Tube Removal Research Articles

Combined effects of reflexology massage and respiratory relaxation on pain following chest tube removal in heart surgery patients

Background and aimRemoving the chest tube in cardiac patients after surgery is one of the worst experiences of hospitalization in the intensive care units. Various pharmacological and non-pharmacological methods are available to control pain in these patients. This study aimed to investigate the combined effect of reflexology massage and respiratory relaxation on pain following chest tube removal in cardiac surgery patients of Shahid Beheshti Hospital in Shiraz, Iran, in 2023.MethodsThis was a double-blind randomized clinical trial performed on 140 patients who underwent heart surgery and had a chest tube in Shiraz, Iran. The samples were randomly divided into four groups: 1- control group, 2- respiratory relaxation group, 3- foot reflex massage group, and 4- a combination of respiratory relaxation and reflexology massage. To collect data, two demographic questionnaires, and a visual analog scale were used.ResultsThe participants of the four groups were not meaningfully different in terms of age, BMI, duration of surgical operation, gender, job, education, place of residency, number of chest tubes, history of operation (P = 0.99, 0.31, 0.06, 0.81, 0.97, 0.96, 0.17, 0.10, 0.89 respectively). The mean scores of pain intensity during chest tube removal, and 15 min after chest tube removal were not statistically different among the four groups of study (P = 0.15, 0.54 respectively); However, just after chest tube removal, the mean scores of pain intensity differed meaningfully among four groups (P = 0.008).ConclusionThe results showed that reflexology massage and respiratory relaxation both reduce pain immediately after chest tube removal in heart surgery patients. Also, the combination of these two techniques was more effective in reducing patients’ average pain.

Understanding the Current Practice in Chest Tube Management Following Lung Resection-A Canadian National Survey.

Timing of chest tube removal post lung resection is variable in practice and often based on personal experience rather than evidence. The current practice in chest tube management among thoracic surgeons across Canada is so far unknown. Our primary aim was to assess the current status of chest tube removal in Canada in order to uncover potential shortcomings. An online anonymous survey was emailed to members of Canadian Association of Thoracic Surgeons in order to better understand the status quo of the chest tubes' removal policy in the different departments preparing the grounds for suggesting a future uniformity. Data were collected and analysed with descriptive statistics. A linear regression analysis was performed in order to understand the factors related to chest tube removal. Sixty responses were received (44.4% response rate). Most surgeons place a single chest tube in both open (75%, 45/60) and minimally invasive lobectomies (93.3%, 56/60). Digital drainage systems are used by half of the surgeons surveyed. A quarter of the respondents report removing chest tubes regardless of drainage output. This practice was independent of the surgeons' number of years in practice (p = 0.127), number of lobectomies performed annually (p = 0.877), proportion of lobectomies performed minimally invasively (p = 0.259), whether digital drainage system is used (p = 0.141) and whether the surgeon is aware of the Enhanced Recovery after Surgery (ERAS) guideline (p = 0.374). Of those who remove chest tubes based on fluid output, thresholds vary widely; a significant proportion (86%, 37/43) uses a volume lower than the 450 mL/24 h threshold set out ERAS. Most respondents (77%) were interested in a clinical trial studying chest tube removal independent of drainage volume. This study demonstrated ongoing diverse practice amongst thoracic surgeons in Canada with regards to post-operative chest tube management, indicating a much-needed area of research.

Life-threatening Lymphatic Malformation With Somatic Activating NRAS Mutation Successfully Treated With Trametinib: A Case Study.

Kaposiform lymphangiomatosis (KLA) is a rare and aggressive subtype of complex lymphatic anomalies (CLA), characterized by abnormal lymphatic proliferation leading to distinct clinical manifestations. Despite the complexity of this condition, there is no established standard therapy, and treatment options such as sclerotherapy, laser therapy, and surgery remain variably effective and are limited to symptom management rather than curative. Sirolimus, an mTOR pathway inhibitor, has shown promise as a primary therapy, particularly in patients without a driver mutation. However, in some instances, the genetic landscape of KLA has revealed somatic mutations in the RAS-MAPK pathway, most notably the NRAS variant (c.182A>G, p.Q61R), representing a potential therapeutic target. We present a case of a 4-year-old male who presented with pericardial and pleural effusions without notable coagulopathy found to harbor an NRAS p.Gln61Arg gene mutation, diagnosed through next-generation sequencing (NGS) analysis. Initial therapy with sirolimus failed to provide optimal benefit with persistent pleural effusion. Subsequent treatment with the MEK inhibitor trametinib led to significant clinical improvement, evidenced by the resolution of effusions and removal of the chest tube. In the short term, no significant adverse effect was reported. Our findings underscore the value of genomic profiling in guiding personalized treatment strategies for rare and complex diseases presenting like KLA. This case highlights the potential of targeted therapies, such as trametinib, in improving clinical outcomes for patients with disease with activating NRAS variants, emphasizing the importance of ongoing research to validate and expand these therapeutic approaches in the management of vascular anomalies.

