Ventilation Time Research Articles

Rehabilitation effects of acupuncture on the diaphragmatic dysfunction in respiratory insufficiency: A systematic review and meta-analysis

IntroductionMechanical ventilation after respiratory insufficiency can induce diaphragm dysfunction through various hypothesized mechanisms. In this study, we evaluated the rehabilitative effect of acupuncture on diaphragm function in patients with respiratory insufficiency using meta-analysis and summarised the rules of acupoints through association rules analysis. MethodsArticles (published from January 2000 to February 2024) were retrieved from the following databases: PubMed, Cochrane Library, Embase, Web of Science, CNKI, VIP, SinoMed, and Wanfang. Two researchers conducted literature selection, data extraction, and statistical analysis independently. The risk of bias was assessed utilizing the Physical Therapy Evidence Database (PEDro) scale. The meta-analysis was performed with RevMan 5.4 software, and the quality of each outcome evidence was assessed via the online software GRADEpro GDT. The regularity of acupoint selection was summarized using association rules analysis. This study is registered on PROSPERO, number CRD42024526705. ResultsEleven articles were eventually included, all of which were of low to moderate quality. Results of the meta-analysis showed a significant increase in diaphragmatic thickening fraction (MD 3.40 [1.52, 5.27]) and diaphragmatic excursion (MD 0.95 [0.58, 1.31]) in patients with respiratory insufficiency after acupuncture treatment. Also, OI (MD 28.52 [15.93, 41.11]) and PaO2 (MD 7.18 [2.22, 12.13]) were significantly elevated and PaCO2 (MD −6.94 [-12.30, −1.59]) was decreased. Mechanical ventilation time (MD-1.86 [-2.28, −1.45]) was also significantly improved. The overall quality of the outcome evidence is deemed moderate. Association rules analysis showed that ST36, RN4, RN6, and others are core acupoints for the treatment of diaphragmatic dysfunction in patients with respiratory insufficiency by acupuncture. ConclusionAcupuncture shows potential in the rehabilitation of patients with respiratory insufficiency and may serve as a complementary and alternative therapy for related conditions. We suggest the use of ST36 as a core acupoint, in combination with other acupoints. Due to the potential publication bias and high heterogeneity of the current data, further high-quality RCTs are needed to confirm these findings.

Fiberoptic bronchoscopy for the prevention of ventilator-associated pneumonia: a meta-analysis of randomized controlled trials.

Ventilator-associated pneumonia (VAP) causes increased time of mechanical ventilation (MV), prolonged intensive care unit (ICU) stay, and a higher mortality risk. The systematic review and meta-analysis aimed to compare the efficacies between fiberoptic bronchoscopy (FOB) and general sputum suction for the prevention of VAP in patients with invasive MV. Relevant randomized controlled trials (RCTs) were obtained via a search of PubMed, Embase, Cochrane Library, Wanfang, and CNKI databases. A random-effects model was used to pool the results if significant heterogeneity was observed. Otherwise, a fixed-effects model was used. Sixteen RCTs were included. Compared to general sputum suction, sputum suction with FOB was associated with a significantly reduced risk of VAP (risk ratio [RR]: 0.56, 95% CI: 0.47 to 0.67, p < 0.001; I2 = 0%). Subgroup analyses showed that the combination of FOB-assisted sputum suction with bronchoalveolar lavage (BAL) further reduced the risk of VAP as compared to FOB-assisted sputum suction alone (p for subgroup difference = 0.04). In addition, FOB-assisted treatment was also associated with a reduced MV time (mean difference [MD]: -2.19 days, 95% CI: -2.69 to -1.68, p < 0.001; I2 = 18%), a shorter ICU stay (MD: 2.9 days, 95% CI: -3.68 to -2.13, p < 0.001; I2 = 34%), and a reduced mortality risk (RR: 0.46, 95% CI: 0.24 to 0.90, p = 0.02; I2 = 0%) in patients with invasive MV. FOB for sputum suction and BAL in patients with invasive MV is effective in reducing the incidence of VAP.

