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The Journal of Thoracic and... Sep 2021
Review
Topics: Acute Disease; Analgesics; Aortic Dissection; Aortic Aneurysm; Cardiovascular Agents; Clinical Decision-Making; Consensus; Delphi Technique; Humans; Patient Selection; Postoperative Complications; Risk Assessment; Risk Factors; Thoracic Surgery; Treatment Outcome; Vascular Surgical Procedures
PubMed: 34112502
DOI: 10.1016/j.jtcvs.2021.04.053 -
The Journal of Thoracic and... Jun 2021
Topics: Clinical Competence; Humans; Knowledge; Leadership; Thoracic Surgery
PubMed: 33722391
DOI: 10.1016/j.jtcvs.2021.01.138 -
The Journal of Thoracic and... Dec 2021
Topics: Periodicals as Topic; Publishing; Thoracic Surgery; United States
PubMed: 34620503
DOI: 10.1016/j.jtcvs.2021.09.032 -
The Journal of Thoracic and... Jan 2022
Topics: Cardiovascular Surgical Procedures; Editorial Policies; Humans; Organizational Culture; Organizational Objectives; Periodicals as Topic; Publishing; Societies, Medical; Thoracic Surgery; United States
PubMed: 34785072
DOI: 10.1016/j.jtcvs.2021.10.055 -
The Journal of Thoracic and... Nov 2020
Topics: Education, Medical, Graduate; History, 21st Century; Humans; Thoracic Surgery; Thoracic Surgical Procedures
PubMed: 32245669
DOI: 10.1016/j.jtcvs.2019.12.132 -
The Journal of Thoracic and... Jan 2022
Topics: Cardiac Surgical Procedures; Heart Defects, Congenital; Humans; Internship and Residency; Postoperative Complications; Preceptorship; Surgeons; Thoracic Surgery
PubMed: 33581903
DOI: 10.1016/j.jtcvs.2020.12.115 -
The Journal of Thoracic and... Apr 2022
Topics: Aortic Dissection; Aortic Aneurysm; Blood Vessel Prosthesis Implantation; Clinical Decision-Making; Humans; Practice Patterns, Physicians'; Thoracic Surgical Procedures; Time-to-Treatment
PubMed: 33419545
DOI: 10.1016/j.jtcvs.2020.09.149 -
British Journal of Anaesthesia Jan 2023Airway driving pressure, easily measured as plateau pressure minus PEEP, is a surrogate for alveolar stress and strain. However, the effect of its targeted reduction... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Airway driving pressure, easily measured as plateau pressure minus PEEP, is a surrogate for alveolar stress and strain. However, the effect of its targeted reduction remains unclear.
METHODS
In this multicentre trial, patients undergoing lung resection surgery were randomised to either a driving pressure group (n=650) receiving an alveolar recruitment/individualised PEEP to deliver the lowest driving pressure or to a conventional protective ventilation group (n=650) with fixed PEEP of 5 cm HO. The primary outcome was a composite of pulmonary complications within 7 days postoperatively.
RESULTS
The modified intention-to-treat analysis included 1170 patients (mean [standard deviation, sd]; age, 63 [10] yr; 47% female). The mean driving pressure was 7.1 cm HO in the driving pressure group vs 9.2 cm HO in the protective ventilation group (mean difference [95% confidence interval, CI]; -2.1 [-2.4 to -1.9] cm HO; P<0.001). The incidence of pulmonary complications was not different between the two groups: driving pressure group (233/576, 40.5%) vs protective ventilation group (254/594, 42.8%) (risk difference -2.3%; 95% CI, -8.0% to 3.3%; P=0.42). Intraoperatively, lung compliance (mean [sd], 42.7 [12.4] vs 33.5 [11.1] ml cm HO; P<0.001) and Pa (median [inter-quartile range], 21.5 [14.5 to 30.4] vs 19.5 [13.5 to 29.1] kPa; P=0.03) were higher and the need for rescue ventilation was less frequent (6.8% vs 10.8%; P=0.02) in the driving pressure group.
CONCLUSIONS
In lung resection surgery, a driving pressure-guided ventilation improved pulmonary mechanics intraoperatively, but did not reduce the incidence of postoperative pulmonary complications compared with a conventional protective ventilation.
CLINICAL TRIAL REGISTRATION
NCT04260451.