Outcomes and Complications of Ahmed Glaucoma Valve Implantation in Neovascular versus Other Secondary Glaucoma: A One-Year Follow-up Study

Purpose: To compare the visual outcomes and intraocular pressure between patients with neovascular glaucoma (NVG) and other secondary glaucoma (OSG) one year after Ahmed glaucoma valve (AGV) implantation. Study design: Retrospective study. Place and Duration of Study: Islamic International Medical College/Railway Hospital Westridge Rawalpindi, from January 2015 to January 2022. Methods: Ahmed glaucoma valve (model FP7) was implanted in 54 patients with NVG and OSG. The preoperative and post-operative vision and IOP was compared between the two groups with one year follow up. Success was defined as IOP of 5-21 mmHg without topical therapy (complete success) or with topical therapy (qualified success), no loss of light perception and not requiring subsequent glaucoma surgery or tube removal. Results: After one year, the mean postoperative vision improved to 0.9385 from 1.25 LogMAR in NVG group and to 0.8143 from 0.8500 LogMAR in OSG group. The mean IOP reduced from 41.69 to 16.27mmHg in NVG group. While in OSG group it reduced from 33.39 to 12.857 mmHg one year postoperatively (p-value 0.0001). Hyphema was the commonest complication in NVG and hypertensive phase in the OSG. NVG group showed complete success in 2, qualified success in 18 and failure in 6 cases. In the second group, complete success was seen in 8, qualified success in 18 and failure in 2 cases. Conclusion: Ahmed glaucoma valve implantation is effective in saving useful vision andcontrolling IOP in majority of refractory glaucomas and the results are comparable between neovascular and other secondary glaucomas.

Developing a predictive model for delayed healing of esophagojejunal anastomotic fistula following total gastrectomy based on imaging and clinical inflammatory-nutritional status.

Esophagojejunal anastomotic fistula (EJF) following radical total gastrectomy is a severe perioperative complication in patients with gastric cancer, particularly as delayed fistula healing increases hospitalization costs and leads to poor prognosis. Numerous factors influence the occurrence and progression of EJF, with inflammation and nutritional status being significant contributors to perioperative complications. Therefore, this study aims to investigate the prediction of delayed EJF healing based on postoperative clinical and imaging-related inflammation-nutrition status. We retrospectively collected data on 315 cases of EJF following radical total gastrectomy for gastric cancer from two centers between 2015 and 2023 (training group: center one with 194 cases, validation group: center two with 121 cases). EJF was diagnosed based on clinical presentation, gastrointestinal imaging, or endoscopic findings. The healing time for EJF was defined as the period from diagnosis to the removal of the abdominal drainage tube, and patients were categorized into early healing and delayed healing groups based on the median healing time. Postoperative abdominal computed tomography(CT) scans and clinical characteristics at the time of EJF diagnosis were collected. Univariate and multivariable logistic regression analyses were performed on the training group data to construct a predictive model (nomogram). The model's performance in both the training and validation groups was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC), calibration curves, and decision curve analysis (DCA). The mean healing time for EJF was 16 ± 7 days (median time: 12 days, range: 4-43 days). Postoperative systemic immune-inflammation index (SII) > 521×10ˆ9/L, controlling nutritional status score (CONUT) > 4, nutritional support method, visceral fat index (VFI) < 74.42 cm2/m2, and skeletal muscle index (SMI) < 41.25 cm2/m2 were associated with delayed EJF healing times. A comprehensive model was developed, in the validation group, the model demonstrated an AUC of 0.838 (95% confidence interval (95% CI): 0.763-0.912). The DCA and calibration curves indicated a strong predictive consistency and clinical utility of the model.

Prevention of unplanned extubation in neonatal patients: Protocol for a systematic review and meta-analysis.

