Respiratory Complications Research Articles (Page 1)

Paraquat is a widely used herbicide as it is easily available. Accidental ingestion can cause high-case fatality. Even modest amounts of paraquat can be fatal. Poisoning can irritate the mouth, oropharynx and oesophagus. It also results in multiple organ failure. Pulmonary failure is the most common cause of death and lung fibrosis is the main respiratory complication in paraquat poisoning. Here, we report a rare case of paraquat poisoning presented with pulmonary thromboembolism. Our patient was already treated for paraquat poisoning and acute kidney injury with haemodialysis in an outside hospital. After 1 month, he came to our hospital with complaints of haemoptysis and shortness of breath. On further investigations, the patient was found to have a partial thrombus in the right common femoral vein and saddle embolism in the bifurcation of the right pulmonary artery extending into upper, middle and lower lobe branches. After ruling out all other causes, the reason for embolism was considered either due to paraquat poisoning per se or due to catheterisation for haemodialysis. The patient was started on anticoagulants. While treating the patient with paraquat poisoning, complications such as pulmonary thromboembolism due to haemodialysis or paraquat poisoning should also be considered.

Background: Connective tissue disorders (CTDs), including Ehlers-Danlos syndrome (EDS) and Marfan syndrome (MS), are known risk factors for aortic dissection (AD). Sex-based disparities in clinical outcomes among these patients remain underexplored, particularly in the context of short- and long-term complications. We aimed to evaluate these outcomes using a national database. Methods: In this retrospective study, we queried the TriNetX global health research network to identify adults (≥18 years) with CTD (EDS and MS) who experienced type A AD. Baseline demographics (age, race), comorbidities, and medication use were collected. Propensity score matching (1:1) was applied based on age, race, major comorbidities, and medication use to generate balanced male and female cohorts. We compared short-term (30-day) and long-term outcomes, including all-cause mortality, neurological, respiratory, and vascular complications, acute kidney injury (AKI), rehospitalization, and infections. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated, with p < 0.05 considered statistically significant. Results: A total of 1,588 CTD patients with type A AD were identified. After PSM, two well-balanced cohorts of 631 male and 631 female patients were obtained. The mean age was 52.6 ± 15.2 years; 68.5% were White and 13.8% were Black or African American. No significant sex-based differences were observed in all-cause mortality or in neurological, respiratory, or vascular complications at either time point. However, male patients had significantly higher rates of AKI (p < 0.001), rehospitalization (p = 0.035), and infections (p = 0.001) during both short- and long-term follow-up. Conclusion: While overall mortality and major cardiovascular outcomes were similar between sexes, male patients with CTD and type A AD experienced higher rates of renal injury, infection, and rehospitalization. These findings underscore the need for enhanced post-discharge monitoring and supportive care in this high-risk group.

Background and Aims: Duchenne muscular dystrophy (DMD) leads to fatal cardiomyopathy caused by mutations in the dystrophin gene. Gene therapy for the heart is limited due to poor delivery efficiency. In addition, patients are ineligible for heart transplants due to scoliosis and respiratory complications. Given the lack of effective therapies, efforts to clarify the mechanisms of DMD cardiomyopathy have been hampered by the limited availability of cardiac specimens. Here, we aimed to identify key driver pathways for DMD cardiomyopathy by constructing multicellular engineered heart tissue (EHT) under disease-relevant stress. Methods: EHTs were generated from patient iPSC-derived cardiomyocytes and epicardial cell–derived non-cardiomyocytes. An isogenic control with a corrected dystrophin mutation was used as comparison. To induce an adult-like disease phenotype, we shifted cardiomyocyte metabolism toward fatty acid oxidation and applied pathological stress. Single-cell RNA sequencing (scRNA-seq) was conducted before and after pathological stimulation to capture disease-associated molecular changes. Results: Phenotypic assessment revealed that while control EHTs showed increased contractility during maturation, DMD EHTs lacked this improvement (p < 0.05) and exhibited disorganized sarcomeres (p < 0.01). Upon pathological stimulation with mechanical stress and inflammatory cytokines, DMD EHTs showed a further decline in contractility (p < 0.01), accompanied by increased fibrosis (p < 0.05) and DNA damage. TFvelocity analysis of time-course scRNA-seq revealed that DMD cardiomyocytes exhibited a gene expression profile resembling that of dilated cardiomyopathy. This analysis identified early activation of pathways related to microtubule instability and fibrosis, followed by later activation of pathways associated with responses to oxidative stress and inflammation, as well as muscle atrophy, all with −log 10 (P) > 3. Furthermore, scMetabolism analysis showed a marked decline in glutathione metabolism and mitochondrial ATP production as the disease progressed. Conclusion: Single-cell transcriptomic and metabolic dynamics profiles suggest that the reduced contractility observed in our DMD cardiomyopathy model is driven by mitochondrial dysfunction caused by increased sensitivity to oxidative and inflammatory stress, as well as microtubule instability. These findings provide novel insights beyond the previously reported membrane fragility due to dystrophin deficiency.

