Cases Of Atelectasis Research Articles

Simultaneous Minimally Invasive Coronary Artery Bypass Grafting and Lung Resection.

The best surgical treatment strategy for coexisting coronary artery disease (CAD) and lung cancer (LC) remains controversial. This study analyzed the safety and efficacy of a simultaneous minimally invasive procedure for patients with CAD and LC. Patients who underwent simultaneous minimally invasive off-pump coronary artery bypass grafting and lung resection from January 2016 to December 2021 were retrospectively analyzed. The procedure was performed in the fourth intercostal space through a small left anterolateral minithoracotomy. Harvesting of the left internal mammary artery (LIMA) and sewing of the anastomoses were performed under direct vision. Lung resections were performed with or without the assistance of a thoracoscope. Sixteen patients were included with a mean age of 67.13 ± 10.61 years. Procedural success occurred in all patients with a mean operative time of 366.88 ± 94.48 minutes. All patients received at least one coronary artery bypass LIMA graft. Pneumonectomy, lobectomy, segment resection, and wedge resection were performed in one (6.25%), eight (50%), two (12.5%), and five (31.25%) patients, respectively. There were no perioperative deaths or new myocardial infarctions. Complications included one case of postoperative bleeding, two lung infections, two cases of atelectasis, one case of pleural effusion, and one case of cardiac arrhythmia. All the patients were followed up for 1 to 57 months, cancer recurrence occurred in two patients, and one patient died. The remaining patients showed no evidence of tumor recurrence or myocardial infarction. This simultaneous minimally invasive procedure is safe and effective for selected patients with CAD and LC.

Individualized strategy of minimally invasive cardiac surgery in congenital cardiac septal defects

BackgroundIntracardiac septal defect is repaired using median sternotomy in most centers; however, there are several reports using minimally invasive surgery in both children and adults. This study summarized our strategy of minimally invasive therapy using various lateral mini-thoracotomies in patients with congenital septal defect.MethodsIn this study, 472 patients who underwent minimally invasive repair of intracardiac septal defects (atrial septal defect, (ASD), ventricular septal defect, (VSD), and atrioventricular septal defect, (AVSD)) from January 2012 to June 2020 were retrospectively reviewed. Those who underwent device closure were excluded. The minimally invasive strategy included three groups: the right sub-axillary vertical incision (RSAVI) group (N = 335, including192 ASDs, 135 VSDs and 8 AVSDs); the right anterolateral thoracotomy (RALT) group (N = 132, including 77 ASDs, 51 VSDs and 4 AVSDs); and the left anterolateral thoracotomy (LALT) group (N = 5, all subpulmonary VSDs).ResultsConcomitant surgeries included nine cases of right ventricular outflow tract obstruction relief, nine cases of mitral repairs and 37 cases of tricuspid repairs. There was one transition from thoracotomy to sternotomy. Three patients required second pump run for residual lesions (two residual VSD shunts and one mitral regurgitation). The age and body weight of the RSAVI group were significantly lower than those of the RALT and LALT groups (all P < 0.01). No postoperative death was observed. Postoperative complications included one case of chest exploration for bleeding, one case of reoperation due to patch dehiscence during the same admission, one case of transient neural dysfunction, three cases of diaphragmatic paresis and 13 cases of atelectasis. The median stay in the intensive care unit was two days, while the median postoperative hospitalization duration was six days. The echocardiography results before discharge indicated no significant residual lesions. No reoperation, no new onset of chest deformities and no sclerosis were observed during the follow-up.ConclusionsIntracardiac septal defects can be safely and effectively repaired by minimally invasive surgery with good cosmetic results. RSAVI is suitable in infants and children, while RALT is more commonly used in adolescents and adults. LALT is an alternative incision to repair subpulmonary VSD.

Analysis of bacterial pathogens and clinical characteristics of children with respiratory tract infections in Tianjin

