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Objective: To compare lung injury induced by a hemorrhagic shock resuscitated with normal saline or with small volumes of a hypertonic/hyperoncotic solution.Design and Setting: Randomized, controlled, laboratory study in an animal research laboratory.Subjects: Nineteen pigs (43 +/- 4 kg).Interventions: After anesthesia and mechanical ventilation animals were bled to induce a 2-h deep shock and resuscitated for 2 h using normal saline (NS, 2 ml/kg per minute, n = 7) or the association of 7.2% NaCl with 6% hydroxyethylstarch 200/0.5 (HSHES, 4 ml/kg in 10 min followed by 0.2 ml/kg per minute, n = 7) to reach cardiac index and mixed venous oxygen saturation goals. Lungs were removed 6[Symbol: see text]h after the initiation of hemorrhage. Five animals were used as controls without hemorrhage.Measurements and Results: Resuscitation goals were achieved using 90 +/- 17 ml/kg NS or 6.8 +/- 1.9 ml/kg HSHES. Lung injury was noted in both hemorrhage groups but was not influenced by the type of resuscitation. Extravascular lung water was measured at 9.6 +/- 1.8 ml/kg in the NS group, 9.2 +/- 1.6 ml/kg in the HSHES, group and 6.4 +/- 1 m/kg in the control group. The degree of histological alveolar membrane focal thickening and interstitial neutrophil infiltration were significantly more pronounced in the hemorrhage groups with no difference between the two types of fluid loading. Finally, pulmonary levels of IL-8 were higher after hemorrhage regardless of the type of resuscitation.Conclusions: When included in an optimized and goal directed resuscitation, the use of normal saline or a small volume of hypertonic/hyperoncotic solution does not result in a different early hemorrhage-induced lung injury. [ABSTRACT FROM AUTHOR]

The article describes a case of management of postesophagectomy respiratory failure in a 63-year-old man who underwent transthoracic esophagectomy for adenocarcinoma with noninvasive ventilation. His pulmonary function test revealed a forced expiratory volume of 3 liters per second and a forced vital capacity of 3.43 liters as the patient was a former smoker but stopped 5 years before surgery. Blood gas values for the main stages of clinical course in the end of first postoperative day and before paravertebral block second postoperative day.

The way that pain is assessed in the PACU could impact on postoperative pain and analgesic consumption. However, there is currently no evidence to support this speculation. The authors hypothesised that using a comfort scale reduces postoperative opioid consumption when compared with a standard numerical rating scale (NRS) to evaluate pain in the PACU. In this cluster-randomised trial, patients were assessed using either a comfort scale (comfort group) or a pain NRS (NRS group). The primary outcome was the opioid consumption in the PACU. The main secondary outcomes were postoperative pain, nausea and vomiting, length of stay in the PACU, and satisfaction. Of 885 randomised patients, 860 were included in the analysis. Opioid consumption in the PACU was comparable in the comfort and NRS groups (median [interquartile range [IQR] 0 (0–5) vs 0 (0–6); P =0.2436), irrespective of the type of surgical procedure. The majority of patients did not need any postoperative opioid (59% in the comfort group and 56% in the NRS group, P =0.2260). There was no difference in postoperative pain, nausea and vomiting, time to reach an Aldrete score ≥9 after extubation, and global satisfaction. Using a comfort scale to assess pain in the PACU did not spare any opioid compared with use of a standard NRS. Further studies focusing on patients at risk of increased postoperative opioid consumption are necessary. NCT05234216. [ABSTRACT FROM AUTHOR]

Abstract: Background: Respiratory complications are the most frequent concern following oesophagectomy. We aimed to assess the postoperative inflammatory response after oesophagectomy and to determine its reliability to predict the occurrence of pulmonary complications. Methods: A total of 97 patients were enrolled in this prospective observational study. All patients underwent a transthoracic oesophagectomy for cancer. From D0 to D3, plasmatic cytokine levels (interleukin (IL)-1, IL-6, IL-8, IL-10, tumour necrosis factor (TNF)-α), short synacthen test (SST), PaO2/FiO2 ratio and clinical factors determining the systemic inflammatory response syndrome (SIRS) were monitored and compared between patients who experienced pulmonary complications (group I) and those who did not (group II). Results: The overall in-hospital mortality was 5%. Postoperative pulmonary complications occurred in 33 patients (34%). Sputum retention was the first step of pulmonary complications in 26 patients (occurring at a mean of 2.8±1 days after the operation), leading to pneumonia in 22 patients (4.7±1 days) and acute respiratory distress syndrome (ARDS) in 10 (6.9±3 days). At day 2, group I patients had significantly higher plasmatic levels of IL-6, IL-10 and TNF-α than group II patients. PaO2/FiO2 was impaired accordingly (215 vs 348; p =0.006). SST was negative in 38% of group I patients and in 30% of group II patients (p =0.51). SIRS was present in 33% and 6% of group I and group II patients, respectively (p ≤0.01). At multivariate analysis, early occurrence of SIRS was the sole significant predictor of pulmonary complications (p =0.005; odds ratio (OR):11.4, confidence interval (CI): 2–63). Conclusions: The vast majority of postoperative pulmonary complications after oesophagectomy occur after the 4th postoperative day. The earlier detection (first 48h) of SIRS, high plasmatic cytokine levels and impairment of PaO2/FiO2 predicts the onset of these complications. This finding suggests that early pharmacological intervention may have a beneficial impact. [Copyright &y& Elsevier]

Background: Hypertonic saline may be administered in the setting of lung transplantation but may affect the development of ischemia–reperfusion lung injury. This study investigated the effects of the pre-treatment by intravenous hypertonic saline in a pig model of single lung ischemia–reperfusion. Methods: Forty-three pigs (34 ± 4 kg) under mechanical ventilation were randomly assigned to a left lung ischemia–reperfusion alone or preceded by 4-ml/kg 7.5% hypertonic saline, 33-ml/kg normal saline, or by the infusion of the vasodilator nicardipine. Animals without ischemia served as controls. After euthanasia, the left lung was sampled for histologic analysis and measurement of lung water and alveolar–capillary permeability. Results: Ischemia–reperfusion resulted in high-permeability pulmonary edema, hypoxemia, and increased interleukin-6 serum level. Hypertonic saline pre-treatment worsened pulmonary edema of the left lung (6.6 ± 0.7 vs 4.8 ± 0.8 ml/kg of body weight, p < 0.05) and resulted in a higher ratio of the protein level in the alveolar fluid to the serum protein level (0.41 ± 0.04 vs 0.21 ± 0.09, p < 0.05) and in a higher histologic damage score (11 [range, 9–11.75] vs 6.5 [range, 4.5–7.5], p < 0.05) without promoting pulmonary or systemic inflammation. Lung injury was affected neither by normal saline nor by nicardipine pre-treatment. Nicardipine did not influence the deleterious effect of hypertonic saline. Conclusions: Pre-treatment by intravenous hypertonic saline worsened ischemia–reperfusion lung injury independently of its effects on the cardiac index or pulmonary circulation but probably through a direct effect of hyperosmolarity on endothelial permeability. [Copyright &y& Elsevier]