Search

After esophagectomy, an imbalanced inflammatory response increases the risk of postoperative morbidity. The vagus nerve modulates local and systemic inflammatory responses, but its pulmonary branches are transected during esophagectomy as part of the oncological resection, which may account for the high incidence of postoperative (pulmonary) complications. This study investigated the effect of electrical vagus nerve stimulation (VNS) on lipopolysaccharide (LPS)-induced lung injury in rats. Rats (n = 60) were randomly assigned to a non-vagotomy or cervical vagotomy group, with VNS or without (NOSTIM). There were four non-vagotomy groups: NOSTIM and bilateral VNS with 100, 50, or 10 µA. The four vagotomy groups were NOSTIM and VNS with fixed amplitude (50 µA) bilaterally before (VNS-50-before) or after bilateral vagotomy (VNS-50-after), or unilaterally (left) before ipsilateral vagotomy (VNS-50-unilaterally). LPS was administered intratracheally after surgery. Pulmonary function, pro-inflammatory cytokines in serum, broncho-alveolar lavage fluid (BALF), and histopathological lung injury (LIS) were assessed 180 min post-procedure. In non-vagotomized rats, neutrophil influx in BALF following intra-tracheal LPS (mean 30 [± 23]; P = 0.075) and LIS (mean 0.342 [± 0.067]; P = 0.142) were similar after VNS-100, compared with NOSTIM. VNS-50 reduced neutrophil influx (23 [± 19]; P = 0.024) and LIS (0.316 [± 0.093]; P = 0.043). VNS-10 reduced neutrophil influx (15 [± 6]; P = 0.009), while LIS (0.331 [± 0.053]; P = 0.088) was similar. In vagotomized rats, neutrophil influx (52 [± 37]; P = 0.818) and LIS (0.407 [SD ± 0.037]; P = 0.895) in VNS-50-before were similar compared with NOSTIM, as well as in VNS-50-after (neutrophils 30 [± 26]; P = 0.090 and LIS 0.344 [± 0.053]; P = 0.073). In contrast, VNS-50-unilaterally reduced neutrophil influx (26 [± 10]; P = 0.050) and LIS (0.296 [± 0.065]; P = 0.005). Systemic levels of cytokines TNF-α and IL-6 were undetectable in all groups. Pulmonary function was not statistically significantly affected. In conclusion, VNS limited influx of neutrophils in lungs in non-vagotomized rats and may attenuate LIS. Unilateral VNS attenuated lung injury even after ipsilateral vagotomy. This effect was absent for bilateral VNS before and after bilateral vagotomy. It is suggested that the effect of VNS is dependent on (partially) intact vagus nerves and that the level of the vagotomy during esophagectomy may influence postoperative pulmonary outcomes. [ABSTRACT FROM AUTHOR]

Background: Pulmonary complications influence morbidity, mortality and hospital stay in patients following cardiac surgery. Acute post-operative pain and less than optimal respiratory muscle strength may affect a patient's ability to take deep breaths, cough and clear secretions, thereby influencing recovery after surgery. To date, few studies described patients' pain levels, respiratory muscle strength and the presence of pulmonary dysfunction preoperatively and evaluated the effect of a median sternotomy on parameters at hospital discharge. This study investigates this in patients at a private urban hospital in South Africa. Methods: Participants were consecutively sampled for this longitudinal observational study and assessed at hospital admission and discharge. The visual analogue scale provides information on participants' pain levels. Respiratory muscle strength (maximal inspiratory pressure and peak inspiratory flow) was assessed with a POWERbreathe KHI device. The presence of pulmonary complications was determined with a chest X-ray radiographic scoring tool. Descriptive and inferential analyses with significance set at p ≤ 0.05 were performed. Results: The population consisted of 61 participants [males: n = 47 (77%)], and the majority underwent coronary artery bypass graft surgery (n = 35, 57%) and had a theatre time of 5.84 (± 1.30) h and time on cardiopulmonary bypass 2.01 (IQR1.14) h. Intensive care stay was 5 (IQR 2.75) days with mechanical ventilation time 17.33 (IQR 11.21) h and hospital stay 9 (IQR 7) days. Forty-one (67.2%) participants had weak respiratory muscles at hospital admission. Respiratory muscle strength reduced significantly between hospital admission and discharge: maximal inspiratory pressure: 55 cmH20 vs 30.66 cmH20, p < 0.001, and peak inspiratory flow: 2.70 l/s vs. 1.66 l/s, p < 0.001. Atelectasis (n = 28, 46, 6%) and pleural fluid (n = 26, 43, 3%) were chest X-ray abnormalities at hospital discharge. Chest X-ray scores (Z = − 5.825, p < 0.001) and pain levels (Z = − 5.867, p < 0.001) increased significantly over time. There was a fair, negative correlation between admission maximal inspiratory pressure and chest X-ray scores, which was statistically significant (r = − 0.356, p = 0.004). Conclusions: Respiratory muscle weakness, abnormal chest X-ray findings and persistent pain were noted in study participants. This study highlights the need for continued rehabilitation services to optimise patient outcomes as it relates to ventilation and pain management. [ABSTRACT FROM AUTHOR]

