Conventional Chest Research Articles

A randomized controlled trial: Comparison of 14 and 24 French thoracic drainage after minimally invasive lobectomy – MZ 14-24 study

BackgroundThe optimal placement of a chest drain after video-assisted minimally invasive lobectomy should facilitate the aspiration of air and drainage of fluid. Typically, a conventional 24Ch polyvinyl chloride chest drain is used for this purpose. However, there is currently no scientific literature available on the impact of drain diameter on postoperative outcomes following anatomical lung resection. MethodsThis is a prospective, randomized, phase-1 trial that will include 40 patients, which will be randomly assigned into two groups. Group 1 will receive a 24 French chest drain according to current standards, while group 2 will receive a 14 French drain. Primary endpoint of the trial is the incidence of postoperative drainage-related complications, such as obstruction, dislocation, pleural effusion, and reintervention. Secondary endpoints are postoperative pain, chest drainage duration, incidence of complications, and hospital length of stay. The study aims to determine the number of subjects needed to achieve a sufficient test power of 0.8 for a non-inferiority study. DiscussionThoracic surgery is becoming more and more minimally invasive. One of the remaining unresolved problems is postoperative pain, with the intercostal drain being one of the main contributing factors. Previous data from other studies suggest that the use of small-bore drains can reduce pain and speed up recovery without an increase in drain-related complications. However, no studies have been conducted on patients undergoing anatomic lung resections to date. The initial step in transitioning from larger to smaller drains is to establish the safety of this approach, which is the primary objective of this trial.Trial registration: The study has been registered in the German Clinical Trials Register.Registration number: DRKS00029982.URL: https://drks.de/search/de/trial/DRKS00029982.

Handheld metal detector versus conventional chest and abdominal plain radiography in children with suspected metallic foreign body ingestion: can we safely abandon X-rays?

Ingestion of metallic foreign bodies (MFBs) is a frequent occurrence in children and is commonly diagnosed via X-rays. In recent years, the handheld metal detector (HMD) has been increasingly adopted by several pediatric hospitals as it is considered an effective and accurate diagnostic tool that avoids exposure to ionizing radiations. Sensitivity of HMD has been reported high (99.4%) in case of coin ingestion, but significantly lower (46%) when considering the ingestion of other types of MFBs. We tested the effectiveness of the HMD in diagnosing ingested MFBs in children less than 14 years of age, in our Pediatric Emergency Department (PED). We prospectively evaluated all cases of MFBs ingestion that presented at the PED of our hospital from March 2015 to July 2017. Ninety-eight patients were included. The overall sensitivity was 63.2% (79.5% for coins, 25.5% for batteries and 56% for other objects) while the specificity was 95%. The HMD could have replaced the X-ray examination only if a MFB was detected below the xyphoid process. Based on our findings, a negative result of HMD is not sufficient to exclude an ingestion of MFBs. Therefore, in case of an evocative history and depending on type and size of the foreign body, a radiological investigation is still necessary.

The effects of aerobic exercises compared to conventional chest physiotherapy on pulmonary function, functional capacity, sputum culture, and quality of life in children and adolescents with cystic fibrosis: a study protocol for randomized controlled trial study

BackgroundCystic fibrosis (CF) is an autosomal recessive disorder caused by abnormal function of the chloride ion channels and characterized by pancreatic insufficiency and chronic endobronchial airway infection. Pulmonary dysfunction is very common and could lead to a reduction in the quality of life. Airway clearance techniques (ACT) and physical exercises are introduced as one of the main components of treatment. Therefore, it will be of interest to examine the effect of aerobic exercises compared to conventional chest physiotherapy (CPT) on pulmonary function, functional capacity, sputum culture, and quality of life in patients with CF.MethodsThirty patients with CF will participate in a double-blind parallel controlled trial containing 18 sessions of treatment. Group A consists of CPT and placebo aerobic exercise, and group B includes aerobic exercise and placebo CPT. Pulmonary function, functional capacity, sputum culture, and quality of life will be evaluated with a spirometry test, 6-min walk test (6MWT), sputum culture test, and the Cystic Fibrosis Questionnaire-Revised (CFQ-R), respectively, before and after the intervention.DiscussionWe will evaluate and compare the effectiveness of aerobic exercises and conventional chest physiotherapy on pulmonary function, functional capacity, sputum culture, and quality of life. Comparing these two treatment patterns can contribute to a better understanding of the effectiveness. Therefore, if there is a significant difference between the two treatments, the superior treatment will be prioritized clinically.Trial registrationhttps://www.irct.ir, IRCT20210505051181N5. Registered on 19 February 2023.

