Number Of Pulmonary Complications Research Articles

Integrating StEP-COMPAC definition and enhanced recovery after surgery status in a machine-learning-based model for postoperative pulmonary complications in laparoscopic hepatectomy

BackgroundPostoperative pulmonary complications (PPCs) contribute to high mortality rates and impose significant financial burdens. In this study, a machine learning-based prediction model was developed to identify patients at high risk of developing PPCs following laparoscopic hepatectomy. MethodsData were collected from 1022 adult patients who underwent laparoscopic hepatectomy at two centres between January 2015 and February 2021. The dataset was divided into a development set and a temporal external validation set based on the year of surgery. A total of 42 factors were extracted for pre-modelling, including the implementation status of Enhanced Recovery after Surgery (ERAS). Feature selection was performed using the least absolute shrinkage and selection operator (LASSO) method. Model performance was assessed using the area under the receiver operating characteristic curve (AUC). The model with the best performance was externally validated using temporal data. ResultsThe incidence of PPCs was 8.7%. Lambda.1se was selected as the optimal lambda for LASSO feature selection. For implementation of ERAS, serum gamma-glutamyl transferase levels, malignant tumour presence, total bilirubin levels, and age-adjusted Charleston Comorbidities Index were the selected factors. Seven models were developed. Among them, logistic regression demonstrated the best performance, with an AUC of 0.745 in the internal validation set and 0.680 in the temporal external validation set. ConclusionsBased on the most recent definition, a machine learning model was employed to predict the risk of PPCs following laparoscopic hepatectomy. Logistic regression was identified as the best-performing model. ERAS implementation was associated with a reduction in the number of PPCs.

Algorithm for the prevention of pulmonary complications after thoracic surgeries

Annotation. The biggest problem after operations on the thoracic cavity is the number of pulmonary complications (according to various authors 26-38% of cases). Despite the development of numerous methods for the prevention and treatment of these complications, they remain one of the leading causes of hospital mortality and may be an independent risk factor for worse long-term survival. Therefore, the aim of the work was to improve the results of treatment of patients after operations on the thoracic cavity by developing an algorithm for anesthesia for perioperative prevention of pulmonary complications. Participated in the study 192 patients with diseases of the thoracic cavity (esophagus, lungs, mediastinum), operated on in the thoracoabdominal department of the National Institute of Surgery and Transplantology named after O.O. Shalimov. Retrospective comparison group - 96 patients after thoracic surgery, which used conventional methods of perioperative management. The study group consisted of 96 patients after thoracic surgery, who used a perioperative anesthesia algorithm for the prevention of pulmonary complications. Statistical software EZR v. Was used for statistical calculations. 1.54 (graphical user interface for statistical software R version 4.0.3, R Foundation for Statistical Computing, Vienna, Austria). When conducting a multifactor analysis, it was found that the proposed method of prevention of pulmonary complications can reduce (p=0.001) the risk of development, HS=0.27 (95% CI 0.13-0.58) compared with the control group (with standardization by sex, weight, ASA of the patient). Pulmonary complications developed in 33 (34.4%) patients of the control group and in 13 (13.5%) patients of the study group, the difference was statistically significant, p=0.001. Thus, the application of the proposed technique reduces (p = 0.001) the risk of complications, BP=0.39 (95% CI 0.22 - 0.70) compared to traditional methods.

English

Liver disease and portal venous disease can present with a number of pulmonary complications, such as hepatic hydrothorax, hepatopulmonary syndrome and Portopulmonary hypertension (POPH). Porto-pulmonary hypertension is a rare but serious condition. Increased vascular pressure occurs due to progressive vasoconstriction, causing respiratory discomfort to the patient and ultimately progressing to right heart failure. Porto-pulmonary hypertension falls into World Health Organization (WHO) group 1 of pulmonary hypertension, indicating that the mechanism involved in the development of the disease is pulmonary vascular remodelling. It is the rarest of all pulmonary complications of liver disease, but perhaps the most destructive, as it is impossible to reverse the changes at the vascular level. Early diagnosis is essential to decrease mortality, and investigations, such as echocardiography and right heart catheterization are available. As POPH is uncommon, not much is known about its treatment. The best therapy is proper and timely management of portal hypertension, to prevent its occurrence altogether. We present a case of a 36-year-old female, who presented with features typical of portal hypertension, but on further examination, patient was found to have pulmonary hypertension as well. Imaging findings suggested non cirrhotic portal fibrosis to have caused portal hypertension, and eventually pulmonary hypertension.