Unplanned extubation (UPE), defined as accidental removal of the endotracheal tube during mechanical ventilation or its replacement due to suspected obstruction or inadequate diameter, is considered the fourth most common adverse event in neonatal intensive care units (NICU). This study aimed to describe a systematic review and meta-analysis protocol that will identify and assess the effect of primary intervention measures designed to prevent UPE in NICU. A search will be carried out in the following databases: PubMed/Medline, EMBASE, Scopus, CINAHL, Cochrane Library, SciELO, and LILACS. Reviewers, in pairs and independently, will select the studies, perform data extraction and assess the methodological quality of the included studies using preestablished tools according to the type of study. The systematic review will provide evidence to present the main intervention measures used in the prevention of UPE during the care of critical neonatal patients. The systematic review and meta-analysis resulting from this protocol may provide important information regarding UPE in the neonatal population, which will help with decision-making and the implementation of safer clinical practices that focus on the reduction of adverse events, contributing to the improvement of service management and the safety of neonatal patients.

Guidelines for safe extubation and respiratory rehabilitation in the intensive care unit

Safe extubation and effective respiratory rehabilitation are pivotal in the recovery of critically ill patients in the intensive care unit (ICU). Extubation readiness is determined by assessing respiratory function, airway patency, neurological status, and hemodynamic stability. Tools such as spontaneous breathing trials (SBTs) and the cuff leak test provide valuable insights, while neurological and hemodynamic evaluations further guide decision-making. Ensuring the resolution of the primary illness is critical to minimize the risk of extubation failure and its associated complications. The process of extubation involves meticulous preparation and technique to ensure a smooth transition from mechanical ventilation. Pre-extubation interventions, including secretion management and corticosteroid administration for high-risk patients, are vital. Techniques like gradual cuff deflation and tube removal during peak inspiration, coupled with positioning strategies, reduce complications such as aspiration and airway obstruction. Post-extubation respiratory support, including high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV), plays a crucial role in stabilizing high-risk patients and preventing reintubation. Rehabilitation strategies focus on early mobilization, inspiratory muscle training, and pulmonary physiotherapy to enhance recovery and prevent long-term sequelae. Nutritional optimization is emphasized to counteract muscle weakness and promote tissue repair. Continuous monitoring for respiratory distress and addressing psychological impacts, such as post-intensive care syndrome (PICS), are integral to comprehensive care. Evidence-based protocols, individualized care plans, and multidisciplinary collaboration are essential to improving patient outcomes and reducing ICU-related morbidity and mortality.

Robotic-assisted Kasai portoenterostomy for child biliary atresia.

The Kasai procedure (KPE) is an important treatment for biliary atresia (BA), the most common cause of neonatal obstructive jaundice. To investigate the efficacy of robotic-assisted Kasai portoenterostomy (RAKPE) in patients with BA. Clinical data of 10 patients with BA who underwent RAKPE at the Seventh Medical Center of the People's Liberation Army General Hospital between December 2018 and December 2021 were retrospectively analyzed. One patient underwent Open Kasai portoenterostomy (OKPE) due to intraoperative bleeding. Consequently, nine patients were included in this study. Fifty-two patients who underwent OKPE during the same period served as the control group. Preoperative and postoperative biochemical indexes, surgery-related indexes, and postoperative clearance of jaundice (CJ) were recorded and statistically analyzed. RAKPE was successfully completed in all nine patients, with an average total operative time of 352.2 minutes (including intraoperative cholangiography). Milk feeding resumed on an average 9.89 days postoperatively, and the average time of drainage tube removal was 18.11 days. All patients were followed up for 6 months to 2 years. The liver function indicators and bilirubin levels in 8 patients returned to normal within 3 months after surgery. Three patients developed recurrent cholangitis after discharge, with elevated white blood cell counts, liver function indicators, and bilirubin levels, requiring hospitalization for intravenous antibiotic treatment. The duration of cholangitis ranged from 5 to 8 months post-surgery. To date, no subsequent cases of cholangitis have occurred. All patients have normal liver function and bilirubin levels, with no intrahepatic bile duct dilatation on ultrasonography. Statistical analysis comparing these indicators with those of patients who underwent OKPE showed that the RAKPE group had longer operative times and postoperative drainage tube removal durations. However, there were no significant differences in intraoperative blood loss, postoperative oral milk intake resumption, postoperative hospital stay, or CJ at 3 months post-surgery. RAKPE is technically feasible, safe, and effective for treating BA. Once the technique is mastered, RAKPE may achieve CJ outcomes comparable to those of OKPE.