Objective: To analyze the pathogenic bacteria and epidemiological characteristics in children with respiratory tract infection in Tianjin area. Methods: Retrospective case analysis was performed on 2 392 hospitalized children in the wards of respiratory diseases, intensive care unit and special care ward of Tianjin Children's Hospital from June 2018 to May 2019. Thirteen pathogenic bacteria in deep sputum and bronchoalveolar lavage fluid samples were detected by loop-mediated isothermal amplification. The laboratory data and clinical characteristics of the infected children were analyzed, and the comparison between groups was performed by t test or χ2 test. Results: Among 2 392 cases, 1 407 were males and 985 females. There was no significant difference in the detection rate between males and females (72.5% (1 020/1 407) vs.74.2% (731/985), χ2=0.87, P=0.35). A total of 1 751 strains and 12 kinds of positive respiratory pathogens were detected, with a detection rate of 73.2%. Among them, 913 (38.2%) strains were Mycoplasma pneumoniae (MP), 514 (21.5%) were Streptococcus pneumoniae (Sp), 381 (15.9%) were Methicillin-resistant Staphylococcus aureus (MRSA) and 279 (11.7%) were Hemophilus influenzae (Hi). There was significant difference in the detection rate of pathogens among different age groups (χ²=83.67, P<0.01). The positive rate of alveolar lavage fluid group was higher than that of deep sputum fluid group [81.6% (614/752) vs. 69.3% (1 137/1 640), χ2=39.89, P<0.01]. The length of hospital stay of children infected with different pathogens was significantly different (all P<0.01). There was significant difference in duration of fever among children infected with different pathogens (χ²=228.69,103.56, 3.96, 27.38,24.50,41.66, all P<0.05). There were 63 (7.7%) cases of atelectasis, 260 (31.9%) cases of pleurisy and 120 (14.7%) cases of pleural effusion in MP children. Children with Sma were most likely to involve the heart system (2/9), and children with Eco infection had a higher incidence of complications such as those of blood (3/19), urinary (2/19), digestive systems(4/19), systemic inflammatory response syndrome and sepsis (1/19). Conclusions: The main bacterial pathogens of respiratory tract infection in children in Tianjin were MP, Sp, MRSA and Hi. It is suggested that clinicians should not only pay attention to the respiratory symptoms of children, but also pay attention to the complications caused by bacterial pathogen infection, so as to prevent the deterioration of the disease and improve the prognosis.

Economic impact of improving patient safety using Sugammadex for routine reversal of neuromuscular blockade in Spain

BackgroundNeuromuscular blocking (NMB) agents are often administered to facilitate tracheal intubation and prevent patient movement during surgical procedures requiring the use of general anesthetics. Incomplete reversal of NMB, can lead to residual NMB, which can increase the risk of post-operative pulmonary complications. Sugammadex is indicated to reverse neuromuscular blockade induced by rocuronium or vecuronium in adults. The aim of this study is to estimate the clinical and economic impact of introducing sugammadex to routine reversal of neuromuscular blockade (NMB) with rocuronium in Spain.MethodsA decision analytic model was constructed reflecting a set of procedures using rocuronium that resulted in moderate or deep NMB at the end of the procedure. Two scenarios were considered for 537,931 procedures using NMB agents in Spain in 2015: a scenario without sugammadex versus a scenario with sugammadex. Comparators included neostigmine (plus glycopyrrolate) and no reversal agent. The total costs for the healthcare system were estimated from the net of costs of reversal agents and overall cost offsets via reduction in postoperative pneumonias and atelectasis for which incidence rates were based on a Spanish real-world evidence (RWE) study. The model time horizon was assumed to be one year. Costs were expressed in 2019 euros (€) and estimated from the perspective of a healthcare system. One-way sensitivity analysis was carried out by varying each parameter included in the model within a range of +/− 50%.ResultsThe estimated budget impact of the introduction of sugammadex to the routine reversal of neuromuscular blockade in Spanish hospitals was a net saving of €57.1 million annually. An increase in drug acquisition costs was offset by savings in post-operative pulmonary events, including 4806 post-operative pneumonias and 13,996 cases of atelectasis. The total cost of complications avoided was €70.4 million. All parameters included in the model were tested in sensitivity analysis and were favorable to the scenario with sugammadex.ConclusionsThis economic analysis shows that sugammadex can potentially lead to cost savings for the reversal of rocuronium-induced moderate or profound NMB compared to no reversal and reversal with neostigmine in the Spanish health care setting. The economic model was based on data obtained from Spain and from assumptions from clinical practice and may not be valid for other countries.

