RESUMEN
Tracheal stenosis in children is a challenge for the healthcare team, since it is a rare disease. Patients usually have other clinical comorbidities, mainly previous cardiac surgical interventions. This retrospective single-center study included infants with tracheal stenosis (congenital or acquired) operated between 2016 and 2020 on venoarterial extracorporeal membrane oxygenation (VA ECMO). Five patients were operated and the median age of detection of the tracheal disease was 3.7 months, and the median age at the operation was 5 months. All patients had associated cardiac anomalies. Four patients had congenital tracheal stenosis; two with associated pig bronchus. One patient had acquired subglottic stenosis with concomitant stenosis at the carina. After the operation, the patients were referred to ICU on ECMO with an open chest. Minor ECMO-related complications occurred in two patients (hemothorax and wound infection). All patients required endoscopic evaluation during the postoperative care; median of 3.2 procedures. Two patients are currently in follow-up and three have died. Slide tracheoplasty with VA-ECMO can be successfully performed in infants with prior cardiac surgery. Nevertheless, a difficult postoperative course should be anticipated, with possible prolonged ECMO use, readmissions, and higher morbidity and mortality than in children with tracheal stenosis alone.
Asunto(s)
Oxigenación por Membrana Extracorpórea , Estenosis Traqueal/cirugía , Oxigenación por Membrana Extracorpórea/efectos adversos , Femenino , Cardiopatías Congénitas/complicaciones , Hemotórax/etiología , Humanos , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos , Estenosis Traqueal/complicaciones , Estenosis Traqueal/mortalidad , Infección de Heridas/etiologíaRESUMEN
A female newborn presented with respiratory distress at birth and was diagnosed with congenital tracheal stenosis. The stenosis was positioned at the distal trachea and compromised the carina and the right and left bronchi. She underwent surgical treatment using circulatory life support with veno-arterial peripheral extracorporeal membrane oxygenation, and the airway was reconstructed using the slide tracheoplasty technique to build a neocarina. The patient had an excellent postoperative course, was successfully weaned from extracorporeal membrane oxygenation and invasive ventilation, and was discharged.
Asunto(s)
Bronquios , Oxigenación por Membrana Extracorpórea , Procedimientos de Cirugía Plástica , Tráquea , Estenosis Traqueal , Humanos , Femenino , Estenosis Traqueal/cirugía , Estenosis Traqueal/congénito , Estenosis Traqueal/diagnóstico por imagen , Recién Nacido , Tráquea/cirugía , Tráquea/anomalías , Tráquea/diagnóstico por imagen , Oxigenación por Membrana Extracorpórea/métodos , Bronquios/cirugía , Bronquios/anomalías , Bronquios/diagnóstico por imagen , Procedimientos de Cirugía Plástica/métodos , Resultado del TratamientoRESUMEN
BACKGROUND AND OBJECTIVE: This study aims to quantify bedside pleural procedures performed at a quaternary teaching hospital describing technical and epidemiological aspects. MATERIALS AND METHODS: The authors retrospectively reviewed consecutive patients who underwent invasive thoracic bedside procedures between March 2022 and February 2023. RESULTS: 463 chest tube insertions and 200 thoracenteses were performed during the study period. Most procedures were conducted by 1st-year Thoracic Surgery residents, with Ultrasound Guidance (USG). There was a notable preference for small-bore pigtail catheters, with a low rate of immediate complications. CONCLUSION: Bedside thoracic procedures are commonly performed in current medical practice and are significant in surgical resident training. The utilization of pigtail catheters and point-of-care ultrasonography by surgical residents in pleural procedures is increasingly prevalent and demonstrates high safety.
Asunto(s)
Tubos Torácicos , Hospitales de Enseñanza , Internado y Residencia , Humanos , Estudios Retrospectivos , Femenino , Masculino , Persona de Mediana Edad , Anciano , Adulto , Toracocentesis/educación , Competencia Clínica , Cirugía Torácica/educación , Sistemas de Atención de Punto , Ultrasonografía Intervencional , Anciano de 80 o más AñosRESUMEN
OBJECTIVE: This study aims to evaluate the role of TUSG in the postoperative period and the detection of early complications after surgical treatment, pulmonary resection, or decortication for infectious and inflammatory thoracic diseases, comparing with the standard method (Chest Radiography â CXR). METHODS: Prospective non-randomized self-controlled study. Twenty-one patients over 16 years of age have undergone surgical treatment of inflammatory and infectious lung diseases. These patients were followed up with CXR and TUSG (performed on the 1st and 3rd postoperative days and/or after the chest tube removal). RESULTS: Both exams demonstrated similar results regarding their ability to safely predict the adequate moment for chest drain removal. TUSG allowed chest drain removal in 30% of cases and CXR in 34%. Statistical analysis demonstrates that both exams have similar capabilities in detecting postoperative changes in the pleural space. However, the authors report that TUSG is statistically more accurate in detecting subcutaneous emphysema than CXR (p = 0.037, Kappa [κ = 0.3068]). The analysis of other parameters showed no statistical difference. CONCLUSION: The authors conclude that TUSG in trained hands is equivalent to CXR in searching for postoperative complications regarding the surgical treatment of infectious and inflammatory thoracic diseases and can be used as a complement, and not a substitute, to CXR, when CCT is not feasible, or a more urgent diagnosis is needed.
Asunto(s)
Complicaciones Posoperatorias , Humanos , Masculino , Femenino , Estudios Prospectivos , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Periodo Posoperatorio , Adulto , Anciano , Ultrasonografía/métodos , Adulto Joven , Radiografía Torácica , Enfermedades Pulmonares/cirugía , Enfermedades Pulmonares/diagnóstico por imagen , Drenaje/métodos , Factores de Tiempo , Tubos Torácicos , Reproducibilidad de los ResultadosRESUMEN
ABSTRACT A female newborn presented with respiratory distress at birth and was diagnosed with congenital tracheal stenosis. The stenosis was positioned at the distal trachea and compromised the carina and the right and left bronchi. She underwent surgical treatment using circulatory life support with veno-arterial peripheral extracorporeal membrane oxygenation, and the airway was reconstructed using the slide tracheoplasty technique to build a neocarina. The patient had an excellent postoperative course, was successfully weaned from extracorporeal membrane oxygenation and invasive ventilation, and was discharged.
RESUMEN
Abstract Background and objective This study aims to quantify bedside pleural procedures performed at a quaternary teaching hospital describing technical and epidemiological aspects. Materials and methods The authors retrospectively reviewed consecutive patients who underwent invasive thoracic bedside procedures between March 2022 and February 2023. Results 463 chest tube insertions and 200 thoracenteses were performed during the study period. Most procedures were conducted by 1st-year Thoracic Surgery residents, with Ultrasound Guidance (USG). There was a notable preference for small-bore pigtail catheters, with a low rate of immediate complications. Conclusion Bedside thoracic procedures are commonly performed in current medical practice and are significant in surgical resident training. The utilization of pigtail catheters and point-of-care ultrasonography by surgical residents in pleural procedures is increasingly prevalent and demonstrates high safety.