Early Pulmonary Complications Research Articles

Donor great vessel free arterial grafts for complex reconstruction during pediatric heart transplantation

ObjectivePrior studies suggest that prolonged donor heart warm ischemia time increases heart transplant mortality. Patients with single-ventricle heart disease requiring transplant with concomitant aortic arch or central pulmonary artery reconstruction present technical challenges that extend donor warm ischemia time using conventional techniques. Studies in larger pediatric and adult patients with single-ventricle anatomy have described the use of prosthetic material for concomitant great vessel reconstruction. We have used donor free arterial grafts to simplify concomitant great vessel reconstructions and reduce warm donor ischemia time in small patients with single-ventricle physiology undergoing heart transplant. The purpose of this study is to review our results in these patients. MethodsChildren with single-ventricle heart disease who underwent free donor arterial graft great vessel reconstruction at heart transplant were identified, divided into aortic arch and central pulmonary artery groups, and retrospectively reviewed. Warm and total ischemia times were recorded contemporaneously at transplant. ResultsFifteen pediatric patients with single-ventricle physiology underwent donor free arterial graft great vessel reconstructions (9 aortic arch, 6 pulmonary artery). Mean donor warm and total ischemia times for the entire cohort were 52.8 ± 10.7 and 341.7 ± 41.2 minutes. Two patients required postoperative extracorporeal membrane oxygenation. Hospital survival was 94% (1 death). There were no late deaths, and 2 patients had late retransplant. There were no early or late aortic or pulmonary artery obstructions, reinterventions, or complications at median follow-up of 14.2 years (interquartile range, 4.2-16.3 years). ConclusionsDonor free arterial grafts for concomitant great vessel reconstruction during heart transplant in small, single-ventricle patients reduces warm ischemia time, simplifies technical demands, and preserves growth potential.

Postoperative outcomes of pediatric patients with perioperative COVID-19 infection: a systematic review and meta-analysis of observational studies.

To quantify the risk of adverse postoperative outcomes in pediatric patients with COVID-19 infection. We searched PubMed, Embase, Cochrane Library from December 2019 to 21 April 2023. Observational cohort studies that reported postoperative early mortality and pulmonary complications of pediatric patients with confirmed COVID-19-positive compared with COVID-19-negative were eligible for inclusion. We excluded pediatric patients underwent organ transplantation or cardiac surgery. Reviews, case reports, letters, and editorials were also excluded. We used the Newcastle-Ottawa Scale to assess the methodological quality and risk of bias for each included study. The primary outcome was postoperative early mortality, defined as mortality within 30days after surgery or during hospitalization. The random-effects model was performed to assess the pooled estimates, which were expressed as risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI). 9 studies involving 23,031 pediatric patients were included, and all studies were rated as high quality. Compared with pediatric patients without COVID-19, pediatric patients with COVID-19 showed a significantly increased risk of postoperative pulmonary complications (PPCs) (RR = 4.24; 95% CI 2.08-8.64). No clear evidence was found for differences in postoperative early mortality (RR = 0.84; 95% CI 0.34-2.06), postoperative intensive care unit (ICU) admission (RR = 0.80; 95% CI 0.39-1.68), and length of hospital stay (MD = 0.35, 95% CI -1.81-2.51) between pediatric patients with and without COVID-19. Perioperative COVID-19 infection was strongly associated with increased risk of PPCs, but it did not increase the risk of postoperative early mortality, the rate of postoperative ICU admission, and the length of hospital stay in pediatric patients. Our preplanned sensitivity analyses confirmed the robustness of our study findings.

Model for predicting early and late-onset postoperative pulmonary complications in perioperative patients receiving neuromuscular blockade: a secondary analysis

Pulmonary complications continue to be the most common adverse event after surgery. The main objective was to carry out two independent predictive models, both for early pulmonary complications in the Post-Anesthesia Care Unit and late-onset pulmonary complications after 30 postoperative days. The secondary objective was to determine whether presenting early complications subsequently causes patients to have other late-onset events. This is a secondary analysis of a cohort study. 714 patients were divided into four groups depending on the neuromuscular blocking agent, and spontaneous or pharmacological reversal. Incidence of late-onset complications if we have not previously had any early complications was 4.96%. If the patient has previously had early complications the incidence of late-onset complications was 22.02%. If airway obstruction occurs, the risk of atelectasis increased from 6.88 to 22.58% (p = 0.002). If hypoxemia occurs, the incidence increased from 5.82 to 21.79% (p < 0.001). Based on our predictive models, we conclude that diabetes mellitus and preoperative anemia are two risk factors for early and late-onset postoperative pulmonary complications, respectively. Hypoxemia and airway obstruction in Post-Anesthesia Care Unit increased four times the risk of the development of pneumonia and atelectasis at 30 postoperative days.