Background: Transcatheter mitral valve edge-to-edge repair (M-TEER; MitraClip) has emerged as a less invasive alternative to surgical mitral valve repair (SMVr) in older adults with mitral regurgitation and heart failure (HF). However, comparative real-world data on outcomes between these approaches in elderly patients remain limited. Methods: We conducted a retrospective analysis of the TriNetX global health network to identify adults over 65 years with heart failure (HF) who underwent transcatheter mitral valve edge-to-edge repair (M-TEER; MitraClip) or surgical mitral valve repair (SMVr). Patients were ascertained using ICD-10 codes. Baseline demographics (age, race), comorbidities (e.g., hypertension, diabetes, chronic kidney disease), and outpatient medication use (β-blockers, ACE inhibitors/ARBs, statins, anticoagulants) were collected. A 1:1 propensity score matching (PSM) algorithm—matching on age, race, key comorbidities, and medication use—was applied to generate two balanced cohorts. We then compared short-term (30-day) and long-term (1-year) outcomes between matched M-TEER and SMVr groups, including all-cause mortality, heart failure exacerbation, neurological, respiratory, and vascular complications, acute kidney injury (AKI), mechanical ventilator use, and readmission. Risk ratios with 95% confidence intervals were calculated, and statistical significance was defined as p < 0.05. Results: Among 5,096 older adults undergoing M-TEER and 2,812 undergoing SMVr, PSM yielded two well-balanced cohorts of 1,020 patients each (mean age 80.1 ± 7.7 years; 40% female; 10.1% Black). At both 30 days and 1 year, the M-TEER group experienced significantly fewer respiratory complications (p = 0.002), reduced mechanical ventilator use (p = 0.046), and lower rates of heart failure exacerbation (p < 0.001) compared to SMVr. However, SMVr was associated with a lower all-cause mortality rate at 1 year (p < 0.001). Conclusion: In older adults with HF, M-TEER was associated with fewer cardiopulmonary complications and HF exacerbations, while SMVr conferred improved long-term survival. These findings highlight the need to individualize procedural decisions based on patient comorbidity profiles and clinical goals.

Background and Objective: Kommerell's diverticulum is a special type of proximal subclavian artery aneurysm that is associated with the aberrant subclavian artery. Although most patients are asymptomatic, there is a high risk of aortic rupture and aortic dissection. This study aimed to investigate the clinical characteristics, treatment strategies, and long-term prognosis of this specific type of proximal subclavian artery aneurysm (Kommerell's diverticulum) through a single-center retrospective study, providing valuable support for clinical decision-making. Methods: Patient data were collected from the medical records system from February 2011 to April 2022 for patients who had computer tomography scan reports indicating Kommerell's diverticulum and underwent intervention at our institution. A total of 76 adult patients aged 18 years and above with Kommerell's diverticulum were included in this study, of which 48 had concomitant aortic dissection and 28 without. Results: The overall early postoperative mortality rate for the included cases in this study was 9.2% (7/76 cases), with a 30-day mortality rate of 12.5% (6/48 cases) for the group with concomitant aortic dissection and 3.6% (1/28 cases) for the non-aortic dissection group. The median follow-up time for all included patients in this study was 4.0 years. Preoperative coronary artery atherosclerotic heart disease was identified as a risk factor associated with surgical mortality (OR=3.15, P=0.0163). Central nervous system complications occurred in 10 patients (13.2%), and respiratory system complications occurred in 4 patients (5.3%), with both cases in the group with concomitant aortic dissection resulting in postoperative death within 30 days due to compression of the right main bronchus by the aneurysm, leading to lung infection and respiratory failure. The 3-year, 5-year, and 7-year survival rates for the group with concomitant aortic dissection were 82.5%, 79.7%, and 75.1%, respectively, while the survival rates for the non-aortic dissection group were all 88.9%. Conclusion: The treatment approach for patients with this specific type of proximal subclavian artery aneurysm (Kommerell's diverticulum) should be based on comprehensive evaluation including age, symptoms, and imaging findings. Attention should be paid to the relationship and compression of the aortic dissection with the right main bronchus in patients with Kommerell's diverticulum and a right-sided aortic arch.