The Impact Of Active Chest Tube Clearance Technology On Surgical Outcomes After Cardiac Surgery: An Updated Systematic Review And Meta-Analysis.

Active chest tube clearance technology (ACT) systems were introduced to improve the patency of chest tubes and to reduce the potential complications associated with inadequate mediastinal blood drainage after cardiac surgical procedures. The purpose of this study is to assess the impact of ACT on the incidence of chest tube clogging, retained blood syndromes (RBS), re-exploration for bleeding, and the incidence of postoperative atrial fibrillation (POAF) after cardiac surgical procedures. A database search was conducted using Medline, Embase, Cochrane Library, and Web of Science. Only articles comparing the use of ACT to conventional chest tube drainage after cardiac surgery were screened. Included articles were restricted to adult patients and English language only. Nine of the 841 articles screened were included in this review. Two studies were randomized controlled trials (RCT) and seven were observational studies. Pooled estimates showed RBS, surgical re-exploration rates, and POAF were significantly less common in the ACT group. Our meta-analysis suggests that the use of ACT may be beneficial in reducing the incidence of postoperative complications associated with inadequate drainage of mediastinal blood after cardiac surgery. However, more robust evidence is required to endorse these findings and support the routing use of ACT in clinical practice.

Smoking index and COPD duration as potential risk factors for development of osteoporosis in patients with non-small cell lung cancer – A retrospective case control study evaluated by CT Hounsfield unit

ObjectiveTo investigate the effect of smoking index (calculated as number of cigarettes per day × smoking years) and chronic obstructive pulmonary disease (COPD) duration on osteoporosis (OP)evaluated by opportunistic chest CT in patients with non-small cell lung cancer (NSCLC). MethodsA total of 101 patients diagnosed with NSCLC were included in our cohort study. Among them, 50 patients with a history of smoking and COPD were assigned to the experimental group, while 51 patients without a history of smoking and COPD were assigned to the control group. Hounsfield unit (HU) value was measured by conventional chest CT to investigate the bone mineral density; and the mean values of axial HU value in the upper, middle and lower parts of T4, T7, T10 and L1 vertebral bodies were measured as the study variables. ResultsThere were no significant differences in gender, age, body mass index, type of lung cancer, clinical stage of lung cancer and comorbidities between the two groups (P = 0.938，P = 0.158，P = 0.722,P = 0.596,P = 0.813,P = 0.655). The overall mean HU values of T4, T7, T10, L1 in the experimental group were 116.60 ± 30.67, 110.56 ± 30.03, 109.18 (96.85–122.95), 94.63 (85.20–104.12) and 106.86 ± 22.26, respectively, which were significantly lower than those in the control group (189.55 ± 34.57, 174.54 ± 35.30, 172.73 (156.33–199.50), 158.20 (141.60–179.40) and 177.50 ± 33.49) (P ＜0.05). And in the experimental group, smoking index and COPD duration were significantly and negatively correlated with HU values (r = −0.627, −0.542, P ＜0.05, respectively). ConclusionPatients with NSCLC who have a history of smoking and COPD exhibit a notably lower HU value compared to the control groups. Additionally, it has been observed that the smoking index and duration of COPD may be influential factors affecting bone mineral density in NSCLC patients.