Background: Intraoperative driving pressure (ΔP) has an independent association with the development of postoperative pulmonary complications (PPCs) in patients receiving ventilation during general anesthesia for major surgery. Ventilation with high intraoperative positive end–expiratory pressure (PEEP) with recruitment maneuvers (RMs) that result in a low ΔP has the potential to prevent PPCs. This trial tests the hypothesis that compared to standard low PEEP without RMs, an individualized high PEEP strategy, titrated to the lowest ΔP, with RMs prevents PPCs in patients receiving intraoperative protective ventilation during anesthesia for minimally invasive abdominal surgery. Methods: "DrivinG prEssure duriNg gEneRal AnesThesia fOr minimally invasive abdominal suRgery (GENERATOR)" is an international, multicenter, two–group, patient and outcome–assessor blinded randomized clinical trial. In total, 1806 adult patients scheduled for minimally invasive abdominal surgery and with an increased risk of PPCs based on (i) the ARISCAT risk score for PPCs (≥ 26 points) and/or (ii) a combination of age > 40 years and scheduled surgery lasting > 2 h and planned to receive an intra–arterial catheter for blood pressure monitoring during the surgery will be included. Patients are assigned to either an intraoperative ventilation strategy with individualized high PEEP, titrated to the lowest ΔP, with RMs or one with a standard low PEEP of 5 cm H2O without RMs. The primary outcome is a collapsed composite endpoint of PPCs until postoperative day 5. Discussion: GENERATOR will be the first adequately powered randomized clinical trial to compare the effects of individualized high PEEP with RMs versus standard low PEEP without RMs on the occurrence of PPCs after minimally invasive abdominal surgery. The results of the GENERATOR trial will support anesthesiologists in their decisions regarding PEEP settings during minimally invasive abdominal surgery. Trial registration: GENERATOR is registered at ClinicalTrials.gov (study identifier: NCT06101511) on 26 October 2023. [ABSTRACT FROM AUTHOR]

Abstract Background Pulmonary complications influence morbidity, mortality and hospital stay in patients following cardiac surgery. Acute post-operative pain and less than optimal respiratory muscle strength may affect a patient’s ability to take deep breaths, cough and clear secretions, thereby influencing recovery after surgery. To date, few studies described patients’ pain levels, respiratory muscle strength and the presence of pulmonary dysfunction preoperatively and evaluated the effect of a median sternotomy on parameters at hospital discharge. This study investigates this in patients at a private urban hospital in South Africa. Methods Participants were consecutively sampled for this longitudinal observational study and assessed at hospital admission and discharge. The visual analogue scale provides information on participants’ pain levels. Respiratory muscle strength (maximal inspiratory pressure and peak inspiratory flow) was assessed with a POWERbreathe KHI device. The presence of pulmonary complications was determined with a chest X-ray radiographic scoring tool. Descriptive and inferential analyses with significance set at p ≤ 0.05 were performed. Results The population consisted of 61 participants [males: n = 47 (77%)], and the majority underwent coronary artery bypass graft surgery (n = 35, 57%) and had a theatre time of 5.84 (± 1.30) h and time on cardiopulmonary bypass 2.01 (IQR1.14) h. Intensive care stay was 5 (IQR 2.75) days with mechanical ventilation time 17.33 (IQR 11.21) h and hospital stay 9 (IQR 7) days. Forty-one (67.2%) participants had weak respiratory muscles at hospital admission. Respiratory muscle strength reduced significantly between hospital admission and discharge: maximal inspiratory pressure: 55 cmH20 vs 30.66 cmH20, p

Currently, the literature has limited information on potential risks of pulmonary toxicity in patients receiving anticancer therapy. Nevertheless, this complication is not uncommon in some patients and can manifest in various patterns of changes in the lung parenchyma.