Introduction: Activation of natriuretic peptide receptor 1 (NPR1) regulates vascular tone, lowers venous pressures, and effects natriuresis and diuresis, which may have therapeutic benefit in heart failure with preserved ejection fraction (HFpEF). REGN5381, an investigational monoclonal antibody agonist of NPR1, has the potential to overcome the limitations of previous recombinant natriuretic peptide (NP) infusions that were limited by their short half-life. Research question: What are the safety, tolerability, and hemodynamic effects of REGN5381 in patients with HFpEF (NCT05353166)? Methods: Patients aged 18–75 years, with New York Heart Association class II/III heart failure with left ventricular ejection fraction ≥50% and N-terminal pro B-type natriuretic peptide (NT-proBNP) >300 pg/mL, were randomized 1:1 to a single intravenous injection of REGN5381 (30 mg, 100 mg, 300 mg) or placebo. Key hemodynamic inclusion criteria were pulmonary capillary wedge pressure (PCWP) ≥15 mmHg and right atrial pressure >5 mmHg upon right heart catheterization on Day 1. Safety and tolerability were assessed, including change from baseline in PCWP, systemic blood pressure (BP), and biomarkers. Results: Thirty-six patients received REGN5381 30 mg (n=3), 100 mg (n=3), 300 mg (n=12), or placebo (n=18). Mean (SD) change from baseline 6 h post-infusion in PCWP for 100 mg and 300 mg was −9.3 (1.4) and −7.7 (2.1), respectively, and −3.3 (2.4) for placebo (Fig. 1). Baseline mean (SD) systolic BP was 141.1 (20.3), 128.3 (12.6), and 134.8 (8.8) mmHg in the placebo, 100 mg, and 300 mg dose groups, respectively, with changes from baseline 6 h post-infusion of −0.6 (11.2), −5.7 (6.4), and −8.5 (13.7) mmHg, respectively. No effect of REGN5381 on cardiac output, no effect on systemic BP beyond 24 h, and no effects on renal function or biomarkers including NP, were observed. Most reported treatment-emergent adverse events (TEAEs) were mild (Table). One patient (8.3%) had a serious TEAE (respiratory tract procedural complication and hemoptysis), and 2 (16.7%) had mild treatment-related TEAEs (increased liver enzymes and dizziness) in the 300 mg dose group. No deaths were reported. Conclusions: REGN5381 was generally well-tolerated and improved PCWP with no persistent drops in systemic BP or cardiac output in patients with HFpEF. A reduction in PCWP with REGN5381 suggests efficacy in cardiopulmonary decongestion. These data support future clinical studies of REGN5381 in patients with HFpEF.

