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1.
Surg Clin North Am ; 100(2): 237-248, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32169178

RESUMO

Minimally invasive surgery for diseases of the chest offsets the morbidity of painful thoracic incisions while allowing for meticulous dissection of major anatomic structures. This benefit translates to improved outcomes and recovery following the surgical management of benign and malignant esophageal pathologic condition, mediastinal tumors, and lung resections. This anatomic region is particularly amenable to a robotic approach given the fixed space and need for complex intracorporeal dissection. As robotic platforms continue to evolve, more complex thoracic surgical interventions will be facilitated, translating to improved outcomes for our patients.


Assuntos
Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Torácicos/métodos , Esofagectomia , Humanos , Doenças do Mediastino/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Pneumonectomia , Cirurgia Torácica Vídeoassistida
2.
Thorac Surg Clin ; 30(1): 1-13, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31761277

RESUMO

Nonintubated thoracic surgery (NITS) has a good safety record in experienced hands, but has pitfalls for beginners. The main aim of NITS is to keep the patient under spontaneous respiration, avoiding adverse effects, such as hypoxemia, hypercapnia, panic attacks, and finally conversion to general anesthesia. In this paper, the safety aspects of anesthesia for NITS is discussed based on data from the literature and personnel clinical experiences.


Assuntos
Anestesia Geral/métodos , Segurança do Paciente , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Torácicos , Anestesia Epidural/métodos , Humanos , Monitorização Intraoperatória/métodos , Transtorno de Pânico/prevenção & controle , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Procedimentos Cirúrgicos Torácicos/métodos , Procedimentos Cirúrgicos Torácicos/psicologia
3.
Artigo em Inglês | MEDLINE | ID: mdl-31751008

RESUMO

Malignant pleural mesothelioma is a cancer of the mesothelial cells lining the pleural sac. Surgery for malignant pleural mesothelioma should be part of a multimodality treatment approach and the aim of surgery should be macroscopic complete tumor resection. Lung-sparing operations, such as extended pleurectomy decortication, have gained increasing popularity in the past decade.  This video tutorial illustrates the main steps of extended pleurectomy decortication for the treatment of malignant pleural mesothelioma.


Assuntos
Neoplasias Pulmonares , Pulmão , Mesotelioma , Pleura/cirurgia , Neoplasias Pleurais , Procedimentos Cirúrgicos Torácicos/métodos , Idoso , Dissecação/métodos , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Masculino , Mesotelioma/patologia , Mesotelioma/cirurgia , Tratamentos com Preservação do Órgão/métodos , Pleura/patologia , Neoplasias Pleurais/patologia , Neoplasias Pleurais/cirurgia , Resultado do Tratamento
4.
Medicine (Baltimore) ; 98(41): e17387, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593088

RESUMO

BACKGROUND: Double-lumen bronchial tubes (DLBT) and bronchial blockers (BB) are commonly used in the anesthesia for clinical thoracic surgery. But there are few systematic clinical comparisons between them. In this study, the effects of BB and DLBT on one-lung ventilation (OLV) are studied. METHODS: The 200 patients with thoracic tuberculosis undergoing thoracic surgery, were randomly assigned to group A (DLBT) and group B (BB). Intubation time, hemodynamic changes (mean arterial pressure [MAP], heart rate [HR]), and arterial blood gas indicators (arterial partial pressure of carbon dioxide [PaCO2], arterial partial pressure of oxygen [PaO2], airway plateau pressure [Pplat], and airway peak pressure [Ppeak]) at 4 time points were recorded. Complications such as hoarseness, pulmonary infection, pharyngalgia, and surgical success rate were also evaluated postoperatively. RESULTS: Intubation times were shorter in group B. Both MAP and HR in group A were significantly higher 1 minute after intubation than before, but also higher than those in group B. PaO2 levels were lower in both groups during (OLV) than immediately after anesthesia and after two-lung ventilation (TLV), with PaO2 being lower after 60 minutes of OLV than after 20 minutes of OLV. Furthermore, at both points during OLV, PaO2 was lower in group A than in group B. No significant differences in PaCO2 were found between the 2 groups. Ppeak and Pplat were increased in both groups during OLV, with both being higher in group A than in group B. The incidence of postoperative hoarseness, pulmonary infection, and pharyngalgia were lower in group B. There was no significant difference in the success rate of operation between the 2 groups. CONCLUSIONS: Compare with using DLBT, implementation of BB in general anesthesia has less impact on hemodynamics, PaO2 and airway pressures, and achieves lower incidence of postoperative complication.