Efficacy of oral modafinil on accelerating consciousness recovery in adult patients with moderate to severe acute traumatic brain injury admitted to intensive care unit: a randomized double-blind clinical trial.

Traumatic Brain Injury (TBI) is a leading cause of hospitalization and disability in young and middle-aged adults. This study aims to survey the efficacy of oral modafinil, a low-side-effect central nervous system stimulant, in the enhancement of consciousness recovery in moderate to severe TBI patients in the ICUs of a referral trauma center. All ICU patients meeting inclusion criteria between April 2021 and April 2023 were screened. Eligible patients had a motor Glasgow Coma Score(GCS) of 4 or 5 and did not receive continuous intravenous sedatives within 24 h before screening. They were randomly assigned to receive 200mg of enteral modafinil or placebo daily for 7 days. Motor GCS and total GCS scores, ICU/hospital stay duration, mechanical ventilation requirement, tracheal tube removal time, and tracheostomy needs were recorded. Among the included 85 eligible patients, there was no significant difference between the modafinil and placebo groups in the median days between the intervention and the time of a 2-unit increase in total GCS (P = 0.25) or a 1-unit increase in motor GCS (P-value = 0.31). The group assignment also had no impact on the mean GCS (P-value = 0.533) and mean motor GCS (P-value = 0.167) over time. The only significant difference was in the proportion of patients with an increase in total GCS by 2 units, which was 54% for the modafinil vs. 32% for the placebo group (P-value = 0.04), and an increase in motor GCS by 1 unit, with 56% in the modafinil vs. 34% in the placebo group (P-value = 0.04). The administration of modafinil appears to be safe and beneficial for patients with severe TBI during their stay in the ICU.

Patient and Surgeon Attitudes Toward Opportunistic Salpingectomy During Nongynecological Surgeries for the Prevention of Ovarian Cancer: A Qualitative Study

ABSTRACTBackground and ObjectivesOpportunity salpingectomy (OS), or prophylactic removal of the fallopian tubes during an operation for another indication, is broadly accepted as a risk‐reduction strategy for ovarian cancer during gynecological operations. However, OS during nongynecological abdominal surgery is rare in the United States. A better understanding of surgeon and patient attitudes and perceived barriers to OS during nongynecological surgeries may facilitate implementation in the United States.Study DesignQualitative interviews were conducted with general surgeons (n = 10), gynecologic surgeons (n = 10), and patients (n = 20) to assess perspectives and barriers towards OS during nongynecological surgeries. Interviews were transcribed and inductive analysis was carried out to identify themes and categorize responses using NVivo data analysis software.ResultsOS during nongynecological surgery was viewed favorably by most patients and surgeons interviewed. While patients emphasized the importance of raising awareness of OS, both subsets of surgeons highlighted coordination, counseling, and billing barriers that would need to be overcome for efficient implementation.ConclusionOS was positively accepted by both patients and surgeons in our cohort. Improved attention to the shared barriers to implementation from our study may facilitate OS implementation during nongynecological surgery in the United States.

Enhanced recovery after surgery pathway reduces back pain, hospitalization costs, length of stay, and satisfaction rate of lumbar tubular microdiscectomy: A retrospective cohort study.

Tubular microdiscectomy is one of the most commonly performed surgical procedures for lumbar disc herniation (LDH). This study aimed to investigate the effectiveness of the enhanced recovery after surgery (ERAS) pathway for microdiscectomy in improving perioperative clinical outcomes in patients with LDH. This study retrospectively analyzed the prospectively collected perioperative outcomes of patients in pre-ERAS (January 2020 to December 2021) and post-ERAS (January 2022 to September 2023) groups. Length of stay was the primary outcome measure, while secondary outcome measures included operative time, estimated blood loss (EBL), postoperative first ambulation time, postoperative drainage volume, drainage tube removal time, complication rate, hospitalization cost, perioperative visual analog scale (VAS) scores for leg pain and low back pain (LBP), readmission rate within 30 days, and patient satisfaction rate. No significant differences in baseline parameters, including sex, age, body mass index, preoperative VAS scores for leg pain and LBP, and comorbidities, were observed between the groups. Additionally, operative time, complication rates, and 30-day readmission rates did not differ significantly between the groups. However, the post-ERAS group exhibited significantly lower length of stay compared to the pre-ERAS group (5.1 ± 1.2 vs 6.2 ± 1.6, P < .001). Additionally, the estimated blood loss (P < .001), drainage tube removal time (P < .001), postoperative drainage volume (P = .002), postoperative first ambulation time (P < .001), and hospitalization costs (P = .032) in the post-ERAS group were significantly lower in the pre-ERAS group. Furthermore, the LBP VAS score was significantly lower on the first day (P = .001) and third days (P = .002) postoperatively in the post-ERAS group, whereas the patient satisfaction rate on the first day (P = .036) postoperatively was significantly higher in the pre-ERAS group. Compared with the conventional pathway, the ERAS pathway in tubular microdiscectomy is associated with better perioperative clinical outcomes in patients with LDH.

