Acute Pulmonary Complications Research Articles

Risk of Acute Complications with Rocuronium versus Cisatracurium in Patients with Chronic Kidney Disease: A Propensity-Matched Study.

Neuromuscular blocking agents (NMBAs) play an integral role in modern anesthesia by facilitating endotracheal tube placement, assisting with mechanical ventilation, and creating optimal surgical conditions. However, NMBAs can have deleterious side effects. The purpose of this study was to retrospectively analyze acute complications of 2 pharmacodynamically similar but pharmacokinetically different NMBAs and their respective reversal agents. The global research network database, TriNetX, was used to evaluate deidentified patient information from 63 health care organizations. Cohort A was defined as patients aged 18 to 80 years who had chronic kidney disease (CKD) and were administered rocuronium with sugammadex. Cohort B was defined as patients aged 18 to 80 years who had CKD and were administered cisatracurium with neostigmine. Cohorts were propensity matched for age at event, ethnicity, race, sex, and relevant confounding pathologies. All outcomes besides mortality were analyzed from the same day to 1 week after administration of the indexed drug. Mortality was analyzed from the same day to thirty days after administration of the indexed drug. A total of 95,740 patients with CKD-administered rocuronium with sugammadex were matched with 10,708 patients with CKD-administered cisatracurium with neostigmine. Patients administered rocuronium with sugammadex had a significantly higher associated risk of respiratory failure (risk ratios [RR], 1.98, confidence interval [CI], 1.71-2.29, P < .0001), acute respiratory distress (RR, 2.70, CI, 1.31-5.58, P = .0052), hypertensive crisis (RR, 1.85, CI, 1.37-2.49, P < .0001), heart failure (RR, 1.14, CI, 1.06-1.23, P = .0004), pleural effusion (RR, 1.30, CI, 1.14-1.49, P < .0001), and 30-day mortality (RR, 1.31, CI, 1.10-1.56, P = .0021). From 2003 to 2023, patients who were administered rocuronium plus sugammadex were at a significantly higher risk for acute cardiovascular and pulmonary complications when compared to patients who were administered cisatracurium plus neostigmine.

Inspiratory Muscle Trainer Versus Diaphragmatic Breathing Exercise on 6-Minute Walk Test in Adolescent Girls with End-Stage Renal Disease

Objective: Inspiratory muscle weakness (IMW) is very common among adolescents with end-stage renal disease (ESRD). Untreated IMW in ESRD adolescents induces acute and chronic pulmonary complications, low physical performance, and impairment in quality of life (QoL). This was a 12-week breathing-retraining trial that compared the effects of threshold inspiratory muscle trainer (TIMT) versus the diaphragmatic breathing exercise procedure (DBEP), on ESRD adolescent girls’ maximal inspiratory pressure (MIP) and QoL, which was assessed by the Child Health Questionnaire (50-item parent form) (CHQ/PF50), pulmonary functions, and six-minute walk test (6MWT).Material and Methods: This breathing-retraining trial enrolled forty adolescent girls with ESRD. The girls were randomly divided into two groups: one group contained twenty girls that were trained by TIMT, while the other group contained 20 girls whom were trained by DBEP. The 20-minute rehabilitation of IMW by TIMT or DBEP was applied 3 times weekly. Adolescent girls’ forced vital capacity (FVC), CHQ/PF50-related score of physical summary, MIP, 6MWT, CHQ/PF50-related score of psychosocial summary, forced expiratory volume in the first second of girls’ expiration (FEV1), and 6MWT-associated physiological data (blood pressure, heart rate, and rate of perceived exertion) were assessed.Results: All outcomes of adolescent girls with ESRD in the first group that were trained by TIMT showed significant improvements, whereas the other group’s girls did not show the same reported significant improvements. Conclusion: Compared to DBEP, the 12-week training by TIMT significantly improved ESRD adolescent girls’ FVC, CHQ/PF50-related score of physical summary, MIP, 6MWT, CHQ/PF50-related score of psychosocial summary, FEV1, and 6MWT-associated physiological data.

Mechanical ventilation guided by driving pressure optimizes local pulmonary biomechanics in an ovine model.

Mechanical ventilation exposes the lung to injurious stresses and strains that can negatively affect clinical outcomes in acute respiratory distress syndrome or cause pulmonary complications after general anesthesia. Excess global lung strain, estimated as increased respiratory system driving pressure, is associated with mortality related to mechanical ventilation. The role of small-dimension biomechanical factors underlying this association and their spatial heterogeneity within the lung are currently unknown. Using four-dimensional computed tomography with a voxel resolution of 2.4 cubic millimeters and a multiresolution convolutional neural network for whole-lung image segmentation, we dynamically measured voxel-wise lung inflation and tidal parenchymal strains. Healthy or injured ovine lungs were evaluated as the mechanical ventilation positive end-expiratory pressure (PEEP) was titrated from 20 to 2 centimeters of water. The PEEP of minimal driving pressure (PEEPDP) optimized local lung biomechanics. We observed a greater rate of change in nonaerated lung mass with respect to PEEP below PEEPDP compared with PEEP values above this threshold. PEEPDP similarly characterized a breaking point in the relationships between PEEP and SD of local tidal parenchymal strain, the 95th percentile of local strains, and the magnitude of tidal overdistension. These findings advance the understanding of lung collapse, tidal overdistension, and strain heterogeneity as local triggers of ventilator-induced lung injury in large-animal lungs similar to those of humans and could inform the clinical management of mechanical ventilation to improve local lung biomechanics.