Characterization of Objective Skin Color Changes during and after Breast and Chest Wall Radiotherapy and Correlation with Radiation-Induced Skin Toxicity in Breast Cancer Patients, Including Patients with Skin of Color

Radiation dermatitis (RD) is common among women undergoing breast and chest wall radiotherapy (RT); however, existing scales to assess the severity of RD are subjective and do not account for variability in skin of color (SOC). For instance, the Common Terminology Criteria for Adverse Events (CTCAE) criteria do not include hyperpigmentation in the grading scale. There is data indicating worse RD in African American and Hispanic patients; however, the rate and severity in SOC remains unknown given the lack of data using objective measures of RD. Spectrophotometry is one method to quantify the appearance of color by measuring spectral characteristics without the bias associated with subjective clinical scoring. We present a phase I prospective non-therapeutic clinical trial to objectively define SOC at baseline and evaluate spectrophotometric skin changes during and after breast or chest wall RT in parallel with physician-graded RD using CTCAE criteria. We hypothesize that there will be greater discrepancy between physician graded RD and objective measures of RD in patients with SOC in whom hyperpigmentation will be undercaptured by physician-grading. This is the first study intending to correlate SOC with objective changes after RT as a reliable indicator of RD. We offer a novel system for evaluating RD that is applicable to SOC. A total of 60 patients with localized breast cancer (stage 0-III) undergoing conventional whole breast or chest wall RT (50Gy/ 25 fx), hypofractionated whole breast RT (40.5Gy/15 fx) or ultrahypofractionated partial breast RT (6Gy x5), with or without regional nodal RT were enrolled. 3 skin color readouts using the Commission International de l'Eclairage 3D color system (l*, a*, b*) were measured within the radiation field using a spectrophotometer at baseline, once weekly during RT, 10 days post RT, 4 weeks and 12 months post RT. The spectrophotometer is a non-invasive, hand-held device that is used in the clinic room with no additional equipment or setup requirements. Data is automatically exported to a spreadsheet organized by timepoint and patient. The l* axis is a gray scale (0 = black, 100 = white) correlating with skin pigmentation and the a* axis describes red and green values correlating with erythema. The primary objective is to evaluate the changes from baseline in skin color readouts in the quadrant of tumor location during and after RT based on fractionation. The secondary objective is to evaluate changes within and across groups defined by baseline skin color. Exploratory objectives include evaluating the association of baseline color readouts and changes after RT with acute and late grade > 2 clinician-rated skin and subcutaneous tissue effects according to the CTCAE, v5.0, physician graded cosmesis and clinical interventions to treat RD, such as use of topical steroids and oral analgesics. As of January 2023, we have enrolled 100% of the planned patients. To be determined. To be determined. Clinical Study Identifier: S22-00192.

Pulmonary Congestion by Conventional Chest Radiography: Relationship With Hemodynamics and Mortality in Patients With Severe Aortic Stenosis

BackgroundThe relationship between chest radiograph (CXR) findings of pulmonary congestion and invasive hemodynamics and clinical outcomes in patients with cardiac diseases is unclear. We assessed the correlation between a CXR-based congestion score (RxCS) and the mean pulmonary artery wedge pressure (mPAWP) and the prognostic impact of RxCS and mPAWP in severe aortic stenosis (AS). MethodsIn 471 patients with severe AS undergoing right heart catheterization and upright CXR, the RxCS was calculated (6 items, maximum score: 10 points) independently by 2 radiologists (average value taken) blinded to clinical data. Congestion was defined as an RxCS > 1. Four patterns were defined based on the presence or absence of congestion (C+ or C–) and elevated (> 15 mm Hg) or normal mPAWP (P+ or P–). ResultsThe median (interquartile range) RxCS was 1 (0-2). Patients with an RxCS > 1 (n = 207) had a higher mean right atrial pressure, mean pulmonary artery pressure, mPAWP, and pulmonary vascular resistance than patients with an RxCS ≤ 1 (n = 264). However, the correlation between the RxCS and the mPAWP was moderate only (r = 0.45). Patients with a C+/P+ pattern had the worst hemodynamics, whereas C–/P– patients had the most favourable constellation. After a median post–valve replacement follow-up of 1361 days, mortality was higher in patients with RxCs > 1 vs ≤ 1 as well as mPAWP > 15 mm Hg vs ≤15 mm Hg. Mortality was highest in C+/P+ patients and lowest in C–/P– patients, whereas it was intermediate in C–/P+ and C+/P– patients. ConclusionsIn AS patients, RxCS and mPAWP have a significant but moderate correlation. Both RxCS and mPAWP provide prognostic information.