SAFETY OF A NOVEL SLEEP APNEA TRIAGE TOOL FOR POST-OPERATIVE ORTHOPEDIC SURGERY PATIENTS

SESSION TITLE: Education, Research, and Quality Improvement Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The purpose of this quality improvement project is to provide a tool for effective and safe triage of post-operative patients in the post-anesthesia care unit with known or suspected obstructive sleep apnea (OSA) at an academic orthopedic hospital in New York City. METHODS: Results are reported from a single center experience in a hospital where there was no standard of care risk assessment tool used in triaging known or suspected OSA patients during the post-operative period. Adult patients who underwent orthopedic surgery between October 2018 and February 2020 who had a known or suspected history of OSA were studied. After admission to the PACU and upon meeting their modified Aldrete criteria or after 2 hours had elapsed, whichever came first, the PACU primary provider used our novel risk-assessment tool to assess whether the patient had high risk criteria related to OSA. Patients without high-risk criteria based on the tool were discharged from the PACU to the general medical/surgical unit. For patients with high-risk criteria, the provider would request critical care consultation in the PACU to determine the patient’s appropriate hospital disposition upon PACU discharge. RESULTS: Over the course of the study period, 216 patients were evaluated using the OSA triage tool. 53.2% of the cohort was male, median BMI was 36.3 kg/m2, 80.1% had prior diagnosis of sleep apnea. Patients had undergone a wide variety of surgeries with 23.6% having undergone hip surgery, 51.4% knee surgery, 13.4% spine surgery, 9.7% shoulder surgery, and 1.9% foot or ankle surgery. Notably, with the use of this tool, only 12.5% of patients met criteria for critical care consult and 91.7% were admitted to the floor from the PACU. Rapid response for respiratory complications were not observed in any of the patients and the three patients that required critical care consult after PACU discharge were related to an acute abdominal issue, tachycardia, and a case of atelectasis. Notably, the anonymous survey was completed by PACU nurse practioners and anesthesiologists and had a 96.8% self-reported satisfaction with guideline implementation tool. CONCLUSIONS: The use of the novel risk assessment tool at NYULMC demonstrated that this tool is a safe and effective method of triaging OSA post-operative patients in the post-anesthesia care unit with known or suspected OSA. Triaging patients using this tool did not result in subsequent rapid responses or mistriage of OSA patients. It allowed for safe care of these patients, reduced critical care resource utilization, and offered a tool perceived to be useful by utilizers. CLINICAL IMPLICATIONS: Implementing the use of this tool in orthopedic patients with obstructive sleep apnea in the post-surgical setting could be an effective and safe means of triaging these patients appropriately without increasing the risk of harm to patients in the post-op period. DISCLOSURES: No relevant relationships by Eric Bondarsky, source=Web Response No relevant relationships by Ezra Dweck, source=Web Response No relevant relationships by Chase Hardwick, source=Web Response No relevant relationships by Bashar Mourad, source=Web Response No relevant relationships by Theresa Reilly, source=Web Response No relevant relationships by Sheeja Schuster, source=Web Response

Splenectomy for people with thalassaemia major or intermedia.

Thalassaemia is a genetic disorder of the haemoglobin protein in red blood cells. It has been historically classified into thalassaemia minor, intermedia and major, depending on the genetic defect and severity of the disease. The clinical presentation of β-thalassaemia varies widely from a mild asymptomatic form in thalassaemia minor, to a severe disease in thalassaemia major where individuals are dependant on life-long blood transfusions. The hallmark of thalassaemia syndromes is the production of defective red blood cells that are removed by the spleen resulting in an enlarged hyperfunctioning spleen (splenomegaly). Removal of the spleen may thus prolong red blood cell survival by reducing the amount of red blood cells removed from circulation and may ultimately result in the reduced need for blood transfusions. To assess the efficacy and safety of splenectomy in people with β-thalassaemia major or intermedia. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Review Group's Haemoglobinopathies Trials Register, compiled from searches of electronic databases and the handsearching of journals and conference abstract books. We also searched online trial registries and the reference lists of relevant articles and reviews (27 July 2018).Date of the most recent search of the Group's trials register: 02 August 2019. We included randomised controlled and quasi-randomised controlled studies of people of any age with thalassaemia major or intermedia, evaluating splenectomy in comparison to conservative treatment (transfusion therapy and iron chelation) or other forms of splenectomy compared to each other (laparoscopic, open, radio-frequency). Two authors independently selected and extracted data from the single included study using a customised data extraction form and assessed the risk of bias. The quality of the evidence was assessed using GRADE. One study, including 28 participants was included in the review; the results were described, primarily, in a narrative manner. This study assessed the feasibility of splenectomy using a laparoscopic approach versus open surgery. Given the lack of detail regarding the study methods beyond randomisation, the overall risk of bias for this study was unclear. The study was carried out over a period of 3.5 years, with each participant followed up only until discharge (less than one week after the intervention); it did not assess the majority of the outcomes outlined in this review (including two of the three primary outcomes, frequency of transfusion and quality of life). A total of three serious post-operative adverse events (the review's third primary outcome) were reported in the laparoscopic splenectomy group (one case of atelectasis and two cases of bleeding), compared to two events of atelectasis in the open surgery group; however, there were no significant differences between the groups for either atelectasis, risk ratio (RR) 0.50 (95% confidence interval (CI) 0.05 to 4.90) or for bleeding, RR 5.00 (95% CI 0.26 to 95.61) (very low-quality evidence). In addition, the study also reported three serious cases of intra-operative bleeding in the laparoscopic group which mandated conversion to open surgery, although the difference between groups was not statistically significant, RR 7.00 (95% CI 0.39 to 124.14) (very low-quality evidence). These effect estimates are based on very small numbers and hence are unreliable and imprecise. From this small study, there appeared to be an advantage for the laparoscopic approach, in terms of post-operative hospital stay, although the group difference was not large (median difference of 1.5 days, P = 0.03). The review was unable to find good quality evidence, in the form of randomised controlled studies, regarding the efficacy of splenectomy for treating thalassaemia major or intermedia. The single included study provided little information about the efficacy of splenectomy, and compared open surgery and laparoscopic methods. Further studies need to evaluate the long-term effectiveness of splenectomy and the comparative advantages of surgical methods. Due to a lack of high quality evidence from randomised controlled studies, well-conducted observational studies may be used to answer this question.