Mechanism matters: Differential benefits of cold-stored whole blood for trauma resuscitation from a prospective multicenter study.

Resuscitation with cold-stored low-titre whole blood (LTOWB) has increased despite the paucity of robust civilian data. Most studies are in predominately blunt trauma and lack analysis of specific subgroups or mechanism of injury. We sought to compare outcomes between patients receiving LTOWB versus balanced component therapy (BCT) after blunt (BL) and penetrating (PN) trauma. Secondary analysis of a prospective multicenter study of patients receiving either LTWOB-containing or BCT resuscitation was performed. Patients were grouped by mechanism of injury (BL vs. PN). A generalized estimated equations model using inverse probability of treatment weighting was employed. Primary outcome was mortality and secondary outcomes were acute kidney injury, venous thromboembolism, pulmonary complications, and bleeding complications. Additional analyses were performed on no-traumatic brain injury (TBI), severe torso injury, and LTOWB-only resuscitation patients. There were 1,617 patients (BL 47% vs PN 54%) identified; 1,175 (73%) of which received LTOWB. PN trauma patients receiving LTOWB demonstrated improved survival compared to BCT (77% vs. 56%; p < 0.01). Interval survival was higher at 6 hours (95% vs. 88%), 12 hours (93% vs. 80%), and 24 hours (88% vs. 57%) (all p < 0.05). The survival benefit following LTOWB was also seen across PN non-TBI (83% vs. 52%), and severe torso injuries (75% vs. 43%) (all p < 0.05). After controlling for age, sex, injury severity, and trauma center, LTWOB was associated with decreased odds of death (odds ratio, 0.31, p < 0.05) in PN trauma. However, no difference in overall mortality was seen across the BL groups. Both PN and BL patients receiving LTOWB had more frequent acute kidney injury compared to BCT (19% vs. 7% and 12% vs 6%, respectively; p < 0.05). Low-titre whole blood resuscitation was independently associated with decreased mortality following PN trauma, but not BL trauma. Further analysis in BL trauma is required to identify subgroups that may demonstrate survival benefit. Therapeutic/Care Management; Level III.

Outcomes of HLA-mismatched HSCT with TCRαβ/CD19 depletion or post-HSCT cyclophosphamide for inborn errors of immunity

AbstractHLA-mismatched transplants with either in vitro depletion of CD3+ T-cell receptor (TCR)αβ/CD19 (TCRαβ) cells or in vivo T-cell depletion using posttransplant cyclophosphamide (PTCY) have been increasingly used for patients with inborn errors of immunity (IEIs). We performed a retrospective multicenter study via the EBMT registry on 306 children with IEIs undergoing their first transplant between 2010 and 2019 from an HLA-mismatched donor using TCRαβ (n = 167) or PTCY (n = 139). The median age for hematopoietic stem cell transplantation (HSCT) was 1.2 years (range, 0.03-19.6 years). The 3-year overall survival (OS) was 78% (95% confidence interval (CI), 71-84) after TCRαβ and 66% (57-74) after PTCY (P = .013). Pre-HSCT morbidity score (hazard ratio [HR], 2.27; 1.07-4.80, P = .032) and non-busulfan/treosulfan conditioning (HR, 3.12; 1.98-4.92, P < .001) were the only independent predictors of unfavorable OS. The 3-year event-free survival (EFS) was 58% (50%-66%) after TCRαβ and 57% (48%-66%) after PTCY (P = .804). The cumulative incidence of severe acute graft-versus-host disease (GvHD) was higher after PTCY (15%, 9%-21%) than TCRαβ (6%, 2%-9%, P = .007), with no difference in chronic GvHD (PTCY, 11%, 6%-17%; TCRαβ, 7%, 3%-11%, P = .173). The 3-year GvHD-free EFS was 53% (44%-61%) after TCRαβ and 41% (32%-50%) after PTCY (P = .080). PTCY had significantly higher rates of veno-occlusive disease (14.4% vs TCRαβ 4.9%, P = .009), acute kidney injury (12.7% vs 4.6%, P = .032), and pulmonary complications (38.2% vs 24.1%, P = .017). Adenoviremia (18.3% vs PTCY 8.0%, P = .015), primary graft failure (10% vs 5%, P = .048), and second HSCT (17.4% vs 7.9%, P = .023) were significantly higher in TCRαβ. In conclusion, this study demonstrates that both approaches are suitable options in patients with IEIs, although they are characterized by different advantages and outcomes.