Effect of auricular point pressure on anaesthetic recovery in the patients undergoing laparoscopic cholecystectomy: a randomized controlled trial

To explore the effect of auricular point pressure on anesthetic recovery in the patients undergoing laparoscopic cholecystectomy. One hundred and forty patients undergoing laparoscopic cholecystectomy were randomized into a trial group (52 cases, 2 cases dropped out) and a control group (52 cases, 2 cases were eliminated). In the control group, the conventional anesthesia program and recovery intervention were adopted. In the trial group, on the basis of the regimen as the control group, the intervention of auricular point pressure was supplemented. The auricular points on the right side were selected, including sympathetic (AH6a), brain (subcortex, AT4), thalamus, exciting point, heart and sore center. One day before operation, the auricular point pressure started; and the auricular points were stimulated specially before anesthesia (T0), at the moment of operation ending (T1), when entering the recovery room, at the moment of the tube removal (T2) and in 10 min of the tube removal (T3), respectively; each auricular point was pressed for 1 min a time. The recovery time of spontaneous breathing, the time of eye opening, the removal time of endotracheal tube, the recovery time of orientation, and the time of exiting recovery room were compared between the two groups. The score of pain visual analogue scale (VAS) and that of Richmond agitation-sedation scale (RASS) at T2, T3 and when exiting recovery room (T4), and the relevant circulatory indexes (heart rate [HR], systolic blood pressure [SBP], diastolic blood pressure [DBP] and mean arterial pressure [MAP]) at T0, T1, T2 and T3 were observed in the two groups. In the trial group, the recovery time of spontaneous breathing, the time of eye opening, the removal time of endotracheal tube, the recovery time of orientation, the time of exiting recovery room were shorter than those of the control group (P<0.01, P<0.05). The pain VAS and RASS scores at T2, T3 and T4, as well as HR, SBP, DBP and MAP at T0, T1, T2 and T3 were not different statistically between the two groups (P>0.05). Auricular point pressure can shorten the recovery time from anesthesia in the patients undergoing laparoscopic cholecystectomy.

Heart Disease and Pectus Excavatum: An Underestimated Issue-Single Center Experience and Literature Review.

Pectus excavatum (PE) can be associated with either congenital or acquired heart disease. This study highlights the importance of PE surgical repair in cases of severe chest depression on the heart in underlying cardiac diseases exacerbating cardiopulmonary impairment. From January 2023 to March 2024, four male patients underwent PE repair, having heart disease including pericarditis, mitral valve prolapse, ventricular fibrillation arrest and type 1 second-degree atrioventricular block. PE severity was determined by the Haller index (HI). Preoperative assessment included a pulmonary function test, chest computed tomography and cardiac evaluation. The Nuss procedure was performed in three patients, whereas, in one patient, it was performed in combination with a modified Ravitch procedure. The median HI was five. The median time of chest tube removal was 6.5 days. Postoperative complications were prolonged air leak, atrial fibrillation and atelectasis. The median length of hospital stay was 19.5 days, and no 30-day postoperative mortality was recorded. In all patients, surgical repair helped to resolve the underlying cardiological issues, and surgical follow-ups were deemed regular. PE is generally an isolated congenital chest wall abnormality, and, when associated with a heart disease, it can have severe life-threatening hemodynamic consequences due to mechanical compression on the heart for which surgical corrections should be considered.

