Introduction: The COVID 19 pandemic was highlighted by a rise in hospital admissions secondary to respiratory decompensation. This was accompanied by an increase in ICU admissions, endotracheal intubation and mechanical ventilation. As a consequence, tracheostomies became essential in preventing complications of prolonged intubation and to facilitate weaning from sedation and mechanical ventilation. With the lack of international consensus on tracheostomy technique and optimal timing, we present our experience with 377 percutaneous tracheostomies performed on critically ill COVID 19 patients. Objective: To report the outcomes of critically ill patients with COVID 19 who underwent percutaneous tracheostomy during a period of 24 months. Methods: A retrospective single-center electronic chart review was performed on all ICU patients who underwent percutaneous tracheostomy after respiratory failure secondary to COVID 19 between March 2020 to March 2022. Results: A total of 377 percutaneous tracheostomies were performed. The mean duration between intubation and percutaneous tracheostomy was 17.4 days (3 to 61). The study included 222 males (59%) and 155 females (41%). The mean age of patients was 56.2 years (17-94), with a mean BMI was 31.3 (14 to 68). The commonest comorbidities among patients were diabetes mellitus (50%) and hypertension (48%). Complications were encountered in 85 cases (23%), with the commonest overall complication being minor bleeding. 203 patients (54%) were weaned from sedation. The mean duration between tracheostomy and weaning from sedation was 7.5 days (1 to 47 days). 156 patients (41%) were weaned from MV. The mean duration between tracheostomy and weaning from MV was 12.9 days (1 to 58 days). There was a total of 236 (63%) deaths reported during the period of this study. No deaths were attributable to the surgical procedure. Conclusion: Percutaneous tracheostomy can be safely performed in patients with COVID 19. With lack of conclusive objective data regarding the optimal timing for tracheostomy, we recommend that tracheostomy be performed as soon as possible after the 7th day endotracheal intubation. Key Words: Percutaneous tracheostomy, COVID 19, Critically ill, ICU
Objectives An error in the diagnosis of an oral or maxillofacial lesion could potentially be detrimental to a patient’s prognosis and management. Major discrepancies between the initial and subsequent diagnoses of head and neck pathologies range from 7 to 53%. This study determined the rate of discrepancies found in the diagnoses of oral and maxillofacial lesions after a second opinion in Saudi Arabia. Methods A retrospective single-center study was conducted by oral and maxillofacial pathology consultants to review all cases referred for a second opinion to the oral and maxillofacial pathology laboratory between January 2015 and December 2020. If the second-opinion diagnosis matched the original diagnosis, this was described as “agreement.” If the second-opinion diagnosis did not match the original diagnosis but would not change the management or prognosis of a patient, this was classified as a “minor disagreement.” If the second-opinion diagnosis resulted in the changing of a patient’s management or prognosis, this was categorized as a “major disagreement.” Chi-square test and Fisher’s exact test were used to compare data between original and second-opinion diagnoses. A p-value of less than 0.05 was considered significant. Results Of 138 cases, 59 (43%) had an initial diagnosis and a second-opinion diagnosis that were in major disagreement. The most common tumor for which there was a major disagreement was squamous cell carcinoma. No single factor influenced the occurrence of major disagreements. Conclusions Our evaluation reiterates the importance of obtaining a second opinion from a specialist in oral and maxillofacial pathology to improve the diagnostic accuracy for lesions. A formal system for this step, in addition to the obtaining of adequate clinical and radiographic information about a patient, is mandatory for the review of difficult cases.
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