The prophylactic effect of different levels of positive endexpiratory pressure on the incidence rate of atelectasis after cardiac surgery: A Randomized Controlled Trial.

Background: The use of positive end-expiratory pressure (PEEP) can have an important role as one of the ways to prevent and treat atelectasis, but it seems that there is still no consensus about its beneficial level. The aim of this study was to determine the effect of different levels of PEEP on the incidence of atelectasis after heart surgery. Methods: This is a double-blind randomized controlled trial that was adopted from a research project recorded in the Iranian Registry of Clinical Trials. This paper is the result of a research project undertaken at Fatemeh Zahra Hospital (Mazandaran Heart Center) in 2015. 180 patients underwent open heart surgery were selected and were divided randomly into three groups: control, PEEP=8, and PEEP=10 (60 in each group). The patients in the two PEEP8 and PEEP10 intervention groups separately received 8 cm H2O and 10 cm H2O PEEP, respectively, 30 minutes after admission to the ICU for 4 hours and then received 5 cm H2O PEEP until extubation. Atelectasis was examined two hours after the extubation and on the third day after surgery. Results: The incidence rates of atelectasis two hours after extubation on the first day of surgery were 22 (36.7%), 20 (33.3%) and 10 (16.7%) patients in the control, PEEP8 and PEEP10 groups, respectively. The differences were statistically significant among the three groups (p=0.035). The incidence rates of atelectasis on the third day after surgery were 39 (65%), 36 (60%) and 21 (35%) patients in the control, PEEP8 and PEEP10 groups, respectively. The differences were also statistically significant among the three groups (p=0.003). Conclusion: The use of 10 cm H2O PEEP can lead to a reduction in the incidence of atelectasis, intubation time at the ICU and length of ICU and hospital stay. Given that this level of PEEP is effective, this method is recommended to be used in postoperative care of patients.

Rupture of a noncoronary sinus of Valsalva aneurysm into the left atrium: a rare cause of acute pulmonary edema.

A sinus of Valsalva aneurysm is a dilatation of the aortic wall caused by the lack of continuity between the middle layer of the aortic wall and the aortic valve. It has an incidence of <0.1%. The most common cause of a sinus of Valsalva aneurysms is congenital, although they may also be acquired. The most common complication is rupture into the right atrium or ventricle, with rupture into the left chambers occurring very rarely. We present a 40-year-old man admitted to the hospital with an acute onset of respiratory distress and pleuritic chest pain. Transthoracic echocardiography followed by transesophageal echocardiography showed rupture of a noncoronary aneurysm of Valsalva sinus into the left atrium. The jet from the fistula caused retrograde flow into the pulmonary veins.

The successful withdrawal of a migrated central venous catheter.

BACKGROUND: Central venous catheters (CVCs) have been used widely in clinics. These catheters are also recommended for children and infants receiving chemotherapy and total parenteral nutrition (TPN) and etc. In this paper, we present migrated fractured control line of the heart of a girl. CASE PRESENTATION: A 2.5 year old girl with migrated of the fractured central line into the heart. In the catheterization laboratory, first we placed a long sheath (8 F) into the inferior vena cava via femoral vein and then trapped the foreign body by pigtail catheter and wire 0.035 inch and pulled it down to make its proximal free. After that, we snared the catheter by snare-catheter and pulled it into the femoral vein, and then the cardiac surgeon bridged it out by cut-down successfully. CONCLUSION: A rare complication in the use of central catheters is fraction and cardiac embolization. We offer gentle bringing out of the catheter lines under fluoroscopy guide in all of the cases, if this is technically possible and safe.