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Malignant Airway Obstruction (MAO) results from various processes including direct invasion due to bronchogenic carcinoma, metastatic deposits with endobronchial obstructions, and extrinsic compression by mediastinal tumors and lymphadenopathies. Despite an overall poor prognosis, some patients may benefit from a palliative intervention with advanced endoluminal therapies. The ultimate goal is to restore airway patency, avoid hospital readmissions, and improve respiratory symptoms. Here, we present our experience in treating patients with MAO with endoluminal therapies including YAG laser, balloon tracho-bronchoplasties, and airway stenting.

To evaluate the safety and efficacy of percutaneous tracheostomy in patients with severe acute respiratory syndrome coronavirus (SARS-CoV-2) requiring prolonged intubation. METHODS: We retrospectively reviewed patients with confirmed SARS-CoV-2 infection between April 1st, 2020 to July 20, 2020 at Mount Sinai Medical Center who required endotracheal intubation. We identified 10 patients who underwent percutaneous tracheostomy due to prolonged intubation. The following baseline data was collected: age, sex, BMI, SARS-CoV-2 status, mechanical ventilation requirements and treatments administered. RESULTS: We reviewed over 200 patients admitted to ICU with SARS-COV2. Ten patients underwent percutaneous tracheostomy. The mean age was 64.2 AE 12.4, 90% were male, with mean BMI of 29 AE 5.3. Six patients underwent bedside tracheostomy, in an airborne isolation room and 4 patients underwent the procedure in an operating room (OR). Prior to tracheostomy, the mean days on ventilator were 26.5 AE 8.3 with 90% on deep sedation and/or paralysis. Four patients were positive for SARS-CoV-2 infection on the day of the procedure. Eight patients were treated with Hydroxychloroquine and Azithromycin, 90% treated with convalescent plasma, and 70% with IL-6 inhibitors. One returned to OR for excessive bleeding and one patient required a tracheostomy exchange. Currently, 5 patients (50%) have recovered to long-term facilities. Three patients were successfully decannulated, 2 patients remain hospitalized and 2 patients succumbed due to multiorgan failure. No staff involved in procedures developed SARS-CoV-2 infection. CONCLUSIONS: Percutaneous tracheostomy in SARS-CoV-2 critically ill patients is feasible, safe and can facilitate the weaning process from the ventilator. Adequate selection and appropriate timing are of utmost importance to obtain positive outcomes. Unfortunately, a vast number of patients suffering respiratory failure secondary to SARS-CoV-2 are not suitable candidates. Although, a small sample size, this cohort suggests that in adequately selected patients' early tracheostomy can facilitate recovery from respiratory failure due to SARS-CoV-2. CLINICAL IMPLICATIONS: In adequately selected patients, early tracheostomy may assist the weaning process of patients unable to come off the ventilator, facilitating mobilization and hasten recoveries.

Background Epicardial adipose tissue (EAT) is a highly inflammatory depot of fat, with high concentrations of IL-6 and macrophages, which can directly reach the myo-pericardium via the vasa vasorum or paracrine pathways. TNF-α and IL-6 diminish cardiac inotropic function, making EAT inflammation a potential cause of cardiac dysfunction. Methods A retrospective cohort study assessing EAT Thickness and Density from CT scans, without contrast, from adult patients during index admission for COVID-19 infection at Mount Sinai Medical Center from March 2020 to January 2021. A total of 1,644 patients were screened, of which 148 patients were included. Follow-up completed until death or discharge. The descriptive analysis was applied to the general population, parametric test of normality for comparisons between groups. Kaplan survival analysis was conducted after survival distribution was confirmed significant. It was followed by the assumption of normality by Q-Q Plot, prior to performing a multiple regression analysis in the vulnerable group using a K-Matrix input for cofounders. A log-rank test was conducted to determine differences in the survival distributions for the different ranges of EAT thickness. Results A total of 148 Participants were assigned to two groups based on epicardial adipose tissue in order to classify them as increased or decreased risk of cardiovascular risk: >5mm (n = 99), < 5mm (n = 49). The survival percentage was higher in the group with no EAT inflammation compared to the group with EAT inflammation (95.0% and 65%, respectively). Participants with EAT >5mm had a median day of hospital stay of 18 (95% CI, 16.86 to 29.92). The survival distributions for the two categories were statistically significantly different, χ2(2) = 6.9, p < 0.01. A Bonferroni correction was made with statistical significance accepted at the p < 0.025 level. There was a statistically significant difference in survival distributions for the EAT >5 mm vs EAT < 5 mm, χ2(1) =6.953, p = 0.008. EAT Thickness Survival Analysis 2020-2021 COVID-19 MSMC Scatter Plot Length of Stay by EAT Thickness Conclusion There was an association with increased EAT thickness and increased mortality. These findings suggest that EAT thickness can be used as a prognostic factor and as a risk factor for increased mortality in patients with COVID-19 Disclosures All Authors: No reported disclosures

Background Extended-spectrum beta lactamase (ESBL) enzymes are plasmid-mediated, rapidly emerging and complex thereby posing a major therapeutic challenge in the management of urinary tract infections (UTIs) in community and hospital settings. In 2017, there were an estimated 197,400 cases of ESBL-producing Enterobacterales among hospitalized patients and 9,100 estimated deaths in the United States. Methods We conducted a retrospective cohort study using a publicly accessible National Inpatient Sample (NIS) database from October 2015 to December 2017. Adult patients (age >/= 18 years old) with UTI as a principal diagnosis were included. SAS 9.4 was used for univariate and multivariate linear. Logistic regression statistical analyses were used to compare mean age at the time of admission, length of stay, in-hospital mortality, hospitalization costs, and Elixhauser comorbidity indices. Results Of the total 5,776,156 patients included in the study, 52,765 patients had ESBL-enzyme induced UTIs. 66% were females and 34% were males. 63.3% were Caucasian, 11.6% were African-American, 18.8% were Hispanic, and 4.4% were Asian or Pacific Islander. The most common comorbidities were renal failure (22.8%), diabetes mellitus with complications (20.8%), congestive heart failure (20.5%), chronic lung disease (20.0%), neurological diseases (17.8%), obesity (12.6%), paralysis (12.5%), and depression (11.5%). In-hospital mortality was 2.5% (p< 0.0001), which was most likely due to the underlying co-morbidities. In patients without ESBL-enzyme induced UTIs, average length of stay was 7.8±8.5 days, and economic burden was &16,166.8 ± &21,183.5 USD. In comparison, patients with ESBL-enzyme induced UTIs had in-hospital mortality of 3.9%, average length of stay of 7.0 ± 9.7 days, and economic burden of &15,793.3 ± &29,268.6 USD. ESBL and UTI data analysis image 1 ESBL and UTI data analysis image 2 Conclusion We found that ESBL-enzyme-producing UTIs have statistically significant prolonged length of stay and economic burden, though in hospital mortality rate is low. This could be due to judicious use of antimicrobial therapy. There is a need for further research, as well as increased antimicrobial stewardship for UTIs, a globally recognized major cause of nosocomial acquired infections. Disclosures All Authors: No reported disclosures