Prophylactic use of non-invasive mechanical ventilation in lung resection.

OBJECTIVE: To evaluate if the prophylactic application of BiPAP previous to lung resection and 17 hours postoperatively improves respiratory function. In order to do this, we studied the results of arterial blood gases and portable spirometry in the immediate postoperative period and at the first and third postoperative day. Secondary objectives included evaluating whether this same pattern decreases the incidence of postoperative pulmonary complications (PPC) and hospital stay. PATIENTS AND METHODS: This was a prospective, randomized clinical study. Between January 2012 and June 2013, 50 patients who had undergone lung resection with posterolateral thoracotomy were assigned to one of two groups by a random number generator according to whether or not they would receive prophylactic BiPAP pre- and postoperatively. RESULTS: The results of the gasometric and spirometric values were similar in both groups. There were no statistically significant differences (p > 0.05). There was not a decrease in the incidence of PPC in the group that received prophylactic BiPAP. Likewise, postoperative stay was similar in both groups. The BiPAP group was 6.60 ± 4 days and the non BiPAP group was 6.84 ± 3.94 days (p = 0.63). CONCLUSIONS: One drawback of this work was the limited number of hours that BiPAP was employed, and when compared to other studies, the application of low-pressure support. We did not find any significant differences between using prophylactic BiPAP or not, suggesting that such treatment should not be performed indiscriminately. More investigations are needed with a larger number of patients in order to better evaluate the possible benefits of using prophylactic BiPAP in thoracic surgery.

Síndrome de dolor regional complejo sin causa aparente. A propósito de un caso / The complex regional pain syndrome with no apparent cause. A case report

El síndrome de dolor regional complejo (SDRC) es una entidad nosológica que cursa con dolor, inestabilidad vasomotora y limitación funcional, cuya etiología no está aún demostrada; con frecuencia se produce después de un traumatismo. Se caracteriza por dolor, y el cuadro se puede agravar con inflamación, tumefacción, alteraciones cutáneas, cambios de color y claudicación. La gammagrafía con tecnecio-99 es una prueba sensible, sin embargo no existe una prueba específica para el diagnóstico certero; hoy en día se han descrito numerosas escalas cuyos criterios permiten llegar a un diagnóstico probable. El tratamiento del SDRC debe ser introducido lo antes posible; se plantea en varios escalones: farmacológico, bloqueos nerviosos, simpatectomía, estimulación medular, infusión intratecal, acompañados de rehabilitación y en algunos casos de psicoterapia. Se describe el caso de una mujer de 38 años que sin causa previa desarrolla un SDRC. Asimismo se hace una revisión bibliográfica de esta enfermedad (AU)

TThe Complex Regional Pain Syndrome (CRPS) is a nosological entity characterized by the presence of pain, vasomotor instability and limitation of the normal function, whose etiology has still not been demonstrated, although it usually occurs after a traumatic injury. It is defined by the presence of pain and its picture may become worse with inflammation, swelling, skin abnormalities, changes in color and limp.The 99TC-scintigraphy is a sensitive diagnostic test. However, there is no specific test for its diagnosis. Nowadays, several scales have been described whose criteria make it possible to reach a probable diagnosis.Treatment of CRPS must be begun as soon as possible. Several steps are proposed: pharmacological treatment, neural blockade, sympathectomy, spinal cord stimulation, intrathecal drug delivery accompanied by rehabilitation and in some cases psychotherapy. We describe the case of a 38-year-old woman with no previous factors who develops CRPS.We present a bibliographic review on this disease (AU)