Perioperative intravenous dexamethasone use is not associated with periprosthetic joint infection or wound healing complications following shoulder arthroplasty

BackgroundPerioperative intravenous (IV) dexamethasone is commonly used in lower extremity total joint arthroplasty to manage postoperative pain and nausea/vomiting, and recent studies have demonstrated that its use may lower rates of acute postoperative medical complications. However, there is limited information regarding the safety and efficacy of IV dexamethasone in patients undergoing total shoulder arthroplasty (TSA). Additionally, there is concern surrounding corticosteroid use prior to surgery as preoperative corticosteroid injections have been associated with adverse outcomes after TSA, including periprosthetic joint infection (PJI) and revision surgery. Thus, the purpose of this study was to evaluate the effect of perioperative IV dexamethasone on 90-day rates of PJI, wound complications, and medical complications after TSA. MethodsThe Premiere national hospital database was used to identify adult patients undergoing elective TSA between 2016 and 2020; patients were excluded if they were under 18 years old, were undergoing revision TSA, or had a prior proximal humerus open reduction internal fixation (ORIF) procedure. Patients who did and did not receive perioperative IV dexamethasone were then compared in both univariate and multivariate analyses. A Bonferroni correction was utilized to adjust for multiple comparisons. The primary endpoint was risk of acute infectious complications within 90 days of surgery, including PJI and wound infection/dehiscence. Secondary endpoints included acute pulmonary, renal, and thromboembolic complications. ResultsA total of 135,333 patients underwent TSA during the study period; 61.2% underwent reverse total shoulder arthroplasty (RTSA), 33.8% underwent anatomic total shoulder arthroplasty (ATSA), and 5.0% underwent hemiarthroplasty (HA). From 2016 to 2020, perioperative IV dexamethasone use increased by 135%. Multivariate analysis revealed that patients who received perioperative IV dexamethasone did not have increased odds of PJI, superficial wound infection, or wound dehiscence (p = 0.15 – 0.47) but did have decreased odds of sepsis (OR 0.67, 95% CI 0.55-0.81) and other medical complications such as urinary tract infection (UTI) and acute kidney injury (AKI). Additionally, there was a trend towards decreased 90-day hospital readmission (OR 0.88, 95% CI 0.81-0.96, p=0.003). ConclusionsPerioperative IV dexamethasone was not associated with increased risk of acute infectious and wound healing complications. Moreover, patients who received perioperative IV dexamethasone had decreased odds of medical complications and trended towards lower rates of 90-day hospital readmission. The results of this study support the safety of perioperative IV dexamethasone use in patients undergoing elective TSA.

Autologous cell salvage in off-pump coronary artery bypass surgery reduces post-operative complications: a retrospective weighted-matching analysis.

Blood transfusion plays a crucial role in coronary artery bypass grafting (CABG). The choice between autologouscell saver (CS) and allogenic blood transfusion (ABT) has been a continuous debate in the medical community, especially within cardiac surgery. This study aimed to assess the outcomes of off-pump CABG (OPCAB) surgery in patients receiving blood solely via cell salvage compared to those receiving ABT or a combination of ABT and CS perioperatively. A total of 414 patients who underwent isolated OPCAB surgery at our cardiovascular clinic were analyzed. Among them, 250 patients (60.4%) received blood via CS alone, while 164 patients (39.6%) received either ABT or a mix of ABT and CS. Stabilized inverse probability treatment weighted (IPTW) matching technique ensured balance in baseline covariates. We found no significant differences in 30-day mortality rates between the CS and ABT groups. The CS group displayed significantly lower rates of overall complications, encompassing stroke, acute kidney injury, atrial fibrillation, and pulmonary complications. Rates of sepsis, readmission, gastrointestinal complications, heparin-induced thrombosis, and deep venous thrombosis were comparable between the two groups. However, in contrast to the ABT group,the CS group exhibited significantly shorter median lengths of hospital stay (LOHS), ICU stay, andventilation time, along with higher rates of discharge to homerather than acute care facilities. Our data suggest that autologous blood transfusion via CS results in fewer perioperative complications and faster recovery following OPCAB procedures as compared to ABT.

