Timing of tracheostomy in mechanically ventilated COVID-19 patients

According to the World Health Organization as of September 16,2021,there have been over 226 million documented cases of coronavirus disease 2019(COVID-19),which has resulted in more than 4.6 million deaths and approximately 14%develop a more severe disease that requires respiratory assistance such as intubation.Early tracheostomy is recommended for patients that are expected to be on prolonged mechanical ventilation;however,supporting data has not yet been provided for early tracheostomies in COVID-19 patients.The aim of this study was to explore established guidelines for performing tracheostomies in patients diagnosed with COVID-19.Factors considered were patient outcomes such as mortality,ventilator-associated pneumonia,intensive care unit length of stay,complications associated with procedures,and risks to healthcare providers that performed tracheostomies.Various observational studies,meta-analyses,and systematic reviews were collected through a PubMed Database search.Additional sources were found through Google.The search was refined to publications in English and between the years of 2003 and 2021.The keywords used were“Coronavirus”and/or“guidelines”and/or“tracheostomy”and/or“intensive care”.Twenty-three studies were retained.Due to the complex presentation of the respiratory virus COVID-19,previously established guidelines for tracheostomies had to be reevaluated to determine if these guidelines were still applicable to these critically ill ventilated patients.More specifically,medical guidelines state benefits to early tracheostomies in critically ill ventilated non-COVID-19 patients.However,after having conducted this review,the assumptions about the benefits of early tracheostomies in critically ill ventilated patients may not be appropriate for COVID-19 patients.

Changes in trends of orthopedic services due to the COVID-19 pandemic: A review

As of June 10,2022,the World Health Organization has recorded over 532 million documented coronavirus disease 2019(COVID-19)[(Coronavirus)SARS-CoV-2]cases and almost 6.3 million deaths worldwide,which has caused strain on medical specialties globally.The aim of this review is to explore the impact that COVID-19 has had on orthopedic practices.Providers observed a rapid decline in the number of orthopedic patients’admissions due to cancellation of elective procedures;however,emergent cases still required treatment.Various observational studies,case reports,and clinical trials were collected through a PubMed database search.Additional sources were found through Google.The search was refined to publications in English and between the years of 2019 and 2021.The keywords used were“COVID-19”and/or“Orthopedic Injuries”.Thirty-seven studies were retained.The pandemic brought on significant changes to the mechanism of injury,number of admissions,type of injuries,and patient outcomes.Mortality rates significantly increased particularly amongst patients with hip fractures and COVID-19.Road traffic injuries remained a common cause of injury and domestic injuries became more prevalent with lockdown.Social isolation negatively affected mental health resulting in several orthopedic injuries.Telehealth services and separation for COVID-positive and COVID-negative patients benefited both patients and providers.While hospitals and medical facilities are still facing COVID-19 case surges,it is important to understand how this pandemic has impacted preparation,care,and opportunities for prevention education and ongoing care.