Assuntos
Anestesia Geral/métodos , Broncoconstritores/administração & dosagem , Ventilação Monopulmonar/métodos , Procedimentos Cirúrgicos Torácicos/métodos , Tuberculose Pulmonar/cirurgia , Idoso , Feminino , Hemodinâmica , Humanos , Intubação Intratraqueal , Masculino , Pessoa de Meia-Idade , Pressão Parcial
5.
Orv Hetil ; 160(42): 1655-1662, 2019 Oct.
Artigo em Húngaro | MEDLINE | ID: mdl-31608689

RESUMO

Introduction: Most modern thoracic operations are performed with single-lung ventilation balancing between convenient surgical approach and adequate gas exchange. The technical limitations include difficult airways or insufficient parenchyma for the intraoperative single-lung ventilation. Earlier, cardiopulmonary bypass was the only solution, however, today the extracorporeal membrane oxygenation is in the forefront. Aim: We retrospectively analysed our elective operations by use of venovenous ECMO to assess the indication, safety, perioperative morbidity and mortality. Patients and method: 12 patients were operated using venovenous (VV-) ECMO between 28 April 2014 and 30 April 2018 in the National Institute of Oncology. The main clinicopathological characteristics, data regarding the operation, the use of ECMO and survival were collected. Results: The mean age was 45 years, 2 patients had benign and 10 had malignant diseases. Extreme tracheal stricture was the indication for ECMO in 3 cases, while 4 patients had previous lung resection and lacked enough parenchyma for single-lung ventilation. 5 patients had both airway and parenchymal insufficiency. The average time of apnoea was 142 minutes without interruption in any of the cases. We did not experience any ECMO-related complication. We had no intraoperative death and 30-day mortality was 8.33%. Conclusion: In case of technical inoperability, when there is no airway or insufficient parenchyma for gas exchange, but pulmonary vascular bed is enough and there is no need for great-vessel resection, VV-ECMO can safely replace the complete gas exchange without further risk of bleeding. The use of VV-ECMO did not increase the perioperative morbidity and mortality. Previously inoperable patients can be operated with VV-ECMO. Orv Hetil. 2019; 160(42): 1655-1662.


Assuntos
Obstrução das Vias Respiratórias/terapia , Oxigenação por Membrana Extracorpórea/métodos , Cirurgia Torácica/métodos , Procedimentos Cirúrgicos Torácicos/métodos , Adulto , Idoso , Obstrução das Vias Respiratórias/etiologia , Oxigenação por Membrana Extracorpórea/efeitos adversos , Feminino , Humanos , Hungria , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Resultado do Tratamento
6.
Artigo em Inglês | MEDLINE | ID: mdl-31497937

RESUMO

A 61-year-old male who lived for 30 years in a rural area presented chest pain of 3 months duration. Multiple hydatid cysts (Echinococcus granulosus) were diagnosed in the pericardium and the mediastinum by echocardiography and computed tomography. The cysts were removed successfully with the patient on cardiopulmonary bypass and beating heart.  This video tutorial shows how we removed the cysts, using the puncture-aspiration and enucleation technique.  Few videos of this technique exist, and we believe that this tutorial is a helpful demonstration of how to handle mediastinal and pericardial hydatid cysts.