Effect of mixed probiotics on pulmonary flora in patients with mechanical ventilation: an exploratory randomized intervention study

ObjectiveThe study objective was to investigate the effect of mixed probiotics on the diversity of the pulmonary flora in critically ill patients requiring mechanical ventilation by analysing the changes in lung microbes.Methods24 adult critically ill patients who needed mechanical ventilation in our hospital were randomly divided into a probiotic group and a control group. Then, the probiotic group was given Live Combined Bifidobacterium, Lactobacillus and Enterococcus Capsules, Oral (Bifico) by nasal feeding within 24 h after mechanical ventilation. Bronchoalveolar lavage fluid (BALF) and venous blood were collected within 24 h after mechanical ventilation and on the 5th day after mechanical ventilation, and the treatment status of patients (mechanical ventilation time, 28-day survival), measured cytokine levels (IL-1 β, IL-6, IL-8, IL-17A) and changes in pulmonary microorganisms were observed.ResultsThe microbial diversity of BALF samples decreased in the control group, and there was no significant difference in the probiotic group. Species difference analysis showed that among the three probiotics (Bifidobacterium, Lactobacillus, Enterococcus) used for intervention, Lactobacillus caused significant differences in BALF in the control group. Clinical factor association analysis displayed significant associations with IL-17A levels in both blood and BALF.ConclusionMechanical ventilation can cause a decline in pulmonary microbial diversity, which can be improved by administering mixed probiotics.

Comparison GDP and conventional CPB impact on metabolism in cardiac center Sardjito general hospital

Abstract* Background Goal-directed perfusion (GDP) aims to balance oxygen delivery (DO2) and consumption (VO2) in cardiac surgery. Elevated lactate during CPB is common and linked to higher morbidity and mortality. Evaluating lactate with base excess (BE) is vital due to their relationship. Reducing severe BE and lactate predicts cardiac surgery outcomes better. Methods Fifty adult patients undergoing cardiac surgery with CPB were randomly assigned to either the GDP group or the conventional group. In the GDP group, the priming solution was adjusted to target a hematocrit (HCT) level of 24 to 27% with a pump flow of 1.8 to 2.2 L/min/m2 to maintain mean arterial pressure (MAP) between 60 and 65 mmHg. The primary outcomes was oxygen delivery index (DO2i). Results There were increasing trends in lactate levels and decreasing trends in BE levels at all timeframes. The GDP mean difference of lactate [1.504 (1.52); p &lt; 0.001] and BE [-0.87 (2.93); p = 0.22] levels showed better value in the GDP group, with statistically significant increased values in the control group for BE [-1.667 (2.93); p = 0.017] and lactate levels [2.215 (2.919); p &lt; 0.001]. The postoperative outcome showed a significant difference in AKI and ventilator time. Conclusions The GDP low flow CPB compared with conventional flow CPB maintained DO2 matched with VO2 with a better clinical values in the lactate and BE levels and significantly lowered AKI and ventilator duration in cardiac surgery.

Association between window ventilation frequency and depressive symptoms among older Chinese adults

ObjectivesIndoor air pollution exposure is harmful to people's physical and mental health, especially in the elderly population. Depressive symptoms are the most common mental health issue among elderly individuals. However, evidence linking the frequency of indoor natural ventilation to depressive symptoms in the elderly population is limited. MethodsThis study included 7887 individuals 65 years and older from 2017 to 2018 the China Longitudinal Healthy Longevity Survey (CLHLS). The frequency of indoor window ventilation was measured as the self-reported times of ventilation of indoor window per week in each season, and the four seasons' scores were added up to calculate the annual ventilation frequency. Depressive symptoms were measured by the 10-item Center for Epidemiologic Studies Short Depression Scale (CESD). Using three models adjusted for demographic, socio-economic, health status, and environmental factors successively, the correlation between indoor window ventilation frequency and depressive symptoms was verified through logistic regression. ResultsAmong the 7887 elderly people included in this study, 1952 (24.7 %) had depressive symptoms. In the fully adjusted model, compared with the lower indoor annual ventilation frequency group, high indoor annual ventilation frequency group was significantly associated with a 33 % (OR: 0.67, 95%CI: 0.51–0.88) lower probability of depressive symptoms. Subgroup analysis and sensitivity analysis yielded similar results. ConclusionsHigh frequency of window ventilation is significantly associated with the lower risk of depressive symptoms in Chinese individuals aged 65 and older. This result provides strong evidence for health intervention and policy formulation.

Clinical Outcomes and Cost Analysis in Patients with Heart Failure Undergoing Transcatheter Edge-to-Edge Repair for Mitral Valve Regurgitation.

