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Background: Acute Respiratory Distress Syndrome (ARDS) as defined by the Berlin definition has an approximate mortality rate of 40% and no curative treatment. Mutliple therapies have been studied to reduce mortality but only neuromuscular blocking agents show potential benefits on mortality and other complications of ARDS., Objective: This review aimed to investigate the efficacy of neuromuscular blockers in ARDS METHODS: Medline, Embase, Cochrane Central and Web of Science were queried on October 1st, 2021. Randomized clinical trials comparing neuromuscular blockers to any comparator in treating ARDS were included. Primary outcome was mortality. Secondary outcomes were ventilator-free days, intensive care (ICU) length of stay (LOS) and complications. Results between sedation levels were examined with a Bayesian Network for Meta-analysis method., Results: We included 6 trials compiling a total of 1557 patients. Neuromuscular blockers compared to any comparator in treating ARDS showed a reduction in mortality (RR 0.79 [95% CI, 0.62 to 0.99]). No difference in ventilator-free days (MD 0.68 [95% CI, -0.50 to 1.85]) or ICU LOS (MD 0.77 [95% CI, -2.99 to 4.54]) were found. A Bayesian Network Meta-analysis yielded no difference in mortality when using light sedation compared to heavy sedation in ARDS. (OR 0.58 [95% CrI, 0.07 to 4.46].) CONCLUSION: Neuromuscular blockers safely reduce mortality. Light sedation potentially has a similar impact on mortality as heavy sedation that carries some burden. A non-inferiority trial comparing both sedation levels may be warranted considering the added value of light sedation., Competing Interests: Declaration of Competing Interest No authors must declare any conflict of interest., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objectives: Minimally invasive techniques for lung cancer surgery have revolutionized thoracic surgery, and single-port approaches are becoming increasingly used. We analyzed our experience with uniportal video-assisted thoracoscopic surgery for lobectomy to identify the number of procedures necessary to achieve proficiency according to clinical outcomes., Methods: We queried our institutional prospective database for all single-port lobectomies in patients with early-stage lung cancer performed by a single surgeon from 2014 to 2017; 274 patients met the inclusion criteria. Using cubic splines, we derived 3 distinct learning phases based on the length of the procedure. Blood loss, additional port insertion, and conversion to thoracotomy were also compared according to these learning phases., Results: The initial phase (procedures 1-60) had the longest procedure times and the most variability in procedure length (158.8 ± 52.2 minutes) compared with the transition phase (procedures 61-140; 145.9 ± 43.8 minutes) and the proficient phase (procedures 141-274; 117.9 ± 32.6 minutes, P < .001). Blood loss (156 mL vs 130.4 mL vs 64.9 mL, P = .003), conversion rate to thoracotomy (11.7% vs 3.8% vs 0.7%, P = .001), and need for a second incision (8.3% vs 5% vs 0.7%, P = .025) were all highest during the initial phase. In a multivariable model, there was a significant interaction between procedure number and learning phase (P = .003), indicating that the effect of each additional procedure on procedure length differed in each phase., Conclusions: In this analysis, a distinct learning curve for uniportal video-assisted thoracoscopic surgery lobectomy was observed. Procedure time decreased sharply at approximately the 60th procedure, but 80 additional lobectomies were required to master the approach., (Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)