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Few interventions are known to reduce the incidence of respiratory failure that occurs following elective surgery (postoperative respiratory failure; PRF). We previously reported risk factors associated with PRF that occurs within the first 5 days after elective surgery (early PRF; E-PRF); however, PRF that occurs six or more days after elective surgery (late PRF; L-PRF) likely represents a different entity. We hypothesized that L-PRF would be associated with worse outcomes and different risk factors than E-PRF.This was a retrospective matched case-control study of 59,073 consecutive adult patients admitted for elective non-cardiac and non-pulmonary surgical procedures at one of five University of California academic medical centers between October 2012 and September 2015. We identified patients with L-PRF, confirmed by surgeon and intensivist subject matter expert review, and matched them 1:1 to patients who did not develop PRF (No-PRF) based on hospital, age, and surgical procedure. We then analyzed risk factors and outcomes associated with L-PRF compared to E-PRF and No-PRF.Among 95 patients with L-PRF, 50.5% were female, 71.6% white, 27.4% Hispanic, and 53.7% Medicare recipients; the median age was 63 years (IQR 56, 70). Compared to 95 matched patients with No-PRF and 319 patients who developed E-PRF, L-PRF was associated with higher morbidity and mortality, longer hospital and intensive care unit length of stay, and increased costs. Compared to No-PRF, factors associated with L-PRF included: preexisiting neurologic disease (OR 4.36, 95% CI 1.81-10.46), anesthesia duration per hour (OR 1.22, 95% CI 1.04-1.44), and maximum intraoperative peak inspiratory pressure per cm HWe identified that pre-existing neurologic disease, longer duration of anesthesia, and greater maximum intraoperative peak inspiratory pressures were associated with respiratory failure that developed six or more days after elective surgery in adult patients (L-PRF). Interventions targeting these factors may be worthy of future evaluation.

Video-assisted thoracoscopic surgery can be beneficial for patients with penetrating and blunt thoracic trauma. It has utility in the initial assessment as well as the management of sequelae of traumatic injuries, especially retained hemothorax, and should be part of any trauma surgeon’s skill set. This review intends to emphasize the best-supported indications and timing for the use of this surgical approach in the injured patient.

Background The immunologic relationship between T H 1-type autoimmune disorders and T H 2-type allergic disorders and the role of T-cell regulation in humans is as yet unclear. The regulatory cytokine production capacity of individuals with concomitant allergy and T H 1-type autoimmunity may provide insight into the role of T-cell regulation in both disorders. Objectives To examine the production capacity of interleukin 10 (IL-10) and transforming growth factor β (TGF-β), 2 regulatory cytokines, in individuals with concomitant allergic rhinitis and T H 1-type autoimmune diagnoses and to compare that capacity with that in individuals with allergic rhinitis only and individuals with neither diagnosis. Methods Seventeen case subjects and 17 age-, sex-, and ethnicity-matched controls with allergic rhinitis only were recruited from an allergy clinic. Fourteen matched controls with neither diagnosis were recruited from the general population. Peripheral blood mononuclear cells were obtained and cultured with and without mitogen stimulation (lipopolysaccharide and phytohemagglutinin). Cytokine levels from culture supernatants were measured by enzyme-linked immunosorbent assay. Results Cases with allergic rhinitis and autoimmune diseases had significantly lower unstimulated day 3 IL-10 levels compared with controls with allergic rhinitis only ( P = .05) and significantly lower stimulated day 5 TGF-β levels compared with controls with neither diagnosis ( P = .02). Cases had consistently lower regulatory capacity compared with both control groups, as measured by an additive index using IL-10 and TGF-β levels. Conclusion Individuals with concomitant allergic rhinitis and T H 1-type autoimmune disorders have a lower regulatory cytokine production capacity than individuals with allergic rhinitis only and those with neither diagnosis.