Postoperative Pulmonary Complications in Patients Undergoing Elective Thoracotomy Versus Thoracoscopic Surgeries.

Background Postoperative pulmonary complications correlate highly with thoracic surgery compared to other surgeries. Video-assisted thoracoscopic surgery (VATS) is a minimally invasive surgical approach that provides considerable advantages over major open thoracotomy. Methodology This is a retrospective cohort study. All patients aged 18 years and above of both genders were included in the study. Cases following up outside King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, were excluded from our study. Complications were measured per the records on follow-up day 1, day 7, and day 30. Mortality was measured within 30 days after the surgery. Results A total of 151 patients were included in the study. Age ranged from 18 to 85 years, with males representing 62.3% of the sample, while Saudis represented 59.6%. VATS was performed in 71.5%, while thoracotomy was performed in 28.5%. Of the total, 19.4% had postoperative complications within 30 days in the VATS group, while 23.3% were in the thoracotomy group. No significant differences were found between the rates of complications between the two groups. Additionally, the admission rate to ICU was significantly twice as common in the thoracotomy group (65.1%) compared to the VATS group (33.3%). Besides, the average duration of the chest tube's stay was three to seven days in both groups (62.1% in the VATS group and 70.7% in the thoracotomy group). Lastly, regarding the requirements of opioids, VATS showed more need for opioids (44.4%) compared to thoracotomy (32.6%). Conclusion The rates of postoperative complications were low in both groups, and no significant differences were found between the two procedures. In addition, the VATS group showed significantly higher use of opioids compared to the thoracotomy group. We recommend conducting further studies with larger sample sizes to increase the statistical power of detection.

Acute Kidney Injury After Open Heart Surgery.

INTRODUCTION:  Acute kidney injury (AKI) is a term used to describe when the kidney loses its function rapidly. And it's associated with an increase in the level of serum creatinine by 0.5 to 1mg/dL. It can be diagnosed by a plethora of criteria such as the Kidney Disease Improving Global Outcomes (KDIGO) and the Risk, Injury, Failure, Loss, End-stage (RIFLE) criteria. Cardiac surgery-associated AKI (CSA-AKI) is the most prevalent complication in patients following cardiac surgery and is also linked to increased mortality and morbidity rates. In addition, exogenous and endogenous toxins, ischemia and reperfusion, inflammation, oxidative stress, metabolic factors, and neurohormonal activation may all play a role in the development of CSA-AKI. All these factors may be active at varying time intervals and with different degrees of intensity, or may function simultaneously.  Methods: In late 2019, a retrospective study was conducted by reviewing the health data of patients who underwent coronary artery bypass graft (CABG), valvular repairs, and other open cardiac surgeries at the King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, between November 2014 and June 2019. Information was obtained from the Hospital information system, Jeddah, Saudi Arabia. Of the 159 patients who underwent open-heart surgery at KAUH, 126 (79.2%) were male and 33 (20.8%) were female. Patients below 15 years of age and those with poor renal function prior to open cardiac surgery were excluded. The KDIGO criteria were used to diagnose AKI for our patients. RESULTS:  In this study, 34% of the patients experienced AKI after open cardiac surgery, and the most frequent risk factor encountered was diabetes mellitus (DM), which was present in 97 (61%) patients, followed by angina pectoris in 93 (58.5%) patients. Hypertension was identified in 85 (53.5%) and acute myocardial infarction in 82 (51.6%) patients. There were only two (1.3%) patients with known cases of chronic obstructive lung disease (COPD). Of the surgeries, 131 (82.4%) were classified as elective and 28 (17.6%) were urgent. CONCLUSION:  The most common risk factor associated with AKI following open-heart surgery is DM, followed by angina pectoris. However, further studies are required to investigate all the cardiac procedures.

Clinical experience with orthotic repair of pectus carinatum.

BACKGROUND: Pectus carinatum is a congenital chest wall deformity characterized by protrusion of the sternum and adjacent costal cartilages. Multiple treatment options are available for correction of pectus carinatum. OBJECTIVE: We report our initial experience with first-line treatment using a custom fitted dynamic compression orthosis. DESIGN: Prospective evaluation of all patients seen between November 2013 and December 2014. SETTING: University hospital. PATIENTS AND METHODS: The treatment protocol for patients who had pressure for initial correction.

Effect of modified ultrafiltration on pulmonary function after cardiopulmonary bypass.

BACKGROUND: Pulmonary dysfunction is one of the most common manifestations of inflammatory response after cardiopulmonary bypass (CPB). OBJECTIVE: This prospective randomized study was conducted to evaluate the effect of a modified ultrafiltration (MUF) technique on pulmonary function after CPB in children. METHODS: Forty patients weighing from 5 to 10 kg with congenital heart disease who required CPB for primary biventricular operative repair were prospectively randomized into two groups. The control group received conventional ultrafiltration (CUF) during CPB, and the study group received CUF and MUF. Pulmonary compliance (static and dynamic) and gas exchange capacity of the lung expressed as oxygen index, respiratory index, ventilation index, and alveolar-arterial oxygen pressure difference were measured after intubation (baseline), at the termination of CPB, at the end of MUF, on admission to the ICU, and 6 h postoperatively. RESULTS: There was no significant difference in lung compliance and gas exchange between the two groups before CPB. CPB produced a significant decrease in static and dynamic lung compliance in both groups. In the control group, static and dynamic lung compliance decreased from 1.0 +/- 0.3 to 0.90 +/- 0.3 mL/cm/kg and 0.87 +/- 0.2 to 0.71 +/- 0.1 mL/cm/kg (+/- SE) [p = 0.0002 and p = 0.002, respectively]. In the study group, static and dynamic lung compliance decreased from 1.0 +/- 0.2 to 0.89 +/- 0.03 mL/cm/kg and 0.94 +/- 0.2 to 0.77 +/- 0.1 mL/cm/kg (p = 0.002 and p = 0.002, respectively). There was no significant difference in the decrease in static (p = 0.9) or dynamic lung compliance (p = 0.3) between the two groups. MUF produced a significant immediate improvement in both static lung compliance (0.89 +/- 0.2 to 0.98 +/- 0.2 mL/cm/kg, p = 0.03) and dynamic lung compliance (0.77 +/- 0.1 to 0.93 +/- 0.2 mL/cm/kg, p = 0.007). The same was observed regarding the gas exchange capacity. CPB produced a significant decrease in lung gas exchange capacity, and MUF produced a significant immediate improvement in lung gas exchange capacity. The effect of MUF on lung compliance and gas exchange capacity was not sustained after admission to the ICU nor 6 h later postoperatively. There was no significant difference in the time of extubation between the two groups (12 +/- 3 h and 13 +/- 2 h, p = 0.4), the length of ICU stay, or the total hospital stay postoperatively. CONCLUSIONS: The use of MUF after CPB can produce an immediate improvement in lung compliance and gas exchange capacity, which may effectively minimize pulmonary dysfunction postbiventricular repair of congenital heart disease. However, these improvements are not sustained for the first 6 h postoperatively and do not reduce the duration of postoperative intubation, ICU stay, or total hospital stay.