Ventilation Time Research Articles

A single-center experience involving the first 50 patients of minimally invasive cardiac surgery of coronary artery bypass grafting: at district level

Aim. To examine the learning curve and results of the first 50 instances of coronary artery bypass grafting (CABG) that were done at our facility using minimally invasive cardiac surgery (MICS).Material and methods. A total of 50 patients received CABG using the left anterior thoracotomy technique between January 2021 and November 2022. We examined the MICS CABG patients' operating hours to assess our learning curve. In addition, we reviewed postoperative outcomes and compared them with those of patients who underwent sternotomy.Results. The median age was 49.5 years (the range was 27-72). Males made up 38 of the group, while females — 12. Ejection fraction (EF) before surgery averaged 40±5%. After exclusion criteria were met, all of these patients underwent CABG by left-sided thoracotomy. The radial artery and saphenous vein were the next alternate conduits, and all patients got left internal mammary artery (LIMA) to left anterior descending (LAD) artery as a conventional transplant. The average incision length was 7.08±0.5 cm. On the pump, only 1 case was completed. Per patient, there were 2.53±0.82 grafts on average. On average, the operation took 130.43±9.78 minutes. The median intensive care unit (ICU) length of stay was 2.82±0.74 days, while the median ventilation time was 5.79±1.80 hours. In our study, there were no conversions and no deaths. After the first 20 cases, we noticed a considerable decrease in operating time, which was our learning curve.Conclusion. Once the learning curve has been overcome, MICS CABG can be performed for multivessel disease with the same comfort for the operator as for a singleor double-vessel disease. Only during the learning curve, and not subsequently, there were greater operating time for MICS CABG observed as a significant difference from the sternotomy technique. While there was no difference in postoperative adverse events, there were notable advantages of MICS vs sternotomy in the parameters of immediate postoperative time such as ventilation time, mean drainage, postoperative discomfort, length of stay in ICU and hospital.

Transthoracic device closure of perimembranous ventricular septal defect via a small left intercostal incision in children.

In children with perimembranous ventricular septal defect, surgical repair requires sternotomy and leaves unsightly scars, which can trigger long-term physical and psychological distress. However, transcatheter device closure is limited by vascular diameter, radiographic exposure, and expensive DSA equipment. We used an ultra-small left intercostal incision for transthoracic device closure to avoid the above problems and investigated its safety and feasibility by comparing it with surgical repair. This study enrolled 358 children with perimembranous ventricular septal defect. Among them, 152 patients were treated by surgical closure and 206 by transthoracic device closure via an ultra-small left intercostal incision. Perioperative clinical data and postoperative follow-up results were collected and analyzed retrospectively. The success rate was similar (P = 0.265) in the two groups: 203/206 patients in the device group vs. 152/152 patients in the surgical group. The operative time, intensive care unit time, mechanical ventilation time, and postoperative hospital stay were significantly shorter in the device group than in the surgical group. Although the incision length of the device group (1.1 ± 0.2 cm) was significant shorter (P < 0.001) than that of the surgical group (6.7 ± 1.5 cm), there was no difference in hospitalization costs between the two groups (P = 0.099). Except for small residual shunt (16/206 vs. 3/152, P = 0.017), the incidence of complications in the device group was lower or equal to that in the surgical group, and all small residual shunt disappeared during follow-up. There was no thoracic deformity in the device group, compared with 11 cases in the surgery group during follow-up (P < 0.001). Transthoracic device closure via an ultra-small left intercostal incision under transesophageal echocardiography guidance is safe and feasible. With appropriate indications, it can be a suitable alternative to surgical closure for treating perimembranous ventricular septal defect in children.

Concomitant valve surgery is associated with worse outcomes in surgical treatments of post-infarction ventricular aneurysm.