Safety of Esophageal Cancer Surgery During the First Wave of the COVID-19 Pandemic in Europe: A Multicenter Study

BackgroundMany hospitals postponed elective surgical care during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. Some centers continued elective surgery, including esophageal cancer surgery, with the use of preoperative screening methods; however, there is no evidence supporting the safety of this strategy as postoperative outcomes after esophageal cancer surgery during the COVID-19 pandemic have not yet been investigated.MethodsThis multicenter study in four European tertiary esophageal cancer referral centers included consecutive adult patients undergoing elective esophageal cancer surgery from a prospectively maintained database in a COVID-19 pandemic cohort (1 March 2020–31 May 2020) and a control cohort (1 October 2019–29 February 2020). The primary outcome was the rate of respiratory failure requiring mechanical ventilation.ResultsThe COVID-19 cohort consisted of 139 patients, versus 168 patients in the control cohort. There was no difference in the rate of respiratory failure requiring mechanical ventilation (13.7% vs. 8.3%, p = 0.127) and number of pulmonary complications (32.4% vs. 29.9%, p = 0.646) between the COVID-19 cohort and the control cohort. Overall, postoperative morbidity and mortality rates were comparable between both cohorts. History taking and reverse transcription polymerase chain reaction (RT-PCR) were used as preoperative screening methods to detect a possible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in all centers. No patients were diagnosed with COVID-19 pre- or postoperatively.ConclusionEsophageal cancer surgery during the first wave of the COVID-19 pandemic was not associated with an increase in pulmonary complications as no patients were diagnosed with COVID-19. Esophageal cancer surgery can be performed safely with the use of adequate preoperative SARS-CoV-2 screening methods.

Use of early non-invasive artificial ventilation in full term newborns with moderate and severe hypoxic ischemic encephalopathy

The search for and use of alternative respiratory support strategies is promising to improve both close and distant nursing outcomes for newborns with hypoxic ischemic encephalopathy (HIE).Aim. To study the efficacy and safety of early extubation followed by non-invasive lung ventilation in premature infants with severe and moderate hypoxic ischemic encephalopathy.Materials and methods. A prospective, cohortal, randomized study was conducted, which included 60 full term babies. All patients were treated at the intensive care unit for newborns of the Regional Children’s Clinical Hospital in Zaporizhzhia with hypoxic ischemic encephalopathy (HIE) of II and III degree on the Sarnat scale and the presence of respiratory disorders and need for artificial lung ventilation (ALV). The main group included 30 (50 %) patients who in 72 hours after birth were undergoing early tracheal extubation and were transferred to noninvasive nasal lung ventilation with intermittent positive pressure (NIPPV). The comparison group was 30 (50 %) newborns who had a traditional P-SIMV artificial lung ventilation through an intubation tube until they regained consciousness, had no corns and had established a regular pattern of independent breathing.Results. When non-invasive NIPPV ALV was performed, the parameters that corresponded to the parameters of standard endotracheal ventilation were used, while the SpO2 level per day after the NIPPV mode was not significantly changed (P = 0.0765) in comparison with the traditional ALV. Respiratory support duration in patients transferred to NIPPV (P = 0.0004), duration of stay in beds of the intensive care unit (P = 0.0002) and in the in-patient department in general was significantly reduced (P < 0.0001). The total number of pulmonary complications in the main group decreased (P = 0.0487).Conclusions. Early tracheal extubation with subsequent non-invasive ALV can be safely and effectively used in practice to provide respiratory support to newborn infants with HIE. The proposed technique significantly affects the reduction of the total number of complications associated with ALV (P = 0.0375), which in turn reduces the stay of children on hospital beds (P < 0.0001).