The Effect of Acupressure on Pain Associated with Chest Tube Removal in Patients with Chest Trauma

Background: Inserting a chest tube is a life-saving procedure for patients with chest trauma, but it is often associated with significant pain. To alleviate this discomfort, non-pharmacological methods such as acupressure can be employed. Therefore, this study aimed to determine the effect of acupressure on pain during chest tube removal in patients with thoracic trauma. Methods: This quasi-experimental study involved the selection of 204 patients with chest tubes following chest trauma in Zahedan in 2022. The through patients were selected purposefully and Non-random allocation divided into two intervention and control groups of 102 people. The intervention group received acupressure treatment, while the control group did not. Pain levels of the patients were measured using a pain intensity scale on both the day of chest tube insertion and the day of removal. The data were analyzed using statistical test such as independent-t, paired-t and chi-square statistical tests within the SPSS 26 software. Results: The normality of the main variable was assessed using the Kolmogorov-Smirnov (KS) test. The significance level for the pain variable was found to be less than 0.05 (P&lt;0.001), indicating a non-normal distribution. Therefore, the Mann-Whitney U test was utilized for data analysis. The results of the Mann-Whitney test revealed that before the intervention, the mean pain scores were 9.46±0.69 in the intervention group and 9.47±0.65 in the control group. After the intervention, the mean pain scores were 7.11±0.98 in the intervention group and 9.39±0.90 in the control group. Based on the Mann-Whitney U value obtained from the comparison of the two groups before and after the intervention, it can be concluded that the intervention had a significant effect on reducing pain (Table 2). Conclusion: The insertion and removal of chest tube after trauma can be an extremely painful experiences for individuals. Considering the crucial role of nurses, non-pharmacological methods such as acupressure can be used to alleviate their pain. Acupressure is a cost-effective, accessible, and readily available approach that can be utilized in this context.

Longitudinal Trends in the Incidence of Hyperactive Delirium and Its Causes of Change After Surgery for Degenerative Lumbar Disease: A Population-Based Study of 7250 Surgical Patients Over 11 Years.

Delirium is one of the common complications in elderly patients after spinal surgery. Severe delirium can lead to a series of adverse consequences such as drainage tube removal, wound rupture, patient falls, and severe adverse effects. The current research on POD is mostly small sample studies. This study aimed to investigate longitudinal changes in the incidence of hyper-postoperative delirium in patients with lumbar degenerative disease at our institution over the past 11 years and to identify the potential causes of these changes. This is a retrospective cohort study included 7250 patients who underwent surgical treatment for lumbar degenerative diseases at a single center from 2011 to 2021. These patients were diagnosed with delirium through the Confusion Assessment Method and then diagnosed with high activity delirium through the Richmond Agitation-Sedation Scale, totaling 130 cases. According to the incidence rate of hyper-postoperative delirium within 11 years, the trend test is divided into three groups: S1 upward trend (2011-2014), S2 downward trend (2015-2016) and S3 upward trend (2016-2021). The study collected variables from patients before, during, and after surgery, including gender, age, laboratory tests, anesthesia risk score, New York Heart Association cardiac function grading, number of surgical segments, surgical time, estimated intraoperative blood loss, anesthesia medication, and supplementary analgesic medication in the ward within 3 days after surgery. Kruskal Wallis one-way ANOVA test, Kruskal-Wallis H test, or chi-square test are used to evaluate inter group differences. p < 0.05 is considered statistically significant. The pooled incidence of hyper-postoperative delirium over the past 11 years was 1.79% (130/7250). The average age of 7250 patients was 54.5 ± 13 years, with a male/female ratio close to 1:1. We statistically analyzed the relevant influencing factors before, during, and after surgery of S1 and S3 in the incidence rate increase group and found no statistical difference between the two groups. Our research results show that the incidence of high activity delirium is correlated with age, number of surgical segments, surgical duration, use of dexmedetomidine, remifentanil, and benzodiazepines, with p < 0.05. The reduced use of dexmedetomidine, increased use of benzodiazepines, and prolonged surgical time are the reasons for the increased incidence of hyper-postoperative delirium. The joint management of orthopedic surgeons and anesthesiologists during the perioperative period is of great significance in reducing the incidence of hyper-postoperative delirium in patients undergoing lumbar spine surgery.

Study on the role of postoperative rehabilitation based on the ERAS concept for patients undergoing pancreaticoduodenectomy: Protocol for a randomized controlled clinical trial.