To evaluate the impact of concomitant valve surgery on the prognosis of patients who experienced coronary artery bypass graft (CABG) with/without ventricular reconstruction for the ventricular aneurysm. In our department, 354 patients underwent CABG with/without ventricular reconstruction for a ventricular aneurysm from July 23rd, 2000 to December 23rd, 2022. A total of 77 patients received concomitant valve surgery, 37 of whom underwent replacement, and 40 of whom underwent repair. The baseline characteristics, prognostic, and follow-up information were statically analyzed. Univariate and multivariate Cox regression analyses were applied to identify the risk factors of long-term outcomes. Compared with patients who did not undergo valvular surgery, patients who experienced concomitant valve surgical treatments had a significantly lower survival rate (p = 0.00022) and a longer total mechanical ventilation time. Subgroup analysis indicated that the options of repair or replacement exhibited no statistically significant difference in postoperative mortality (p = 0.44) and prognosis. The multivariate Cox regression analysis suggested that the pre-operative cholesterol level (HR = 1.68), postoperative IABP (HR = 6.29), NYHA level (HR = 2.84), and pre-operative triglyceride level (HR = 1.09) were independent and significant predictors for overall all-cause mortality after surgery. Concomitant valve surgery was considerably related to a higher risk of postoperative mortality in patients with post-infarction ventricle aneurysms who underwent surgical treatments. No significant difference in the prognosis outcomes was observed between the operating methods of repair or replacement valve surgery.

Can water dating trace the transport history of HCHs in the ocean?

Long-range atmospheric and oceanic transport play a crucial role in the accumulation of persistent organic pollutants (POPs), including hexachlorocyclohexanes (HCHs), in the Arctic Ocean. Herein, transient tracers, specifically chlorofluorocarbon-12 and sulfur hexafluoride, were used to determine the ventilation time of HCHs. Results revealed that dissolved HCHs can penetrate to a depth of ~500 m in the western Arctic Ocean, corresponding to water masses with a mean age of 45 ± 14 years. The average long-range transport time for α-HCH from initial atmospheric release to entering the western Arctic Ocean was estimated to be >30 ± 5 years, indicating continued moderate to high ecological risks from HCHs in the Arctic. This study demonstrates that transient tracers serve as effective water dating tools to elucidate the transport history of stable POPs in the ocean, contributing to a better understanding of their environmental characteristics and fate.

Experiences in Patent Ductus Arteriosus Closure of Preterm Infants Transported to Another Center for Surgical Ligation.

The timing of surgical patent ductus arteriosus ligation in preterm infants remains controversial. Early ligation (<2 or 3 weeks of life) benefits preterm infants with a lower incidence of bronchopulmonary dysplasia and necrotizing enterocolitis. We present patent ductus arteriosus ligation experience in premature infants who had been transported for closure to an outside centre other than the hospital they were hospitalized. We retrospectively evaluated 17 consecutive patients who had undergone surgery of premature infant patent ductus arteriosus closure during the period of March 2009-December 2020. Patent ductus arteriosus had been clipped in 17 patients. The median birth weight and age were 930 g and 28 gestation weeks, respectively. The birth age of the sub-groups were A: ≤28 weeks and B: >28 weeks and birthweight were group I: ≤800 g and group II: >800 g. The median day of PDA ligation wasa 20 days, and patients with birthweight ≤800 g were ligated later than patients weighing >800 g. Two patients had intracranial hemorrhage, 6 had bronchopulmonary dysplasia, and 2 were dead. We found that exposure to large patent ductus arteriosus and low birth age in preterm babies was associated with longer hospitalization duration, preoperative mechanical ventilation time, and sepsis. Infants exposed to moderate-to-large patent ductus arteriosus requiring intubation and resistant to medical therapy for more than 2 weeks should have surgical ligation as soon as possible.

Advanced artificial intelligence–guided hemodynamic management within cardiac enhanced recovery after surgery pathways: A multi-institution review

ObjectiveThe study objective was to report early outcomes of integrating Hypotension Prediction Index–guided hemodynamic management within a cardiac enhanced recovery pathway on total initial ventilation hours and length of stay in the intensive care unit. MethodsA multicenter, historical control, observational analysis of implementation of a hemodynamic management tool within enhanced recovery pathways was conducted by identifying cardiac surgery cases from 3 sites during 2 time periods, August 1 to December 31, 2019 (preprogram), and April 1 to August 31, 2021 (program). Reoperations, emergency (salvage), or cases requiring mechanical assist were excluded. Data were extracted from electronic medical records and chart reviews. Two primary outcome variables were length of stay in the intensive care unit (using Society of Thoracic Surgeons definitions) and acute kidney injury (using modified Kidney Disease Improving Global Outcomes criteria). One secondary outcome variable, total initial ventilation hours, used Society of Thoracic Surgeons definitions. Differences in length of stay in the intensive care unit and total ventilation time were analyzed using Kruskal–Wallis and stepwise multiple linear regression. Acute kidney injury stage used chi-square and stepwise cumulative logistic regression. ResultsA total of 1404 cases (795 preprogram; 609 program) were identified. Overall reductions of 6.8 and 4.4 hours in intensive care unit length of stay (P = .08) and ventilation time (P = .03) were found, respectively. No significant association between proportion of patients identified with acute kidney injury by stage and period was found. ConclusionsAdding artificial intelligence–guided hemodynamic management to cardiac enhanced recovery pathways resulted in associated reduced time in the intensive care unit for patients undergoing nonemergency cardiac surgery across institutions in a real-world setting.