Assuntos
Equinococose/cirurgia , Cardiopatias/cirurgia , Doenças do Mediastino/cirurgia , Procedimentos Cirúrgicos Torácicos/métodos , Equinococose/diagnóstico , Equinococose/parasitologia , Ecocardiografia , Cardiopatias/diagnóstico , Cardiopatias/parasitologia , Humanos , Masculino , Doenças do Mediastino/diagnóstico , Doenças do Mediastino/parasitologia , Mediastino , Pessoa de Meia-Idade , Pericárdio , Tomografia Computadorizada por Raios X
9.
Khirurgiia (Mosk) ; (7): 5-9, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31355807

RESUMO

OBJECTIVE: To present our experience in the treatment of patients with bronchopleural fistula and chronic non-specific pleural empyema after pneumonectomy. MATERIAL AND METHODS: There were 25 patients with chronic pleural empyema following bronchopleural fistula after pneumonectomy. All patients were examined in standard fashion and divided into two groups depending on length of bronchial stump: more or equal to 20 mm and less than 20 mm. Transsternal occlusion of bronchial stump was performed in the 1st group. Pedicled muscle or omental flap was applied for bronchial stump repair in the 2nd group. RESULTS: Follow-up period ranged from 18 to 110 months (median 48 (19; 52) months). Complications were grade daccording to Clavien-Dindo classification. Infectious complications not associated with bronchial stump insufficiency and required antibiotic therapy and/or topical treatment were registered in 6 (24%) out of 25 patients (95% CI 11.5-43.4): suppurative tracheobronchitis, pneumonia, postoperative wound suppuration in 1 (4%), 2 (8%) and 3 (12%) patients, respectively. Overall mortality rate was 2 (8%) out of 25 patients. There were no recurrences after transsternal occlusion of bronchial stump. In the control group, recurrent bronchopleural fistula was noted in 2 (12.5%) out of 16 patients (95% CI 3.5-36). Mean hospital-stay was 13 (13; 16) and 20 (11; 35) days in both groups, respectively (p<0.05). A good and satisfactory result after transsternal occlusion of bronchial stump was achieved in 23 (92%) out of 25 patients (95% CI 75-97.8). CONCLUSION: Transsternal occlusion of bronchial stump is more advisable than tissue flap transposition in patients with chronic pleural empyema followed by BPF and bronchial stump length over 20 mm due to less trauma and good reproducibility.


Assuntos
Brônquios/cirurgia , Fístula Brônquica/cirurgia , Doenças Pleurais/cirurgia , Pneumonectomia/efeitos adversos , Fístula Brônquica/etiologia , Empiema Pleural/etiologia , Empiema Pleural/cirurgia , Humanos , Recidiva Local de Neoplasia , Doenças Pleurais/etiologia , Reoperação , Reprodutibilidade dos Testes , Esternotomia , Retalhos Cirúrgicos , Procedimentos Cirúrgicos Torácicos/métodos
10.
Medicine (Baltimore) ; 98(30): e16564, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348281

RESUMO

RATIONALE: Neuroblastoma is one of the most common malignant tumors in childhood, which mainly occurs in adrenal glands and peripheral sympathetic nerve system. Neuroblastoma occurring in adulthood is rare, and adults with neuroblastoma arising from thorax are exceedingly rare. A case of neuroblastoma that originated from thorax was reported, and was treated by resection operation. PATIENT CONCERNS: A 46-year-old woman was admitted to our hospital with left side chest pain for 5 days. Laboratory examinations were all normal. Chest computerized tomogram (CT) showed a lesion with clear boundary that was located at the left dorsal pleura. The nature of the mass was heterogeneous, showing slight heterogeneous enhancement after contrast and there was no obvious necrosis. DIAGNOSES: Based on the morphologic and immunohistochemical features, the tumor diagnosis was favorable for neuroblastoma. INTERVENTIONS: A resection operation was carried out. OUTCOMES: Three years postoperative, no sign of recurrence or metastasis has been observed. LESSONS: Primary neuroblastoma in adulthood is rare and has poor prognosis. Resection can be an important treatment option, and combining with other methods like chemotherapy, stem cell transplantation, the survival rate may be improved.