Effect of dexmedetomidine on the intraoperative and early postoperative complications of patients undergoing orthotopic liver transplantation

Objective: To investigate the effect of dexmedetomidine on the intraoperative and early postoperative complications of patients undergoing orthotopic liver transplantation. Methods: This is a retrospective cohort study. The clinical data of 399 patients who underwent orthotopic liver transplantation at the First Affiliated Hospital of Nanjing Medical University from January 2016 to September 2020 were retrospectively collected. There were 319 males and 80 females, aged (50.9±10.2) years (range: 10 to 73 years). These patients were divided into the control group (369 cases) and the dexmedetomidine group (30 cases) according to whether dexmedetomidine was continuously pumped intravenously during the operation until the operation ended. The 1∶2 propensity score matching was used to match the preoperative and intraoperative conditions of the two groups of patients, and the caliper width was 0.2. Outcome indicators included intraoperative postreperfusion syndrome, acute kidney injury and pulmonary complications within 7 days after surgery, length of hospital stay, time of stay in ICU, duration of assisted mechanical ventilation, rate of reintubation, 6-month and 1-year survival and recurrence-free survival rate after surgery. The independent sample t test, χ2 test, Mann-Whitney U test or Fisher exact test was used to statistically analyze the data of the two groups of patients, respectively. Survival curves of overall survival and disease-free-survival were plotted by Kaplan-Meier method, and the survival rate and recurrence-free survival rate were compared by Log-rank test. Results: A total of 78 patients were included after propensity score matching, including 26 in the dexmedetomidine group and 52 in the control group. The incidence of acute kidney injury in the dexmedetomidine group within 7 days after surgery was 0 (0/26), significantly lower than that of the control group (21.2%,11/52)(corrected χ2=4.776, P=0.029). There were no significant differences in the incidence of intraoperative postreperfusion syndrome and pulmonary complications within 7 days after surgery, length of hospital stay, ICU time, the duration of assisted mechanical ventilation, rate of reintubation, 6-month and 1-year survival, and recurrence-free survival rate after surgery between the two groups (all P>0.05). Conclusion: Continuous infusion of dexmedetomidine via intravenous pump during operation may be beneficial in reducing the incidence of acute kidney injury within 7 days after orthotopic liver transplantation.

Effects of Diaphragmatic Breathing in Sickle Cell Disease Patients: Preliminary Data

Introduction: Sickle cell disease (SCD) can be defined as an autosomal recessive disease, characterized by hemolytic anemia, progressive lesions in most organs and vaso-occlusive crises. Affected individuals suffer from severe pain due to vaso-occlusion and ischemic damage. Acute and chronic pulmonary complications including acute thoracic syndrome, pulmonary hypertension, thromboembolism, sleep-disordered breathing and asthma are among the leading causes of morbidity and mortality of SCD individuals. Dyspnea may be present due to pulmonary involvement, exercise intolerance, as well as a feature of pulmonary complications or due to the complications inherent to SCD. The practice of diaphragmatic breathing (DB) has been shown to improve exercise tolerance, reduce dyspnea and increase inspiratory muscle strength in several diseases, especially asthma and chronic obstructive pulmonary disease. However, the effects of this breathing exercise are not yet known in patients with SCD. Thus, the aim of this study was to evaluate the effects of BD in patients with SCD. Methods: The study was approved by the UNICAMP ethics committee and all the patients who agreed to participate signed a written informed consent form. Participants were randomly divided into a control group (CG) and an intervention group (IG). The IG was instructed to do 3 sets of 20 repetitions per day of DB at home, 5 times a week. They were instructed to write down the date and time of DB, as well as justify any reason that prevented them from carrying out the training at some point. Patients in both groups were contacted weekly via the smartphone messaging application (app). In the case of IG patients, this contact aimed to reinforce the importance of continuing the intervention protocol. For the CG participants, the weekly contact was important in order avoid a bias of the GI participants alone receiving continuous attention from the researchers. In addition, once a week, IG participants had to record and send a video via the smartphone messaging app showing how they were doing the exercise. The video was analyzed and the patient received feedback, also via messaging app, from the researchers with compliments or suggestions for corrections regarding the practice of DB. Thus, there was constant monitoring of the implementation of the intervention protocol seeking to maintain patient adherence to the training protocol. The CG did not perform any breathing exercises during the study. The effects of DB on SCD patients were evaluated twice, the initial evaluation (IE) and final evaluation (FE), performed with a 12-week interval and consisted of the application of the Modified Medical Research Council Scale (mMRC), assessment of the maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), volumetric capnography (VCap) and 6-minute walk test (6MWT). Comparison between groups was performed using the Mann-Whitney and Fisher's exact tests. Within-group comparisons of BD effects were performed using Wilcoxon's Sign Rank Test. The comparison between groups was performed with the Mann-Whitney Test with Bonferroni correction. Results: 19 patients completed the 12 weeks between IE and FE. There were no significant differences between CG (n=9) and IG (n=10) based on age (p=0.1619), sex (p=0.0698), body mass index (p=0.5490) or severity of genotype (n=13 HbSS, 4 HbSC, 1 HbSβ0 and 1 HbSβ +) with p=0.9879. At the end of the DB protocol, in the within-group comparations, the IG presented significant changes in MIP (p=0.0117) and among the variables measured by VCap, such as inspiratory tidal volume (p=0.0371), expiratory tidal volume (p=0.0371), Tobin index (p=0.0488) and oxygen saturation (p=0.0488). No significant alterations were observed in the other variables evaluated in between-group comparisons. The CG showed no significant change in any of the comparisons. Conclusions: DB is an exercise that can be easily applied to outpatients with SCD, allowing for an improvement in inspiratory muscle strength, VCap and favoring blood oxygenation in these individuals. Funding: FAPESP 2017/21801-2; CNPq grants #303405/2018-0; #405918/2022-4 - Instituto Nacional de Ciência e Tecnologia do Sangue (INCT do Sangue).