Clinical Value of Sampling Time of Metagenomic Next-Generation Sequencing in Patients with Severe Pneumonia.

Severe pneumonia is a common infectious disease with high morbidity and mortality. Early etiological diagnosis is crucial for improving the prognosis. The aim of this study is to evaluate the clinical value ofsamplingtime of mNGS in patients with severe pneumonia. This retrospective study enrolled 105 patients with severe pneumonia. mNGS was performed on bronchoalveolar lavage fluid (BALF). Patients were divided into the sampling time ≤ 72h vs sampling time >72h groups and survivors vs non-survivors groups according to their sampling time and prognosis. Clinical characteristics, the adjustment of antibiotics and clinical prognostic value were evaluated. Our study showed that, early sampling of mNGS can significantly shorten the mechanical ventilation time (p = 0.007) and hospitalization time (p = 0.004). In the non-survivors group, CURB-65, SOFA, and APACHE II scores were higher. Age (OR: 1.051, 95% CI: 1.004-1.100, p = 0.034), chronic respiratory diseases (OR: 4.639, 95% CI: 1.260-17.082, p = 0.021), immunosuppression (OR: 5.008, 95% CI: 1.617-15.510, p = 0.005) and SOFA score on the day of mNGS sampling (OR: 1.492, 95% CI: 1.212-1.837, p < 0.001) were independent risk factors of in-hospital mortality. The most common pathogens were Klebsiella pneumoniae and Human gammaherpesvirus 4. The proportion of appropriate and targeted antibiotics adjusted was significantly higher than that in the sampling time > 72h group, and the proportion of antifungal and antiviral agents adjusted was lower. In the early sampling group, it was significantly decreased in the CRP, PCT level and NEU% at discharge. This study demonstrated that early sampling of mNGS could shorten the time of mechanical ventilation and hospitalization of patients with severe pneumonia. Patients with higher SOFA score on the day of sampling had a poorer prognosis. It emphasizes that early sampling of mNGS has a positive value.

Comparison of the effects of minimally invasive cardiopulmonary bypass and conventional cardiopulmonary bypass on atrial fibrillation after coronary artery bypass grafting and application of magnetic nanoparticles chemiluminescence immunoassay to detect serum indexes

To compare the effects of minimally invasive cardiopulmonary bypass coronary artery bypass grafting (MICB-CABG) and conventional cardiopulmonary bypass (CCPB)-CABG on the occurrence of atrial fibrillation (AF), in this research, totally 86 patients with CABG, admitted in our hospital from March 2020 to October 2021, were selected and divided equally into MICB-CABG and CCPB-CABG groups, according to the random number table method. The incidence of AF and left atrial volume index (LAVI) were compared between the two groups. In total, 104 patients with symptoms such as chest tightness, breathlessness, chest pain, and precordial discomfort were included in the study. All patients were examined by nano-CT and coronary angiography. However, time of ventilator use and time of fever were shorter in the MICB-CABG group. AF is closely related to LAVI, and levels of inflammatory factors, such as high-sensitivity (hs)-CRP, IL-6, and tumor necrosis factor-α (TNF-α), in the CCPB-CABG group were significantly higher than those in the MICB-CABG group. Taking the results of selective coronary angiography as the gold standard, the sensitivity and specificity of nano-CT in detecting coronary artery abnormalities were 99.17% and 97.93%, respectively, suggesting that nano-CT can display coronary artery variations precisely. Compared with the CCPB-CABG group, the incidence of AF after surgery and the risk indicators related to the occurrence of AF were significantly lower in the MICB-CABG group. Compared with traditional CCPB-CABG, MICB-CABG interferes less with the physiological functions of the body, reduces atrium damage, and improves the therapeutic effect. In addition, magnetic nanoparticle CLIA can meet the clinical need for detecting serum indexes and has good potential for clinical use.