Objective: To analyze the clinical and cost outcomes of transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR) in heart failure (HF) patients. Methods: All 162 HF patients undergoing TEER for MR between January 2019 and March 2023 were included. A propensity-adjusted analysis was used to compare 32 systolic vs. 97 diastolic vs. 33 mixed (systolic + diastolic) HF patients. Systolic, diastolic, and mixed HF patients were defined according to AHA guidelines. The primary outcome was the long-term incidence of all-cause death and major adverse cardiovascular and cerebrovascular events (MACCEs, all-cause mortality + stroke + myocardial infarction + repeat intervention). Results: The mean age was 76.3 vs. 80.9 vs. 76 years old, and the mean ejection fraction (EF) was 39.5% vs. 59.8% vs. 39.7% in systolic vs. diastolic vs. mixed HF, respectively. Postoperatively, the diastolic vs. systolic HF group had a higher intensive care unit stay (21 vs. 0 h; HR 67.5 (23.7, 111.4)]; lower ventilation time [2 vs. 2.3 h; HR 49.4 (8.6, 90.2)]; lower EF [38% vs. 58.5%; HR 9.9 (3.7, 16.1)]. In addition, the diastolic vs. mixed HF groups had a lower incidence of EF < 50% (11 vs. 27 patients; HR 6.6 (1.6, 27.3) and a lower use of dialysis (one vs. three patients; HR 18.1 (1.1, 287.3), respectively. At a mean 1.6 years follow-up, all-cause death [HR 39.8 (26.2, 60.5)], MACCEs [HR 50.3 (33.7-75.1)], and new pacemaker implantations [HR 17.3 (8.7, 34.6)] were higher in the mixed group. There was no significant total hospital cost difference among the systolic (USD 106,859) vs. diastolic (USD 91,731) vs. mixed (USD 120,522) HF groups (p = 0.08). Conclusions: TEER for MR evidenced the worst postoperative and follow-up clinical outcomes in the mixed HF group compared to diastolic and systolic HF groups. No total hospital cost differences were observed.

Complications in patients with severe COVID-19 infection who required admission to an intensive care unit in a fourth-level hospital in Bogotá, Colombia

Objective: To analyze the complications experienced by patients admitted to the ICU with severe COVID-19 at a fourth-level hospital in Bogotá, Colombia. Materials and Methods: This retrospective, descriptive, cross-sectional study included 181 patients aged over 18 years with severe COVID-19 admitted to the ICU at Fundación Cardioinfantil from August 2020 to May 2021. Results: Infections were the most prevalent complication, occurring in 72.9% of patients, with pulmonary superinfections and tracheitis being the most common. Neuropathy was observed in 18.7% of patients. Swallowing disorders were noted in 74% of patients, with 52.5% continuing to experience swallowing difficulties at discharge, leading to gastrostomy in 4.9%. Acute kidney injury was present in 26.5% of patients; 7.1% required de novo renal replacement therapy, and 2.8% needed renal replacement therapy at discharge. Myocardial injury was documented in 13.8% of patients. Discussion: The study highlights the extensive range of complications affecting post-COVID-19 patients, particularly those with severe infections. Polyneuropathy and myopathy are reported in 25-45% of critically ill patients, whereas our study documented neuropathy in 18.7%. Swallowing disorders, occurring in 74% of patients, led to a gastrostomy rate of 4.9%, slightly above the literature range of 1.9%-4.8%. Tracheostomy, used as an alternative to reduce sedation and mechanical ventilation time, was performed in 21.5% of patients, resulting in reduced ICU and ward stays. Conclusions: The most frequent ICU complications were healthcare-associated infections, underscoring the importance of early detection and preventive strategies. Neuromuscular sequelae, such as neuropathy, are significant factors affecting patient outcomes, highlighting the need for targeted rehabilitation methods.

Postoperative epidural analgesia and outcomes following pediatric bilateral lung and heart-lung transplantation: a retrospective observational study

BackgroundThe value of epidural analgesia in pediatric patients having heart and lung transplant surgery is unknown. We aimed to characterize various quality outcomes in patients who did and did not...

Perioperative anesthetic management of patients with hypoplastic left heart syndrome undergoing the comprehensive stage II surgery-A review of 148 cases.