Exhaled phospholipids as a prognostic factor of pulmonary complications in children with acute lymphoblastic leukemia

Introduction. Pulmonary complications are common in children with acute lymphoblastic leukemia (ALL). The assessment of phospholipids (PL) in the exhaled breath condensate can provide more information about pathological processes in the lungs in children with ALL. Purpose - to assess the level of PL in the exhaled breath condensate (EBC) in children with ALL and its prognostic value. Materials and methods. 40 children with ALL aged 6-17 years were examined. 1st group included newly diagnosed children with ALL (n=18). 2nd group involved ALL survivors, who had completed the total course of chemotherapy (n=22). The control (С) group consisted of 15 healthy children. The levels of PL in the EBC were investigated by spectrophotometric thin-layer chromatography using an SPh 46 spectrophotometer. Results. The frequency of pulmonary complication was 82.5% during chemotherapy protocols and 18.4% in ALL survivals. The statistically significant increase in the level of phospholipids in 1st (150.75 (137.62; 158.45) mmol/l) and 2nd (130.12 (120.59; 138.34) mmol/l) ALL groups compared with the group C (54.80 (48.30; 60.80) mmol/l) has been detected (p1-C=0.0000; p2-C=0.0000). Children of the 1st group had significantly higher levels of PL in the EBC than children of the 2nd group (p1-2=0.002911). PL level in EBC collected during induction phase of chemotherapy &gt;132.15 mmol/l can be prognostic for the development of acute pulmonary complications (Sensitivity 93.75%; Specificity 100%). PL level in EBC collected after a complete course of chemotherapy &gt;133.28 mmol/l can be predictive for persistent pulmonary complications (Sensitivity 100.00%; Specificity 83.33%). Conclusions. PL level in EBC can be prognostic for the development of pulmonary complications, both during chemotherapy and in long-term remission after completed chemotherapy course. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Outcomes of HLA-mismatched HSCT with TCRαβ/CD19 depletion or post-transplant cyclophosphamide in patients with inborn errors of immunity – an EBMT inborn errors working party analysis

HLA-mismatched donor HSCT is an increasingly utilized approach for patients with inborn errors of immunity (IEI) lacking a matched donor, thanks to the development of in-vivo T-cell depletion with post-transplant cyclophosphamide (PTCY) or in-vitro TCRαβ/CD19 depletion (TCRab). Our study analyzed the outcome with these approaches in patients with IEI. Pediatric patients who received a first HSCT between 2011 and 2019 from haploidentical related or ≤9/10 HLA-mismatched unrelated (MMUD) donors were included in this retrospective study.We included 296 patients, 139 with PTCY and 157 with TCRab, who received HSCT at a median age of 1.4 years (0.1–19.6) from haploidentical donors (n = 282) or MMUD (n = 14). There were significant differences in patient characteristics: PTCY recipients had a higher rate of pre-HSCT infections (p = 0.002), and organ damage (p < 0.001), had lower performance scores (0.008), and were transplanted more recently (p = 0.001). Owing to the approach, there was a higher proportion with busulfan-based conditioning and multi-drug GVHD prophylaxis, and a lower proportion with serotherapy in the PTCY group; and lower CD34+ but higher CD3+ numbers were infused to PTCY recipients (all p < 0.001). Neutrophil and platelet engraftment occurred significantly earlier after TCRab depletion (p < 0.001). Acute GVHD°III-IV occurred in 10.3% of patients, more frequently after PTCY (p = 0.022), while 14.3% of patients required secondary cellular therapy (boost, DLI, 2nd HSCT), more frequently after TCRab (p = 0.026). Adenoviremia was more frequent (p = 0.012) and veno-occlusive disease (p = 0.015), acute kidney injury (p = 0.028), autoimmune cytopenia (p = 0.032), and pulmonary complications (p = 0.011) less frequent after TCRab. Overall survival at 3 years was 81% (95%CI: 75–88%) and 70% (63–78%; p = 0.001) after TCRab and PTCY, respectively, while event free survival (graft failure, extensive chronic GVHD) was 69% (62–77%) and 63% (55–71%), respectively. In univariate analysis, use of PTCY, conditioning other than busulfan or treosulfan, pre HSCT organ damage, preHSCT infections and number of preHSCT morbidities correlated negatively with overall survival.This study of HLA-mismatched HSCT in IEI demonstrated better overall but not event-free survival after TCRab, but patients with PTCY had significantly higher rates of preHSCT risk factors. We conclude that both approaches are feasible and efficacious in patients with IEI lacking an HLA-matched donor.