Prophylactic penehyclidine inhalation for prevention of postoperative pulmonary complications in high-risk patients: study protocol of a randomized controlled trial

BackgroundPostoperative pulmonary complications (PPCs) are major causes of morbidity, mortality, and prolonged hospital stay in patients after surgery. Using effective strategies to prevent its occurrence is essential to improve outcome. However, despite various efforts, the incidence of PPCs remains elevated in high-risk patients. Anticholinergic inhalation is used to reduce high airway resistance and improve pulmonary function; it may be helpful to decrease the risk of PPCs. Penehyclidine is a long-acting anticholinergic agent which selectively blocks M1 and M3 receptors. We hypothesize that, in high-risk patients, prophylactic penehyclidine inhalation may decrease the incidence of PPCs.MethodsThis is a randomized, double-blind, placebo-controlled trial with two parallel arms. A total of 864 patients at high risk of PPCs will be enrolled and randomized to receive prophylactic inhalation of either penehyclidine or placebo (water for injection). Study drug inhalation will be administered from the night (7 pm) before surgery until the second day after surgery, in an interval of every 12 hours. The primary outcome is the incidence of PPCs within 30 days after surgery. Secondary outcomes include the time to onset of PPCs (from end of surgery to first diagnosis of PPCs), the number of PPCs (indicates the number of diagnosed individual PPCs), the incidence of postoperative extrapulmonary complications, the length of stay in hospital after surgery, and the 30-day all-cause mortality.DiscussionResults of the present study will provide evidence to guide clinical practice in using prophylactic inhalation of an anticholinergic to prevent PPCs in high-risk patients.Trial registrationThe study was registered prospectively in Chinese Clinical Trial Registry (www.chictr.org.cn, ChiCTR-IPC-15006603) on 14 May 2015 and retrospectively in ClinicalTrials.gov (NCT02644876) on 30 December 2015.

Do Changes in Perioperative and Postoperative Treatment Protocol Influence the Frequency of Pulmonary Complications? A Retrospective Analysis of Four Different Bariatric Groups.

The aim of this study was to observe how changes in perioperative and postoperative treatments affect the incidence of pulmonary complications in bariatric patients. This is a retrospective clinical study of 400 consecutive bariatric patients. The patients, who either underwent a sleeve gastrectomy or a Roux-en-Y gastric bypass, were divided consecutively into four subgroups with different approaches to perioperative treatment. The first group (patients 0-100) was recovered in the intensive care unit with minimal mobilization (ICU). They had a urinary catheter and a drain. The second group (patients 101-200) was similar to the first group, but the patients used a continuous positive airway pressure (CPAP) device intermittently (ICU-CPAP). The third group (patients 201-300) was recovered on a normal ward without a urinary catheter or a drain and used a CPAP device (ward-slow). The fourth group (patients 301-400) walked to the operating theater and was mobilized in the recovery room during the first 2h after the operation (ward-fast). CPAP was also used. Primary endpoints were pulmonary complications, pneumonia, and infection, non-ultra descriptus (NUD). The number of pulmonary complications among the groups was significantly different. A long operation time increased the risk for infection (p < 0.001 95% CI from 2.02 to 6.59%). Operation time increases the risk for pulmonary complications. Changes in perioperative care toward the ERAS protocol may have a positive effect on the number of pulmonary complications.

