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    Management of mechanical ventilation in a morbidly obese patient with COVID-19-induced ARDS
    (Verduci Publisher, 2021) Demircan, S.; Disli, Z. Korkmaz; Kalkan, S.; Ozer, A. B.
    Coronavirus disease 2019-induced acute respiratory distress syndrome (AR-DS) is more severe in morbidly obese patients. Mechanical ventilation differs between obese and non-obese patients. We examined these differences in an obese (body mass index = 47 kg/m(2)) 32-year-old patient followed up in our clinic. The patient was admitted to the intensive care unit due to respiratory failure. Recruitment maneuvers were performed in pressure-controlled ventilation mode. The optimal positive end-expiratory pressure was 25 cm H2O. The inspiratory pressure was adjusted to 45 cm H2O to provide a tidal volume of 6 ml/kg and driving pressure <= 15. The patient was discharged with full recovery.
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    Tracheomediastinal emphysema after tracheostomy in a post-COVID-19 patient: a case report
    (Verduci Publisher, 2022) Bicakcioglu, M.; Demircan, S.; Yucel, A.; Ozer, A. B.
    OBJECTIVE: There are no reports of tracheomediastinal fistula development after tracheostomy. CASE REPORT: A 72-year-old female patient with post acute COVID-19 was transferred to our intensive care unit. After two unsuccessful weaning attempts, a tracheostomy was performed at hospitalization on day 32. The patient's body mass index was 35 kg/m2 and she had a narrow neck anatomy. A percutaneous tracheostomy was performed using the Griggs method without any problems. Pneumothorax, pneumomediastinum, subcutaneous emphysema, and hemorrhage were not observed. Twenty-two days after the tracheostomy, the patient developed subcutaneous emphysema and experienced a sudden decrease in oxygen saturation. Bedside anterior-posterior chest X-ray did not detect pneumothorax and a tracheoesophageal fistula was found via esophageal endoscopy. A tracheomediastinal fistula was observed just below the cannula distal end via computed tomography. CONCLUSIONS: There are multiple reasons why a tracheomediastinal fistula could develop after tracheostomy. Therefore, this condition should be considered in cases of sudden subcutaneous emphysema and oxygen deterioration following tracheostomy.