One-Lung Ventilation and Postoperative Pulmonary Complications After Major Lung Resection Surgery. A Multicenter Randomized Controlled Trial

The effect of one-lung ventilation (OLV) strategy based on low tidal volume (TV), application of positive end-expiratory pressure (PEEP), and alveolar recruitment maneuvers (ARM) to reduce postoperative acute respiratory distress syndrome (ARDS) and pulmonary complications (PPCs) compared with higher TV without PEEP and ARM strategy in adult patients undergoing lobectomy or pneumonectomy has not been well established. Multicenter, randomized, single-blind, controlled trial. Sixteen Italian hospitals. A total of 880 patients undergoing elective major lung resection. Patients were randomized to receive lower tidal volume (LTV group: 4 mL/kg predicted body weight, PEEP of 5 cmH2O, and ARMs) or higher tidal volume (HTL group: 6 mL/kg predicted body weight, no PEEP, and no ARMs). After OLV, until extubation, both groups were ventilated using a tidal volume of 8 mL/kg and a PEEP value of 5 cmH2O. The primary outcome was the incidence of in-hospital ARDS. Secondary outcomes were the in-hospital rate of PPCs, major cardiovascular events, unplanned intensive care unit (ICU) admission, in-hospital mortality, ICU length of stay, and in-hospital length of stay. ARDS occurred in 3 of 438 patients (0.7%, 95% CI 0.1-2.0) and in 1 of 442 patients (0.2%, 95% CI 0-1.4) in the LTV and HTV group, respectively (Risk ratio: 3.03 95% CI 0.32-29, p=0.372). Pulmonary complications occurred in 125 of 438 patients (28.5%, 95% CI 24.5-32.9) and in 136 of 442 patients (30.8%, 95% CI 26.6-35.2) in the LTV and HTV group, respectively (risk ratio: 0.93, 95% CI 0.76-1.14, p=0.507). The incidence of major complications, in-hospital mortality, and unplanned ICU admission, ICU and in-hospital length of stay were comparable in both groups. In conclusion, among adult patients undergoing elective lung resection, an OLV with lower tidal volume, PEEP 5 cmH2O, and ARMs and a higher tidal volume strategy resulted in low ARDS incidence and comparable postoperative complications, in-hospital length of stay, and mortality.

Regional Anesthesia Vs General Anesthesia In Patients With Covid-19: The Effect On Critical Care Admission, Mortality Rates And Pulmonary Complications

Objectives&#x0D; The appropriate anesthesia method in patients requiring surgical treatment with confirmed or suspected new coronavirus disease (COVID-19) is unclear. This study aimed to compare regional anesthesia (RA) with general anesthesia (GA) in patients with COVID-19 infection in terms of admission to intensive care unit (ICU), rate of pulmonary complications, and mortality.&#x0D; Materials and Methods&#x0D; We reviewed medical records between March 2020 and December 2021 added patients with COVID-19 that operated under RA or GA in the study. The patients were assigned into two groups: 1. patients operated under RA and 2. patients operated under GA. Primary outcomes were admission rates to the ICU, acute pulmonary, renal, and hepatic complications, and perioperative mortality rates.&#x0D; Results&#x0D; We included 123 patients in the study. Regional anesthesia was significantly higher in the cohort. 97 (78.9 %) patients were operated under RA and 26 (21.1 %) patients under GA. The admission rate to ICU was 8.2 %in the RA group and 11.5 %in the GA group. The difference was not significant (p=0.422). Pulmonary complications were seen in 6 (6.2 %) patients in the RA group and 2 (7.7 %) patients in the GA group without a significant difference (p=0.535). Perioperative mortality rates were comparable between groups (5.2 %in the RA group vs. 7.7 %in the GA group) (p=0.535).&#x0D; Conclusion&#x0D; Pulmonary complications, ICU admission, and perioperative mortality rates were lower in COVID-19 patients operated under regional anesthesia; however, the differences were not significant.

Predictors of Post-chemoradiotherapy Pulmonary Complication in Locally Advanced Non-Small Cell Lung Cancer.