Pancreaticoduodenectomy (PD), an abdominal surgery, is known for its complexity, cost and inherent risks. Recently, there has been increasing interest in enhanced recovery after surgery (ERAS) as a therapeutic approach. However, the mechanisms underlying postoperative functional recovery remain uncertain, and there are limited data on the efficacy of ERAS in postoperative physiotherapy following complex PD. This study aims to examine the feasibility and effectiveness of conducting a large powered randomized controlled trial (RCT) to evaluate a 2-week postoperative rehabilitation program based on the ERAS concept for patients undergoing pancreaticoduodenectomy. This study is a RCT with a single treatment group. From June 2022 to June 2024, 28 PD patients will participate in the trial. Patients will be randomly assigned to either a control group receiving standard clinical care or an intervention group undergoing a 2-week postoperative rehabilitation program. Cardiopulmonary function will be assessed using the 6-minute walk test (6MWT), and gastrointestinal (GI) recovery will be evaluated using the Intake, Feeling nausea, Emesis, physical Exam, and Duration of symptoms (I-FEED) scoring system. Secondary outcomes, including changes in recovery quality post-surgery, will be evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) and the Quality of Recovery Questionnaire (QOR-40). Additional recorded items will include time to first flatus and feces, daily volume of stomach fluid, time to gastric tube removal, length of hospital stay (LOS), and postoperative complications. The study will utilize the I-FEED score, a novel tool for assessing GI function, to monitor the impact of a 2-week postoperative rehabilitation exercise program on patients. The primary outcome will focus on improvements in cardiopulmonary capacity following postoperative rehabilitation activities.

A single left fourth intercostal thoracotomy approach for resolution of idiopathic chylothorax with thoracic duct ligation and pericardiectomy: a preliminary clinical study in two dogs.

Open surgical treatment of idiopathic chylothorax via thoracic duct ligation and pericardiectomy requires a lengthy procedure with two thoracotomy incisions. The objectives of this report were to describe an approach for thoracic duct ligation and pericardiectomy via a single thoracotomy at the left fourth intercostal space and to describe the clinical outcome in two dogs with idiopathic chylothorax. Dogs were prospectively enrolled in a pilot study to evaluate the clinical efficacy of thoracic duct ligation at the left fourth intercostal space, combined with subphrenic pericardiectomy performed through the same incision. Dogs had a preoperative CT lymphangiogram to evaluate the anatomy of the thoracic duct and its branching pattern prior to surgery. Recheck radiographs were performed every 2-4 weeks until effusion resolved. Pleural effusion became non-chylous by 5 days postoperatively. Pleural effusion volume decreased by day 5 postoperatively, allowing removal of thoracostomy tube and discharge from the hospital. Radiographically, effusion resolved within 6 weeks without a need for further drainage after discharge. Dogs remained symptom-free at last follow up (>11 months postoperatively). CT lymphangiograms were repeated >11 months postoperatively and revealed no recurrence of pleural effusion. No intraoperative or postoperative complications directly related to surgery were noted for either dog. Collateral lymphatic vessels were not identified on recheck CT lymphangiograms. The left fourth intercostal approach to thoracic duct ligation and pericardiectomy has potential to be a safe and effective alternative to an open approach requiring two lateral thoracotomies. Further investigation of this approach using open or minimally invasive techniques is warranted.

Effect of prophylactic perphenazine on delirium after extubation in severe acute pancreatitis

BackgroundSevere acute pancreatitis (SAP) is a life-threatening condition that can require invasive mechanical ventilation (IMV) to ensure adequate oxygenation and ventilation. However, IMV can cause delirium, a temporary and fluctuating state of consciousness disorder, which negatively impacts patient outcomes. Perphenazine, an antipsychotic drug that blocks dopamine receptors, can alleviate symptoms such as irritability and restlessness that caused by delirium. This retrospective study aimed to identify risk factors associated with delirium in SAP patients after extubation and withdrawal from IMV, and to determine whether prophylactic use of perphenazine could reduce the incidence of delirium.MethodsA total of 40 patients with SAP aged 18–75 years who underwent IMV and were successfully extubated offline after treatment were included. Perphenazine was used consistently 2 mg q12 h for 2 days before extubation. The assessment of delirium began after the removal of the endotracheal tube, using Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) every 12 h. Patients were divided into delirium (n = 9) and non-delirium (n = 31) groups or perphenazine (n = 22) and non-perphenazine (n = 18) groups. The clinical data of patients upon admission and after extubation between groups were analyzed using SPSS 26 software. Binary logistic regression was used to evaluate the risk factors for delirium.ResultsPatients with a mean age of 42 years and a male to female ratio of 1.58:1 were enrolled. The incidence of delirium was 22.50%. Univariate analysis (P = 0.025) and binary logistic regression (P = 0.035, 95%CI 0.002–0.762) showed that prophylactic use of perphenazine reduced the incidence of delirium. Fentanyl use was a risk factor for delirium in the univariate analysis (P = 0.039). Patients in the delirium group were hospitalized longer than those in the non-delirium group (P < 0.05).ConclusionPerphenazine might have a potential effect on post-extubation delirium in SAP patients.

