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International audience; Purpose Our study aimed to explore the association between early hyperoxemia of the first 24 h on outcomes in patients with severe blunt chest trauma.Materials and methods In a level I trauma center, we conducted a retrospective study of 426 consecutive patients. Hyperoxemic groups were classified in severe (average PaO2 ≥ 200 mmHg), moderate (≥150 and < 200 mmHg) or mild (≥ 100 and < 200 mmHg) and compared to control group (≥60 and < 100 mmHg) using a propensity score based analysis. The first endpoint was the incidence of a composite outcome including death and hospital-acquired pneumonia occurring from admission to day 28. The secondary endpoints were the incidence of death, the number of hospital-acquired pneumonia, mechanical ventilation-free days and intensive care unit-free day at day 28.Results The incidence of the composite endpoint was lower in the severe hyperoxemia group(OR, 0.25; 95%CI, 0.09–0.73; P < 0.001) compared with control. The 28-day mortality incidence was lower in severe (OR, 0.23; 95%CI, 0.08–0.68; P < 0.001) hyperoxemia group (OR, 0.41; 95%CI, 0.17–0.97; P = 0.04). Significant association was found between hyperoxemia and secondary outcomes.Conclusion In our cohort early hyperoxemia during the first 24 h of admission after severe blunt chest trauma was not associated with worse outcome.

Background Physiotherapy is a major cornerstone of enhanced rehabilitation after surgery (ERAS) and reduces the development of atelectasis after thoracic surgery. By initiating physiotherapy in the post-anaesthesia care unit (PACU), the aim was to evaluate whether the ultra-early initiation of rehabilitation (in the first hour following tracheal extubation) would improve the outcomes of patients undergoing elective thoracic surgery. Methods A case–control study with a before-and-after design was conducted. From a historical control group, patients were paired at a 3:1 ratio with an intervention group. This group consisted of patients treated with the ultra-early rehabilitation programme after elective thoracic surgery (clear fluids, physiotherapy, and ambulation). The primary outcome was the incidence of postoperative atelectasis and/or pneumonia during the hospital stay. Results After pairing, 675 patients were allocated to the historical control group and 225 patients to the intervention group. A significant decrease in the incidence of postoperative atelectasis and/or pneumonia was found in the latter (11.4 versus 6.7 per cent respectively; P = 0.042) and remained significant on multivariate analysis (OR 0.53, 95 per cent c.i. 0.26 to 0.98; P = 0.045). A subgroup analysis of the intervention group showed that early ambulation during the PACU stay was associated with a further significant decrease in the incidence of postoperative atelectasis and/or pneumonia (2.2 versus 9.5 per cent; P = 0.012). Conclusions Ultra-early rehabilitation in the PACU was associated with a decrease in the incidence of postoperative atelectasis and/or pneumonia after major elective thoracic surgery.

JCTCV:21(4), The purpose of this study was to compare our initial experience with RATS pulmonary lobectomy with that of our well-established VATS program. Methods: We compared the early outcomes of those 81 patients having had a 3-port full thoracoscopic lobectomy performed by the most experienced VATS surgeon with those 91 patients having had a 3-arm RATS lobectomy performed by a single surgeon during a 24-month period. Results: Operative time was longer in the RATS group (mean: 134.5 ± 154.2 minutes vs. 37.7 ± 47.3 minutes; p = 0.004). Overall morbidity was similar (43.4% vs. 39.1%; p = 0.57). Five patients in the VATS group required blood transfusions and only one in the RATS group (p = 0.12). Readmission rates at 90 days were similar (3.9% vs. 6.9%; p = 0.38). The 90-day mortality rates were 2.6% and 0% (p = 0.12). More N2 nodes were removed in the VATS group (mean: 9.92 ± 5.41 vs. 6.24 ± 5.584; p < 0.0001). The proportion of lymph node upstaging was similar in both groups (16% vs. 13%; p = 0.65). Conclusions: Our early experience of pulmonary lobectomy by RATS appears to be as safe and more mature than VATS, with regards to the 90-day postoperative period.