Pulmonary complications in children and adolescents after allogeneic hematopoietic stem cell transplantation

Relevance. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) makes it possible to treat severe malignant and non-malignant hematopoietic disorders system. Pulmonary complications (PC) occur in 40–60 % of patients after allo-HSCT. However to date, the effect of HSCT on functional and morphological pulmonary changes in recipients remains insufficiently studied.The objective of current study was to evaluate risk factors affecting long-term survival in children and adolescents after allo-HSCT.Methods and materials. The current study was both retrospective and prospective. The analysis included 362 patients with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML), aged 5 months to 18 years, who received allo-HSCT at Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology and Transplantation in 2000–2018. All the patients underwent chest computed tomography (CT). When detecting CT changes, we performed fibrobronchoscopy (FBS) with microbiological examination of bronchoalveolar lavage (BAL).Results. PC were diagnosed in 124 patients (64 %) who received allo-HSCT in 2014–2018. Decrease of overall survival (OS) is associated with PC development during the first year after allo-HSCT(р&lt;0,001).The development of early PC in remission of the underlying disease significantly affected OS (p=0.001).The probability of PC development is 2.26 times higher in patients older than 9 years (p=0.006). When comparing the intensity of conditioning regimens (MACvsRIC) in remission of the underlying disease, we did not get significant differences in the incidence of PC (p&gt;0.05). Graft source, donor type, HLA-compatibility, recipient gender did not affect the incidence of PC (p&gt;0.05). When using graft-versus-host disease (GVHD) prophylaxis (ptCYvsATG), the 5-year OS in patients without PC was 78.8 % and 62.8 %respectively. The 5-year OS in patients with PC was 51.8 % and 42.4 % respectively (р=0.007). Decrease of OS in patients with PC is associated with chGVHD(58.3 %,) (р=0.03).Conclusion. Pulmonary complications (infectious and non-infectious) in allo-HSCT recipients are more likely to occur in the first year after transplantation. Among bacterial pathogens, the predominance of Gr(-) flora remains. The incidence of pulmonary complications was significantly lower when using ptCY as a prevention of GVHD.

Early pulmonary complications related to cancer treatment in children.

In this review, we summarize early pulmonary complications related to cancer therapy in children and highlight characteristic findings on imaging that should be familiar to a radiologist reviewing imaging from pediatric cancer patients.

Early Postoperative Outcomes of Super Morbid Obese Compared to Morbid Obese Patients After Ambulatory Surgery Under General Anesthesia: A Propensity-Matched Analysis of a National Database.

Patients with body mass index (BMI) ≥50 kg/m2, defined as super morbid obesity, represent the fastest growing segment of patients with obesity in the United States. It is currently unknown if super morbid obese patients are at greater odds than morbid obese patients for poor outcomes after outpatient surgery. The main objective of the current investigation is to assess if super morbid obese patients are at increased odds for postoperative complications after outpatient surgery when compared to morbid obese patients. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2017 to 2018 was queried to extract and compare patients who underwent outpatient surgery and were defined as either morbidly obese (BMI >40 and <50 kg/m2) or super morbidly obese (BMI ≥50 kg/m2). The primary outcome was the occurrence of medical adverse events within 72 hours of discharge. In addition, we also examine death and readmissions as secondary outcomes. A propensity-matched analysis was used to evaluate the association of BMI ≥50 kg/m2 versus BMI between 40 and 50 kg/m2 and the outcomes. A total of 661,729 outpatient surgeries were included in the 2017-2018 NSQIP database. Of those, 7160 with a BMI ≥50 kg/m2 were successfully matched to 7160 with a BMI <50 and ≥40 kg/m2. After matching, 17 of 7160 (0.24%) super morbid obese patients had 3-day medical complications compared to 15 of 7160 (0.21%) morbid obese patients (odds ratio [OR; 95% confidence interval {CI}] = 1.13 [0.57-2.27], P = .72). The rate of 3-day surgical complications in super morbid obese patients was also not different from morbid obese patients. Thirty-five of 7160 (0.48%) super morbid obese patients were readmitted within 3 days, compared to 33 of 7160 (0.46%) morbid obese patients (OR [95% CI] = 1.06 [0.66-1.71], P = .80). When evaluated in a multivariable analysis as a continuous variable (1 unit increase in BMI) in all patients, BMI ≥40 kg/m2 was not significantly associated with overall medical complications (OR [95% CI] = 1.00 [0.98-1.04], P = .87), overall surgical complication (OR [95% CI] = 1.02 [0.98-1.06], P = .23), or readmissions (OR [95% CI] = 0.99 [0.97-1.02], P = .8). Super morbid obesity is not associated with higher rates of early postoperative complications when compared to morbid obese patients. Specifically, early pulmonary complications were very low after outpatient surgery. Super morbid obese patients should not be excluded from outpatient procedures based on a BMI cutoff alone.