Assuntos
Neuroblastoma/cirurgia , Neoplasias Torácicas/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Neuroblastoma/patologia , Neoplasias Torácicas/patologia , Procedimentos Cirúrgicos Torácicos/métodos , Resultado do Tratamento
11.
J Thorac Cardiovasc Surg ; 158(5): 1481-1488, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31358338

RESUMO

OBJECTIVE: The main therapeutic method of treatment for local hyperhidrosis is endoscopic thoracic sympathectomy. Generally, resections of the sympathetic trunk or ganglia are performed between the second rib and sixth rib. However, this procedure can result in compensatory sweating, in which excess sweating occurs on the back, chest, and abdomen. Compensatory sweating has been regarded as a thermoregulatory response and thought to be untreatable. This study suggests that compensatory sweating is not a physiologic reaction and is indeed treatable. METHODS: Eight patients with severe compensatory sweating were treated by observing blood perfusion of the skin with laser speckle flowgraphy, which determines the sympathetic nerves related to the area of skin with compensatory sweating. When intraoperative monitoring with laser speckle flowgraphy indicated the position of compensatory sweating by electrical stimulation of the sympathetic ganglion, ganglionectomy was performed. RESULTS: The skin domain that each sympathetic nerve controls was able to be detected by laser speckle flowgraphy. In all patients, compensatory sweating was resolved after interruption of the ganglia or sympathetic nerves related to compensatory sweating. CONCLUSIONS: Our results demonstrate that compensatory sweating is caused by denatured sympathetic nerves influenced by endoscopic thoracic sympathectomy and is not the result of a physiological response. With laser speckle flowgraphy, the sympathetic nerve related to the sweating of various parts of the body could be identified. The treatment of compensatory sweating on the back, chest, and stomach was previously considered to be difficult; however, compensatory sweating is demonstrated to be treatable with this technique.


Assuntos
Estimulação Elétrica/métodos , Hiperidrose , Monitorização Intraoperatória , Simpatectomia , Procedimentos Cirúrgicos Torácicos , Adulto , Endoscopia/efeitos adversos , Endoscopia/métodos , Feminino , Ganglionectomia/métodos , Humanos , Hiperidrose/diagnóstico , Hiperidrose/etiologia , Hiperidrose/fisiopatologia , Hiperidrose/terapia , Fluxometria por Laser-Doppler/métodos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/instrumentação , Monitorização Intraoperatória/métodos , Imagem de Perfusão/métodos , Glândulas Sudoríparas/inervação , Sudorese/fisiologia , Simpatectomia/efeitos adversos , Simpatectomia/métodos , Sistema Nervoso Simpático/cirurgia , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Procedimentos Cirúrgicos Torácicos/métodos , Resultado do Tratamento
13.
BMC Anesthesiol ; 19(1): 78, 2019 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-31101080

RESUMO

BACKGROUND: This study investigated the effect of different degrees of passive leg raising (PLR) on the internal jugular vein (IJV) cross-sectional area (CSA) and on the success rate of IJV cannulation in patients waiting for thoracic surgery, to analyze whether body mass index (BMI), gender, age, fasting time and preoperative rehydration have any impact on changes in the IJV CSA. METHODS: Eighty-two patients scheduled for selective thoracic surgery were enrolled in this study. Patients were randomly assigned based on a computer-generated randomization sequence into 3 groups: 0, 30, and 50 degrees (n = 32, 25, and 25 patients, respectively). The right IJV CSA in the sequence of 0-degree (supine position), 30-degree and 50-degree PLR positions was recorded in all patients using an ultrasound probe. The relationship of BMI, gender, age, fasting time and preoperative rehydration to the IJV CSA was analyzed. Then, each patient was returned to a supine position. After waiting for at least 5 min, patients were placed in a PLR position at 0, 30, or 50 degrees, and then IJV cannulation was performed without ultrasound guidance. The success rate of IJV catheterization at different PLR angles was compared. RESULTS: The average CSA of the right IJV in the supine position, 30-degree PLR position and 50-degree PLR position was 1.39 ± 0.63 cm2, 1.65 ± 0.73 cm2, and 1.68 ± 0.71 cm2, respectively. These results showed gradual increases in the IJV CSA of 18.5% (30-degree PLR) and 20.2% (50-degree PLR) when compared to that in the supine position (P = 0.045 and 0.025, respectively). However, only fasting time had a significant impact on the increase in the right IJV CSA at different PLR angles (P = 0.026). Other factors, such as BMI, gender, age and preoperative rehydration, had no significant effects. The success rates of IJV catheterization at angles of 0, 30 and 50 degrees were 84.3, 88 and 92%, respectively; however, there were no significant differences among the three groups (P = 0.674). CONCLUSIONS: PLR increases the CSA of the right IJV, especially for patients with long fasting times before thoracic surgery. The effect of the 30-degree PLR position is similar to that of the 50-degree PLR position. However, the success rate of right IJV catheterization was not enhanced in this study using landmark-guided puncture, even though the CSA of the right IJV was increased. TRIAL REGISTRATION: Clinical trial registration number: ChiCTR1800015051 . Date of registration: March 2018.