EARLY MOBILIZATION AND THE ELASTIC BAND, AN EFFICIENT SOLUTION FOR AN INTUBATED SUBJECT: A CASE STUDY

ABSTRACT. Introduction: In severely ill patients, weakness acquired in the intensive care unit is a frequent consequence. The advantages of early mobilization for adult intensive care unit patients include shorter stays in the intensive care unit and hospitals, a shorter need for mechanical ventilation, fewer days of harmful bedrest, fewer negative or dangerous occurrences, and increased walking distance. Early mobilization and rehabilitation programs using elastic bands for patients with severe illnesses in intensive care units enhance the weaning success and shorten ventilation times while also enhancing arm muscular power. Objective: This study case aimed to present the fact that early mobilization and elastic band exercises were efficient solutions for an intubated subject from the intensive care unit. Methods: A mechanically ventilated subject postoperatively for hiatal hernia and suspected phrenic nerve paresis, benefited from early mobilization and elastic band exercises and was assessed for the state of consciousness with the Richmond Agitation Scale, and muscle strength for the upper limb with the EH101 digital dynamometer. Results: Muscle strength at the level of the upper limbs increased from weak to normal and the subject was successfully extubated. Conclusions: In this case study we consider that early mobilization and the elastic band exercises program were effective, safe, inexpensive, and suitable for an intensive care unit, and it was the right solution for the success of weaning from the ventilator.

Encouraging results of blood conservation in neonatal open-heart surgery

ObjectiveTo report early outcomes of blood conservation in neonatal open-heart surgery. MethodsNinety-nine patients undergoing neonatal open-heart surgery during the implementation of a blood conservation program between May 2021 and February 2023 were reviewed. Patients either received traditional blood management (blood prime, n = 43) or received blood conservation strategies (clear prime, n = 56). Baseline characteristics and outcomes were compared between groups. ResultsThere was no difference in body weight (median, 3.2 kg vs 3.3 kg; P = .83), age at surgery (median, 5 days vs 5 days; P = .37), distribution of The Society of Thoracic Surgeons–European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality Categories categories or duration of cardiopulmonary bypass. Patients in the clear prime group had higher preoperative hematocrit (median, 41% vs 38%; P < .01), shorter postoperative mechanical ventilation time (median, 48 hours vs 92 hours; P = .02) and postoperative intensive care unit length of stay (median, 6 days vs 9 days; P < .01) than patients in the blood prime group. Fourteen patients (25%) in the clear prime group, including 1 Norwood patient, were discharged without any transfusion. Among patients within the clear prime group, hospitalizations without blood exposure were associated with higher preoperative hematocrit (median, 43% vs 40%; P = .02), shorter postoperative mechanical ventilation times (median, 22 hours vs 66 hours; P = .01) and shorter postoperative hospital stays (median, 10 days vs 15 days; P = .02). ConclusionsBloodless surgery is possible in a significant proportion of neonates undergoing open-heart surgery, including the Norwood operation, even in the early stages of experience. Early clinical results are favorable but long-term follow-up and continued efforts are warranted to prove safety and reproducibility.

Respiratory tract infection after oral and maxillofacial surgery under general anesthesia and related factors.

We aimed to explore the respiratory tract infection after oral and maxillofacial surgery under general anesthesia and related factors. A total of 494 patients receiving oral and maxillofacial surgery under general anesthesia with tracheal intubation were assigned to a non-infection group (n=469) and an infection group (n=25). Another 494 healthy people undergoing physical examination in the same period were enrolled to establish a classification tree model. The distribution of pathogens, drug resistance of main pathogens, and related influencing factors of postoperative respiratory tract infection were analyzed. The influencing factors of respiratory tract infection were screened by logistic regression analysis. After construction of the classification and regression tree (CART) model based on the influencing factors, the accuracy was evaluated by plotting receiver operating characteristic (ROC) curve. Pseudomonas aeruginosa was highly resistant to cefazolin and more sensitive to cefoperazone, ciprofloxacin, norfloxacin and imipenem. Staphylococcus aureus was highly resistant to gentamicin and more sensitive to vancomycin. Age ≥ 60 years old, history of lung diseases, operation time ≥ 4 h, anesthesia ventilation time ≥ 120 min, and orotracheal intubation were independent influencing factors of respiratory tract infection (p< 0.05). The results of the gain chart, index map, and Risk value indicated a high predictive value of the CART model for the risk of postoperative respiratory tract infection. The area under the ROC curve was 0.869 [95% confidence interval: 0.795-0.947]. The CART model has a high predictive value and may reduce the risk of postoperative infection.

The predictive values of monocyte-lymphocyte ratio in postoperative acute kidney injury and prognosis of patients with Stanford type A aortic dissection.