Short apical rib resections thoracoplasty compared to conventional thoracoplasty in adolescent idiopathic scoliosis surgery

To introduce a modified technique of thoracoplasty (short apical rib resection thoracoplasty (SARRT)) and compare its clinical, functional radiological outcomes and postoperative lung functions with conventional thoracoplasty (CT) in scoliosis surgery. Retrospectively review of adolescent idiopathic scoliosis patients who underwent corrective surgery with thoracoplasty from 2006 to 2010 was performed. Thoracoplasty was performed in 58 patients (CT in 31 and SARRT in 27 patients). 21 patients who underwent deformity correction only, without thoracoplasty were taken as control group (non-thoracoplasty, NT). To evaluate the outcome of SARRT, radiological parameters, pulmonary functions and clinical outcomes were compared among all the three groups. Age, sex and scoliosis types were evenly distributed between 3 groups (p = 0.66, 0.92, 0.31). Number of levels fused, change in Cobb angle, lordosis, kyphosis, coronal balance, sagittal balance, coronal translation and sagittal translation were not significantly different among the three groups (p > 0.05 for all). There was 38.6% improvement in rib hump in NT, 44.04% in CT and 60.9% correction in SARRT group. Pulmonary complications were significantly higher in the CT group, especially in view of pleural rupture, pulmonary effusion and intercostal neuralgia (p = 0.041, 0.029, 0.049). There was no difference among three groups in postoperative pulmonary function but the score of satisfaction as sub-category in SRS-22 questionnaire was decreased in CT groups (p = 0.046). SAART is effective in correcting the rib deformity without altering the pulmonary functions and SAART has less number of pulmonary complications as compared to CT.

Variations in the Vascular Endothelial Growth Factor Pathway Predict Pulmonary Complications

Clinical factors predicting pulmonary complications after lung resection have been well described, whereas the role of genetics is unknown. The vascular endothelial growth factor (VEGF) signaling pathway has been linked to acute lung injury. We hypothesized that genetic variations in this pathway may be associated with postoperative pulmonary complications after lung resection. One hundred ninety-six single nucleotide polymorphisms (SNPs) in 17 genes in the VEGF pathway were genotyped in a discovery set of 264 patients and a replication set of 264 patients who underwent lobectomy for lung cancer. Multivariable analysis adjusting for baseline clinical factors was used to identify SNPs associated with pulmonary complications. Cumulative and classification and regression tree (CART) analyses were used to further stratify risk groups. The overall number of pulmonary complications was 164/528 (31%). The effects of 6 SNPs were consistent in the discovery and replication sets (pooled p value<0.05). The rs9319425 SNP in the VEGF receptor gene FLT1 resulted in a 1.50-fold increased risk (1.15-1.96; p=0.003). A cumulative effect for the number of risk genotypes and complications was also evident (p<0.01). Patients carrying 5 risk genotypes had a 5.76-fold increase in risk (2.73-12.16; p=4.44×10(-6)). Regression tree analysis identified potential gene-gene interactions between FLT1:rs9319425 and RAF1:rs713178. The addition of the 6 SNPs to the clinical model increased the area under the receiver operating characteristic curve by 6.8%. Genetic variations in the VEGF pathway are associated with risk of pulmonary complications after lobectomy. This may offer insight into the underlying biological mechanisms of pulmonary complications.

Treatment of intractable pulmonary hemorrhage in two patients with childhood systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown etiology with multisystem involvement. A number of pulmonary complications including pleuritis, pneumonitis, infectious pneumonia, and pulmonary hemorrhage, have been reported in patients with SLE. Pulmonary hemorrhage is a major life-threatening manifestation in children and adolescents with SLE. Mycophenolate mofetil is an immunosuppressive agent used in solid organ transplantation, and it may play an increasing role in autoimmune disease. In this report, we present two cases of childhood SLE with recurrent pulmonary hemorrhage, which were unresponsive to treatment with high-dose corticosteroids, cytotoxic therapy, IVIG, plasmaphoresis, and supportive therapy, but responded to IV mycophenolate mofetil. A multimodal therapy including mycophenolate mofetil was effective in treatment of these two children.