Different Intraoperative Ventilatory Strategies for Prevention of Pulmonary Atelectasis in Obese Patients Undergoing Non-Bariatric Surgeries; Randomized Controlled Trial

Background: Upper abdominal surgeries have been reported to be associated with an increased incidence of postoperative atelectasis. Preventing atelectasis is important for all patients but is more important when caring for obese patients. Objectives: To determine which of the following ventilatory strategies is better in prevention of pulmonary atelectasis in obese patients undergoing non-bariatric surgery: Volume control ventilation VC, Pressure control Ventilation PC, Volume control ventilation + Positive End Expiratory Pressure PEEP, Volume control ventilation + Positive End Expiratory Pressure PEEP + lung recruitment maneuver. Patients and methods: A randomized-controlled trial study was carried out in the operating room (OR) in Zagazig University Hospital including 92 patients. Patients were randomly allocated into four groups. G1: Volume control ventilation VC, G2: Pressure control Ventilation PC, G3: Volume control ventilation + Positive End Expiratory Pressure PEEP, G4: as in G3 + lung recruitment maneuver. Results: There was significant difference between the studied groups as regards PaO2/FiO2 ratio as the 4th group was highly significant. There was also significant difference between the studied groups as regards atelectasis score with the least atelectasis score in group 4. There was a significant difference in group 4 than the other groups as regards length of stay in PACU, and need for 100% Fio2 in PACU.Finally,there was a significant difference between the studied groups as regards postoperative pulmonary complications with the 4th group has the least postoperative complication. Conclusion: Our results suggest that volume control ventilation + Positive End Expiratory Pressure PEEP + lung recruitment maneuver had beneficial effects on oxygenation continued into the early recovery period and decrease pulmonary complications in the early post-operative period in obese patients undergoing non-bariatric upper abdominal surgeries.

Peri-operative Outcomes and Predictors of Mortality in COVID-19 Positive Patients with Hip Fractures: A Multicentre Study in the UK

AimThis UK based multi-centre study reports clinical characteristics, early outcomes and predictors of mortality in 34 consecutive COVID-19-positive hip fractures so that the lessons learnt could be utilised in other parts of World who are at a different phase of the pandemic.MethodsThis study analysed patient admitted with hip fractures with COVID positive swabs, between March and May’2020 in three large hospitals covering a population of nearly two million. Data was collected on demographic profile, peri-operative variables, post-operative complications and mortality. The specific aim was to identify any variables, which could predict high 30-day mortality.ResultsOverall, 12% of hip fractures were COVID positive with the mortality rate of 41.2%. The higher age (p = 0.036) and male gender (p = 0.025) was significantly associated with mortality and most of the deaths were between American Society of Anaesthesiologists (ASA) grade 3 and 4 patients. The patients having intramedullary (IM) nailing were more likely to die (p = 0.02). There was no difference in laboratory parameters but there was significant difference in findings on chest radiographs (p < 0.001), post-operative oxygen requirements (p = 0.006) and early respiratory complications (p = 0.006).ConclusionThis study suggests that the mortality following surgery for a hip fracture in COVID-positive patients is strikingly high and is associated with higher age and male gender. Higher mortality has been observed for extracapsular fracture operated with intramedullary nailing. In the immediate post-operative period, rapid deterioration of chest imaging, higher oxygen requirement and early pulmonary complications can serve as warning signs and predicting factors for higher mortality.