Background: Anti-inflammatory effects of tranexamic acid (TXA) in reducing trauma endotheliopathy may protect from acute lung injury. Clinical data showing this benefit in trauma patients is lacking. We hypothesized that TXA administration mitigates pulmonary complications in penetrating trauma patients. Materials and Methods: This is a post-hoc analysis of a multicenter, prospective, observational study of adults (18+ years) with penetrating torso and/or proximal extremity injury presenting at 25 urban trauma centers. Tranexamic acid administration in the prehospital setting or within three hours of admission was examined. Participants were propensity matched to compare similarly injured patients. The primary outcome was development of pulmonary complication (ARDS and/or pneumonia). Results: A total of 2382 patients were included, and 206 (8.6%) received TXA. Of the 206, 93 (45%) received TXA prehospital and 113 (55%) received it within three hours of hospital admission. Age, sex, and incidence of massive transfusion did not differ. The TXA group was more severely injured, more frequently presented in shock (SBP < 90 mmHg), developed more pulmonary complications, and had lower survival (P < 0.01 for all). After propensity matching, 410 patients remained (205 in each cohort) with no difference in age, sex, or rate of shock. On logistic regression, increased emergency department heart rate was associated with pulmonary complications. Tranexamic acid was not associated with different rate of pulmonary complications or survival on logistic regression. Survival was not different between the groups on logistic regression or propensity score–matched analysis. Conclusions: Tranexamic acid administration is not protective against pulmonary complications in penetrating trauma patients. [ABSTRACT FROM AUTHOR]

Abstract Background Our aim was to evaluate the influence of staged goal directed therapy (GDT) on postoperative pulmonary complications (PPCs), intraoperative hemodynamics and oxygenation in patients undergoing Mckeown esophagectomy. Methods Patients were randomly divided into three groups, staged GDT group (group A, n = 56): stroke volume variation (SVV) was set at 8–10% during the one lung ventilation (OLV) stage and 8–12% during the two lung ventilation (TLV) stage, GDT group (group B, n = 56): received GDT with a target SVV of 8–12% During the entire surgical procedure, and control group (group C, n = 56): conventional fluid therapy was administered by mean arterial pressure (MAP), central venous pressure (CVP), and urine volume. The primary outcome was the incidence of postoperative pulmonary complications within Postoperative days (POD) 7. The secondary outcomes were postoperative lung ultrasound (LUS) B-lines artefacts (BLA) scoring, incidence of other complications, the length of hospital stay, intraoperative hemodynamic and oxygenation indicators included mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), cardiac output (CO), oxygenation index (OI), respiratory indices (RI), alveolar-arterial oxygen difference (Aa-DO2). Results Patients in group A and group B had a lower incidence of PPCs (7/56 vs. 17/56 and 9/56 vs. 17/56, p

Abstract Background The Revised Cardiac Risk Index (RCRI) and the American Society of Anaesthesiologists (ASA-PS) classification system are two commonly used tools for preoperative risk assessment. This study aimed to assess the accuracy of RCRI compared to the ASA-PS classification system in preoperative risk assessment for pulmonary and cardiac problems among non-cardiothoracic surgery patients admitted at Muhimbili National Hospital (MNH). Methods This was a prospective cohort study design conducted from August 2022 to April 2023 among 184 patients of 18 years and above admitted at MNH for elective non-cardiothoracic surgery. Data Analysis was conducted using STATA software version 16. Means and standard deviations were used to summarize continuous data. Frequencies and percentages were used to summarize categorical data. The logistic regression and ROC curve analysis were used to determine the correlation between variables. Results The majority of patients (43.3%) had an RCRI score of 1 point, and 39.9% were classified as ASA class 1. Patients in ASA classes 3 and 4 had higher odds of developing cardiac and pulmonary complications (AUC = 0.75 and 0.77, respectively). Patients with an RCRI score of 2 or ≥ 3 points were also more likely to experience cardiac and pulmonary complications (AUC = 0.73 and 0.72, respectively). There was no significant difference in the predictive ability of the two tools. Both RCRI and ASA-PS classification systems were equally effective in predicting these complications. Conclusion Both the RCRI and the ASA-PS classification system demonstrated good predictive ability for cardiac and pulmonary complications among patients undergoing non-cardiothoracic surgery.