We investigated the clinical effects and predictive factors of severe post-chemoradiotherapy pulmonary complications (PCPC) in locally advanced non-small cell lung cancer (LA-NSCLC). Medical records of 317 patients who underwent definitive concurrent chemoradiation (CCRT) for LA-NSCLC were reviewed retrospectively. PCPC was defined as an event of admission or emergency department visit for acute or subacute pulmonary inflammatory complications, including pneumonitis and pneumonia, within 6 months after CCRT initiation. Patient characteristics, baseline lung function tests, radiation dosimetric parameters, and laboratory tests were analyzed to investigate their association with PCPC. Prognostic endpoints were disease progression rate (DPR) and overall survival (OS). PCPC was reported in 53 patients (16.7%). The OS of patients with PCPC was significantly worse (35.0% in 2 years) than that of patients without PCPC (67.0% in 2 years, p < 0.001). However, 2-year DPRs were 77.0% and 70.7% in patients with and without PCPC, respectively, which were not significantly different (p=0.087). In multivariate logistic regression, PCPC was independently associated with grade ≥ 1 hypoalbuminemia during CCRT (odds ratio [OR], 5.670; 95% confidence interval [CI], 2.487 to 13.40; p < 0.001), lower diffusing capacity of carbon monoxide (DLCO) (per mL/min/mmHg; OR, 0.855; 95% CI, 0.743 to 0.974; p=0.022), and higher lung V5 (per 10%; OR, 1.872; 95% CI, 1.336 to 2.699; p < 0.001). PCPC might be a clinical endpoint to evaluate complications and predict the survival of patients subjected to CCRT for LA-NSCLC. Hypoalbuminaemia, DLCO, and lung V5 might predict PCPC in LA-NSCLC.

Clinical Correlates of Acute and Chronic Pulmonary Complications in Children with Sickle Cell Disease from Madhya Pradesh, India: A Cross-sectional Study

Introduction: Sickle Cell Disease (SCD) is one of the most common hereditary haemoglobinopathies globally. Patients with SCD are at a high risk of pulmonary complications. However, there have been very few studies in literature regarding the spectrum of pulmonary involvement and its association with clinicotherapeutic parameters in Indian patients. Aim: To study the incidence of acute and chronic pulmonary complications in children with SCD and to estimate the association of various risk factors with pulmonary complications. Materials and Methods: The present observational crosssectional study was conducted in the Department of Paediatrics, Mahatma Gandhi Memorial Medical College (tertiary care hospital) and Maharaja Yeshwantrao (MY) Hospital, Indore, Madhya Pradesh, India, from June 2021 to July 2022. A total of 100 patients with SCD below the age of 18 years attending sickle-thalassaemia Outpatient Department (OPD) and Inpatient Department (IPD) with pulmonary symptoms admitted were enrolled in the study. Clinical history, physical examination and laboratory findings were noted as per the preconstructed proforma. Data were statistically analysed with unpaired t-test and Pearson’s Chi- square test. Results: A total of 100 patients with SCD were enrolled and the mean age of the study subjects was 9.27±3.39 years. Nearly equal distribution of males (n=52) and females (n=48) were seen with male to female ratio of 1:1.08. Incidence of complications was seen very high in homozygous sickle disease (63%) followed by only 40% in Haemoglobin S (HbS) beta thalassaemia. Most common complication noted in our patients was Acute Chest Syndrome (ACS) (57.7%), followed pneumonia (20%), sympneumonic effusion (15.6%) while only 6.7% had pulmonary hypertension. A statistically significant association (p-value&lt;0.05) was found between compliance to Hydroxyurea therapy and frequency of Vaso-occlusive Crisis (VOC) episodes with pulmonary complications status. Conclusion: In the present study, most frequent acute pulmonary complication noted was ACS followed by pneumonia and sympneumonic effusion. Frequency of VOCs episodes was significantly associated with increased risk of developing pulmonary complications.

Lung cancer presenting with acute myocardial infarction and pulmonary embolism within 1 month

Acute myocardial infarction and pulmonary embolism can have life-threatening consequences such as congestive heart and respiratory failure, respectively. Cancer patients are at great risk of both acute myocardial infarction and pulmonary embolism complications because the malignancy sparks the patient’s blood hypercoagulable state. Nevertheless, the literature currently offers only a few reports on acute myocardial infarction associated with pulmonary embolism, and two of them occurred in the same cancer patient. Here, we present a case of a 60-year-old woman who had been diagnosed with lung cancer. She was admitted to the emergency department twice. She was diagnosed with acute myocardial infarction at her first admission, when she experienced sudden-onset chest pain. Electrocardiography showed ST-segment elevation in leads V1–V3 with inverted T wave and pathological Q wave, suggesting an acute myocardial infarction. Coronary angiography revealed a thrombus in the left anterior descending coronary artery, and thrombus aspiration was performed. After 1 month, she had an attack of pulmonary embolism with syncope upon the second admission. A computed tomographic pulmonary angiography showed branches of right and left pulmonary embolism. Anticoagulation and antiplatelet measures were taken. In this article, we discuss the relationship between cancer and thrombosis with a special focus on the conservative management strategy regarding anticoagulant and antiplatelet therapy in our case.