Patients with hypoplastic left heart syndrome undergo the comprehensive stage 2 procedure as the second stage in the hybrid approach toward Fontan circulation. The complexity of comprehensive stage 2 procedure is considered a potential limitation, and limited information is available on its anesthetic management. This study aims to address this gap. A single-center retrospective cohort study analyzed 148 HLHS patients who underwent comprehensive stage 2 procedure, divided into Group A (stable condition, n = 116) and Group B (requiring preoperative intravenous inotropic therapy, n = 32). Demographic data, intraoperative hemodynamics, anesthetic management, and postoperative outcomes were collected. Etomidate (40%) was the most common induction agent, followed by esketamine (24%), midazolam (16%), and propofol (13%). Inhaled induction was rarely necessary (2%), occurring only in Group A patients. No statistical differences were found between groups for induction drug choice. Post-cardiopulmonary bypass management included moderate hypoventilation, inhaled nitric oxide (100%), and hemodynamic support with milrinone (97%) and norepinephrine (77%). Group B patients more frequently required additional levosimendan (20%) and epinephrine (18%). Extracorporeal membrane oxygenation was necessary in 8 patients (5%) with no between-group differences. Switching from fentanyl to remifentanil reduced postoperative ventilation time overall. However, Group B experienced significantly longer ventilation (6.3 vs. 3.5 h) and ICU stay (22 vs. 14 days). In-hospital mortality was 5% overall (Group A: 4%, Group B: 9%). Long-term survival analysis revealed a significant advantage for Group A. The use of short-acting opioids and adjusted ventilation modes enables optimal pulmonary blood flow and rapid transition to spontaneous breathing. Differentiated hemodynamic support with milrinone, norepinephrine, supplemented by levosimendan and epinephrine in high-risk patients, can mitigate the effects on the preoperatively volume-loaded right ventricle. However, differences in long-term survival probability were observed between groups. Local ethics committee, Medical Faculty, Justus-Liebig-University-Giessen (Trial Code Number: 216/14).

An experimental study of fire development under varying ventilation conditions during the depressurization process in pressurized buildings

Hermetic pressurized buildings are a new type of building in high-altitude areas that efficiently addresses issues such as high-altitude reactions. The indoor pressure is higher than the external pressure under working conditions, and pressure relief must be carried out first during emergencies. The emergency pressure relief process during a fire may lead to complex fire behavior that is different from that in regular buildings. In this study, we focus on the impact of ventilation conditions and the status of doors in such buildings on fire evolution and smoke plume characteristics through experiments. The temperature variation in the fire room and corridor is measured under different ventilation power, ventilation time, and door opening width conditions. This shows that the width of the door has the greatest impact on fire development. A smaller gap in the door opening restricts air circulation between the interior and exterior of the room, resulting in a rapid decrease in the oxygen concentration within the fire room and a decrease in the combustion reaction rate of wood fires. The ventilation power exerts the most significant influence on the temperature variation in the corridor. These findings provide empirical data and a basis for fire science studies in high-altitude hermetic pressurized buildings and can guide existing fire protection design and management for improved safety.

Commuter exposure to ultrafine particles (UFPs), lung deposited surface area (LDSA), and noise in Ho Chi Minh City, Vietnam

IntroductionTransport is a main contributor to air and noise pollution, particularly in urban areas with the high number of motorized vehicles. Promoting active transport (i.e., cycling and walking) and public transport is an instrumental factor in reducing traffic-related air and noise pollution. However, commuters of these transport modes are often exposed to high air and noise pollution than other commuter groups. MethodsThe levels of exposure to UFP, LDSA, and noise during commuting of different transport modes in Ho Chi Minh City (HCMC) were measured and compared. Then, the dose of inhaled pollutants during commuting was calculated for each commuter group by considering the travel time and minute ventilation. ResultsThe level of exposure to air and noise pollution varies across transport modes. Cyclists and motorcyclists were exposed to the highest level of air and noise pollution. Motorcyclists and cyclists were exposed to the highest UFP number concentrations during their trips, 3.6*105 and 3.1*105 particles/cm3, respectively. Car commuters were exposed to the lowest air and noise pollution level, followed by bus commuters. When considering the minute ventilation and travel time, cyclists inhaled significantly higher levels of air pollution than other commuters, followed by pedestrians, motorcyclists, bus commuters, and car users. As a result, the health impacts of exposure to traffic-related air and noise pollution for active commuters could be greater than other commuter groups. ConclusionsPromoting active and public transport is a promising approach to improving air quality and reducing congestion in HCMC. Using these transport modes also has potential positive health effects on commuters through physical activities. However, active commuters are faced with the highest risk of exposure to high air and noise pollution levels. To promote active transport and public transport in HCMC, measures to reduce the level of exposure to air and noise pollution for these commuter groups are needed.