Postoperative acute kidney injury (pAKI) is a serious complication of Stanford type A aortic dissection (TAAD) surgery, which is significantly associated with the inflammatory response. This study aimed to explore the relationship between blood count-derived inflammatory markers (BCDIMs) and pAKI and to construct a predictive model for pAKI. Patients who underwent TAAD surgery were obtained from our center and the Medical Information Mart for Intensive Care (MIMIC)-IV database. The differences in preoperative BCDIMs and clinical outcomes of patients with and without pAKI were analyzed. Logistic regression was used to construct predictive models based on preoperative BCDIMs or white cell counts (WCCs). The performance of the BCDIMs and WCCs models was evaluated and compared using the receiver operating characteristic (ROC) curve, area under the ROC curve (AUC), Hosmer-Lemeshow test, calibration plot, net reclassification index (NRI), integrated discrimination improvement index (IDI), and decision curve analysis (DCA). The Kaplan-Meier curves were applied to compare the survival rate between different groups. The overall incidence of pAKI in patients who underwent TAAD surgery from our center was 48.63% (124/255). The presence of pAKI was associated with longer ventilation time, higher incidence of cerebral complications and postoperative hepatic dysfunction, and higher in-hospital mortality. The results of the logistic regression indicated that the monocyte-lymphocyte ratio (MLR) was an independent risk factor for pAKI. The BCDIMs model had good discriminating ability, predictive ability, and clinical utility. In addition, the performance of the BCDIMs model was significantly better than that of the WCCs model. Analysis of data from the MIMIC-IV database validated that MLR was an independent risk factor for pAKI and had predictive value for pAKI. Finally, data from the MIMIC-IV database demonstrated that patients with a high MLR had a significantly poor 28-day survival rate when compared to patients with a low MLR. Our study suggested that the MLR is an independent risk factor for pAKI. A predictive model based on BCDIMs had good discriminating ability, predictive ability, and clinical utility. Moreover, the performance of the BCDIMs model was significantly better than that of the WCCs model. Finally, a high MLR was significantly associated with poor short-term survival of patients who underwent TAAD surgery.

Diagnostic and Prognostic Potential of Exosomal Cytokines IL-6 and IL-10 in Polytrauma Patients.

Trauma remains a leading cause of morbidity and mortality. Polytraumatized patients need a precise, early diagnosis to avoid complications such as multiorgan failure or sepsis. Inflammatory cytokines, commonly used for diagnosis, have a short half-life, which limits their efficacy as a diagnostic or prognostic marker. In this study, we hypothesized that cytokines in exosomes could have a longer half-life, and therefore could be used as diagnostic and prognostic markers in polytrauma patients. Plasma samples from polytraumatized patients (ISS ≥ 16, n = 18) were collected in the emergency room (ER) 1, 2, 3 and 5 days after trauma. Plasma-exosomes were isolated via size exclusion chromatography from polytraumatized patients and healthy volunteers (n = 10). The systemic and exosomal concentrations of interleukin (IL)-6, IL-10, IL-1β and TNF were measured using high-sensitive ELISAs. To investigate the diagnostic and prognostic potential of exosomal cytokines, data were correlated with clinical outcome parameters (injury severity, ventilation time, time in ICU and survival) documented in the patients' electronic records. Despite the use of high-sensitive ELISAs, IL-1β and TNF alpha were not detected in exosomes. IL-6 and IL-10 were detectable in polytraumatized patient exosomes at all time points. A decrease over time of both systemic and exosomal IL-6 concentrations was observed. Furthermore, exosomal and systemic IL-6 concentrations moderately correlated (r = 0.63). Exosomal IL-6 in the ER moderately correlated with the Injury Severity Score (ISS) (mean 35.5 ± 11.5) (r = 0.45) and was associated with non-survival in polytrauma patients (p < 0.05). In contrast to IL-6, no correlation between systemic and exosomal IL-10 concentrations was found. Exosomal IL-10 concentrations remained unchanged throughout the observation time, whereas systemic IL-10 concentrations peaked in the ER and were significantly reduced after 24 h. Data from this study support our hypothesis that some cytokines (IL-10), but not all (IL-6), are detectable in exosomes significantly longer than they are in plasma. This might indicate that they are protected from degradation. Although we did not find a correlation between IL-10 exosomal concentration and patient outcome, our data confirm that exosomal cytokines are of interest as potential diagnostic and prognostic markers in polytrauma patients, and require further detailed research.