Three-year clinical application practice report of lung ultrasound in our NICU

Objective To retrospectively analyze the application of lung ultrasound in neonatal department of our hospital in the past three years, and summed up the clinical diagnosis and treatment changes brought by it. Methods The clinical data of infants accepted the bedside lung ultrasound examination from May to December 2016(early carry out stage), from January to December 2017(adaptation stage), from January to August 2018(normal conduct stage) in our NICU of Jingzhou Central Hospital were collected.The clinical data of 878 infants with different stages of application were compared and analyzed. Results In 878 children, 1 225 of lung ultrasound were performed, 64.1% of patients had pulmonary disease, and 35.9% had no lung disease.There were 67 cases of neonatal respiratory distress syndrome, 278 cases of wet lung, 259 cases of pneumonia, 64 cases of meconium aspiration syndrome, 72 cases of acute respiratory distress syndrome, 63 cases of atelectasis and 14 cases of pleural effusion.A total of 1 122 times of lung X-ray examination were performed in 878 children.The number of X-ray examinations per capita decreased from 2.48 times in 2016 to 1.40 times in 2017 and 0.84 times in 2018.A total of 32 times of pulmonary CT examination were performed.The number of lung CT inspection decreased from 0.060 times in 2016 to 0.038 times in 2017 and 0.029 times in 2018.Lung ultrasound was convenient for dynamic observation, and could be used to determine the improvement, aggravation or new pulmonary lesions. Conclusion Lung ultrasound is accurate in the diagnosis of lung disease in NICU, especially for children with long hospital stay, repeated illness and difficult to withdraw.It is easy to carry out in clinic, at the bedside, which can reduce the times of chest X-ray and CT per capita examination.Lung ultrasound is an effective and feasible method for NICU to diagnose lung diseases and it is worth promoting. Key words: Newborn; Lung ultrasound; Chest X-ray; Lung CT

Is adjuvant antifungal therapy after video-assisted thoracic surgery for pulmonary aspergilloma necessary?

The aim of this current retrospective study was to assess the necessity of postoperative antifungal therapy for pulmonary aspergilloma (PA) patients who underwent video-assisted thoracic surgery (VATS) lung resection. We enrolled 22 PA patients who underwent VATS lung resection between 2014 and 2018. Of these, 12 patients were prescribed antifungal agents during the perioperative period (group A), and the other 10 were treated with surgery alone without any antifungal therapy postoperatively (group B). All patients were immunocompetent. Seven patients (58.3%) developed postoperative complications in group A, including 2 cases of empyema (16.7%), 1 case of bronchopleural fistula (8.3%), 1 case of pneumonia (8.3%), 1 case of wound infection (8.3%), 1 case of bleeding (8.3%) and 1 case of atelectasis (8.3%). In group B, 3 patients (30%) developed postoperative complications, including 2 cases of pneumonia (20%) and 1 case of empyema (10%). There was no significant difference between the groups with respect to postoperative complications rates (P=0.23). The follow-up period ranged from 1 to 38 months (a median of 19 months), during which no hospital deaths, recurrence of disease or lesion relapses were noted in either group. Our results suggested that postoperative adjuvant antifungal therapy has limited advantages for the surgical treatment of PA in immunocompetent patients.

PSY52 - ECONOMIC IMPACT OF IMPROVING PATIENT SAFETY USING SUGAMMADEX FOR ROUTINE REVERSAL OF NEUROMUSCULAR BLOCKADE IN SPAIN