Abstract Background It is controversial whether pulmonary function testing should be performed routinely in cardiac surgery patients. The aim of our study was to focus on patients who have congestive heart failure, caused by left ventricular dysfunction or left-sided heart valve disease, and study the prognostic value of performing preoperative pulmonary function testing on their postoperative outcomes. Methods This is a retrospective propensity score matched study that included 366 patients with congestive heart failure who underwent cardiac surgery and had preoperative pulmonary function test. The patients were divided into two groups: Group 1 who had a normal or mild reduction in pulmonary function tests and group 2 who had moderate to severe reduction in pulmonary function tests. The postoperative outcomes, including pulmonary complications, were compared between the two groups. Results Pulmonary function tests were normal or mildly reduced in 190 patients (group 1) and moderately to severely reduced in 176 patients (group 2). Propensity matching identified 111 matched pairs in each group with balanced preoperative and operative characteristics. Compared to group 1, Group 2 had longer duration of mechanical ventilation [12 (7.5–16) vs. 9 (6.5–13) hours, p

Abstract Objectives Esophagectomy after chemoradiotherapy is associated with an increased risk of surgical complications. The significance of preoperative neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio after chemoradiotherapy in predicting pulmonary complications following radical esophagectomy in esophageal squamous cell carcinoma patients receiving preoperative chemoradiotherapy remains unknown. We aimed to investigate the utility of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in predicting the pulmonary complications of esophagectomy after preoperative chemoradiotherapy. Methods We retrospectively reviewed 111 consecutive patients with stage III esophageal squamous cell carcinoma who received preoperative chemoradiotherapy followed by esophagectomy between January 2009 and December 2017. Laboratory data were collected before the operation and surgical outcomes and complications were recorded. We calculated neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and correlated them with the clinical parameters, postoperative complications, overall survival, and disease-free survival. Results Postoperative complications were observed in 75 (68%) patients, including 32 (29%) with pulmonary complications. The preoperative neutrophil-to-lymphocyte ratio of ≥ 3 (P = 0.008), clinical T4 classification (P = 0.007), and advanced stage IIIC (P = 0.012) were significantly associated with pulmonary complications. Pulmonary complication rates were 15% and 38% in patients with preoperative neutrophil-to-lymphocyte ratio of

Background: Our aim was to evaluate the influence of staged goal directed therapy (GDT) on postoperative pulmonary complications (PPCs), intraoperative hemodynamics and oxygenation in patients undergoing Mckeown esophagectomy. Methods: Patients were randomly divided into three groups, staged GDT group (group A, n = 56): stroke volume variation (SVV) was set at 8–10% during the one lung ventilation (OLV) stage and 8–12% during the two lung ventilation (TLV) stage, GDT group (group B, n = 56): received GDT with a target SVV of 8–12% During the entire surgical procedure, and control group (group C, n = 56): conventional fluid therapy was administered by mean arterial pressure (MAP), central venous pressure (CVP), and urine volume. The primary outcome was the incidence of postoperative pulmonary complications within Postoperative days (POD) 7. The secondary outcomes were postoperative lung ultrasound (LUS) B-lines artefacts (BLA) scoring, incidence of other complications, the length of hospital stay, intraoperative hemodynamic and oxygenation indicators included mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), cardiac output (CO), oxygenation index (OI), respiratory indices (RI), alveolar-arterial oxygen difference (Aa-DO2). Results: Patients in group A and group B had a lower incidence of PPCs (7/56 vs. 17/56 and 9/56 vs. 17/56, p < 0.05), and a fewer B-lines score on postoperative ultrasound (4.61 ± 0.51 vs. 6.15 ± 0.74 and 4.75 ± 0.62 vs. 6.15 ± 0.74, p < 0.05) compared to group C. The CI, CO, MAP, and OI were higher in group A compared to group B and group C in the stage of thoracic operation. During the abdominal operation stage, patients in group A and group B had a better hemodynamic and oxygenation indicators than group C. Conclusions: In comparison to conventional fluid therapy, intraoperative staged GDT can significantly reduce the incidence of postoperative pulmonary complications in patients undergoing McKeown esophagectomy, facilitating patient recovery. Compared to GDT, it can improve intraoperative oxygenation and stabilize intraoperative hemodynamics in patients. Trial registration: This study was registered in the Chinese Clinical Trial Registry on 24/11/2021 (ChiCTR2100053598). [ABSTRACT FROM AUTHOR]

