among 187 geriatric trauma patients, the median age was 74 years, and 53% were female. Frail patients (CFS 4–7) were significantly older than pre-frail patients (CFS 1–3) (76.08 vs. 71.55 years; p = 0.001). TSFI was markedly higher in frail patients (0.20 vs. 0.07; p < 0.001) and positively correlated with CFS ( r = 0.53). No significant differences were found in the LOS, discharge disposition, complications, or 28-day mortality (5% frail vs. 0% pre-frail). Conclusion: Frailty assessed using the CFS was not associated with prolonged LOS or adverse discharge outcomes. Although the TSFI was not associated with LOS, it showed a positive correlation with CFS scores.

Fat embolism syndrome (FES) often occurs following a long bone fracture and typically manifests within 24–72 h as respiratory distress, petechiae, and neurological signs. Fat embolism associated diffuse alveolar hemorrhage (DAH) is a rare but potentially life-threatening pulmonary complication. Here, we present a case of a 22-year-old male with femur and mandibular fractures following trauma who developed progressive hypoxemia and hemoptysis on day 2 of trauma. Chest X-ray imaging revealed bilateral alveolar infiltrates, and bronchoscopy confirmed alveolar hemorrhage. The patient was placed on mechanical ventilation due to severe alveolar hemorrhage. Treatment was initiated with methylprednisolone, along with nebulization of adrenaline and tranexamic acid to control the bleeding. DAH secondary to FES should be suspected in trauma patients presenting with hemoptysis and hypoxemia. Early diagnosis and prompt administration of corticosteroids and antifibrinolytic therapy can significantly improve patient outcomes.

Neuroleptic malignant syndrome (NMS) is a rare, idiosyncratic, and potentially fatal complication associated with the abrupt withdrawal of dopaminergic agents or the use of antidopaminergic medications that affect the hypothalamus and basal ganglia. Its hallmark features include severe hyperthermia, altered consciousness, skeletal muscle rigidity, and autonomic instability. We present the case of a young patient with a cervical spine injury who was admitted to the trauma intensive care unit (ICU). The patient developed a persistent high-grade fever that did not respond to standard interventions, which was ultimately attributed to NMS resulting from the administration of neuroleptic medications. Because of a high degree of clinical suspicion and the implementation of prompt therapeutic measures, the patient achieved a favorable clinical outcome. Early diagnosis and timely intervention are crucial in NMS due to its rapid clinical progression, particularly as the use of dopaminergic antagonists becomes more prevalent in ICU settings. This case highlights the diagnostic challenges of managing NMS alongside spinal trauma in the ICU, as NMS often mimics common postoperative and ICU-related complications, necessitating heightened clinical vigilance.

Autologous blood transfusion is defined as the collection of blood from the patient, either preoperatively or intraoperatively, and its transfusion back to the same patient as and when required. We report a case of a 23-year-old pregnant female, G3P1L1A1, presenting with severe Rh alloimmunization, along with a baby requiring intrauterine transfusion for fetal anemia, planned for elective cesarean section and autologous blood transfusion.

COVID-19,mortality,pandemic,second wave

Introduction: Air leak consisting of pneumothorax, pneumomediastinum, and subcutaneous emphysema has been described as one of the complications of coronavirus disease-2019 (COVID-19) infection affecting disease course and outcome. We aimed to conduct a systematic review of published literature to highlight the risk factors, types, and outcomes in COVID-19. Method: A systematic search of PubMed, Embase, Scopus, and Google Scholar was performed from November 1, 2019, to February 28, 2021. Seventy-one studies fulfilled the inclusion criteria and 136 adult patients were included in the final analysis. Results: Majority of patients were male (75.2%) with the mean age of 58 years. Hypertension was the most common comorbidity followed by diabetes mellitus. Moreover, 12.5% of patients had a history of smoking while 11.7% had preexisting lung disease. Isolated pneumothorax (48.5%) was the most common and 17.65% had developed spontaneous pneumothorax. Mean onset time was 11.6 days and 67% of patients required an intercostal drainage tube for management. Mortality was 40%, and elderly, female gender, obese and hypertensive were at higher risk. Conclusion: COVID-19 related air leaks are associated with higher mortality and longer hospital stay and can occur even without positive pressure ventilation. History of smoking and preexisting lung disease has not been shown to increase the incidence of air leak. A well-designed study is required for a better understanding of COVID-19 related air leak.