Neuromuscular blocking (NMB) agents are often administered to facilitate tracheal intubation and prevent patient movement during surgical procedures requiring the use of general anesthetics. Incomplete reversal of NMB, can lead to residual NMB, which can increase the risk of post-operative pulmonary complications. Sugammadex is indicated to reverse neuromuscular blockade induced by rocuronium or vecuronium in adults. The aim of this study is to estimate the clinical and economic impact of introducing sugammadex to routine reversal of neuromuscular blockade (NMB) with rocuronium in Spain. A decision analytic model was constructed reflecting a set of procedures using rocuronium that resulted in moderate or deep NMB at the end of the procedure. Two scenarios were considered for 537,931 procedures using NMB agents in Spain in 2015: a scenario without sugammadex versus a scenario with sugammadex. Comparators included neostigmine (plus glycopyrrolate) and no reversal agent. The total costs for the healthcare system were estimated from the net of costs of reversal agents and overall cost offsets via reduction in postoperative pneumonias and atelectasis for which incidence rates were based on a Spanish real-world evidence (RWE) study. The model time horizon was assumed to be one year. Costs were expressed in 2019 euros (€) and estimated from the perspective of a healthcare system. One-way sensitivity analysis was carried out by varying each parameter included in the model within a range of +/− 50%. The estimated budget impact of the introduction of sugammadex to the routine reversal of neuromuscular blockade in Spanish hospitals was a net saving of €57.1 million annually. An increase in drug acquisition costs was offset by savings in post-operative pulmonary events, including 4806 post-operative pneumonias and 13,996 cases of atelectasis. The total cost of complications avoided was €70.4 million. All parameters included in the model were tested in sensitivity analysis and were favorable to the scenario with sugammadex. This economic analysis shows that sugammadex can potentially lead to cost savings for the reversal of rocuronium-induced moderate or profound NMB compared to no reversal and reversal with neostigmine in the Spanish health care setting. The economic model was based on data obtained from Spain and from assumptions from clinical practice and may not be valid for other countries.

Atelectasis as a Complication of Tuberculosis: a Case Report

Background: Tuberculosis is an infectious disease caused by a bacillus called Mycobacterium tuberculosis or Koch's Bacillus (BK). It is associated with various long-term lung complications, including: lung scarring (fibrosis), bronchiectasis, Chronic Pulmonary Aspergillosis, and more rarely, atelectasis. There is however very limited data in literature on the full spectrum of these complications, and relies mostly on case reports and small case series.&#x0D; Case: The authors report a case of atelectasis in a patient with previous diagnosis of Tuberculosis. Normal laboratory tests and imaging test presenting right lung atelectasis. Went under respiratory therapy, presented improve and is under clinical control.&#x0D; Conclusion: There is a huge importance of knowing the various methods to diagnose this disease and treat it well. Thus, it enables an improvement in the patient and a reduction in the spread of bacteria.

Splenectomy for people with thalassaemia major or intermedia.

Thalassaemia is a genetic disease of the haemoglobin protein in red blood cells. It is classified into thalassaemia minor, intermedia and major, depending on the severity of the disease and the genetic defect. Thalassaemia major and intermedia require frequent blood transfusions to compensate for the lack of well-functioning red blood cells, although this need is significantly less in thalassaemia intermedia.Damaged or defective red blood cells are normally eliminated in the spleen. In people with thalassaemia there is a large quantity of defective red blood cells which results in an enlarged hyperfunctioning spleen (splenomegaly). Removal of the spleen may thus prolong red blood cell survival by reducing the amount of red blood cells removed from circulation and may ultimately result in the reduced need for blood transfusions. To assess the efficacy and safety of splenectomy in people with beta-thalassaemia major or intermedia. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Review Group's Haemoglobinopathies Trials Register, compiled from searches of electronic databases and the handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews.Date of the most recent search: 25 April 2016. We included randomised controlled studies and quasi-randomised controlled studies of people of any age with thalassaemia major or intermedia, evaluating splenectomy in comparison to conservative treatment (transfusion therapy and iron chelation) or other forms of splenectomy compared to each other (laparoscopic, open, radio-frequency). Two authors independently selected and extracted data from the single included study using a customised data extraction form and assessed the risk of bias. One study, including 28 participants was included in the review; the results were described, primarily, in a narrative manner. The study assessed the feasibility of splenectomy using laparoscopy in comparison to open surgery. Given the lack of detail regarding the study methods beyond randomisation, the overall risk of bias for this study was unclear. The study was carried out over a period of 3.5 years, with each participant followed up only until discharge (less than one week after the intervention); it did not assess the majority of the outcomes outlined in this review (including two of the three primary outcomes, frequency of transfusion and quality of life). A total of three serious post-operative adverse events (the review's third primary outcome) were reported in the laparoscopic splenectomy group (one case of atelectasis and two cases of bleeding), compared to two events of atelectasis in the open surgery group; however, there were no significant differences between the groups for either atelectasis, risk ratio 0.50 (95% confidence interval 0.05 to 4.90) or for bleeding, risk ratio 5.00 (95% confidence interval 0.26 to 95.61). In addition, the study also reported three serious cases of intra-operative bleeding in the laparoscopic group which mandated conversion to open surgery, although the difference between groups was not statistically significant, risk ratio 7.00 (95% confidence interval 0.39 to 124.14). These effect estimates are based on very small numbers and hence are unreliable and imprecise. From this small study, there appeared to be an advantage for the laparoscopic approach, in terms of post-operative hospital stay, although the group difference was not large (median difference of 1.5 days, P = 0.03). The review was unable to find good quality evidence, in the form of randomised controlled studies, regarding the efficacy of splenectomy for treating thalassaemia major or intermedia. The single included study provided little information about the efficacy of splenectomy, and compared open surgery and laparoscopic methods. Further studies need to evaluate the long-term effectiveness of splenectomy and the comparative advantages of surgical methods. Due to a lack of high quality evidence from randomised controlled studies, well-conducted observational studies may be used to answer this question.

Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old.

This Cochrane review was first published in 2005 and updated in 2007, 2012 and now 2015. Acute bronchiolitis is the leading cause of medical emergencies during winter in children younger than two years of age. Chest physiotherapy is sometimes used to assist infants in the clearance of secretions in order to decrease ventilatory effort. To determine the efficacy of chest physiotherapy in infants aged less than 24 months old with acute bronchiolitis. A secondary objective was to determine the efficacy of different techniques of chest physiotherapy (for example, vibration and percussion and passive forced exhalation). We searched CENTRAL (2015, Issue 9) (accessed 8 July 2015), MEDLINE (1966 to July 2015), MEDLINE in-process and other non-indexed citations (July 2015), EMBASE (1990 to July 2015), CINAHL (1982 to July 2015), LILACS (1985 to July 2015), Web of Science (1985 to July 2015) and Pedro (1929 to July 2015). Randomised controlled trials (RCTs) in which chest physiotherapy was compared against no intervention or against another type of physiotherapy in bronchiolitis patients younger than 24 months of age. Two review authors independently extracted data. Primary outcomes were change in the severity status of bronchiolitis and time to recovery. Secondary outcomes were respiratory parameters, duration of oxygen supplementation, length of hospital stay, use of bronchodilators and steroids, adverse events and parents' impression of physiotherapy benefit. No pooling of data was possible. We included 12 RCTs (1249 participants), three more than the previous Cochrane review, comparing physiotherapy with no intervention. Five trials (246 participants) evaluated conventional techniques (vibration and percussion plus postural drainage), and seven trials (1003 participants) evaluated passive flow-oriented expiratory techniques: slow passive expiratory techniques in four trials, and forced passive expiratory techniques in three trials.Conventional techniques failed to show a benefit in the primary outcome of change in severity status of bronchiolitis measured by means of clinical scores (five trials, 241 participants analysed). Safety of conventional techniques has been studied only anecdotally, with one case of atelectasis, the collapse or closure of the lung resulting in reduced or absent gas exchange, reported in the control arm of one trial.Slow passive expiratory techniques failed to show a benefit in the primary outcomes of severity status of bronchiolitis and in time to recovery (low quality of evidence). Three trials analysing 286 participants measured severity of bronchiolitis through clinical scores, with no significant differences between groups in any of these trials, conducted in patients with moderate and severe disease. Only one trial observed a transient significant small improvement in the Wang clinical score immediately after the intervention in patients with moderate severity of disease. There is very low quality evidence that slow passive expiratory techniques seem to be safe, as two studies (256 participants) reported that no adverse effects were observed.Forced passive expiratory techniques failed to show an effect on severity of bronchiolitis in terms of time to recovery (two trials, 509 participants) and time to clinical stability (one trial, 99 participants analysed). This evidence is of high quality and corresponds to patients with severe bronchiolitis. Furthermore, there is also high quality evidence that these techniques are related to an increased risk of transient respiratory destabilisation (risk ratio (RR) 10.2, 95% confidence interval (CI) 1.3 to 78.8, one trial) and vomiting during the procedure (RR 5.4, 95% CI 1.6 to 18.4, one trial). Results are inconclusive for bradycardia with desaturation (RR 1.0, 95% CI 0.2 to 5.0, one trial) and bradycardia without desaturation (RR 3.6, 95% CI 0.7 to 16.9, one trial), due to the limited precision of estimators. However, in mild to moderate bronchiolitis patients, forced expiration combined with conventional techniques produced an immediate relief of disease severity (one trial, 13 participants). None of the chest physiotherapy techniques analysed in this review (conventional, slow passive expiratory techniques or forced expiratory techniques) have demonstrated a reduction in the severity of disease. For these reasons, these techniques cannot be used as standard clinical practice for hospitalised patients with severe bronchiolitis. There is high quality evidence that forced expiratory techniques in severe patients do not improve their health status and can lead to severe adverse events. Slow passive expiratory techniques provide an immediate and transient relief in moderate patients without impact on duration. Future studies should test the potential effect of slow passive expiratory techniques in mild to moderate non-hospitalised patients and patients who are respiratory syncytial virus (RSV) positive. Also, they could explore the combination of chest physiotherapy with salbutamol or hypertonic saline.

