Background: Acute kidney injury (AKI) is repeatedly observed in ventilated critically ill patients with coronavirus disease-2019 (COVID-19) pneumonia. This study aimed to determine the incidence, risk factors, and consequences of AKI in the ventilated critically ill adult patients with COVID-19 pneumonia. Methods: This retrospective study included all the ventilated critically ill adult patients with COVID-19 pneumonia from March 1, 2020, to June 1, 2020. Data were collected from the electronic medical system. AKI was diagnosed using the Kidney Disease: Improving Global Outcomes 2012 Clinical Practice definition. Patients were followed 90 days from the intensive care unit (ICU) admission time or to the date when they were discharged from the hospital. Results: AKI occurred in 65.1% of patients, with 26.6% of these started on continuous renal replacement therapy (CRRT). Patients with AKI had higher comorbidity and illness severity scores ( P < 0.001). Age and the vasopressor requirements were predictors of AKI (P= 0.016 and P = 0.041) and hypertension predicted AKI ( P = 0.099) and its progression ( P = 0.05). The renal recovery rate was 86.7% and was associated with the mean arterial pressure on ICU admission in the no-CRRT group ( P = 0.014) and the hypoxic index in the CRRT group ( P = 0.019). AKI was associated with higher mortality ( P = 0.017) and significantly longer ICU length-of-stay ( P = 0.001). Additionally, AKI patients were more often discharged to a long-term skilled nursing facility ( P = 0.005). Conclusion: COVID-19-associated AKI was common and associated with poor outcome, with the specific mechanisms being the main driving factors.

Upper extremity deep venous thrombosis (UEDVT) is uncommon but may complicate intracerebral hemorrhage (ICH). A unique challenge arises when UEDVT is diagnosed and treated in situations of ICH. <b><i>Case Report:</i></b> We report a 43-year-old man developed edema in his hemiplegic arm 7 days after a spontaneous ICH. UEDVT was detected immediately despite pharmacotherapy with point-of-care compression ultrasound (POCUS). In addition to controlling thrombogenic factors, the dosage of enoxaparin was increased, yet it was subtherapeutic. Following this, the thrombosed veins recanalized and the hematoma diminished as well. <b><i>Conclusion:</i></b> A POCUS scan helps diagnose UEDVT, and the risk and benefits of treating UEDVT should be considered in patients with ICH.

Background: Polytrauma from road accidents is a common cause of hospital admissions and deaths, frequently leading to acute kidney injury (AKI) and impacting patient outcomes. Methods: This retrospective, single-center study included polytrauma victims with an Injury Severity Score (ISS) >25 at a tertiary healthcare center in Dubai. Results: The incidence of AKI in polytrauma victims is 30.5%, associated with higher Carlson comorbidity index (P=0.021) and ISS (P=0.001). Logistic regression shows a significant relationship between ISS and AKI (odds ratio [OR], 1.191; 95% confidence interval [CI], 1.150–1.233; P<0.05). The main causes of trauma-induced AKI are hemorrhagic shock (P=0.001), need for massive transfusion (P<0.001), rhabdomyolysis (P=0.001), and abdominal compartment syndrome (ACS; P<0.001). On multivariate logistic regression AKI can be predicated by higher ISS (OR, 1.08; 95% CI, 1.00–1.17; P=0.05) and low mixed venous oxygen saturation (OR, 1.13; 95% CI, 1.05–1.22; P<0.001). The development of AKI after polytrauma increases length of stay (LOS)-hospital (P=0.006), LOS-intensive care unit (ICU; P=0.003), need for mechanical ventilation (MV) (P<0.001), ventilator days (P=0.001), and mortality (P<0.001). Conclusions: After polytrauma, the occurrence of AKI leads to prolonged hospital and ICU stays, increased need for mechanical ventilation, more ventilator days, and a higher mortality rate. AKI could significantly impact their prognosis.

Tracheoinnominate fistula (TIF) is a rare but potentially life-threatening complication after tracheostomy. TIF was mostly observed within 7–21 days after tracheostomy but can present even years after tracheostomy. The risk factors for TIF are high cuff pressure, mucosal trauma from malpositioned cannula tip, low tracheal incision, excessive neck movement (hyperextension), radiotherapy, prolonged intubation, and high-riding innominate artery (HRIA). HRIA is also a rare anatomical variation of the innominate artery (IA) whereas IA bifurcates above the sternoclavicular joint. We report a rare case of TIF in a patient with HRIA, who presented with airway bleeding 2 months after percutaneous tracheostomy (PT) and was successfully managed with aggressive resuscitation and midline sternotomy. Knowledge of anatomical variation of the aortic arch and its major branches is essential for the physician who is routinely performing or managing tracheostomy. All the health-care workers involved in the management of tracheostomy should bear this complication in mind while dealing with any airway bleed. We recommend the routine use of bedside neck ultrasonography before all PTs to locate any aberrant vessel within the vicinity of tracheostoma to prevent this complication.