Recruitment maneuvers to reduce pulmonary atelectasis after cardiac surgery: A meta-analysis of randomized trials.

BACKGROUND: Pulmonary atelectasis is a common postoperative complication that may lead to intrapulmonary shunt, refractory hypoxemia, and respiratory distress. Recruitment maneuvers may relieve pulmonary atelectasis in patients undergoing cardiac surgery. We conducted a meta-analysis of randomized controlled trials to evaluate the effectiveness of recruitment maneuvers in these patients. METHODS: We conducted a search in PubMed, Embase, Cochrane Library, and the ClinicalTrials.gov registry for trials published before March 2020. Individual effect sizes were standardized, and a meta-analysis was performed to calculate a pooled effect size by using random-effects models. Pulmonary atelectasis was assessed postoperatively. Secondary outcomes included hypoxic events, arterial oxygen tension (Pao2)/inspired oxygen fraction (Fio2) ratio, cardiac index, mean arterial pressure, and postoperative complications including pneumothorax and pneumonia. RESULTS: We reviewed 16 trials involving 1455 patients. Patients receiving recruitment maneuvers had a reduced incidence of pulmonary atelectasis (group with recruited pressure >40 cmH2O: risk ratio [RR], 0.20; 95% confidence interval [CI], 0.07-0.57; group with recruited pressure <40 cmH2O: RR, 0.54; 95% CI, 0.33-0.89), reduced incidence of hypoxic events (RR, 0.23; 95% CI, 0.14-0.37), reduced incidence of pneumonia (RR, 0.42; 95% CI, 0.18-0.95), and improved Pao2/Fio2 ratio (weighted mean difference [WMD]; 58.87, 95% CI, 31.24-86.50) without disturbing the cardiac index (WMD, 0.22; 95% CI, -0.18 to 0.61) or mean arterial pressure (WMD, -0.30, 95% CI, -3.19 to 2.59) as compared with those who received conventional mechanical ventilation. The incidence of pneumothorax was nonsignificant between the groups. CONCLUSIONS: Recruitment maneuvers may reduce postoperative pulmonary atelectasis, hypoxic events, and pneumonia and improve Pao2/Fio2 ratios without hemodynamic disturbance in patients undergoing cardiac surgery.

Nonthrombotic pulmonary embolism caused by intravenous leiomyomatosis: A case report.

RATIONALE: Pulmonary embolism is a potentially devastating medical condition. Although deep-vein thrombosis is the most common etiology, a nonthrombotic pulmonary embolism is not uncommon. PATIENT CONCERNS: A 45-year-old woman was admitted to our hospital for progressive effort dyspnea for 3 weeks. DIAGNOSIS: Echocardiography revealed a mobile mass extending from the right atrium to the bilateral proximal pulmonary artery. As the mass was no response to thrombotic therapy, intravenous leiomyomatosis was suspected. Computed tomography (CT) revealed a hypo-attenuated tumor extending from the ovarian vein to the pulmonary artery. INTERVENTIONS: A 1-stage operation for the surgical removal of the tumor, right salpingo-oophorectomy and subtotal hysterectomy were performed. Surgical specimen was identified as uterine leiomyomatosis without malignant transformation. OUTCOMES: The patient was followed- up for 2 years and subsequent CT did not reveal any notable lesions. LESSONS: Nonthrombotic pulmonary embolism is a potentially life-threatening complication. This case indicated intravenous leiomyomatosis should be considered in the differential diagnosis for certain cases. Complete surgical excision was the only curative treatment.

Management and prevention of complications of subcutaneous intravenous infusion port.

Subcutaneous intravenous infusion port (SIIP) has become an increasingly and widely adopted technique in the management of oncology patients. This route has been used not only for chemotherapy but also for parenteral nutrition provision, blood transfusion, medication administration, blood sample collection, hemodialysis, and so on. This system provides a safe vascular access with low complication rate which helps preventing patients from vascular infection and catheter associated thrombosis. In this study, we reviewed 1247 cases of breast cancer patients that had subcutaneous intravenous infusion port implanted for chemotherapy in our general surgery department from 1990 to 2008. The result indicates that complication decreases as our technique and experience mature. We hereby share our accrued experience and improved technique, hoping to be of help to young surgeons.