The Immediate Effects of Breathing Exercises with Acapella and Incentive Spirometer on Preventing Early Pulmonary Complications Following Cabg. - A Comparitive Study

The Immediate Effects of Breathing Exercises with Acapella and Incentive Spirometer on Preventing Early Pulmonary Complications Following Cabg. - A Comparitive Study

Evaluation of Blood Lactate Level as Predictor of Early Adverse Outcome after Cardiac Surgery under Cardiopulmonary Bypass

Background: We examined the hypothesis that high blood lactate level in intensive care unit patient after adult cardiac surgery under cardiopulmonary bypass is associated with early adverse outcome. The objective of this study was to evaluate whether high blood lactate level after cardiac surgery is a predictor of the early outcome after adult cardiac surgery under cardiopulmonary bypass.&#x0D; Methods: This prospective observational study was carried out in the department of Cardiac Surgery at National Institute of Cardiovascular Disease (NICVD), Dhaka from July, 2013 to April 2014. A total number of 100 patients who underwent cardiac operation with cardiopulmonary bypass were enrolled in this study as per inclusion and exclusion criteria. Patients were divided into two groups according to their blood lactate level 6 hours after transferintensive care unit. Peroperative variables and postoperative variables were observed and recorded during the hospital course of patient. Categorical variables were analyzed by Chi- Square test and Fisher’s exact test and continuous variables were analyzed by ‘t’ test. Multiple Binary Logistic Regression Analysis of predictors for each of the outcome variables was done.&#x0D; Results: Blood lactate levels ≥3mmol/L 6 hours after transfer to intensive care unit were present in 57(57%) patients. Multiple logistic regression analysis showed higher blood lactate level was an independent predictor for early postoperative low output syndrome (OR 9.073, 95% CI 2.819 – 29.207, p = &lt; .0001), pulmonary complication (OR 5.734, 95% CI 1.814 – 18.122, p = .003), neurological deficits (OR 9.725, 95% CI 1.111 - 85.147, p = .040), renal dysfunction (OR 7.393, 95% CI 1.855-29.469, p = .005), arrhythmia (OR 10.512, 95% CI 1.902 – 58.108, p = .007) and wound infection (OR 7.742, 95% CI 1.418 - 42.259, p = .018).&#x0D; Conclusions: High blood lactate level 6 hours after transfer to intensive care unit is an independent predictor for worse outcomes in adult patients after cardiac surgery under cardiopulmonary bypass.&#x0D; Bangladesh Heart Journal 2019; 34(1) : 25-30

The effect of perioperative fluid therapy on early postoperative pulmonary complications after orthotopic liver transplantation

Objective: To investigate the effect of perioperative fluid therapy on early postoperative pulmonary complication (PPC) after orthotopic liver transplantation (OLT). Methods: The clinical data of 132 patients who underwent OLT in the First Affiliated Hospital of Xi'an Jiaotong University from April 2016 to December 2017 were analyzed retrospectively. These patients included 96 males and 36 females, aged (47.3±9.6) years (range: 24-69 years). Based on the clinical manifestations, laboratory and imaging findings of patients in ICU and PPC occurrence within 7 days after OLT surgery, the patients were divided into 2 groups: non-PPC group and PPC group. Univariate and multivariate logistic regression analyses were used to evaluate the association between perioperative variables and PPC. The Kaplan-Meier method was used to estimate cumulative survival of recipients with or without PPC within 2-years. Results: During the follow-up, 11 patients (8.3%) died and 72 patients (54.5%) developed PPC after operation. There were 34 cases, 6 cases, 3 cases, 4 cases, 15 cases, 6 cases and 4 cases of only pleural effusion, only pulmonary edema, only pneumonia, pleural effusion with pneumonia, pleural effusion with pulmonary edema, pleural effusion with atelectasis, and pleural effusion with pneumonia and pneumonia in PPC, respectively. Univariate analysis showed that the preoperative factors (model for end-stage liver disease score), the intra-operative factors (duration of surgery, total infusion volume, total blood products) and the postoperative cumulative fluid balance within the first 24 h, 48 h, and 72 h were the prognosis factors of PPC (P<0.05). At least two out of the first three postoperative days with a fluid balance of ≤-500 ml was a protective factor. Using multivariate analysis by Logistic regression, only the red blood units >10 U (OR=3.55, 95% CI: 1.35-9.26, P=0.010) and the cumulative fluid intake >12 L (OR=2.98, 95% CI: 1.14-7.80, P=0.026) within the first 72 h after operation were independent prognosis factors of PPC after OLT. Kaplan-Meier analysis showed that the cumulative survival rate was lower in PPC group than that in non-PPC group (χ(2)=6.590, P=0.01). Conclusion: Massive red blood cell transfusion and the cumulative fluid volume >12 L during perioperative 72 hours are independent prognosis factors of PPC after OLT.