Early Activation of Children Operated on under Extracorporeal Circulation

Objective: to study the safety and clinical and economic efficiency of early activation of children operated on under extracorporeal circulation (EC). Subjects and methods. Sixty-eight children aged 4—14 years (8.6±0.4 years) operated on under EC for congenital heart diseases (CHD) were examined. In accordance with the time of switching to spontaneous respiration and tracheal extubation, 2 groups were identified: 1) those who received postoperative artificial ventilation (AV) for 2.9±0.2 hours (a study group); 2) those who had AV for 8.7±0.7 hours (a control group). Both groups did not differ in age, cardiac diseases, their severity, anthropometric characteristics, EC duration, aortic ligation time, and abnormality pattern. In the study group, anesthesia was maintained with fentanyl (5.3±0.1 ^g/kg/hr), diazepam (0.15±0.01 mg/kg/hr), and inhaled ftorotan or enflurane. Diazepam was discontinued in the postperfusion period. The control group received fentanyl (7.6±0.4 ^Bg/kg/hr), diazepam (0.3±0.02 mg/kg/hr), droperidol (0.4±0.04 mg/kg/hr), and/or sodium oxybutyrate (81±5 mg/kg/hr). Myoplegia was provided by pancuronium or pipecuronium that was continuously infused until EC was completed in Group 1 and intermittently injected until the end of surgery in Group 2. Results. There were no indications for tracheal reintubation in both groups of patients. The early postoperative period was uncomplicated in 97.2% of the children in the study group and in 28.1% in the control group (p<0.05). The incidence of pulmonary complications was 2.8 and 46.9%, respectively (p<0.05). In the children from Groups 1 and 2, the duration of a resuscita-tive period was 44.2±1.7 and 77.3±4.9 hours, respectively (p<0.05), and that of the whole postoperative period was 12.6±0.3 and 18.0±1.1 days (p<0.05). In the study group, the total final expenditures, including the cost of anesthesia and treatment for postoperative complications, decreased by 127.5% as compared to the control group (p<0.05). Conclusion. Early activation causes a substantial reduction in the number of pulmonary complications and in the duration of all postoperative treatment stages in children with CHD, which permits the cost of cardiosurgery to be significantly decreased under the conditions of a regional clinical hospital. The procedure of total anesthesia that provides activation within 6 hours may be based on the use of the least expensive drugs (fentanyl, diazepam, ftorotan, pancuronium or pipecuronium). Key words: early activation, artificial ventilation, congenital heart diseases, pulmonary complications, cost effectiveness.

Efficacy of budesonide for prevention of bronchopulmonary dysplasia in premature newborns with different gestation age

Prematurely born children with severe respiratory distress-syndrome are at risk of bronchopulmonary dysplasia (BPD) development. Treatment of BPD is extremely difficult and sometimes non-effective; therefore, prevention of this disease is an actual problem. Efficacy of budesonide for BPD prevention in comparison to children not treated with this drug has been proven in recent studies but its action differed according to the gestation age and body weight. The present study was aimed to compare efficacy of inhaled budesonide in newborns with various gestation ages. To evaluate the efficacy of the therapy, all the children involved in the study were divided into 2 groups: 18 children with the body weight &gt;1500 g and gestation age of &gt; 31 weeks (the 1st group) and 21 children with the body weight &lt; 1500 g and the gestation age of &gt; 30 weeks (the 2nd group). Budesonide was given via a nebulizer 400 μg b.i.d. for 15 days. We assessed FiO 2 in the gas mixture, maximal pressure within mechanical ventilation, the mean pressure in the airways, index of the lung injury, dynamical extension of the chest — lung system. The systemic haemodynamics, carbohydrate metabolism, length of mechanical ventilation and of oxygen therapy, and number of complications were also evaluated. The study demonstrated that inhaled budesonide as a preventive measure against BPD was the most effective in premature newborns with gestation age of &lt; 30 weeks. This drug has not affected the systemic haemodynamics nor carbohydrate metabolism. As a result, number of pulmonary complications and time of treatment in the ICU were reduced.

