Cricotracheostomy for patients with severe COVID-19: A case control study

BackgroundTracheostomy is an important procedure for the treatment of severe coronavirus disease-2019 (COVID-19). Older age and obesity have been reported to be associated with the risk of severe COVID-19 and prolonged intubation, and anticoagulants are often administered in patients with severe COVID-19; these factors are also related to a higher risk of tracheostomy. Cricotracheostomy, a modified procedure for opening the airway through intentional partial cricoid cartilage resection, was recently reported to be useful in cases with low-lying larynx, obesity, stiff neck, and bleeding tendency. Here, we investigated the usefulness and safety of cricotracheostomy for severe COVID-19 patients.Materials and methodsFifteen patients with severe COVID-19 who underwent cricotracheostomy between January 2021 and April 2022 with a follow-up period of ≥ 14 days were included in this study. Forty patients with respiratory failure not related to COVID-19 who underwent traditional tracheostomy between January 2015 and April 2022 comprised the control group. Data were collected from medical records and comprised age, sex, body mass index, interval from intubation to tracheostomy, use of anticoagulants, complications of tracheostomy, and decannulation.ResultsAge, sex, and days from intubation to tracheostomy were not significantly different between the COVID-19/cricotracheostomy and control/traditional tracheostomy groups. Body mass index was significantly higher in the COVID-19 group than that in the control group (P = 0.02). The rate of use of anticoagulants was significantly higher in the COVID-19 group compared with the control group (P < 0.01). Peri-operative bleeding, subcutaneous emphysema, and stomal infection rates were not different between the groups, while stomal granulation was significantly less in the COVID-19 group (P = 0.04).ConclusionsThese results suggest that cricotracheostomy is a safe procedure in patients with severe COVID-19

Drinking Citrus Fruit Juice Inhibits Vascular Remodeling in Cuff-Induced Vascular Injury Mouse Model

<div><p>Citrus fruits are thought to have inhibitory effects on oxidative stress, thereby attenuating the onset and progression of cancer and cardiovascular disease; however, there are few reports assessing their effect on vascular remodeling. Here, we investigated the effect of drinking the juice of two different citrus fruits on vascular neointima formation using a cuff-induced vascular injury mouse model. Male C57BL6 mice were divided into five groups as follows: 1) Control (water) (C), 2) 10% <i>Citrus unshiu</i> (CU) juice (CU10), 3) 40% CU juice (CU40), 4) 10% <i>Citrus iyo</i> (CI) juice (CI10), and 5) 40% CI juice (CI40). After drinking them for 2 weeks from 8 weeks of age, cuff injury was induced by polyethylene cuff placement around the femoral artery. Neointima formation was significantly attenuated in CU40, CI10 and CI40 compared with C; however, no remarkable preventive effect was observed in CU10. The increases in levels of various inflammatory markers including cytokines such as monocyte chemotactic protein-1, interleukin-6 (IL-6), IL-1β, and tumor necrosis factor-α in response to vascular injury did not differ significantly between C, CU10 and CI10. The increases in cell proliferation and superoxide anion production were markedly attenuated in CI10, but not in CU10 compared with C. The increase in phosphorylated ERK expression was markedly attenuated both in CU10 and CI10 without significant difference between CU10 and CI10. Accumulation of immune cells did not differ between CU10 and CI10. These results indicate that drinking citrus fruit juice attenuates vascular remodeling partly via a reduction of oxidative stress. Interestingly, the preventive efficacy on neointima formation was stronger in CI than in CU at least in part due to more prominent inhibitory effects on oxidative stress by CI.</p></div

Effect of drinking citrus fruit juice on immune cell infiltration.

<p>Comparison of filtration of macrophage and neutrophils in injured femoral artery 7 days after cuff placement. Representative photos of injured femoral artery in cross-sections after immunofluorescent staining using antibodies against a macrophage marker, F4/80 and a neutrophil marker, LY-6G/-6C. CU; <i>Citrus unshiu</i> juice, CI; <i>Citrus iyo</i> juice.</p

Effect of drinking citrus fruit juice on inflammatory cytokines.

<p>Expression of TNF-α, MCP-1, IL-6, and IL-1β determined by real-time quantitative RT-PCR in femoral artery 7 days after cuff placement. Tissue samples were prepared from cuffed arteries 7 days after operation. CU; <i>Citrus unshiu</i> juice, CI; <i>Citrus iyo</i> juice. Values are mean ± SEM (n = 4 for each group).</p

Effect of drinking citrus fruit juice on neointima formation.

<p>Male C57BL6 mice were divided into five groups as follows: 1) Control (water) (C), 2) 10% <i>Citrus unshiu</i> (CU) juice (CU10), 3) 40% CU juice (CU40), 4) 10% <i>Citrus iyo</i> (CI) juice (CI10), and 5) 40% CI juice (CI40). After drinking them for 2 weeks from 8 weeks of age, cuff injury was induced by polyethylene cuff placement around the femoral artery. Samples were prepared from cuffed-femoral arteries of C57BL/6J mice as described in Methods. A, Representative photos of neointimal area in cross-sections of femoral artery with elastic van Gieson staining 14 days after cuff placement at 100x magnification. B, Higher magnified photos at 400x magnification described as squares in Figure A. Scale bars show 50 μm in each photo. C, Quantitative analysis of neointimal area in injured femoral artery. Values are mean ± SEM (n = 6 for Cuff (-), n = 8 for other groups). *p<0.05, **p<0.01 vs. Cuff (+) Control, †p<0.05 vs. administration of juice of different citrus fruit at same %.</p

Comparison of contents and ingredients between <i>Citrus unshiu</i> and <i>Citrus iyo</i> juice.

<p>Comparison of contents and ingredients between <i>Citrus unshiu</i> and <i>Citrus iyo</i> juice.</p

Comparison of flavonoid concentrations between <i>Citrus unshiu</i> and <i>Citrus iyo</i> juice.

<p>Comparison of flavonoid concentrations between <i>Citrus unshiu</i> and <i>Citrus iyo</i> juice.</p

Effect of drinking citrus fruit juice on superoxide anion production induced in injured artery.

<p>Tissue samples were prepared from cuffed arteries 7 days after operation. Representative photos of injured femoral artery in cross-sections after dihydroethidium staining (A) and fluorescence intensity in intima and media (B). CU; <i>Citrus unshiu</i> juice, CI; <i>Citrus iyo</i> juice. **p<0.01 vs. Cuff (+) Control. Values are mean ± SEM (n = 7 to 8 for each group).</p