Assuntos
Cateterismo Venoso Central/métodos , Veias Jugulares/diagnóstico por imagem , Perna (Membro)/diagnóstico por imagem , Terapia Passiva Contínua de Movimento/métodos , Cuidados Pré-Operatórios/métodos , Procedimentos Cirúrgicos Torácicos/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Veias Jugulares/fisiologia , Veias Jugulares/cirurgia , Perna (Membro)/irrigação sanguínea , Perna (Membro)/fisiologia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
14.
Khirurgiia (Mosk) ; (4): 72-76, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31120451

RESUMO

It is presented diagnosis and treatment of 53-year-old man with multiple echinococcosis of the lungs and mediastinum. The diagnosis was confirmed by chest CT. Patient previously underwent surgery for liver echinococcosis. Excision of echinococcosis lesions in the lungs and mediastinum was performed. Chest wall repair was made by using of pedicled flap from the right lateral surface of the thorax followed by donor site plasty by polypropylene mesh. There were no intraoperative complications. In the postoperative period, intermediate bronchus occlusion mas made by occluder due to persistent air output through the pleural drains. The device was removed after 4 days. The patient was discharged. Multidisciplinary approach is useful to achieve good results in these patients.


Assuntos
Equinococose/cirurgia , Doenças do Mediastino/cirurgia , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Parede Torácica/cirurgia , Fístula Anastomótica/terapia , Brônquios/cirurgia , Equinococose/diagnóstico , Equinococose Pulmonar/diagnóstico , Equinococose Pulmonar/cirurgia , Humanos , Masculino , Doenças do Mediastino/diagnóstico , Pessoa de Meia-Idade , Implantação de Prótese/métodos , Recidiva , Retalhos Cirúrgicos , Procedimentos Cirúrgicos Torácicos/métodos , Tomografia Computadorizada por Raios X
17.
Ann Thorac Surg ; 108(3): 873-882, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31026435

RESUMO

BACKGROUND: Only a small series of studies has investigated primary tracheobronchial adenoid cystic carcinoma (TACC), and its prognosis and prognostic factors have not been well defined. METHODS: Patients with TACC diagnosed histologically between January 1967 and December 2017 at our institution were retrospectively analyzed. RESULTS: A total of 191 consecutive patients were included in our study. One hundred sixty-three patients underwent surgery, while the remaining 28 patients received nonoperative therapy. The 5-year, 10-year, and 20-year survival rates of the surgical group were 85.00%, 63.40%, and 47.00%, while the 5-year and 10-year survival rates of the nonoperative group were 63.70% and 46.40%, respectively. The multivariate analysis showed that the complaint duration (<7 months or ≥7 months) and treatment methods (R0 resection, R1 resection with radiotherapy, R1 resection without radiotherapy) were independent prognostic factors for disease-free survival of the R0/1 (resection with no residual tumor or microscopic residual tumor) resected patients, while the tumor size (≤3 cm or >3 cm) and treatment methods were independent prognostic factors for the overall survival. Sixty-four (45.1%) patients in the R0/1 group experienced recurrence/progression, and compared with chemotherapy or supportive treatment, local treatment significantly improved the prognosis of these patients (P < .050). CONCLUSIONS: The complaint duration and tumor size are independent prognostic factors for disease-free survival and overall survival in TACC, respectively. Complete resection of the primary tumor, postoperative adjuvant radiotherapy for patients with positive margins, and local treatment after postoperative recurrence or progression may contribute to better survival.