Background: The Revised Cardiac Risk Index (RCRI) and the American Society of Anaesthesiologists (ASA-PS) classification system are two commonly used tools for preoperative risk assessment. This study aimed to assess the accuracy of RCRI compared to the ASA-PS classification system in preoperative risk assessment for pulmonary and cardiac problems among non-cardiothoracic surgery patients admitted at Muhimbili National Hospital (MNH). Methods: This was a prospective cohort study design conducted from August 2022 to April 2023 among 184 patients of 18 years and above admitted at MNH for elective non-cardiothoracic surgery. Data Analysis was conducted using STATA software version 16. Means and standard deviations were used to summarize continuous data. Frequencies and percentages were used to summarize categorical data. The logistic regression and ROC curve analysis were used to determine the correlation between variables. Results: The majority of patients (43.3%) had an RCRI score of 1 point, and 39.9% were classified as ASA class 1. Patients in ASA classes 3 and 4 had higher odds of developing cardiac and pulmonary complications (AUC = 0.75 and 0.77, respectively). Patients with an RCRI score of 2 or ≥ 3 points were also more likely to experience cardiac and pulmonary complications (AUC = 0.73 and 0.72, respectively). There was no significant difference in the predictive ability of the two tools. Both RCRI and ASA-PS classification systems were equally effective in predicting these complications. Conclusion: Both the RCRI and the ASA-PS classification system demonstrated good predictive ability for cardiac and pulmonary complications among patients undergoing non-cardiothoracic surgery. [ABSTRACT FROM AUTHOR]

Objectives: Haematopoietic stem cell transplant (HCT) is a cellular therapy that, whilst curative for a child's underlying disease, carries significant risk of mortality, including because of pulmonary complications. The aims of this study were to describe the burden of pulmonary complications post‐HCT in a cohort of Australian children and identify risk factors for the development of these complications. Methods: Patients were identified from the HCT databases at two paediatric transplant centres in Australia. Medical records were reviewed, and demographics, HCT characteristics and pulmonary complications documented. Relative risk ratio was used to identify risk factors for developing pulmonary complications prior to first transplant episode, and survival analysis performed to determine hazard ratio. Results: In total, 243 children underwent transplant during the study period, and pulmonary complications occurred in 48% (117/243) of children. Infectious complications were more common (55%) than non‐infective complications (18%) and 26% of patients developed both. Risk factors for the development of pulmonary complications included the following: diagnoses of MPAL (RR 2.16, P = 0.02), matched unrelated donor (RR1.34, P = 0.03), peripheral blood (RR 1.36, P = 0.028) or cord blood (RR 1.73, P = 0.012) as the stem cell source and pre‐existing lung disease (RR1.72, P < 0.0001). Children with a post‐HCT lung complication had a significantly increased risk of mortality compared with those who did not (HR 3.9, P < 0.0001). Conclusion: This study demonstrates pulmonary complications continue to occur frequently in children post‐HCT and contribute significantly to mortality. Highlighting the need for improved strategies to identify patients at risk pre‐transplant and enhanced treatments for those who develop lung disease. [ABSTRACT FROM AUTHOR]

The current gold standard of scoliosis correction procedures is still posterior spinal fusion, an extensively studied procedure. anterior vertebral body tethering is a newer surgical technique for the correction of scoliotic curves. Consequently, best practices have yet to be determined. A single-institution, retrospective, review of all patients diagnosed with adolescent idiopathic scoliosis who underwent two row anterior vertebral body tethering between June 2020 and April 2022 was performed. Over the study period, 95 patients met inclusion: 79 females (83.2%) and 16 males (16.8%), age 14.4 ± 2.5 years, with a body mass index of 20.0 ± 2.9, and an average of 8.4 ± 2.1 levels treated. 28 (29.5%) procedures were for double curves and 67 (70.5%) for single curves. After tethering, a chest tube was positioned in each corrected side. A total of 123 chest tubes were analyzed, including 67 single curves and 28 double curves. The average chest tube duration was 2.5 ± 1.1 days and the average length of stay was 5.0 ± 2.0 days. The average chest tube output eight hours prior to removal was 61.1 ± 45.6 mL. There was no significant difference in average length of stay for patients who underwent correction of a single curve versus a double curve nor was there a difference in average length of stay or chest tube duration for revisions compared to primary procedures. For the entire cohort, the 30-day emergency department visit rate was 7.4% (n = 7) and the readmission rate was 4.2% (n = 4). This early review of a 2-year two row vertebral body tethering postoperative experience provides a report of a safe and effective approach to chest tube management at a single academic center. [ABSTRACT FROM AUTHOR]