睡眠時無呼吸症候群が術後無気肺の原因と考えられた下葉切除の2例

睡眠時無呼吸症候群が術後無気肺の原因と考えられた下葉切除の2例

Effect of modified postural drainage for treating pulmonary infection of senile patients with gastric cancer

Objective To explore clinical effect of modified postural drainage for treating pulmonary infection of senile patients with gastric cancer. Methods 107 cases of patients with gastric cancer were randomly divided into two groups: control group (n = 53) and treatment group (n = 54), which were respectively treated by routine postoperative therapy and nursing measures and modified postural drainage based on these routine measures, and compared daily amount of expectoration sputum, positive cases of sputum culture, restore time of postoperative blood test, postoperative fever time, cases of pulmonary infection on the postoperative tenth day and length of stay. Results Daily amount of expectoration sputum of patients in treatment group was significantly higher than that of control group [(185.7 ± 23.7) ml vs. (99.7 ± 17.6) ml ] (P < 0.05). However, restore time of postoperative characters of blood test [white blood cell count (2.9±0.9) d vs. (5.0±0.7) d , C-reaction protein (3.5±0.7) d vs. (7.4±0.6) d ], postoperative fever time [(1.9±0.5) d vs. (3.6±1.4) d ], cases of atelectasis (5 cases vs. 19 cases) and length of stay [(1.9±0.5) d vs. (3.6±1.4) d ] were respectively significantly less than those of control group (P < 0.05). Conclusions Modified postural drainage could effectively prevent postoperative atelectasis and pulmonary infection, significantly reduced incidence of postoperative atelectasis of senile patients with gastric cancer operation, and so it was worthy of clinical application. Key words: Pneumonia; Drainage, postural; Stomach neoplasms

Using lung ultrasound to difference the pulmonary reasons of long-term oxygen dependence in premature infants

Objective Lung ultrasound has been used extensively to diagnose many types of lung disease. This study aimed to evaluate the pulmonary reasons for long-term oxygen dependence (LTOD) in premature infants using lung ultrasound. Methods Lung ultrasound was routinely performed in 50 premature infants clinically diagnosed with bronchopulmonary dysplasia (BPD). Results Among the 50 patients studied, there were 9 cases of atelectasis, 4 cases of pneumonia, 2 cases of severe pulmonary edema, and 3 cases of pulmonary edema and consolidation that coexisted with BPD. The babies′ oxygen dependence either resolved completely or significantly decreased following appropriate treatments. Conclusion More than one-third of the cases of LTOD in premature babies were caused by either BPD alone or diseases other than BPD. Lung ultrasound plays an important role in differentiating pulmonary causes of LTOD in BPD patients, and the results of our study suggest that modifying the diagnostic criteria for BPD may be necessary. Key words: Bronchopulmonary dysplasia; Oxygen dependence; Lung ultrasound; Differential diagnosis; Premature infant

BPD, Not BPD, or iatrogenic BPD: findings of lung ultrasound examinations.

Lung ultrasound has been extensively used to diagnose many types of lung disease. This study aimed to evaluate the pulmonary reasons for long-term oxygen dependence (LTOD) in premature infants using lung ultrasound.Lung ultrasound was routinely performed in 50 premature infants clinically diagnosed with bronchopulmonary dysplasia (BPD).Among the 50 patients studied, there were 9 cases of atelectasis, 4 cases of pneumonia, 2 cases of severe pulmonary edema, and 3 cases of pulmonary edema and consolidation that coexisted with BPD. The oxygen dependence of the babies either completely resolved or significantly decreased following appropriate treatments.More than one-third of the cases of LTOD in premature babies were caused by either BPD alone or diseases other than BPD. Lung ultrasound plays an important role in differentiating pulmonary causes of LTOD in patients with BPD, and the results of our study suggest that modifying the diagnostic criteria for BPD may be necessary.

Characteristics and risk factor analysis of 410 cases of tracheobronchial tuberculosis.

The present study analyzed the characteristics and risk factors associated with tracheobronchial tuberculosis (TBTB) in 410 patients with TBTB. Retrospective analysis was performed on the clinical features, bronchoscopy performance, bacteriological examination, imaging and treatment of 410 patients who were diagnosed with TBTB using bronchoscopy. Among the 410 patients, 10 patients underwent chest X-ray which revealed two cases of atelectasis, eight cases of patch or spot shadows, three cases of cavity, one case of nodule and one case with no abnormalities. The remaining 400 patients underwent computed tomography chest scans and/or airway reconstruction examinations. Among all the lesion types, the cavity type was found to be the most likely to cause bronchial stenosis or obstruction, with statistically significant differences when compared with the congestion, stenosis or scar lesion types (P<0.01). Moreover, for the cavity type, there were 194 sites of obstruction prior to therapy; however, only 23 sites of obstruction remained following therapy. Furthermore, there were 34 sites without stenosis prior to therapy and 205 sites without stenosis following therapy. The number of sites of obstruction was significantly decreased and the number of sites without stenosis was increased upon therapy. These findings suggest that the cavity type is the most sensitive type to therapy among the five types of TBTB lesion.