619. ASSOCIATION OF PROLONGED ONE LUNG VENTILATION TIME WITH PERIOPERATIVE COMPLICATIONS IN PATIENTS UNDERGOING ESOPHAGOGASTRIC CANCER RESECTION

Abstract Introduction Esophagectomy for esophagogastric cancer is associated with high rates of peri-operative morbidity and mortality. Little is known of the impact of one lung ventilatory (OLV) times during the thoracic phase of an esophagectomy upon perioperative outcomes. The aim of this study was to determine the impact of OLV upon post-operative complications following esophagogastric cancer resection. Methods Consecutive patients undergoing an esophagectomy at a single, U.K tertiary referral centre for esophagogastric cancer between January 2015–January 2022 were evaluated. OLV time was defined as the number of minutes there was iatrogenic occlusion of one of the main bronchi such that all ventilatory requirements were performed by one lung. Previously published OLV times were used to determine if the duration was standard (&amp;lt;150 minutes) or prolonged (&amp;gt;=150 minutes). Post-operative complications were prospectively evaluated and classified using the Clavien-Dindo (CD) classification system. Patients were grouped as either CD 0-I (none-minor complications) or CD II-V (moderate–severe complications including post-operative mortality). Results There were 361 patients included in the final analysis. OLV times of &amp;lt;150 minutes were recorded in 101 patients and &amp;gt;=150 minutes were recorded in 260 patients. Both groups were comparable in terms of development of CDII-V complications with no statistically significant intergroup differences (91/101 vs 241/260; p=0.075). Notably, 41/91 (45.1%) of patients with an OLV time &amp;lt;150 minutes developed a pulmonary complication versus 100/241 (41.5%) with prolonged OLV times. Conclusion Pulmonary and other peri-operative complications remain a considerable burden in the recovery of patients following esophagogastric cancer resection, independant of OLV times. Strategies to mitigate this are need in order to reduce peri-operative morbidity and improve overall quality of life into survivorship.

Comparison of different surgical approaches for ascending aortic surgery with or without aortic valve involvement: Right anterior minithoracotomy versus conventional median sternotomy

ObjectivesMinimally invasive approach to cardiac surgery has been steadily developing and increasingly being performed since the early 1990s. We aimed to present our initial clinical experience and show the feasibility and safety of the right anterior minithoracotomy (RAT) approach for ascending aorta surgery with or without aortic valve involvement. MethodsThis single-center study included 112 patients who underwent ascending aortic replacement with or without aortic valve intervention, between September 2018 and March 2024. RAT was performed for 48 (42.9%) patients (RAT Group) and conventional median sternotomy (CS) was performed in the remaining 64 (57.1%) (CS Group). The primary end points included operative variables, reoperation for bleeding, transfusion requirements, extubation time, length of intensive care unit stay, hospital stay, and postoperative complications. ResultsThe mean age was 67.63 ± 6.67 years, and 65.1% of patients were men. Total operation time was significantly lower in the CS group (237.84 ± 24.87 minutes vs 259.57 ± 27.41 minutes, respectively; P = .0001). The mean ventilation time (12.73 ± 2.96 hours vs 19.43 ± 4.21 hours) and the mean intensive care unit length of stay (1.71 ± 0.86 days vs 3.6 ± 1.71 days) were both shorter in the RAT group (P < .0001 for both). Wound infection was significantly lower in the RAT group (P = .036). The length of the hospital stay was significantly shorter in the RAT group compared with the sternotomy group (7.48 ± 0.91 days vs 10.6 ± 1.43 days; P < .0001). ConclusionsRAT is a novel and promising approach for ascending aortic surgery with or without aortic valve involvement. This study confirms that this approach is feasible and safe.