Comparative Review of Computed Tomography Scans and Radiography in Evaluating Blunt Chest Trauma

Previous comparative studies revealed that a substantial proportion of blunt chest trauma often goes unnoticed when evaluated \with chest X-rays. The computed tomography scan, therefore, could play an important role in the initial assessment of patients following blunt chest trauma. This review aims to highlight the findings of chest computed tomography scans and compare them to chest radiography in patients with thoracic trauma resulting from blunt trauma. A systematic search across diverse online databases was performed in PubMed, MEDLINE, and Embase databases. The study selection process was guided by inclusion criteria that focused on individuals afflicted with chest injuries following accidents, engaged in a direct comparison of the diagnostic efficacy of chest CT scans and conventional chest X-rays, and was available in English. In the medical literature, chest radiography and CT imaging provide essential insights to guide clinical decision-making. The precise ability to distinguish between typical and atypical indications of damage across both superficial and deeper anatomical structures holds considerable importance during the initial assessment of such cases. A systematic approach, exemplified through the proposed "outside-in" sequence, offers a proficient strategy to evaluate all potential injuries comprehensively. This approach streamlines the evaluation process, ultimately empowering the medical team to promptly and effectively identify and manage these injuries.

Minimally invasive approach with small diameter pleural drainage catheter (Easydren®) in malignant pleural effusions

Aim: Treatment of malignant pleural effusions is drainage and chemical pleurodesis. Our aim in this study is to investigate the success and complications of the procedure in patients who underwent drainage with an 8F pleural drainage catheter due to malignant pleural effusion, in the light of the literature.
 Material and Method: The study included 124 patients who underwent 8F pleural drainage catheter (Easydren®) for malignant pleural effusion between August 2020 and October 2022. Clinical, radiological and laboratory findings of all patients were obtained from the automation system and archive files. Age, gender, etiology, number and duration of catheter drainage, complications and hospital stay of the patients were recorded.
 Results: Of the patients, 67 (54.0%) were female and 57 (45.9%) were male. The mean age was 54 (31-87). A total of 136 pleural drainage catheters were applied to 124 patients. Drainage and complete reexpansion of the lung were successful in 125 (91.9%) of 136 procedures. No acute surgical complications were observed during the application of pleural drainage catheters. The mean drainage time was 4.6 days (3 – 11). The hospital stay was 5.7 days (4-12).
 Conclusion: We believe that small diameter pleural drainage catheters are as effective as conventional chest tubes for the drainage of malignant pleural effusion with greater patient comfort. Although it has the disadvantage of rarely occlusion during follow-up, it is less invasive and has fewer complications compared to tube thoracostomy.

Feasibility Study of Using Cone Beam Computed Tomography (CBCT) for Early Detection of SARS-CoV-2: Case Report

The coronavirus (COVID-19) pneumonia has been spreading worldwide since February 2019. The most common symptoms are fever, dry cough and fatigue. The virus may affect the lungs, leading to complete opacification and in some cases death. Numerous attempts have been made in early diagnosis through imaging and laboratory tests. Imaging examinations such as conventional x-ray chest radiography and Multi-Detector Computed Tomography (MDCT) are now being used for assessment of the lungs. The authors have presented a case in which signs of COVID-19 were detected in cancer patient undergoing Radiotherapy (RT) using Cone Beam Computed Tomography (CBCT). Cone Beam Computed Tomography is a safe, low dose, three dimensional lung screening evaluation method, in patients suspected for chronic and acute pulmonary diseases and COVID-19.

Intrapleural Streptokinase in Management of Multiloculated Pleural Effusion as a Complication of Frequent Relapse Nephrotic Syndrome - A Case Report

Treatment of pleural effusion with intrapleural administration of fibrinolytic drugs has proven to be efficient and secure. Patients with pleural effusion who receive streptokinase instillations in conjunction with chest tube draining avoid surgery and have better outcomes. Its application in multiloculated pleural effusion, which develops as a nephrotic syndrome consequence, has only occasionally been documented. We describe a case of multiloculated pleural effusion that did not react to conventional chest tube drainage but resolved completely and dramatically in response to intrapleural streptokinase.