Background: Fibrosing Mediastinitis (FM) is a rare, progressive disorder characterized by fibrous tissue growth in the mediastinum, the compartment containing the heart, major blood vessels, trachea, and esophagus. This abnormal process can compress these structures, leading to serious complications. It is most commonly associated with Histoplasmosis but can be caused by other infections, autoimmune diseases, radiation therapy, or idiopathically. FM typically affects women in their third or fourth decades, but pregnancy-associated cases are extremely rare. Existing case reports show variable outcomes based on the extent of vascular and airway compromise and the timing of diagnosis. We present a case of FM in a pregnant patient, complicated by antepartum hemoptysis and left lung atelectasis, who was managed with an interdisciplinary approach including pulmonology and cardio-obstetrics. Case Description: A 37-year-old G1P1 female with known idiopathic FM and a previous mediastinectomy presented at 23 weeks and 3 days with preterm labor and cervical dilation to 4 cm. She received steroids and magnesium for fetal neuroprotection. In the days prior to delivery, she experienced hemoptysis, prompting pulmonology consultation. She was managed conservatively with chest physiotherapy and nebulizers. The patient had no more hemoptysis and at 24 weeks and 1 day, she underwent classical cesarean delivery for breech presentation and non-reassuring fetal heart tones. The neonate was admitted to NICU and the patient was discharged in stable condition. Outpatient imaging revealed a stable calcified mediastinal mass causing 80% narrowing of the left main bronchus and left lung atelectasis. Subsequent bronchoscopy with balloon dilation improved airway patency, but stenting was deferred. Discussion: FM can remain stable during pregnancy, but physiologic changes in pregnancy such as increases in blood volume and cardiac output can be exacerbated by FM, potentially leading to pulmonary hypertension and reduced blood flow to the uterus. Notably, FM-related airway obstruction may not always present with overt respiratory distress and can be managed conservatively in select patients. Also, while balloon dilation may offer symptomatic relief, stenting decisions must be individualized based on functional status and patient preference. Finally, early multidisciplinary collaboration is crucial to prepare for peripartum respiratory complications in patients with known mediastinal pathology.

Background: Cardiothoracic surgery is associated with a high incidence of postoperative respiratory complications arising from a combination of patient-related and procedural risk factors. Although noninvasive respiratory support strategies, including high-flow nasal cannula (HFNC), noninvasive positive pressure ventilation (NIPPV), and conventional oxygen therapy (COT), are commonly used to reduce post-extubation complications, their relative effectiveness in this population remains uncertain. Methods: We conducted a comprehensive search of Embase, PubMed, and Scopus between January 2010 and December 2024 to identify randomized controlled trials that compared the efficacy of HFNC, COT and NIPPV in adult patients following CTS. A frequentist network meta-analysis was performed. Outcomes included reintubation rate, in-hospital mortality, ICU and hospital length of stay, pneumonia incidence, CPAP requirement, and PaCO2 levels. Results: Eleven RCTs enrolling 1,664 patients were analyzed. There were no statistically significant differences in reintubation rates, in-hospital mortality, or CPAP requirements between HFNC and COT, NIPPV and COT, or NIPPV and HFNC. NIPPV significantly reduced ICU length of stay compared to both COT (MD –52.16 hours; 95% CI, –77.94 to –26.38) and HFNC (MD –41.99 hours; 95% CI, –67.69 to –16.28), and also shortened hospital length of stay compared to COT (MD –2.51 days; 95% CI, –4.82 to –0.21). Both HFNC and NIPPV were associated with a significantly lower incidence of pneumonia compared to COT (HFNC: OR 0.11; 95% CI, 0.01 to 0.91; NIPPV: OR 0.12; 95% CI, 0.01 to 0.97). In terms of PaCO2 reduction, both HFNC and NIPPV significantly lowered levels compared with COT (HFNC: MD –2.68 mmHg; 95% CI, –3.32 to –2.04; NIPPV: MD –1.61 mmHg; 95% CI, –2.26 to –0.96), with HFNC showing a greater reduction than NIPPV (MD 1.07 mmHg; 95% CI, 0.93 to 1.20). Conclusion: In adult patients undergoing cardiothoracic surgery, the rates of reintubation and in-hospital mortality were similar across noninvasive respiratory support strategies. NIPPV may reduce ICU and hospital length of stay compared with HFNC and COT, while both HFNC and NIPPV may lower the incidence of pneumonia relative to COT. Although these findings support the use of HFNC or NIPPV over COT, the lack of significant differences in key clinical outcomes and overall low certainty of evidence underscores the need for further high-quality randomized trials to clarify their comparative effectiveness.