Assuntos
Neoplasias Brônquicas/patologia , Neoplasias Brônquicas/terapia , Carcinoma Adenoide Cístico/patologia , Carcinoma Adenoide Cístico/terapia , Neoplasias da Traqueia/patologia , Neoplasias da Traqueia/terapia , Adulto , Neoplasias Brônquicas/diagnóstico por imagem , Neoplasias Brônquicas/mortalidade , Broncoscopia/métodos , Carcinoma Adenoide Cístico/diagnóstico por imagem , Carcinoma Adenoide Cístico/mortalidade , Causas de Morte , Quimiorradioterapia Adjuvante , China , Terapia Combinada , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Prognóstico , Modelos de Riscos Proporcionais , Sistema de Registros , Estudos Retrospectivos , Análise de Sobrevida , Procedimentos Cirúrgicos Torácicos/métodos , Tomografia Computadorizada por Raios X/métodos , Neoplasias da Traqueia/diagnóstico por imagem , Neoplasias da Traqueia/mortalidade
18.
Gen Thorac Cardiovasc Surg ; 67(10): 867-875, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30929139

RESUMO

OBJECTIVE: An enhanced recovery after surgery (ERAS) program might be effective for postoperative recovery in elderly patients undergoing thoracic surgery. This study aimed to clarify the impact of ERAS on the post-operative recovery of elderly patients, with regard to shortening hospital stay and reducing complications after open thoracic surgery. METHODS: We used a prospectively collected database and retrospectively accessed the data of patients who underwent lobectomies or segmentectomies for pulmonary malignancies from April 2013 to March 2018 and evaluated outcomes after implementation of ERAS. ERAS patients were those who completed an ERAS program. The control patients were those who underwent surgery before June 2015 and later operated patients who did not receive ERAS. Propensity score matching was performed to balance the characteristics of patients in both groups. Patients were also divided into the following three groups for evaluating the efficacy of ERAS: patients aged < 65 years, 65-74 years of age, and ≥ 75 years of age. RESULTS: Before propensity score matching, the ERAS patients had shorter postoperative stay, shorter duration of chest tube drainage, and lower rate of postoperative complications than the patients without ERAS. The difference between readmission rates was not significant. After matching, the ERAS patients had shorter postoperative stay. The difference between readmission rates was not significant. After matching, the postoperative hospital stay was shorter in the patients aged ≥ 65 years. CONCLUSIONS: ERAS shortened the length of postoperative hospital stay in patients aged ≥ 65 years and did not increase readmission rates.


Assuntos
Complicações Pós-Operatórias/prevenção & controle , Pontuação de Propensão , Procedimentos Cirúrgicos Torácicos/métodos , Idoso , Feminino , Humanos , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos
19.
Scand J Trauma Resusc Emerg Med ; 27(1): 49, 2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31014372