Safety and feasibility of a novel chest tube placement in uniportal video-assisted thoracoscopic surgery for non-small cell lung cancer.

The type and placement of chest tube for patients undergoing uniportal video-assisted thoracoscopic lobectomy remains controversial. The aim of this study was to assess the efficacy and safety of a novel technique in which a pigtail catheter was used alone as the chest tube and placed near the incision for chest drainage after uniportal video-assisted thoracoscopic lobectomy and extended lymphadenectomy. A total of 217 patients undergoing uniportal video-assisted thoracoscopic lobectomy were retrospectively reviewed and divided into two groups. In group A, a 12-Fr pigtail catheter with several side ports was placed next to the uniportal wound. In group B, a conventional 20-Fr chest tube was placed through the uniportal wound itself. Postoperative complications related to chest tube placement and patients' subjective satisfaction were compared between the two groups. Postoperative pain management effect and other clinical outcomes such as duration of chest drainage and postoperative stay were also compared. There were 112 patients in group A and 105 patients in group B. A significantly lower incidence of wound complications was found in group A postoperatively (p = 0.034). The pain score on coughing in group A was significantly lower than that in group B on postoperative day two (POD2) (p = 0.021). There was no significant difference of other clinical outcomes such as duration of chest drainage and postoperative stay as well as major complications between the two groups. Placing a 12-Fr pigtail catheter alone next to the uniportal wound for chest drainage might be effective and safe after uniportal video-assisted thoracoscopic lobectomy and extended lymphadenectomy.

A small-sized tube versus traditional closed thoracic drainage in uniportal thoracoscopic surgery.

To assess the feasibility and safety of placing a small-sized tube as drainage in patients after uniportal thoracoscopic lung resection. Patients who received uniportal video-assisted thoracoscopic surgery (U-VATS) lung resection were identified in our database. Patients placed small-sized tube drainage were compared with those placed conventional chest tube in terms of characteristics, operation modality, post-operative pulmonary complications, post-operative pain, chest tube duration and post-operative hospital stay. Propensity score matching was performed. Of the 217 enrolled patients, 173 were assigned to the conventional tube group and 44 were assigned to the small-sized tube group. Rates of post-operative pulmonary complications were relatively low and similar between the two groups. After propensity score matching, operation duration was shorter (1 h vs. 1.21 h, P = 0.01) was shorter, and the maximum value of the Visual Analogue Scale (VAS) score after operation (1 vs. 1.5, P = 0.02) and the overall average value of VAS score after operation (0.33 vs. 0.88, P = 0.006) was lower in small-sized tube group. No significant difference was observed in chest tube duration (2 vs. 2, P = 0.34) and post-operative hospital stay (3 vs. 3, P = 0.34). Compared to conventional chest tubes, small-sized tubes for post-operative drainage after U-VATS lung resection may be a safe and promising approach for reducing post-operative pain.

Man With Chest Pain After a Traffic Crash.