Is high PEEP low volume ventilation in burn patients beneficial?: A retrospective study of 61 patients

In burn care lung damage by inhalation injury is a major cause of mortality in burn patients. In the field of intensive care medicine ventilation strategies to reduce lung injury caused by ventilation are under investigation. The promising results of the application of pressure controlled high PEEP low volume (HPLV) ventilation prompted us to use this ventilation strategy in our burn ICU. To establish whether this ventilation regime is beneficial the charts of 61 consecutive patients needing artificial respiration were reviewed. A scoring system for PEEP level and tidal volume was developed and treatment groups with high PEEP and low volume and low PEEP high volume regimes were compared. No statistically significant differences could be found when comparing treatment versus mortality, the number of pulmonary complications or incidence of pneumothoraces. However, the trend showed a benefit in mortality for patients with an ABSI scoring up to 9, but at the same time pulmonary complications increase. The Horovitz oxygenation index showed no advantage for the HPLV Group. In a separate analysis we found a significant correlation between absolute PEEP and mortality. The correlation between PEEP level and mortality is a dynamic factor predicting outcome, This not been described yet and can be an addition to the static ABSI score. Differences between ventilation strategies were not as evident as expected in this retrospective study, so prospective randomized studies are needed.

Comparison between the transabdominal and retroperitoneal approaches for aortic reconstruction in patients at high risk

Purpose: The purpose of this study was to compare the transabdominal approach with the retroperitoneal approach for elective aortic reconstruction in the patient who is at high risk. Methods: From January 1992 through January 1997, 148 patients underwent aortic operations: 92 of the patients were classified as American Society of Anesthesia (ASA) class IV. Forty-four operations on the patients of ASA class IV were performed with the transabdominal approach (25 for abdominal aortic aneurysms and 19 for aortoiliac occlusive disease), and 48 operations were performed with the retroperitoneal approach (27 for abdominal aortic aneurysms and 21 for aortoiliac occlusive disease). There were no significant differences between the groups for comorbid risk factors or perioperative care. Results: Among the patients of ASA class IV, eight (8.7%) died after operation (retroperitoneal, 3 [6.26%]; transabdominal, 5 [11.3%]; P = .5). There was no difference between groups in the number of pulmonary complications (retroperitoneal, 23 [47.9%]; transabdominal, 19 [43.2%]; P = .7) or in the development of incisional hernias (retroperitoneal, 6 [12.5%]; transabdominal, 5 [11.3%]; P = .5). The retroperitoneal approach was associated with a significant reduction in cardiac complications (retroperitoneal, 6 [12.5%]; transabdominal, 10 [22.7%]; P = .004) and in gastrointestinal complications (retroperitoneal, 5 [8.3%]; transabdominal, 15 [34.1%]). Operative time was significantly longer in the retroperitoneal group (retroperitoneal, 3.35 hours; transabdominal, 2.98 hours; P = .006), as was blood loss (retroperitoneal, 803 mL; transabdominal, 647 mL; P = .012). The patients in the retroperitoneal group required less intravenous narcotics (retroperitoneal, 36.6 ± 21 mg; transabdominal, 49.5 ± 28.5 mg; P = .004) and less epidural analgesics (retroperitoneal, 39.5 ± 6.4 mg; transabdominal, 56.6 ± 9.5 mg; P = .004). Hospital length of stay (retroperitoneal, 7.2 ± 1.6 days; transabdominal, 12.8 ± 2.3 days; P = .024) and hospital charges (retroperitoneal, $35,587 ± $980; transabdominal, $54,832 ± $1105; P = .04) were significantly lower in the retroperitoneal group. The survival rates at the 40-month follow-up period were similar between the groups (retroperitoneal, 81.3%; transabdominal, 78.7%; P = .53). Conclusion: In this subset of patients who were at high risk for aortic reconstruction, the postoperative complications were common. However, the number of complications was significantly lower in the retroperitoneal group. Aortic reconstruction in patients of ASA class IV appears to be more safely and economically performed with the retroperitoneal approach. (J Vasc Surg 1999;30:400-6.)