Background: Acute type A aortic dissection (AAAD) is frequently complicated by severe respiratory failure due to acute lung injury, contributing to postoperative mortality. This study investigated the association between the extent of the patent false lumen and postoperative hypoxia in patients with AAAD. Methods: We retrospectively analyzed 143 patients with AAAD who had a patent false lumen and underwent surgical repair within 24 hours of diagnosis. Severe hypoxia was defined as PaO 2 /FiO 2 (PF) ratio <200 during postoperative endotracheal intubation. The volume of the patent false lumen was calculated as the product of CT slice thickness and the summed area of the false lumen across all axial slices. Additionally, the length of the aorta with a patent false lumen was measured using centerline analysis (Fig 1). Results: Severe hypoxia occurred in 66% of patients. Compared to those without oxygenation impairment, patients with hypoxia had significantly longer ICU stays, prolonged mechanical ventilation, and lower minimum PF ratios (all p<0.05). The hypoxia group also showed significantly greater false lumen length and volume (p<0.01). In contrast, no significant differences were found in smoking history, surgical procedure, or operative time between the two groups. Receiver operating characteristic (ROC) curve analysis demonstrated that both the length and volume of the patent false lumen had modest predictive ability for postoperative hypoxia, with areas under the curve (AUC) of 0.68 and 0.70, respectively. The optimal cut-off value for length was 439mm (sensitivity 66%, specificity 65%), and for volume, 185 cm 3 (sensitivity 60%, specificity 59%). Conclusions: The extent of the patent false lumen was identified as a risk factor for postoperative hypoxia in AAAD. Greater intimal disruption was associated with postoperative respiratory complications. Preoperative assessment of false lumen morphology may assist in identifying high-risk patients and guiding appropriate respiratory management.

BackgroundPulmonary fibrotic changes (FC) following COVID-19-related ARDS represent a significant concern due to the potential respiratory complications. The identification of early predictive factors for FC and the development of predictive tools are needed to optimize patient management and outcomes.MethodsThis observational prospective multicentre study is a substudy of the RECOVIDS study and included 32 centres in France and Belgium. COVID-19 ARDS survivors were included if they met the Berlin ARDS criteria or if they received high flow oxygen therapy (flow ≥ 50 L/min and FiO2 ≥ 50%). Exclusion criteria were non-attendance at follow-up 6 ± 1 months after ICU discharge, lack of baseline or follow-up chest CT, and history of interstitial lung disease. The primary endpoint was presence of FC at follow-up CT. The secondary outcome was to identify predominant radiological patterns.ResultsAmong 555 patients included in the RECOVIDS study, 440 were analysed, of whom 162 (36.8%) had FC at follow-up. Predictive factors for FC included older age, body mass index < 30, Charlson comorbidity index ≥ 1, invasive mechanical ventilation, early signs of FC, and greater lung involvement on baseline CT. The nomogram for predicting pulmonary FC yielded an AUC of 80.6% (95%CI (76.4–84.8)). Late organizing pneumonia was the most common pattern overall and 30 (18.5%) of the 162 patients with FC presented mainly anterior fibrosis compatible with post ventilatory changes.ConclusionIn this large cohort of COVID-19 ARDS survivors, 36.8% exhibited FC at 6 months post-ICU discharge. The key predictors identified here could guide therapeutic and follow-up strategies.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13613-025-01577-2.

Achalasia is a rare esophageal motility disorder managed through various interventions, including laparoscopic Heller myotomy (LHM), pneumatic dilation (PD), and, more recently, per-oral endoscopic myotomy (POEM). Over the past decade, there has been a shift toward POEM, though nationwide hospitalization trends and outcomes remain understudied. We conducted a retrospective trend analysis using the National Inpatient Sample (NIS) database from 2011 to 2022. Adult patients hospitalized with a primary diagnosis of achalasia were identified using ICD-9/10-CM codes. Trends in management strategies (LHM, POEM, PD, and esophagectomy), hospitalization outcomes, and complications were analyzed. Multivariable regression adjusted for patient and hospital characteristics was also performed to compare outcomes between 2011 and 2022. A total of 63,420 weighted achalasia-related admissions were identified. The use of LHM declined significantly (AAPC -4.66%, p < 0.001), while POEM use rose from 5.8% in 2016 to 10.3% in 2022 (AAPC 7.76%, p = 0.049). Hospitalization costs increased annually by 3.18% (p < 0.001), while the length of stay remained stable. Mortality rates rose over time; however, there was no difference after adjusting for patient-related factors. Adjusted analyses revealed increased odds of POEM in 2022 (aOR 1.87), decreased odds of LHM and esophagectomy, and higher odds of respiratory complications. From 2011 to 2022, there has been a clear shift toward the use of POEM for the inpatient management of achalasia. However, worsening patient comorbidity profiles have driven increased complications and mortality and may contribute to increasing costs. Early intervention and broader POEM adoption may optimize future outcomes.