RESUMO

BACKGROUND: In paediatric trauma patients, tracheobronchial injury can be a rare, life-threatening trauma. In 2011, we instituted a new trauma workflow concept called the hybrid emergency room (Hybrid ER) that combines a sliding CT scanning system with interventional radiology features to permit CT examination and emergency therapeutic intervention without moving the patient. Extracorporeal membrane oxygenation (ECMO) can lead to cannula-related complications. However, procedures supported by moveable C-arm fluoroscopy and ultrasonography equipment can be performed soon after early CT examination. We report a paediatric patient with tracheobronchial injury diagnosed by CT examination who underwent rapid resuscitation and safe installation of veno-venous (VV) ECMO in our Hybrid ER and was successfully treated by surgery. CASE PRESENTATION: A 11-year-old boy was admitted to our Hybrid ER suffering blunt chest trauma. His vital signs were unstable with low oxygen saturation. Early CT examination was performed without relocation. CT revealed bilateral hemopneumothorax, bilateral lung contusion, left multiple rib fractures, and right bronchus intermedius injury. Because his oxygenation was severely low with a PaO2/FiO2 ratio (P/F) of 109, he was at very high risk during transport to the operating room and changing to one-lung ventilation. Thus, we established VV ECMO in the Hybrid ER before we performed thoracotomy under left lung ventilation in the operating room. After the P/F ratio improved, he was transferred to the operating room under VV ECMO. We performed middle- and lower-lobe resection and sutured the stump of the right bronchus intermedius to treat the complete tear of this branch. After his respiratory function recovered, VV ECMO was removed on postoperative day 5. After in-patient rehabilitation, he was discharged home on postoperative day 68 without sequelae. CONCLUSIONS: It is feasible to perform VV ECMO in the Hybrid ER, but one case does not conclude it is safe. In this case, the blood oxygenation improved, but there are no evidence to support the safety of the procedure or the advantage of ECMO initiation in the Hybrid ER rather than in the operating room.


Assuntos
Brônquios/lesões , Serviço Hospitalar de Emergência , Oxigenação por Membrana Extracorpórea/métodos , Traumatismos Torácicos/cirurgia , Procedimentos Cirúrgicos Torácicos/métodos , Traqueia/lesões , Ferimentos não Penetrantes/cirurgia , Brônquios/diagnóstico por imagem , Brônquios/cirurgia , Criança , Emergências , Humanos , Masculino , Alta do Paciente , Traumatismos Torácicos/diagnóstico , Tomografia Computadorizada por Raios X , Traqueia/diagnóstico por imagem , Traqueia/cirurgia , Ferimentos não Penetrantes/diagnóstico
20.
J Thorac Cardiovasc Surg ; 158(1): 279-286.e1, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31014665

RESUMO

OBJECTIVE: Enhanced recovery after surgery integrates multiple evidence-based interventions to accelerate postoperative recovery. We hypothesized that enhanced recovery after surgery would also facilitate adjuvant chemotherapy for non-small cell lung cancer. METHODS: An enhanced recovery after surgery pathway was implemented at a single institution, starting with a transitional rollout in 2012 and full rollout in 2015. Patients with clinical stage I or II non-small cell lung cancer without induction therapy and who were pathologic nodal positive or had 5-cm or larger tumor size were selected for analysis. Dates analyzed were pre-enhanced recovery after surgery (2006-2011), transitional (2012-8/2015), and enhanced recovery after surgery (9/2015-2017). Interrupted time series was used to analyze trends in time to receive adjuvant chemotherapy after resection by era. Logistic regression was used to determine factors associated with receiving 4 or more cycles of adjuvant chemotherapy. RESULTS: A total of 471 patients were identified. The interval between lung resection and commencing adjuvant chemotherapy was progressively shorter after the transition era (P = .041). The rate of receiving adjuvant chemotherapy progressively increased (from 40% pre-enhanced recovery after surgery, to 50% transition era, to 62% enhanced recovery after surgery era, P < .001). Multivariable regression revealed the enhanced recovery after surgery era (odds ratio, 3.6, P < .001), the transitional era (odds ratio, 2.01, P = .007), pN status, tumor grade and histology, age, and preoperative performance status were associated with completing adjuvant therapy. The surgical approach, whether open or thoracoscopic, was not associated with completing adjuvant chemotherapy. CONCLUSIONS: Enhanced recovery after surgery was associated with facilitated delivery of adjuvant chemotherapy, with a shortened interval to receive adjuvant chemotherapy and a higher rate of receiving 4 or more cycles.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/terapia , Quimioterapia Adjuvante , Neoplasias Pulmonares/terapia , Procedimentos Cirúrgicos Torácicos , Idoso , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Quimioterapia Adjuvante/métodos , Terapia Combinada , Feminino , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Procedimentos Cirúrgicos Torácicos/métodos , Toracoscopia/métodos , Resultado do Tratamento
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