A 40-year-old man had been involved in a scooter crash and presented to the emergency department with chest pain. His vital signs were blood pressure, 160/84 mmHg; pulse, 109 beats/min; respiratory rate 24 breaths/min, and temperature, 37.5 °C. Physical examination revealed severe local tenderness in the mid-chest region. Plain radiography (Figure 1) and point-of-care ultrasonography of the chest (Figure 2 and Video 1) were performed, and the diagnosis was confirmed by contrast-enhanced computed tomography.Figure 2The point-of-care ultrasound at the site of pain showed a breach in the anterior cortex of the sternal body (arrowhead) and a mass with mixed echogenicity around the fracture indicating hematoma (asterisk).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Sternum fracture. Plain radiography revealed a suspicious mild depression fracture of the sternum. Point-of-care ultrasound imaging, using a high-frequency linear transducer at the site of pain, showed a discontinuous outline of the sternum. A chest computed tomography (Figure 3) image was obtained for confirmation of the diagnosis and to detect possible concomitant associate injuries, such as great vessel disruption, cardiac contusion, and pulmonary contusion. Sternum fracture is characterized by chest pain, which worsens with deep inspiration and shortness of breath. Motor vehicle crashes are the leading cause of sternum fracture, typically due to hitting the steering wheel without an airbag.1Oyetunji T.A. Jackson H.T. Obirieze A.C. et al.Associated injuries in traumatic sternal fractures: a review of the National Trauma Data Bank.Am Surg. 2013; 79: 702-705Crossref PubMed Google Scholar,2Knobloch K. Wagner S. Haasper C. et al.Sternal fractures occur most often in old cars to seat-belted drivers without any airbag often with concomitant spinal injuries: clinical findings and technical collision variables among 42,055 crash victims.Ann Thorac Surg. 2006; 82: 444-450Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar Conventional chest radiography has variable diagnosis accuracy, and most sternal fractures may be missed by chest radiography alone.3Perez M.R. Rodriguez R.M. Baumann B.M. et al.Sternal fracture in the age of pan-scan.Injury. 2015; 46: 1324-1327Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar The point-of-care ultrasound can be considered a useful technique in identifying sternum fractures.4You J.S. Chung Y.E. Kim D. et al.Role of sonography in the emergency room to diagnose sternal fractures.J Clin Ultrasound. 2010; 38: 135-137PubMed Google Scholar https://www.annemergmed.com/cms/asset/9b3c776c-e7a2-4271-9e98-27acc23ff9ab/mmc1.mp4Loading ... Download .mp4 (3.14 MB) Help with .mp4 files Video 1The point-of-care ultrasound at the site of pain showed a breach in the anterior cortex of the sternal body (arrowhead) and a mass with a mixed echogenicity around the fracture indicating hematoma (asterisk).

Dark-Field Chest Radiography Outperforms Conventional Chest Radiography for the Diagnosis and Staging of Pulmonary Emphysema.

Dark-field chest radiography (dfCXR) has recently reached clinical trials. Here we compare dfCXR to conventional radiography for the detection and staging of pulmonary emphysema. Subjects were included after a medically indicated computed tomography (CT) scan, showing either no lung impairments or different stages of emphysema. To establish a ground truth, all CT scans were assessed by 3 radiologists assigning emphysema severity scores based on the Fleischner Society classification scheme.Participants were imaged at a commercial chest radiography device and at a prototype for dfCXR, yielding both attenuation-based and dark-field images. Three radiologists blinded to CT score independently assessed images from both devices for presence and severity of emphysema (no, mild, moderate, severe).Statistical analysis included evaluation of receiver operating characteristic curves and pairwise comparison of adjacent Fleischner groups using an area under the curve (AUC)-based z test with a significance level of 0.05. A total of 88 participants (54 men) with a mean age of 64 ± 12 years were included. Compared with conventional images (AUC = 0.73), readers were better able to identify emphysema with images from the dark-field prototype (AUC = 0.85, P = 0.005). Although ratings of adjacent emphysema severity groups with conventional radiographs differed only for trace and mild emphysema, ratings based on images from the dark-field prototype were different for trace and mild, mild and moderate, and moderate and confluent emphysema. Dark-field chest radiography is superior to conventional chest radiography for emphysema diagnosis and staging, indicating the technique's potential as a low-dose diagnostic tool for emphysema assessment.

Frequency of pleural effusion in dengue patients by severity, age and imaging modality: a systematic review and meta-analysis