Relevance of chest radiography in pediatric inpatients with asthma

Introduction: The goals of this study are to identify factors associated with ordering of chest radiographs (CXR’s) in children hospitalized with acute asthma exacerbations and determine the overall clinical impact of these CXR’s. Methods: A retrospective study was performed with children ≥ 2 years of age admitted from our emergency department (ED) between 6/1/2011 and 5/31/2012 with a primary diagnosis of acute asthma exacerbation or status asthmaticus. Patients were excluded if they had been on antibiotics prior to the emergency visit, received continuous albuterol or intravenous magnesium during the hospitalization, or had another chronic disease affecting lung function. Results: 180 of the 405 children in the study (44%) had CXR’s ordered, of which 18 (10%) had imaging that altered the patient’s treatment plan. There were six cases of radiologist-diagnosed pneumonia, nine cases of atelectasis treated with antibiotics and three cases of pneumothorax. Factors associated with CXR ordering were: fever at home or in the ED (OR 4.5, 95% CI 2.8–7.4), triage oxygen saturation less than or equal to 92% (OR 1.8, 95% CI 1.2–2.7) and age 4 years or less (OR 2.3, 95% CI 1.4–3.7). Patients with treatment-altering CXR’s were more likely to have oxygen saturations less than or equal to 92% (OR 4.2, 95% CI 1.4–13.0; p = 0.006) or fever in the ED (OR 3.8, 95% CI 1.0–13.6; p < 0.05). No patients with triage oxygen saturation above 96% had a treatment-altering CXR. Conclusions: The majority of CXR’s ordered in pediatric inpatients with asthma exacerbation do not provide clinically relevant information.

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Background and aims: The incidence of congenital stenosis of the main bronchus (MBS) appears in 0.1–5% cases. In patients with congenital heart disease (CHD), the postoperative period is often accompanied by respiratory problems that may be intensified by concomitant bronchial stenosis. Aims: The study aims to determine managing tactics for the children with congenital MBS. Methods: The study included 10 children aged from 10 days to 1 year who underwent surgical correction of complex CHD in 2012–2013. Before the operation all patients breathed spontaneously, and MBS was not pre-operatively diagnosed only in 1 patient. Results: Four patients underwent balloon dilatation of the stenotic bronchus (in one - simultaneously with the correction of CHD) and the others were being managed conservatively. Postoperative respiratory disorders were observed in all patients: 6 cases of atelectasis on the affected side, 4 cases of subsequent air trapping emphysema syndrome and 5 cases of pneumonia. The average duration of mechanical ventilation was 56 days, and it was significantly increased in 50% of the ICU patients due to the MBS effects. There were 3 cases of tracheal reintubation. The ICU period was 2 - 200 days. One patient with critical respiratory insufficiency died. There were four cases of the full restoration of bronchial patency. Conclusions: Children with CHD and MBS always have respiratory problems in postoperative period that intensify the severity of their condition and significantly increase the ICU-time. It is needed to determine tactics for these patients at all stages of treatment.

Single-Incision Thoracoscopic Lobectomy and Segmentectomy With Radical Lymph Node Dissection

Reports of single-incision thoracoscopic lobectomy and segmentectomy are rare. In this article, we present our experience with single-incision thoracoscopic lobectomy and segmentectomy and radical mediastinal lymph node dissection. Nineteen patients with early-stage malignancy or benign lung disease were treated with single-incision thoracoscopic lobectomy and segmentectomy at our institution between November 2010 and May 2012. The surgical approach began with a single incision at the fifth or sixth intercostal space at the anterior axillary line. A 10-mm video camera and working instruments were used at the same time in this incision site throughout the surgery. The perioperative variables and outcomes were collected and analyzed retrospectively. For the 19 patients included in the final analysis, 14 lobectomies and 5 segmentectomies were performed successfully without need for conversion. Among the 19 patients who underwent single-port video-assisted thoracoscopic surgery (VATS), 15 cases of cancer and 4 cases of benign pulmonary disease were noted. The mean operative time was 156±46 minutes, and the median number of lymph nodes retrieved was 22.9±9.8. Average blood loss was 38.4±25.9 mL. There were no deaths 30 days after surgery, and 2 cases of atelectasis were observed. Single-port VATS lobectomy and segmentectomy is safe and feasible for selected patients.