Pulmonary alveolar proteinosis (PAP) is a syndrome, in which surfactants get deposited slowly in alveoli, blocking the airway exchange. PAP severity also varies from mild to severe, presenting with dyspnea, cough, hemoptysis with or without fever. The radiological findings are ground-glass opacities along with septal thickening (Crazy Paving), consolidations, and less commonly air bronchograms. COVID-19 is a viral infection caused by SARS COV2 primarily affecting the lungs and causing atypical viral pneumonia. The clinical picture of the disease varies from a milder form of fever, dry cough with or without expectoration, to severe disease-causing respiratory distress, pneumonia, acute respiratory distress syndrome (ARDS), and even death. Radiologically, the findings of COVID-19 are similar to PAP. So, PAP mimics the COVID-19, posing a differential challenge, though our patient was a known case of PAP. Therefore, for proper management of the disease, it is important to differentiate it from other pathologies. In this case report, we describe a patient who was a known case of autoimmune pulmonary alveolar proteinosis. She presented with acute exacerbation in the emergency department and tested positive for COVID-19. We followed a systematic approach consisting of clinical, laboratory, radiologic parameters to differentiate the cause of this exacerbation.

Coronavirus disease 2019,decannulation,percutaneous tracheostomy,tracheostomy,tracheostomy care

Background: Coronavirus disease (COVID-19) remains a health concern with new challenges emerging as the pandemic progresses. The recent rise of opportunistic infections especially mucormycosis in COVID-19 patients is further complicating their outcomes. Mucormycosis is well known to infect patients with diabetes mellitus, malignancy, chemotherapy, and other immunocompromised conditions. The treatment of COVID-19 largely remains systemic steroids and other immunomodulators that add to the risk of invasive fungal infection. Methodology: Here, we present a retrospective case series of 13 patients with individual clinical characteristics along with the demography and treatment details. The data were collected retrospectively in a single center that caters to a large population of COVID-19 patients with varying severity. Results: Thirteen patients were presented with COVID-19 associated mucormycosis (CAM). The median age was higher in non-survivors (49.5 years), with a higher odds of death (23.8) in those with severe COVID, having overall mortality of 64.3%. Moreover, diabetes mellitus was present in 61.5% of patients with a mortality of 75%. About 11 (84.6%) patients had received prior steroids for COVID-19. The incidence of hyperglycemia at admission was equal among both survivors and non-survivors. Conclusion: The prevalence of mucormycosis seems to be increasing among COVID-19 patients which may be associated with increased use of steroids, the possible immunocompromised state imposed by SARS-CoV-2, or co-existing conditions such as diabetes mellitus. The mortality of CAM is remarkably high and apart from preventive practices and rational use of immunomodulators, a high index of suspicion with early diagnosis would be key to survival.

A large number of studies describing the clinicoepidemiological features of coronavirus disease-2019 (COVID-19) patients are available but very few studies have documented similar features of the deceased. This study was aimed to describe the clinicoepidemiological features and the causes of mortality of COVID-19 deceased patients admitted in a dedicated COVID center in India. This was a retrospective study done in adult deceased patients admitted in COVID ICU from April 4 to July 24, 2020. The clinical features, comorbidities, complications, and causes of mortality in these patients were analyzed. Pediatric deceased were analyzed separately. A total of 654 adult patients were admitted in the ICU during the study period and ICU mortality was 37.7% (247/654). Among the adult deceased, 65.9% were males with a median age of 56 years [interquartile range (IQR), 41.5–65] and 94.74% had one or more comorbidities, most common being hypertension (43.3%), diabetes mellitus (34.8%), and chronic kidney disease (20.6%). The most common presenting features in these deceased were fever (75.7%), cough (68.8%), and shortness of breath (67.6%). The mean initial sequential organ failure assessment score was 9.3 ± 4.7 and 24.2% were already intubated at the time of admission. The median duration of hospital stay was 6 days (IQR, 3–11). The most common cause of death was sepsis with multi-organ failure (55.1%) followed by severe acute respiratory distress syndrome (ARDS) (25.5%). All pediatric deceased had comorbid conditions and the most common cause of death in this group was severe ARDS. In this cohort of adult deceased, most were young males with age less than 65 years with one or more comorbidities, hypertension being the most common. Only 5% of the deceased had no comorbidities. Sepsis with multi-organ dysfunction syndrome was the most common cause of death. Aggarwal R, Bhatia R, Kulshrestha K, Soni KD, Viswanath R, Singh AK, et al. Clinicoepidemiological Features and Mortality Analysis of Deceased Patients with COVID-19 in a Tertiary Care Center. Indian J Crit Care Med 2021; 25(6):622–628.