Comparison of long-term outcomes of 2.5- and 3-field lymph node dissections for esophageal squamous cell carcinoma.

Abstract Introduction We describe a case of a child with systemic capillary leak syndrome (SCLS) secondary to juvenile dermatomyositis (JDM) with likely evolving macrophage activation syndrome (MAS). SCLS is a rare but serious complication of both JDM and MAS. It is characterised by fluid leakage into the extravascular tissue, resulting in anasarca, haemoconcentration, hypotension and hypoalbuminaemia. Whilst its exact pathophysiology is unknown, vasculopathy arising from cytokine-mediated endothelial damage has been posited. No common genetic association has been found. Complications include hypovolaemic shock, pulmonary oedema and compartment syndrome. Early recognition and treatment are essential to prevent end-organ damage and mortality. Case description The patient was a 12-year-old female with no significant previous medical history. She initially presented with severe proximal muscle weakness (with a childhood myositis assessment score (CMAS) of 11/52), widespread erythematous rash, Gottron papules, visibly abnormal nailfold capillaries and periungual erythema. Muscle enzymes were elevated and an MRI thigh confirmed the presence of florid myositis. Myositis antibodies were positive for anti-NXP2 antibody. She was diagnosed with juvenile dermatomyositis and was commenced on IV methylprednisolone, subcutaneous methotrexate and oral hydroxychloroquine. Following a brief period of improvement, her clinical course deteriorated. Her weakness became more profound with bulbar involvement and respiratory weakness, precipitating an aspiration pneumonia, requiring multiple courses of antibiotics and non-invasive ventilatory support. A new derangement in her biochemistry (in particular, hyperferritinaemia, hypertriglycerideaemia and elevated liver enzymes), combined with a worsening thrombocytopaenia, raised the suspicion of evolving MAS. She subsequently developed hypoalbuminaemia and anasarca (gaining up to 10kg in weight), which led to a subclinical compartment syndrome and an extremely painful exacerbation of her inflamed skin. Additionally, she developed a pre-renal acute kidney injury and electrolyte derangement. These combined findings prompted a diagnosis of secondary SCLS. Treatment was targeted at managing her underlying disease process. Following a further course of IV methylprednisolone, she received IV immunoglobulin and rituximab, alongside supportive care for her symptoms, including human albumin solution and optimised analgesia. Following a prolonged rehabilitation, she achieved a full recovery, and did not require inotropic or additional respiratory support. Discussion This case highlights a complex clinical case of JDM. SCLS is a rare complication of JDM but may have also occurred secondary to possible MAS, which in itself is also a rare complication of JDM. Whilst MAS was a consideration, atypical clinical features of worsening muscle weakness (along with elevated muscle enzymes), onset of rapid anasarca, respiratory compromise and electrolyte disturbance, prompted a wider consideration of SCLS. As far as the authors are aware, this case adds to only eight cases of SCLS secondary to JDM reported in the literature. As with our case, anasarca, respiratory complications, acute kidney injury, hypotension, haemoconcentration, hyponatraemia, hypoalbuminaemia, and worsening muscle enzymes were common variables among the reported cases. Interestingly, our case appears to be unique in describing a coincidence of suspected MAS alongside SCLS, secondary to JDM. Whilst five cases reported derangement in liver enzymes, three reported hyperferritinaemia, and one reported thrombocytopenia, none of the eight cases reported a clinical suspicion of MAS. The treatment in this case was targeted at addressing the underlying disease process with escalating immunosuppressive measures. This approach broadly correlated with the other reported cases. Corticosteroids, IV immunoglobulin and methotrexate were commonly used, whilst other options included cyclophosphamide and plasma exchange. As with our case, a common theme from the other case reports suggested corticosteroids alone are insufficient to treat SCLS as a complication of JDM, and escalation to additional immunosuppressive medication is warranted. In addition to direct treatment, involving other clinical teams (including renal, respiratory and intensive care teams) was also imperative to help manage complications. Again, this was echoed in the other case reports. Supportive symptomatic treatments for SCLS and its complications included albumin infusions, diuretics, haemodialysis, inotropes, mechanical ventilation and, in one case of severe compartment syndrome, emergency fasciotomy. Key learning points • SCLS is a rare but serious complication of JDM. Whilst localised oedema (particularly around the face) is a common presenting feature of new-onset JDM, generalised anasarca (particularly rapid onset), alongside a clinical deterioration, should prompt clinicians to consider a diagnosis of SCLS in patients with JDM. • Features to support the diagnosis might include hypoalbuminaemia, hyponatraemia and a high haematocrit. • Complications can be life-threatening. Aggressive treatment of the underlying JDM, as well as early discussions with other clinical teams to assist in managing complications of SCLS, is essential. • This case suggests concurrent MAS may partially mimic, as well as predispose to, the wider complication of SCLS. However, recognising distinguishing characteristics highlighted in this case report can help with early identification, and targeted clinical management, of SCLS.