Topics: Humans; Female; Middle Aged; Male; Positive-Pressure Respiration; Thoracic Surgery; Lung; Postoperative Complications; Thoracic Surgical Procedures; Tidal Volume
PubMed: 35995638
DOI: 10.1016/j.bja.2022.06.037 -
Nagoya Journal of Medical Science May 2020Thoracic surgery has evolved drastically in recent years. Although thoracic surgeons mainly deal with tumorous lesion in the lungs, mediastinum, and pleura, they also... (Review)
Review
Thoracic surgery has evolved drastically in recent years. Although thoracic surgeons mainly deal with tumorous lesion in the lungs, mediastinum, and pleura, they also perform lung transplantation surgery in patients with end-stage lung disease. Herein, we introduce various major current topics in thoracic surgery. Minimally invasive surgical procedures include robot-assisted thoracic surgery and uniportal video-assisted thoracic surgery. Novel techniques for sublobar resection include virtual-assisted lung mapping, image-guided video-assisted thoracic surgery, and segmentectomy using indocyanine green. Three-dimensional (3D) computed tomography (CT) simulation consists of surgeon-friendly 3D-CT image analysis systems and new-generation, dynamic 3D-CT imaging systems. Updates in cadaveric lung transplantation include use of marginal donors, including donation after circulatory death, and lung perfusion for such donors. Topics in living donor lobar lung transplantation include size matching, donor issues, and new surgical techniques. During routine clinical practice, thoracic surgeons encounter various pivotal topics related to thoracic surgery, which are described in this report.
Topics: Humans; Imaging, Three-Dimensional; Living Donors; Lung Neoplasms; Lung Transplantation; Mediastinal Neoplasms; Organ Preservation; Pleural Neoplasms; Pneumonectomy; Robotic Surgical Procedures; Surgery, Computer-Assisted; Thoracic Surgery, Video-Assisted; Thoracic Surgical Procedures; Tissue and Organ Procurement; Tomography, X-Ray Computed
PubMed: 32581397
DOI: 10.18999/nagjms.82.2.161 -
British Journal of Anaesthesia Nov 2020Minimally invasive thoracic surgery causes significant postoperative pain. Erector spinae plane (ESP) block and serratus anterior plane (SAP) block promise effective... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
Minimally invasive thoracic surgery causes significant postoperative pain. Erector spinae plane (ESP) block and serratus anterior plane (SAP) block promise effective thoracic analgesia compared with systemically administered opioids, but have never been compared in terms of terms of quality of recovery and overall morbidity after minimally invasive thoracic surgery.
METHODS
Sixty adult patients undergoing minimally invasive thoracic surgery were randomly assigned to receive either single-shot ESP or SAP block before surgery using levobupivacaine 0.25%, 30 ml. The primary outcome was quality of patient recovery at 24 h, using the Quality of Recovery-15 (QoR-15) scale. Secondary outcomes included area under the curve (AUC) of pain verbal rating scale (VRS) over time, time to first opioid analgesia, postoperative 24 h opioid consumption, in-hospital comprehensive complication index (CCI) score and hospital stay.
RESULTS
The QoR-15 score was higher among ESP patients compared with those in the SAP group, mean (standard deviation): 114 (16) vs 102 (22) (P=0.02). Time (min) to first i.v. opioid analgesia in recovery was 32.6 (20.6) in ESP vs 12.7 (9.5) in SAP (P=0.003). AUC at rest was 92 (31) mm hvs 112 (35) in ESP and SAP (P=0.03), respectively, whereas AUC on deep inspiration was 107 mm h (32) vs 129 (32) in ESP and SAP (P=0.01), respectively. VRS pain on movement in ESP and SAP at 24 h was, median (25-75% range): 4 (2-4) vs 5 (3-6) (P=0.04), respectively. Opioid consumption at 24 h postoperatively was 29 (31) vs 39 (34) (P=0.37). Median (25-75%) CCI in ESP and SAP was 1 (0-2) vs 4 (0-26) (P=0.03), whereas hospital stay was 3 (2-6) vs 6 (3-9) days (P=0.17), respectively.
CONCLUSION
Compared with SAP, ESP provides superior quality of recovery at 24 h, lower morbidity, and better analgesia after minimally invasive thoracic surgery.
CLINICAL TRIAL REGISTRATION
NCT03862612.
Topics: Adult; Aged; Analgesics, Opioid; Anesthesia Recovery Period; Anesthesia, Spinal; Anesthetics, Local; Female; Humans; Length of Stay; Levobupivacaine; Male; Middle Aged; Minimally Invasive Surgical Procedures; Nerve Block; Pain, Postoperative; Postoperative Complications; Robotic Surgical Procedures; Thoracic Surgery, Video-Assisted; Thoracic Surgical Procedures
PubMed: 32660716
DOI: 10.1016/j.bja.2020.06.020