The application of ERAS in the perioperative period management of patients for lung transplantation

ObjectiveTo explore the application of enhanced recovery after surgery (ERAS) in the perioperative period of lung transplantation. MethodsWe retrospectively collected the clinical data of 27 lung transplant patients who underwent ERAS during the perioperative period, while 12 lung transplant patients receiving routine treatment served as controls. General information was collected, including the specific implementation plan of ERAS, the incidence of complications and survival rate during the perioperative period (<30 d), postoperative hospitalization indicators, the postoperative length of stay, and numerical rating scale (NRS) scores. ResultsComparison of postoperative hospitalization indicators, the ERAS group compared with the control group, there were significant differences in postoperative ICU stay time (2.0(2.0,4.0) vs 4.5(3.0,6.0), p = 0.005), postoperative hospital stay time (18(15,26) vs 24(19.5,32.75), p = 0.016), duration of nasogastric tube (3(2,3) vs 4(2.25,4.75), p = 0.023), and first ambulation time (4(3,5) vs 5.8(4.5,7.5), p = 0.004). There was no significant difference in postoperative invasive mechanical ventilation time, time to eat after surgery, duration of urinary catheter and duration of chest tube between the ERAS group and the control group (p>0.05). The perioperative survival of the ERAS group was 81.5%, which was higher than the control group (66.7%), but there is no statistically significant difference. Comparison of post-extubation NRS scores, the ERAS group had lower NRS scores at 12 h (5.30 ± 0.14 vs 6.25 ± 0.75), 24 h (3.44 ± 0.64 vs 5.58 ± 0.9), 48 h (2.74 ± 0.66 vs 4.08 ± 0.79) and 72 h (1.11 ± 0.80 vs 2.33 ± 0.49) than the control group, the difference was statistically significant (p<0.01). Intra-group comparison, post-extubation 12 h comparison post-extubation 24 h, 48 h, 72 h, the NRS scores showed a gradual downward trend, the difference was statistically significant (p<0.01). In the comparison of perioperative complications, the ERAS group had a lower postoperative infection incidence than the control group, the difference was statistically significant (44.4% vs 83.3%, p = 0.037). The ERAS group had lower postoperative delirium incidence than the control group, the difference was statistically significant (11.1% vs 50%, p = 0.014). There was no significant difference in the incidence of acute rejection, primary graft loss (PGD), gastrointestinal (GI) complications and airway complications between two groups (p>0.05). ConclusionThe ERAS can be applied to lung transplant patients to relieve postoperative pain, shorten postoperative tube time, and shorten postoperative stay. Perioperative pulmonary rehabilitation exercises are beneficial to reducing the occurrence of postoperative pulmonary complications.

Effect of minimally invasive cardiac surgery on hospital length of stay: A systematic review and meta-analysis

Background: Perioperative management using minimally invasive cardiac surgery (MICS), compared to full sternotomy (FS) cardiac surgery, is considered to improve postoperative recovery, and reduce hospital length of stay (LOS). Methods: A comprehensive systematic search was conducted across MEDLINE/PubMed, Embase, and the Cochrane library to identify RCT comparing MICS to FS approach for aortic valve, mitral valve, and coronary artery bypass surgery. Meta-analysis of extracted data was performed using random effects models. Results: A total of 33 RCTs including 2920 patients were identified. Overall MD (95% CI) for hospital and intensive care unit (ICU) LOS after MICS was significantly shorter compared to FS (-0.88 days (-1.55;-0.20), p&lt;0.013; 2606 patients) and (-0.23 days (-0.41;-0.05), p=0.012; 2242 patients), respectively. Additionally, postoperative blood loss was reduced with the use of MICS, (-192.07 ml (-292.32;-91.82), p=0.002; 718 patients). There was no evidence for differences between both groups in terms of postoperative ventilation times, duration of surgery, reintervention rate, incidence of postoperative atrial fibrillation or stroke, hospital mortality, or 1-year mortality. Conclusion: Within the limitations of a meta-analysis, MICS was found to be effective in promoting faster recovery by reducing postoperative blood loss, ICU, and hospital LOS.