Respiratory outcomes of adrenergic beta-antagonists in patients undergoing tracheal extubation: a systematic review and meta-analysis of randomized controlled trials.

Association of cognitive impairment with utilization and acute outcomes of aortic valve replacement.

Reevaluating bicarbonate therapy in pediatric DKA: A propensity score-matched analysis of neurological and respiratory outcomes.

Background: Awake fiberoptic nasal intubation (AFOI) is the preferred technique for securing difficult airways, but it requires optimal sedation and hemodynamic stability. Dexmedetomidine and fentanyl are commonly used agents, each with distinct pharmacologic profiles. Aims and Objectives: To compare the efficacy, safety, and impact of dexmedetomidine versus fentanyl on sedation, hemodynamic stability, and respiratory parameters during AFOI under general anesthesia. Materials and Methods: A randomized comparative study was conducted on 80 American Society of Anesthesiologists Grade I/II patients aged 20–40 years, undergoing AFOI for maxillofacial trauma and general surgery cases with restricted mouth opening. Patients were randomly divided into two groups: Group D received dexmedetomidine, and Group F received fentanyl. Parameters evaluated included intubation time, sedation scores, oxygen saturation levels, heart rate trends, cough scores, and side effects. Results: Group D showed significantly shorter intubation times, deeper and more stable sedation, fewer desaturation events, and better heart rate control than Group F. Dexmedetomidine was associated with manageable hypotension and bradycardia, whereas fentanyl had higher rates of hypoxia and respiratory distress. Conclusion: Dexmedetomidine proved superior to fentanyl in facilitating AFOI by offering better sedation, enhanced hemodynamic stability, and fewer respiratory complications, making it a preferred agent in difficult airway scenarios.

The model for end-stage liver disease (MELD) score has been shown to be a valid predictive tool for postoperative risks across various types of surgeries, after initially being restricted to liver transplantation eligibility assessment in cirrhotic patients. Since appendectomy is one of the most common surgical procedures, our objective is to compare the impact of the three versions of the MELD score (1.0, 2.0, and 3.0) on the risk assessment of 30-day postoperative morbidity and mortality in patients undergoing appendectomy for acute appendicitis. Data on patients undergoing appendectomy for acute appendicitis were collected from the ACS-NSQIP database from 2018 to 2022 using the Current Procedural Terminology (CPT) codes 44,950, 44,960, and 44,970. The different MELD scores and outcomes were compared using the Chi-square test. The outcomes measured included 30-day mortality, wound infection, cardiac, respiratory, urinary, and central nervous system complications, thromboembolism, sepsis, bleeding, return to the operating room, and composite morbidity. A total of 121,207 patients were included, with a mean age of 45.31 ± 17.89years, of which 58,495 (48.3%) were females. The majority, 102,895 (90.7%) patients, underwent laparoscopic appendectomy, whereas 10,599 (9.3%) had open appendectomy. The overall 30-day surgical mortality was 0.5% (567/121,207), and postoperative sepsis was observed in 5.8% (7,063/121,207). All the MELD score versions significantly predicted the outcomes independently of the surgical approach (laparoscopic/open appendectomy, simple/complicated appendicitis) with means of 8.21 ± 2.81, 9.01 ± 3.39, and 9.21 ± 3.26 for MELD 1.0, MELD 2.0, and MELD 3.0 scores, respectively. MELD 3.0 score noticeably outperformed its predecessors regarding all the outcomes. Patients with a score ≥ 11 had a higher prevalence of postoperative complications. The MELD score, in its three versions, is a valid tool for assessing 30-day morbidity and mortality risk following appendectomy for acute appendicitis. MELD 3.0, with a cutoff of 11, demonstrated superior predictive performance.