Early recognition of pulmonary complications of sickle cell disease

Sickle cell disease (SCD) is an inherited hematological disorder with multiple-organ involvement. The pulmonary complications of SCD are associated with significant morbidity and mortality. This article presents an important review of acute and chronic pulmonary complications, including acute chest syndrome, pneumonia, pulmonary thromboembolism, pulmonary fat embolism, chronic sickle cell lung disease, and pulmonary hypertension, in patients with SCD. Bronchial asthma and obstructive sleep apnea in relation to SCD are discussed in this article. Early recognition of pulmonary complications leads to early therapeutic interventions and improvement of the overall treatment outcome.

Factors associated with postbronchoaspiration survival: a cross-sectional study

Introduction: Respiratory tract infections are common in both healthy and fragile populations, occurring in about 90% of hospitalized patients with characteristics of aspiration infections. Objective: To analyze the survival rate of adult patients who underwent bronchoaspiration while hospitalized in a public university hospital with oncology care characteristics. Methods: A 12-month retrospective longitudinal study was carried out using bronchoaspiration risk management and event notification analysis forms filled out in the medical records of patients admitted to this hospital. Results: The 34 patients who presented the adverse event of bronchoaspiration had their survival rate reduced by 30% in the first month, and only 29.6% of them survived the second month post-event. Women were more vulnerable to clinical complications originating from the general health status decline as well as to acute pulmonary complications arising from sepsis, consequently presenting a greater reduction in survival. Conclusion: Bronchoaspiration events corroborate an abrupt decrease in patient survival.

Left atrial appendage closure during cardiac surgery: Safe but underutilized in California

ObjectiveLeft atrial appendage (LAA) closure is associated with reduced rates of stroke in patients with atrial fibrillation (AF). We evaluated trends in LAA closure, the association of LAA closure with stroke/systemic embolism, and its safety profile in patients with AF who underwent cardiac surgery in California. We further tested for hospital-level variation in concomitant LAA closure. MethodsAdults who underwent coronary artery bypass grafting and/or valve surgery with preoperative AF were identified in the 2016 to 2019 Office of Statewide Health Planning and Development databases. Propensity score matching was performed to study risk-adjusted associations of LAA closure with ischemic stroke/systemic embolism. Hospital-level variation was studied using intraclass correlation coefficients. ResultsAmong 18,434 patients with AF who underwent coronary artery bypass grafting/valve surgery, 47.7% received LAA closure. Rates of LAA closure increased from 44.4% to 51.4% from 2016 to 2019 (P < .001). In 4652 propensity score-matched patients, LAA closure was associated with reduced incidence of stroke/systemic embolism at discharge (1.6% vs 3.1%; P < .001) and readmission with stroke/systemic embolism at 1 year (2.9% vs 4.5%; P = .004). LAA closure was not associated with acute kidney injury, pulmonary complications, blood transfusion, reoperation, or in-hospital mortality. Approximately 18% of the risk-adjusted variation in LAA use was attributed to the hospital, with median center-level rate of 44.9% (interquartile range, 29.6%-57.4%). ConclusionsLAA closure was associated with minimal surgical morbidity, and reduced short- and midterm incidence of stroke/systemic embolism. Although the use of LAA closure has increased, substantial variation exists among programs in California, suggesting the need for further standardization of care.

Approach to Acute Respiratory Illness in Children with Hematological Malignancy: A Prospective Study Evaluating Utility of CT Scan

Abstract Introduction Various pulmonary complications can occur in children with hematological malignancies including both infection and malignant disease infiltration of pulmonary parenchyma. Objectives To assess the role of CT scan in determining the etiology of acute pulmonary complications in children with hematological malignancies. Materials and Methods All children &lt; 17 years with newly diagnosed hematological malignancy with respiratory symptoms (Group A) along with children who developed fever with persistent respiratory symptoms as well as worsening chest radiographs during treatment (Group B) and underwent CECT thorax, from February 2019 to July 2020 were enrolled. The final diagnosis was made on the basis of clinical history, laboratory as well as radiological investigations and treatment response. Results Thirty-seven children with mean age of 7.5 ± 3.5 years and male to female ratio of 1.3:1 who underwent CECT thorax were included in our study. For newly diagnosed cases, i.e., Group A (n = 8), the most common cause of respiratory symptoms as identified on CECT thorax was pulmonary tumoral infiltration (n = 5) followed by tuberculosis (n = 3). However, in Group B (n = 29) the cause of persistent respiratory symptoms was identified as infection (n = 17) followed by leukemic infiltration (n = 12). Thus, chest CT could accurately identify pulmonary tuberculosis, fungal pneumonia, bacterial infection, and pulmonary tumoral infiltrates. Conclusion CT scan can be used as an adjunctive tool for prompt diagnosis and management of pulmonary complications in children with persistent respiratory symptoms as they are often non-specific.