A Prospective Randomised Observational Study of Obstructed Total Anamalous Pulmonary Venous Connection (TAPVC) Repair Patients with Milrinone Versus Milrinone and Inhaled Nitric Oxide

Abstract Background: Obstructed total anomalous pulmonary venous connection (OTAPVC) typically presents with severe cardiovascular decompensation and requires urgent surgical management. Pulmonary arterial hypertension (PAH) is a major risk factor affecting mortality. Perioperative management focuses on providing inotropic support and managing potential pulmonary hypertensive episodes. The aim of this study was to determine the outcome of patients with high pulmonary arterial pressure (PAP) with milrinone alone and a combination of milrinone and inhaled nitric oxide (INO). Material and Methods: After the approval of the ethical committee, this single-centre prospective randomised and observational study was conducted over a period of two years among eighty-six patients with obstructed TAPVC repair with severe PAH. Group-I patients received milrinone, and Group-II patients received both milrinone (after aortic cross clamp removal) and INO during the post-operative period at the cardiac care unit (CCU). Clinical outcomes such as ventilation time, length of stay (LOS) in the CCU, LOS in the hospital, complications, and hospital mortality were compared between the two groups. Result: The average ventilation time, LOS in CCU, and LOS in hospital for group I were 96.82 ± 19.46 hours, 10.91 ± 7.53 days, and 14.46 ± 7.58 days, respectively, and for group II, it was 85.14 ± 15.79 hours, 7.28 ± 3.68 days, and 10.21 ± 3.14 days, respectively, which was statistically significantly lower for group II. Reintubation, RV dysfunction, and hospital mortality were 16.3%, 37.2%, and 6.9% in group I, and 4.8%, 14.6%, and 2.4% in group II, respectively. The P value for each variable was significant &lt; 0.05 (except mortality). Conclusion: Preoperative obstruction is a risk factor for postoperative obstruction, as 235 patients with obstructed TAPVC had severe PAH (39.98%) in this study. Management of severe PAH with a combination of milrinone and INO had a better outcome than milrinone alone.

Risk Factors for Postoperative Atrial Fibrillation in Myocardial Revascularization Surgery: A 15-Year Experience.

Background: Myocardial revascularization surgery (MRV) is a revascularization therapy for coronary artery disease aimed at improving survival conditions. Elderly patients with increased comorbidities undergoing MRV face challenges in preventing postoperative complications, including atrial fibrillation (AF), a common arrhythmia occurring in 40% of cases or even in 80% of cases if the procedure is combined with valve surgery. This study aimed to determine the risk factors associated with the appearance of postoperative AF (POAF) in patients undergoing isolated MRV. Methods: This is an epidemiological, retrospective, and analytical case-control study (90 cases and 360 controls). Results: Mortality within the group of patients who presented with POAF in the study population was 15.5%, and 9.44% in the control group. Logistic regression showed an association of AF with the presurgical variables age >60 years and urgent/emergency surgery and the postsurgical variables cardiogenic shock, blood transfusion, pulmonary edema, pleural effusion, orotracheal reintubation, and mechanical ventilation time. Conclusions: Strategies should be proposed for the timely identification of risk factors and postoperative complications related to AF onset to avoid the increased morbidity and mortality associated with this type of arrhythmia during the postoperative period.

Does Chronic Obstructive Pulmonary Disease Impact Outcome after Coronary Artery Bypass Grafting? A Population-Based Retrospective Study in Germany.

Background: The interaction between chronic obstructive pulmonary disease (COPD) and coronary artery bypass grafting (CABG) is discussed controversial. Methods: In this population-based retrospective analysis including non-emergency CABG in Germany between 2015 and 2021, the aim was to compare in-hospital mortality, hospital length of stay (HLOS), and perioperative ventilation time (VT) in patients affected by COPD and not affected by COPD. In addition, we compared outcomes after off-pump coronary artery bypass (OPCAB) and on-pump coronary artery bypass (ONCAB) surgery and outcomes after CABG with a minimally invasive technique with and without cardiopulmonary bypass (CPB) in COPD patients. Results: Of the 274,792 analyzed cases undergoing non-emergency CABG, 7.7% suffered from COPD. COPD patients showed a higher in-hospital mortality (6.0% vs. 4.2%; p < 0.001), a longer HLOS (13 days (10-19) vs. 12 days (9-16); p < 0.001), and a longer VT (33 h (11-124) vs. 28 h (9-94); p < 0.001). In subgroup analyses, COPD patients undergoing OPCAB surgery showed a lower in-hospital mortality (3.5% vs. 6.4%; p < 0.001), a shorter HLOS (12 days (9-16) vs. 13 days (10-19); p < 0.001) and a shorter VT (20 h (10-69) vs. 36 h (11-135); p < 0.001) compared to ONCAB surgery. Regression analyses confirmed that using cardiopulmonary bypass in COPD patients is associated with a higher risk of in-hospital mortality (OR, 1.86; 95% CI: 1.51-2.29, p < 0.001), a longer HLOS (1.44 days; 95% CI: 0.91-1.97, p < 0.001), and a longer VT (33.67 h; 95% CI: 18.67-48.66, p < 0.001). In further subgroup analyses, COPD patients undergoing CABG with a minimally invasive technique without CPB showed a lower in-hospital mortality (3.5% vs. 16.5%; p < 0.001) and a shorter VT (20 h (10-69) vs. 65 h (29-210); p < 0.001) compared to CABG with a minimally invasive technique and CPB. Regression analyses confirmed that using CPB in COPD patients undergoing CABG with a minimally invasive technique is associated with a higher risk of in-hospital mortality (OR, 4.80; 95% CI: 2.42-9.51, p < 0.001). Conclusions: COPD negatively impacts outcomes after non-emergency CABG. According to our results, OPCAB surgery and CABG with a minimally invasive technique without CPB seem to be beneficial for COPD patients. Further studies should be performed to confirm this.