Extracorporeal membrane oxygenation (ECMO) can provide an option for high-risk procedures that may result in cardiopulmonary collapse. The indications for ECMO standby are not well delineated. We describe the experiences of pediatric ECMO standby at two high-volume centers. A retrospective review of pediatric ECMO standby from 2016 to 2023 was performed (n = 394). Data regarding the locations of ECMO standby and the types of procedures were obtained. The primary outcome evaluated was requiring ECMO cannulation during standby. Of the 394 pediatric patients, only 8 (2%) required ECMO cannulation during standby. The indications for ECMO standby were cardiac (84%) and respiratory (16%) complications. Standby locations included the cardiac catheterization suite (55.6%), the operating room (OR) (20.6%), the intensive care unit (ICU) (11.9%), and the interventional radiology (IR) suite (11.9%). Standby within the cardiac catheterization suite included diagnostic only (53%) and interventional (47%), of which 0 and 4 (3.9%) patients required ECMO, respectively. Procedures in OR, IR, or ICU consisted of major surgical procedures (14%), minimally invasive minor procedures (64%), intubations (18%), and transfers/births (4%). Few ECMO standby patients require cannulation; however, it is complicated to predict patient decompensation. Further studies are warranted to delineate which patients would benefit from ECMO standby while balancing cost and resource utilization.

Robotic-assisted minimally invasive esophagectomy (RAMIE) has been increasingly adopted, yet the comparative outcomes of its three principal approaches-Ivor Lewis, McKeown, and transhiatal-remain inadequately defined. This study aims to provide a comprehensive comparison to guide surgical decision-making. A systematic review and meta-analysis were conducted following PRISMA guidelines. Databases were searched from January 2010 to December 2023 for studies comparing robotic Ivor Lewis, McKeown, and transhiatal esophagectomy. Primary outcomes included perioperative parameters, complication rates, and oncologic efficacy. Sixteen studies (7,339 patients) were included in the systematic review, with eight studies (3,015 patients) eligible for meta-analysis. Robotic Ivor Lewis esophagectomy demonstrated superior outcomes compared to robotic McKeown, including significantly lower rates of recurrent laryngeal nerve palsy (OR = 0.13, 95% CI = 0.06-0.31, P < 0.00001), reoperation (OR = 0.60, 95% CI = 0.41-0.89, P = 0.01), anastomotic leak (OR = 0.47, 95% CI = 0.28-0.78, P = 0.003), and respiratory complications (OR = 0.53, 95% CI = 0.39-0.71, P < 0.0001). Compared to transhiatal esophagectomy, transthoracic approaches (Ivor Lewis and McKeown) yielded significantly more lymph nodes (mean difference 8.3 nodes, P < 0.001) but were associated with higher pulmonary complications. Transhiatal esophagectomy had shorter operative times and reduced blood loss but higher anastomotic leak rates compared to Ivor Lewis. R0 resection rates and 5-year overall survival were comparable among the approaches. Robotic Ivor Lewis esophagectomy offers an optimal balance of perioperative safety and oncologic efficacy, with lower complication rates while maintaining equivalent long-term survival. The surgical approach should be individualized based on tumor location, patient comorbidities, and surgical expertise. These findings support the tailored adoption of robotic technology in esophageal cancer surgery.