Pulmonary complications after liver transplantation in children: risk factors and impact on early post-operative morbidity.

Liver transplantation (LT) is associated with high post-operative morbidity, despite excellent survival rates. With this retrospective study, we report the incidence of early and late pulmonary complications (PC) after LT, identify modifiable risk factors for PC and analyzed the role of PC in post-operative ventilation duration and hospital length of stay. In a series of 79 children (0-16years) with LT over a 12years period, early (<3months post-LT) and/or late (>3months post-LT) PC occurred in 68 patients (86%). Sixty-four percent (64%) developed early major complications such as pulmonary edema, atelectasis, or pleural effusion. Atelectasis requiring an intervention (P≤.02), pulmonary edema (P≤.02), or elevated PELD/MELD scores (P=.05) were associated with an increase in total ventilation duration and length of stay in the ICU. Risk factors for early PC included preoperative hypoxemia (P=.005), low serum albumin at LT admission (P=.003), or early rejection (P=.002). About 20% of patients experienced late PC of which 81% were infections. Risk factor assessment prior to LT may ultimately help reduce early PC thereby possibly minimizing post-operative morbidity and ICU length of stay.

Challenging Alveolar Hemorrhage Complicating Pneumonia After Liver Transplantation: A Case Report

Alveolar hemorrhage is a life-threatening clinical syndrome often initially thought to be atypical pneumonia. Association with hematopoietic stem cell transplantation is well studied, but not with solid organ transplantation. We report a case of a 54-year-old woman presented with fever and shortness of breath on the third posttransplant day after deceased donor liver transplantation. Imaging studies showed diffuse bilateral pulmonary infiltrates and a positive sequential bronchoalveolar lavage test was revealed during bronchoscopy. Cytomegalovirus antigenemia was present in 8/200,000 white blood cells; Aspergillus galactomannan and Pneumocystis jirovecii were also present. However, only Aspergillus hyphae were found in the sputum culture. Management strategy aimed to treat underlying infections, provide adequate respiratory support, and control inflammation. We proposed that diffuse alveolar hemorrhage should be considered as differential diagnosis in early pulmonary complications after liver transplantation. Early diagnosis and aggressive treatment protocol is the key for a good outcome.

Impact of mesenteric defect closure technique on complications after gastric bypass

BackgroundClosure of mesenteric defects during laparoscopic gastric bypass surgery markedly reduces the risk for small bowel obstruction due to internal hernia. However, this procedure is associated with an increased risk for early small bowel obstruction and pulmonary complication. The purpose of the present study was to evaluate whether the learning curve and subsequent adaptions made to the technique have had an effect on the risk for complications.MethodsThe results of patients operated with a primary laparoscopic gastric bypass procedure, including closure of the mesenteric defects with sutures, during a period soon after introduction (January 1, 2010–December 31, 2011) were compared to those of patients operated recently (January 1, 2014–June 30, 2017). Data were retrieved from the Scandinavian Obesity Surgery Registry (SOReg). The main outcome was reoperation for small bowel obstruction within 30 days after surgery.ResultsA total of 5444 patients were included in the first group (period 1), and 1908 in the second group (period 2). Thirty-day follow-up rates were 97.1 and 97.5% respectively. The risk for early (within 30 days) small bowel obstruction was lower in period 2 than in period 1 (13/1860, 0.7% vs. 67/5285, 1.3%, OR 0.55 (0.30–0.99), p = 0.045). The risk for pulmonary complication was also reduced (5/1860, 0.3%, vs. 41/5285, 0.8%, OR 0.34 (0.14–0.87), p = 0.019).ConclusionClosure of mesenteric defects during laparoscopic gastric bypass surgery can be performed safely and should be viewed as a routine part of that operation.