Successful Management of Refractory Chylothorax in Preterm Infants Using Hypertonic Glucose Pleurodesis

Neonatal chylothorax is a potentially fatal respiratory condition caused by a congenital or traumatic etiology. Conventional therapies, such as fasting, total parenteral nutrition, and intravenous octreotide, are generally successful in such cases; however, more invasive therapeutic measures, such as pleurodesis, should be considered in refractory cases. This case report presents two preterm infants with refractory chylothorax who were non-responsive to conventional treatment but were successfully managed using hypertonic glucose pleurodesis. The first case was that of a female infant born at 24+5 weeks of gestation (585 g) and diagnosed with postsurgical chylothorax at 68 days of life. Even after the initiation of fasting and intravenous octreotide administration, pleural drainage did not reduce. Therefore, the patient underwent three intermittent procedures of 50% glucose pleurodesis, which resulted in the resolution of the chylothorax and subsequent chest tube removal after 37 days. The second case was a female infant born at 34+6 weeks (3,040 g), who was diagnosed with congenital chylothorax immediately after birth. Fasting and intravenous octreotide failed to show any clinical effects; therefore, the patient underwent pleurodesis for 3 consecutive days. After the procedure, the amount of pleural drainage substantially decreased, and the chest tube was removed after 14 days. In both cases, a temporal relation between pleurodesis and chylothorax resolution was observed, suggesting that hypertonic glucose pleurodesis may be an effective and safe alternative for treating refractory chylothorax in preterm infants with minimal side effects. Further studies are needed to establish the optimal protocol for this procedure and to compare its efficacy with that of other pleurodesis agents.

Effectiveness of non-pharmacological interventions for pain reduction following chest tube removal: A systematic review and network meta-analysis

ObjectiveThis study aimed to determine the most effective non-pharmacological intervention for pain relief following chest tube removal in adult patients. MethodsWe performed a systematic review with network meta-analysis, searching electronic databases for randomized controlled trials up to January 20, 2024. Compared to control or placebo groups, the trials included adult patients receiving non-pharmacological interventions, such as cold therapy, relaxation exercises, music therapy, transcutaneous electrical nerve stimulation, or aromatherapy. Data analysis utilized a random-effects model, reporting standardized mean differences (SMD) with 95% confidence intervals (CI), and treatment ranking was determined through surface under the cumulative ranking analysis and forest plots. ResultsSixteen studies enrolling 1,342 patients were included, with moderate to high heterogeneity. Cold therapy and relaxation exercises effectively reduced pain after chest tube removal, with SMD of −1.84 (95 % CI: −2.81 to −0.87) and −2.04 (95 % CI: −3.43 to −0.65), respectively, from baseline to immediately post-removal. From baseline to ten to twenty minutes after removal, both therapies continued to show significant pain reduction, with SMD of −1.96 (95 % CI: −3.14 to −0.77) for cold therapy and −2.01 (95 % CI: −3.75 to −0.28) for relaxation exercises. Sensitivity analysis supported these findings, and cold therapy’s efficacy appeared unaffected by obesity. However, publication bias, possibly due to small study samples, was noted. ConclusionsCold therapy and relaxation exercises proved most effective for reducing pain immediately and up to ten to twenty minutes after chest tube removal. Given their cost-effectiveness, lack of side effects, and ease of use, we recommend relaxation exercises as a practical alternative to cold therapy. Nonetheless, further studies are needed to comprehensively assess non-pharmacological options for managing chest tube removal pain. Implications for clinical practiceIncorporate cold therapy and relaxation exercises into post-chest tube removal pain management to improve patient comfort and minimize reliance on pharmacological interventions.