Reconstructive spine surgery in pediatric patients with major loss in vital capacity.

Thirty-two pediatric patients with severe restrictive lung disease identified with vital capacities < 40% of predicted, who had undergone major reconstructive spine surgery, were reviewed. There were 18 boys and 14 girls, the mean age was 13 years (range, 7-17), and the mean vital capacity was 31% of predicted (range, 16-39%). Fifty-four procedures were performed, 13 posterior only, one of which was staged, and 19 anterior and posterior procedures, of which 15 were staged and four were sequential. The incidence of pulmonary complications (pneumonia, reintubation, pneumothorax, respiratory arrest, or the need for tracheostomy) was 19% (six patients), and only three patients required tracheostomy. The surgical and perioperative mortality rate was zero. Patients who had a thoracotomy or a thoracoabdominal approach had a significantly higher number of pulmonary complications. The use of preoperative decreased vital capacity as a measure of inoperability excludes the young patient most in need of surgical intervention. With improved preoperative, intraoperative, and postoperative techniques, careful monitoring, and the cooperation of pediatric pulmonologists and intensivists, reconstructive spine surgery can be performed in the pediatric patient with severe decreased vital capacity with very acceptable morbidity and mortality.

Thoracoscopic pericardiectomy for effusive pericardial disease

Thoracoscopic techniques were used to perform a pericardiectomy in 35 patients with purely effusive pericardial disease after medical management and pericardioceniesis had failed to be effective. There were no intraoperative complications and postoperative complications were few. Two cases of dysrhythmia and 2 cases of pneumonia occurred postoperatively. Malignancy was identified as the cause in 18 patients and there were benign causes in the remaining 17. The hospital stay in the group with benign effusions was 4.6 days. There were no recurrences of pericardial effusions and no constrictive changes developed during a mean follow-up of 9 months. Fourteen (40%) patients had pleural or pulmonary abnormalities that were managed simultaneously thoracoscopically. These abnormalities included 2 pleural masses, 2 pulmonary nodules, and 12 pleural effusions. In 8 instances, the pericardiectomy was performed from the right pleural cavity in order to address the pleural or pulmonary problem. Thoracoscopic pericardial resection has proved safe and effective. It allows a wider pericardial resection than that usually permitted by the subxiphoid route, and should lessen the pain and the number of pulmonary complications, compared with open thoracotomy. An additional advantage is that it allows the visualization and management of simultaneous pleural and pulmonary abnormalities.

Radiological aspects of the pulmonary complications resulting from intermittent positive pressure ventilation (I.P.P.V.).

SummaryThe use of intermittent positive pressure ventilation is associated with a number of pulmonary complications which are of radiological importance. These complications are grouped into three categories.In the first category are cases of asthma which require resuscitation with intermittent positive pressure ventilation. These cases may develop severe air trapping which can progress to pulmonary interstitial emphysema, although the latter complication is known to develop without a respirator being used. The second category includes pulmonary oedema, and there is brief reference to the effects of oedema of the bronchial mucosa. In an appendix to the paper the possible relationship of pulmonary oedema to the body handling of salt and water when intermittent positive pressure ventilation is used is examined. The analysis of accurately recorded fluid balance data did not reveal any statistical association between the retention of sodium, potassium or water, or any combination of these three and the presence of pulmonary oedema. The third category is represented by the serious condition of obliterative pneumonitis (respirator lung syndrome).In all three categories the clinical and radiological findings and, where relevant, the pathological findings, are described.During the year 1967 it was found that of a total of 267 admissions five developed pulmonary interstitial emphysema, four during intermittent positive pressure ventilation therapy. Two died. Sixty‐nine cases (26%) developed pulmonary oedema, and in 15 cases there seemed no adequate explanation for the oedema other than factors associated with the use of a respirator. The number of cases of pulmonary oedema closely related to the use of intermittent positive pressure ventilation is considered to be higher than 15, however. Two adults and two children under 10 years of age developed fatal obliterative pneumonitis confirmed by necropsy.