THE ROLE OF INFRARED RADIATION WITH TERAHERTZ MODULATION IN POST-CARDIOSURGERY PULMONARY COMPLICATIONS

Background. Early pulmonary complications after cardiosurgery worsen general state of the patients, require additional therapeutic and diagnostic measures, increase the pharmacological load, extend the length of stay in the hospital and in some cases leads to the lethal outcome. Objective. The purpose of this study was to evaluate the effectiveness of the infrared radiation with terahertz modulation in the early-onset hospital-acquired pneumonia and ventilator-associated pneumonia in patients after cardiosurgery. Design and methods. This is an observational retrospective open comparative study with pseudo-control (“case-control study”). We included patients with pulmonary complications (infi ltrative and focal changes in the lungs diagnosed as nosocomial pneumonia and ventilator-associated pneumonia) in the early post-cardiosurgery period (after coronary bypass surgery and / or prosthetic heart valves). They were divided into 2 groups: we applied infrared Terahertz radiation at the acupuncture point Da-bao (RР 21) (“IK-Dipole”, Russia) in addition to the standard therapy in the 1st group. The patients of the 2nd group received only standard therapy. Results. Early (the fi rst day) application of infrared radiation with terahertz modulation allowed to reduce terms of stay of the patient in the intensive care unit (by 4-8 days); to reduce radiological and pharmacological stress; to reduce the intubation and ventilation time (by 4-8 days); to improve prognosis; to start earlier (by 4-8 days) the rehabilitation activities. Conclusion. Therefore, the infrared radiation with terahertz modulation helps to improve the quality and effectiveness of treatment in patients with pulmonary complications after cardiosurgery.

Comparative Study between Intra - Operative Ventilatory Techniques to Prevent Postoperative Pulmonary Complications in Obese Patients Undergoing Laparoscopic Surgery

Background: Managing ventilation and oxygenation during laparoscopic procedures in morbidly obese patients undergoing surgery represents many challenges. There is no specific guideline on the ventilation modes for this group of patients. Although several studies have been performed to determine the optimal ventilatory settings for those patients, the answer is yet to be found. The aim of this study was to determine which mode of ventilation is more effective in improvement of intraoperative oxygenation and prevention of postoperative pulmonary atelectasis with its consequences is PEEP 10cmH2O alone is effective or Recruitment maneuver followed by PEEP 10 cmH2O has better results.Aim of the Work:The study will be performed to compare different intra-operative ventilatory techniques that prevent early postoperative pulmonary complicationsespescially atelectasis in obese patients undergoing laparoscopic surgery.Patients and Methods:Thisprospective, interventional, therapeutic, randomized clinical studywas conducted at Ain Shams University Hospitals, operating theatre department on 100 morbidly obese adult patients of ASA physical status II, admitted to Ain Shams university hospital, scheduled for elective laparoscopic surgery either bariatric or non-bariatric. The study was carried out after approval of the departmental ethical committee.The patients were subdivided into 4 groups A, B, C and D, (25) patients for each group. Results: Regarding the value of PO2/ Fi O2, there is no statistically significant difference between all groups in the preoperative and intra operative values. But there is statistically significant increase in group D and group C respectively compared to group A and B in both post-operative and 6 hours post-operative values. Regarding CT chest,Group A showed the highest number of both lobar and segmental atelectasis followed by group B which showed also a high number of segmental atelectasis. In despite, group C showed a higher number of plate and lamellar atelectasis followed by group D that showed a high number of lamellar atelectasis but the lowest number of other atelectasis scores. Conclusion: In conclusion, repeated Recruitment Maneuvers combined with 10 cmH2O of PEEP have beneficial effects on oxygenation continued into the early recovery period and decrease pulmonary complications in the early post-operative period in morbid obese patients undergoing laparoscopic surgery. Recommendations: Further studies on a larger scale of patients are needed to confirm the results obtained by this work.

Effect of goal-directed fluid therapy on postoperative rehabilitation in elderly patients undergoing surgery in prone position