Comparison of Pulmonary Outcome in Minimally Invasive (TCRAT) and Full Sternotomy CABG.

Pulmonary complications are among the main causes of increased mortality, and morbidity, as well as prolonged intensive care unit (ICU) and hospital stay after cardiac surgery. Recently, a sternum-sparing concept of minimally invasive total coronary revascularization via anterior minithoracotomy (TCRAT) was introduced. A higher risk of pulmonary injury could be anticipated due to the thoracic incision and the longer duration of surgery. Pulmonary complications in TCRAT were compared to standard coronary artery bypass grafting (CABG) via full median sternotomy (FS). Records of 151 consecutive TCRAT (from September 2021 to November 2022) and 229 consecutive FS patients (from January 2017 to December 2018) patients, who underwent elective or urgent CABG, were analyzed. Preoperative baseline characteristics (age, sex, body mass index, diabetes, hypertension, chronic obstructive pulmonary disease, smoking status, left ventricular ejection fraction, pulmonary hypertonus, and EuroScore II) were comparable between groups. Differences between examined groups examined were found for the pulmonary parameters: Horowitz index 6 hours after operation (TCRAT 270 ± 72 vs. FS 293 ± 73, p < 0.05), pneumothorax (TCRAT 0% vs. FS 2.6%, p < 0.05), bronchoscopies (TCRAT 5.9% vs. FS 1.7%, p < 0.05), and pleural effusion (TCRAT 8.6% vs. FS 3.5%, p < 0.05). Moreover, there were differences between groups with regard to mean ICU stay (TCRAT 2.4 ± 3.0 days vs. FS 1.8 ± 1.8 days, p < 0.05), stroke (TCRAT 0% vs. FS 1.3%, p < 0.05), and hospital stay (TCRAT 10.9 ± 8.5 days vs. FS 13.2 ± 9.3 days, p < 0.05). There were no differences regarding atelectasis, reintubations, tracheostomies, ventilation time, and mortality. Pulmonary complications in terms of pleural effusions were more common with TCRAT, however, without substantial impact on clinical outcome.

Preload responsiveness–guided fluid removal in mechanically ventilated patients with fluid overload: A comprehensive clinical–physiological study

This study investigated fluid removal strategies for critically ill patients with fluid overload on mechanical ventilation. Traditionally, a negative fluid balance (FB) is aimed for. However, this approach can have drawbacks. Here, we compared a new approach, namely removing fluids until patients become fluid responsive (FR) to the traditional empiric negative balance approach.Twelve patients were placed in each group (n = 24). FR assessment was performed using passive leg raising (PLR). Both groups maintained stable blood pressure and heart function during fluid management. Notably, the FR group weaned from the ventilator significantly faster than negative FB group (both for a spontaneous breathing trial (14 h vs. 36 h, p = 0.031) and extubation (26 h vs. 57 h, p = 0.007); the difference in total ventilator time wasn't statistically significant (49 h vs. 62 h, p = 0.065). Additionally, FR group avoided metabolic problems like secondary alkalosis and potential hypokalemia seen in the negative FB group.FR-guided fluid-removal in fluid overloaded mechanically ventilated patients was a feasible, safe, and maybe superior strategy in facilitating weaning and disconnection from mechanical ventilation than negative FB-driven fluid removal. FR is a safe endpoint for optimizing cardiac function and preventing adverse consequences during fluid removal.