Sildenafil for congenital heart diseases induced pulmonary hypertension, a meta-analysis of randomized controlled trials

BackgroundSildenafil was first prescribed for angina pectoris and then for erectile dysfunction from its effects on vascular smooth muscle relaxation and vasodilatation. Recently, sildenafil has been proposed for congenital heart diseases induced pulmonary hypertension, which constitutes a huge burden on children's health and can attribute to fatal complications due to presence of unoxygenated blood in the systemic circulation. Therefore, our meta-analysis aims to further investigate the safety and efficacy of sildenafil on children population.MethodsWe searched the following electronic databases: PubMed, Cochrane CENTRAL, WOS, Embase, and Scopus from inception to April 20th, 2022. Randomized controlled trials that assess the efficacy of using sildenafil in comparison to a placebo or any other vasodilator drug were eligible for inclusion. The inverse variance method was used to pool study effect estimates using the random effect model. Effect sizes are provided in the form of mean difference (MD) with 95% confidence intervals (CI).ResultsOur study included 14 studies with (n = 849 children) with a mean age of 7.9 months old. Sildenafil showed a statistically significant decrease over placebo in mean and systolic pulmonary artery pressure (PAP) with MD -7.42 (95%CI [-13.13, -1.71], P = 0.01) and -8.02 (95%CI [-11.16, -4.88], P < 0.0001), respectively. Sildenafil revealed a decrease in mean aortic pressure and pulmonary artery/aortic pressure ratio over placebo with MD -0.34 (95%CI [-2.42, 1.73], P = 0.75) and MD -0.10 (95%CI [-0.11, -0.09], P < 0.00001), respectively. Regarding post corrective operations parameters, sildenafil had a statistically significant lower mechanical ventilation time, intensive care unit stay, and hospital stay over placebo with MD -19.43 (95%CI [-31.04, -7.81], s = 0.001), MD -34.85 (95%CI [-50.84, -18.87], P < 0.00001), and MD -41.87 (95%CI [-79.41, -4.33], P = 0.03), respectively. Nevertheless, no difference in mortality rates between sildenafil and placebo with OR 0.25 (95%CI 0.05, 1.30], P = 0.10) or tadalafil with OR 1 (95%CI 0.06, 17.12], P = 1).ConclusionSildenafil is a well-tolerated treatment in congenital heart diseases induced pulmonary hypertension, as it has proven its efficacy not only in lowering both PAP mean and systolic but also in reducing the ventilation time, intensive care unit and hospital stay with no difference observed regarding mortality rates.

Prone position ventilation for the relief of acute respiratory distress syndrome through improved pulmonary ventilation: Efficacy and safety.

At present, there is a preliminary clinical consensus that prone position ventilation (PPV) is beneficial to the treatment of acute respiratory distress syndrome (ARDS), and further research on the details of treatment and patients' benefits will help to assess its effectiveness and safety. To evaluate the timing, efficacy, and safety of different mechanical ventilation positions (MVP) in treating ARDS. The results of clinical trials were directly or indirectly compared by network meta-analysis to compare the effects of different MVP. Two authors independently searched the papers published in PubMed, Embase, Cochrane Library, China Knowledge Infrastructure (CNKI), China Biomedical Discs (CBM), WanFang, and VIP database from January 2000 to August 2022. The outcome indicators were oxygenation index, mechanical ventilation time, ICU hospitalization time, in-hospital mortality, and incidence of adverse events. Two authors independently screened the literature, evaluated the quality of the studies, and completed the data extraction. Stata 14.0 was used to conduct a network Meta-analysis, and the intervention measures were ranked according to the surface under the cumulative ranking curve (SUCRA). Funnel plots were drawn to evaluate publication bias. According to the inclusion and exclusion criteria, 75 studies (including 6333 patient data) were finally included. According to the analysis results, PPV was the best for improving the oxygenation index. The SUCRA values of mechanical ventilation time, ICU hospitalization time, and in-hospital mortality were ranked as PPV > lateral position ventilation (LPV) > supine position ventilation (SuPV) > semireclining position ventilation (SePV). The SUCRA values in the incidence of adverse events were ranked as LPV > PPV > SuPV > SePV. All outcome measures had good consistency and low statistical heterogeneity. Funnel plot analysis shows that papers reported within three days of mechanical ventilation time, over five days of mechanical ventilation time, and in-hospital mortality were more likely to have publication bias. PPV has the best effect on improving the oxygenation index, reducing mechanical ventilation time, shortening ICU hospitalization time, and reducing in-hospital mortality. Early and long-term use of PPV to improve pulmonary ventilatory function will be the key to improving patients' survival and quality of life with ARDS. PPV significantly affects patients with ARDS, which can shorten the treatment time and reduce hospital costs. During the treatment, nursing observation should be strengthened to prevent adverse events.