BackgroundIdentification of pleural effusion (PE) in dengue infection is an objective measure of plasma leakage and may predict disease progression. However, no studies have systematically assessed the frequency of PE in patients with dengue, and whether this differs across age and imaging modality.MethodsWe searched Pubmed, Embase Web of Science and Lilacs (period 1900–2021) for studies reporting on PE in dengue patients (hospitalized and outpatient). We defined PE as fluid in the thoracic cavity detected by any imaging test. The study was registered in PROSPERO (CRD42021228862). Complicated dengue was defined as hemorrhagic fever, dengue shock syndrome or severe dengue.ResultsThe search identified 2,157 studies of which 85 studies were eligible for inclusion. The studies (n = 31 children, n = 10 adults, n = 44 mixed age) involved 12,800 patients (30% complicated dengue). The overall frequency of PE was 33% [95%CI: 29 to 37%] and the rate of PE increased significantly with disease severity (P = 0.001) such that in complicated vs. uncomplicated dengue the frequencies were 48% and 17% (P < 0.001). When assessing all studies, PE occurred significantly more often in children compared to adults (43% vs. 13%, P = 0.002) and lung ultrasound more frequently detected PE than conventional chest X-ray (P = 0.023).ConclusionsWe found that 1/3 of dengue patients presented with PE and the frequency increased with severity and younger age. Importantly, lung ultrasound demonstrated the highest rate of detection. Our findings suggest that PE is a relatively common finding in dengue and that bedside imaging tools, such as lung ultrasound, potentially may enhance detection.

Combined pulmonary fibrosis and emphysema: A new horizon of smoker’s lung disease with obstructive and restrictive lung functions!

Combined pulmonary fibrosis and emphysema (CPFE) is underestimated chronic lung disease presenting with a combo of emphysema plus interstitial lung disease. CPFE is a heterogeneous lung disease documented usually in smokers which includes emphysema in the upper lobes and pulmonary fibrosis in the lower lobes. Although CPFE is commonly called as Smoker’s lung disease , a proportionate number of cases are having concurrent connective tissue disease. High-Resolution Computed Tomography (HRCT thorax) is a gold standard investigation to evaluate CPFE due less reliability of conventional chest radiography. Pulmonary hypertension and lung cancer are two comorbidities associated with poor outcome in CPFE. Echocardiography, diffusion coefficient, and body plethysmography have documented a role in composite assessment of CPFE. Combination of bronchodilators, oxygen supplementation during rest and ambulation in selected cases and antifibrotics is having a “game changer” role in the management of CPFE.

Management of Persistent Pulmonary Air Leak with the Drentech™ Simple System. Case Report

Persistent pulmonary air leak affects between 10-15% of pulmonary surgical procedures, generally requiring management through the use of conventional chest drainage systems (water-sealed pleural chamber) of subjective interpretation due to poor detection sensitivity. of leaks, resulting in increased morbidity, hospital stay, and costs.

Conventional chest physiotherapy compared to other airway clearance techniques for cystic fibrosis.

Conventional chest physiotherapy compared to other airway clearance techniques for cystic fibrosis.

Drainless robot-assisted minimally invasive oesophagectomy—randomized controlled trial (RESPECT)

BackgroundThe purpose of this randomized trial is to evaluate the early removal of postoperative drains after robot-assisted minimally invasive oesophagectomy (RAMIE). Evidence is lacking about feasibility, associated pain, recovery, and morbidity.Methods/designThis is a randomized controlled multicentric trial involving 72 patients undergoing RAMIE. Patients will be allocated into two groups. The “intervention” group consists of 36 patients. In this group, abdominal and chest drains are removed 3 h after the end of surgery in the absence of contraindications. The control group consists of 36 patients with conventional chest drain management. These drains are removed during the further postoperative course according to a standard algorithm. The primary objective is to investigate whether postoperative pain measured by NRS on the second postoperative day can be significantly reduced in the intervention group. Secondary endpoints are the intensity of pain during the first week, analgesic use, number of postoperative chest X-ray and CT scans, interventions, postoperative mobilization (steps per day as measured with an activity tracker), postoperative morbidity and mortality.DiscussionUntil now, there have been no trials investigating different intraoperative chest drain strategies in patients undergoing RAMIE for oesophageal cancer with regard to perioperative complications until discharge. Minimally invasive approaches combined with enhanced recovery after surgery (ERAS) protocols lower morbidity but still include the insertion of chest drains. Reduction and early removal have been proposed after pulmonary surgery but not after RAMIE. The study concept is based on our own experience and the promising current results of the RAMIE procedure. Therefore, the presented randomized controlled trial will provide statistical evidence of the effectiveness and feasibility of the “drainless” RAMIE.Trial registrationClinicalTrials.gov NCT05553795. Registered on 23 September 2022.