Objective To evaluate the effect of goal-directed fluid therapy on postoperative rehabili-tation in elderly patients undergoing surgery in the prone position. Methods Sixty patients of both sexes, aged 60-75 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective lumbar surgery in the prone position under general anesthesia, were divided into 2 groups(n=30 each)using a random number table: conventional fluid therapy group(group C)and goal-directed fluid therapy group(group G). The CNAP system was used to monitor stroke volume variation and cardiac index continuously in group G. Mean arterial pressure was maintained at 60-110 mmHg, central venous pressure at 6-12 cmH2O and urine volume more than 0.5 ml·kg-1·h-1 using conventional fluid therapy in group C. In group G, goal-directed fluid therapy was performed under the guidance of stroke volume variation, and cardiac index was maintained at 2.5-4.0 L·min-1·m-2.The requirement for crystalloid and colloid solution, total volume of fluid infused, blood loss, urine volume and requirement for vasoactive agents were recorded during operation.After anesthesia induction, at 1 h after turning to the prone position and at the end of operation, blood samples were collected from the left radial artery for blood gas analysis, and the blood lactate concentration was recorded.The volume of drainage within 3 days after operation, perioperative blood transfusion, early postoperative cardiovascular and pulmonary complications, development of oliguria and anuria, emergence time and length of hospital stay were recorded. Results Compared with group C, the requirement for crystalloid solution, total volume of fluid infused, urine volume and requirement for vasoactive agents were significantly decreased during operation, the requirement for colloid solution was increased during operation, the blood lactate concentration was decreased at 1 h after turning to the prone position and at the end of operation, the length of hospital stay was shortened, and the incidence of postoperative cardiovascular and pulmonary complications was decreased in group G(P<0.05). Conclusion Goal-directed fluid therapy can promote postoperative rehabilitation and shows a certain clinical value in elderly patients undergoing surgery in the prone position. Key words: Fluid therapy; Aged; Prone position; Rehabilitation

Transcutaneous electrical nerve stimulation effect on postoperative complications.

Objectives Transcutaneous electrical nerve stimulation has been used to control post-thoracotomy pain, with conflicting results. We aimed to assess its efficacy on post-thoracotomy pain and early complications. Methods Between January 2012 and December 2014, 87 patients underwent a standard posterolateral thoracotomy and were randomized in 2 groups: group T was 43 patients who had transcutaneous electrical nerve stimulation and group C was 44 patients who had placebo stimulation with an inoperative device. Pain score was measured using a visual analogue scale ranging from 0 to 10. The frequency of the device was set at 100 Hz and pulse width at 100 ms. Results There were no statistically significant differences in the demographic characteristics of the 2 groups, and there was no difference in the duration of hospitalization (4.74 ± 1.6 vs. 5.23 ± 1.5 days; p = 0.06). Postoperative pain scores of the two groups showed that on postoperative day 0, 1, and 2, the mean pain scores of group T were significantly lower ( p = 0.001, p < 0.001, and p = 0.003). There were no significant differences in early complications or surgical technique. Conclusion We concluded that electrical stimulation is a safe and effective adjunctive therapy for acute post-thoracotomy pain control. However, it does not affect the duration of hospitalization or early pulmonary complications.

8 - Incidence of early pulmonary complications requiring chest tube insertion in surgically treated paediatric scoliosis

8 - Incidence of early pulmonary complications requiring chest tube insertion in surgically treated paediatric scoliosis

Pulmonary complications for predicting mortality among major burn victims

Objective The aim of this study was to assess the incidence of early and late pulmonary complications among major burn victims and to study their effects on patient's outcome. Background Respiratory complications associated with burn injury are responsible for significant morbidity and mortality. Patients and methods Forty-two patients with major burn with no past history of pulmonary diseases were enrolled in the study. All patients were subjected to medical history taking, general, local (respiratory and burn), and upper airway examination, laboratory investigations, plain chest radiograph, and serial arterial blood gases analysis (initially after admission and then after 48 and 72 h). Results Pulmonary complications developed in 29 of 42 (69%) burned patients. Eleven of 42 (26.2%) patients died; 10 (90.9%) of them died due to pulmonary complications and one (9.1%) patient died due to wound sepsis. Acute respiratory distress syndrome, inhalational injury, pneumonia, acute bronchitis, lung contusion, and hemothorax were early phase (within 48 h of admission) pulmonary complications, whereas pneumonia, lung collapse, and pulmonary embolism were late phase (after 48 h of admission) pulmonary complications. Lower serum albumin and more deep burn were independent risk factors for pulmonary complications, and pulmonary complications, decreased prothrombin time concentration, and lower serum albumin were independent risk factors for mortality in patients with major burns. Conclusion Lower serum albumin and more deep burns were independent risk factors for pulmonary complications, and pulmonary complications, decreased prothrombin time concentration, and lower serum albumin were independent risk factors for mortality in burned patients.