Outcomes of cesarean myomectomy via trans-endometrial approach in women with single intramural fibroid in the posterior uterine wall

Objective To evaluate the feasibility and effectiveness of cesarean myomectomy (CM) via trans-endometrial approach in pregnant women with single intramural fibroid in the posterior uterine wall. Methods Ninety-eight patients with single intramural fibroids in the posterior uterine wall who underwent CM were divided into two groups depending on surgical style. The study group consisted of 50 patients who underwent trans-endometrial myomectomy (EM), whereas the control group included 48 patients who had trans-serosal myomectomy (SM). Patients’ demographic data, intraoperative and postoperative outcomes were analyzed retrospectively. Results No significant differences were found in the baseline characteristics of the two groups, including demographic data, size, location of fibroids, comorbidities, and indications for cesarean section. During the perioperative period, we did not observe significant differences between the two groups in terms of intraoperative hemorrhage, blood transfusion rate, postoperative fever incidence and postoperative hospitalization (all p > .05). It’s worth noting that the time of operation and postoperative ventilation in the EM group was shorter than that in the SM group (p < .05). More importantly, estimated blood loss and postoperative hemoglobin decline were less in the EM group than in the SM group (p < .05). Conclusion EM seems to be a viable approach to CM for the treatment of single intramural fibroids in the posterior wall, with the potential advantages of short operative time, low intraoperative bleeding, and low risk of pelvic adhesions.

Pulmonary function testing in patients with liver cirrhosis (Review).

Liver cirrhosis is a common long-term outcome of chronic hepatic inflammation. Patients with liver cirrhosis may also have pulmonary complications. There are several reasons for pulmonary dysfunction in liver cirrhosis, including intrinsic cardiopulmonary dysfunction unrelated to liver disease and specific disorders related to the presence of liver cirrhosis and/or portal hypertension. The most prevalent and clinically significant pulmonary complications are hepatic hydrothorax, hepatopulmonary syndrome, spontaneous pulmonary empyema and portopulmonary hypertension. Pulmonary function tests (PFTs) have traditionally been used to assess the lung function of patients with liver cirrhosis. To the best of our knowledge, the present review is the first to detail all types of PFTs performed in patients with liver cirrhosis and discuss their clinical significance. Patients with liver cirrhosis have reduced values of spirometric parameters, diffusion capacity for carbon monoxide (DLCO), lung volumes, maximal inspiratory pressure and maximal expiratory pressure. Furthermore, they have a higher closing volume, a greater airway occlusion pressure 0.1 sec after the onset of inspiratory flow and greater exhaled nitric oxide values. In order to improve pulmonary function, patients with ascites may require therapeutic paracentesis. Such findings should be considered when evaluating individuals with liver disease, particularly those who may require surgery. Poor lung function, particularly restrictive lung disease, can have an impact on post-transplant outcomes, such as ventilator time, length of hospital duration and post-operative pulmonary complications; thus, the transplant care team needs to be aware of its prevalence and relevance.

Ratio of procalcitonin/Simpson's dominance index predicted the short-term prognosis of patients with severe bacterial pneumonia.

The aim of this study was to explore the predictive value of the ratio of procalcitonin (PCT) in serum to Simpson's dominance index (SDI) in bronchoalveolar lavage fluid (BALF), in short-term prognosis of patients with severe bacterial pneumonia (SBP). This is a retrospective review of case materials of 110 patients with SBP who selected BALF metagenomic next-generation sequencing technique in the intensive care unit (ICU) of the Affiliated Hospital of Yangzhou University from January 2019 and July 2022. Based on the acute physiology and chronic health status score II, within 24h after admission to the ICU, patients were divided into a non-critical group (n = 40) and a critical group (n = 70). Taking death caused by bacterial pneumonia as the endpoint event, the 28-day prognosis was recorded, and the patients were divided into a survival group (n = 76) and a death group (n = 34). The SDI, PCT, C-reactive protein (CRP), PCT/SDI, and CRP/SDI were compared and analyzed. Compared with the non-critical group, the critical group had a higher PCT level, a greater PCT/SDI ratio, a longer ventilator-assisted ventilation time (VAVT), and more deaths in 28 days. Compared with the survivors, the death group had a higher PCT level, a lower SDI level, and a greater PCT/SDI ratio. The SDI level was significantly negatively correlated with the VAVT (r = -0.675, p < 0.05), while the PCT level, ratio of PCT/SDI, and ratio of CRP/SDI were remarkably positively correlated with VAVT (r = 0.669, 0.749, and 0.718, respectively, p < 0.05). The receiver operating characteristic (ROC) curves analysis showed that the area under ROC curves of PCT/SDI predicting patient death within 28 days was 0.851, followed by PCT + SDI, PCT, SDI, and CRP/SDI (0.845, 0.811, 0.778, and 0.720, respectively). The sensitivity and specificity of PCT/SDI for predicting death were 94.1% and 65.8%, respectively, at the optimal value (11.56). Cox regression analysis displayed that PCT/SDI (HR = 1.562; 95% CI: 1.271 to 1.920; p = 0.039) and PCT (HR = 1.148; 95% CI: 1.105 to 1.314; p = 0.015) were independent predictors of death in patients. The ratio of PCT/SDI was a more valuable marker in predicting the 28-day prognosis in patients with SBP.

Erector spinae plane block for postoperative analgesia in cardiac surgeries- A systematic review and meta-analysis.

Ultrasound-guided erector spinae plane block (ESPB) has been used in many studies for providing opioid-sparing analgesia after various cardiac surgeries. We performed a systematic review and meta-analysis of randomized controlled trials to assess the efficacy of ESPB in cardiac surgeries. We searched PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar to identify the studies in which ESPB was compared with the control group/sham block in patients undergoing cardiac surgeries. The primary outcomes were postoperative opioid consumption and postoperative pain scores. The secondary outcomes were intraoperative opioid consumption, ventilation time, time to the first mobilization, length of ICU and hospital stay, and adverse events. Out of 607 studies identified, 16 studies (n = 1110 patients) fulfilled inclusion criteria and were used for qualitative and quantitative analysis. Although, 24-hr opioid consumption were comparable in both groups group (MD, -18.74; 95% CI, -46.85 to 9.36, P = 0.16), the 48-hr opioid consumption was significantly less in ESPB group than control ((MD, -11.01; 95% CI, -19.98 to --2.04, P = 0.02). The pain scores at various time intervals and intraoperative opioid consumption were significantly less in ESPB group. Moreover, duration of ventilation, time to the first mobilization, and length of ICU and hospital were also less in ESPB group (P < 0.00001, P < 0.00001, P < 0.00001, and P < 0.0001, respectively). This systematic review and meta-analysis demonstrated that ESPB provides opioid-sparing perioperative analgesia, facilitates early extubation and mobilization, leads to early discharge from ICU and hospital, and has lesser pruritus when compared to control in patients undergoing cardiac surgeries.

Risk factors and early outcomes of chylothorax following congenital cardiac surgery: A single-center experience.

This study aims to investigate the incidence and risk factors for chylothorax and to evaluate the effect of chylothorax on the early postoperative outcomes following congenital cardiac surgery. A total of 1,053 patients (606 males, 447 females; median age: 12 months; range, 3 days to 48 years) who underwent surgery for congenital heart disease at our institute between January 2018 and December 2019 were retrospectively analyzed. Patients with chylothorax were identified and the data of this cohort was compared with the entire study population. Following the diagnosis of chylothorax, a standardized management protocol was applied to all patients. Of 1,053 patients operated, 78 (7.4%) were diagnosed with chylothorax. In the univariate analysis, younger age, peritoneal dialysis, preoperative need for mechanical ventilation, surgical complexity, delayed sternal closure, high vasoactive inotrope score in the first 24 h after operation, residual or additional cardiac lesions which required reoperations were found to be the risk factors for chylothorax (p<0.05). In the multivariate analysis, the correlation persisted with only younger age, infections, and peritoneal dialysis requirement (p<0.05). In the chylothorax group, ventilation times were longer, and re-intubation and infection rates were higher (p<0.05). Although the length of intensive care unit and hospital stay was significantly longer in this patient group, there was no significant association between the development of chylothorax and in-hospital mortality (p>0.05). Chylothorax following congenital cardiac surgery is a significant problem which prolongs the length of hospital stay and increases the infection rates. Complex cardiac pathologies which require surgery at early ages and re-operations are risk factors for chylothorax. Although there is no consensus on the most optimal therapeutic strategy, standardizing the management protocol may improve the results.