Objectives: Esophagectomy after chemoradiotherapy is associated with an increased risk of surgical complications. The significance of preoperative neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio after chemoradiotherapy in predicting pulmonary complications following radical esophagectomy in esophageal squamous cell carcinoma patients receiving preoperative chemoradiotherapy remains unknown. We aimed to investigate the utility of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in predicting the pulmonary complications of esophagectomy after preoperative chemoradiotherapy. Methods: We retrospectively reviewed 111 consecutive patients with stage III esophageal squamous cell carcinoma who received preoperative chemoradiotherapy followed by esophagectomy between January 2009 and December 2017. Laboratory data were collected before the operation and surgical outcomes and complications were recorded. We calculated neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and correlated them with the clinical parameters, postoperative complications, overall survival, and disease-free survival. Results: Postoperative complications were observed in 75 (68%) patients, including 32 (29%) with pulmonary complications. The preoperative neutrophil-to-lymphocyte ratio of ≥ 3 (P = 0.008), clinical T4 classification (P = 0.007), and advanced stage IIIC (P = 0.012) were significantly associated with pulmonary complications. Pulmonary complication rates were 15% and 38% in patients with preoperative neutrophil-to-lymphocyte ratio of < 3 and ≥ 3, respectively. Preoperative neutrophil-to-lymphocyte ratio was not associated with the oncological stratification such as pathological T classification, pathological N classification, and pathological AJCC stage. The 3-year overall survival rates were 70% and 34% in patients with preoperative neutrophil-to-lymphocyte ratio of < 3 and ≥ 3, respectively (P = 0.0026). The 3-year disease-free survival rates were 57% and 29% in patients with preoperative neutrophil-to-lymphocyte ratio of < 3 and ≥ 3, respectively (P = 0.0055). The preoperative neutrophil-to-lymphocyte ratio of ≥ 3 was independently associated with more pulmonary complications, inferior overall survival, and worse disease-free survival. Conclusions: Elevated preoperative neutrophil-to-lymphocyte ratio after chemoradiotherapy is independently associated with higher pulmonary complication rate following radical esophagectomy and poor prognosis in patients with esophageal squamous cell carcinoma receiving preoperative chemoradiotherapy. Preoperative neutrophil-to-lymphocyte ratio is routinely available in clinical practice and our findings suggest it can be used as a predictor for pulmonary complications after esophagectomy in patients with esophageal squamous cell carcinoma receiving preoperative chemoradiotherapy. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the pulmonary side effects of chemotherapy drugs in children with Acute Lymphocytic Leukemia (ALL) three years after treatment. The results could be of great help in managing lung complications in pediatric oncology patients. Materials and Methods: This cross-sectional descriptive study included 50 patients (22 males and 28 females) with ALL. Data were collected from patients' files, including age, sex, duration of illness, last dose of chemotherapy, and medications such as PEG.Asparginas, Cyclophosphamid, thioguanine, Dexamethason, cytarabin, cytosin.arabinosid, vincristine, mercaptopurine, and methotrexate. Pulmonary function tests (Forced Vital Capacity (FVC), FEV1 (Forced Expiratory Volume in the first second)) were assessed by spirometry. Results: Out of 50 patients, 47 (94%) did not have pulmonary disorders, while 3 (6%) had pulmonary dysfunction. Forty-seven patients (94%) did not have respiratory symptoms. FVC results showed that 45 patients were normal, and 5 were abnormal. Similarly, 45 patients had normal FEV1, and 5 had abnormal results. Spirometry results were normal in 45 patients and abnormal in 5. A significant relationship was found between the use of these drugs in different doses and spirometry results, recurrence rate, and pulmonary complications (P <0.05). No significant relationship was observed between pulmonary dysfunction and other drugs (P> 0.05). No correlation was found between pulmonary complications due to chemotherapy with duration of chemotherapy, patient age, and patient gender (P> 0.05). Conclusion: Pulmonary dysfunction and respiratory syndrome were observed in 6% of patients receiving chemotherapy. A significant relationship was found between the frequency of pulmonary and respiratory complications with some chemotherapy drugs in children with ALL. Further research is needed to optimize treatment strategies and minimize lung complications in pediatric oncology patients. [ABSTRACT FROM AUTHOR]

Among patients having elective abdominal surgery, how much does preoperative physiotherapy education with breathing exercise training reduce the incidence of postoperative pulmonary complications (PPCs), hospital length of stay and 12-month mortality? How stable are the treatment effects across different PPC definitions, including pneumonia? How much do the treatment effects on PPC, hospital length of stay and mortality vary within clinically relevant subgroups? Individual participant-level meta-analysis (n = 800) from two randomised controlled trials analysed with multivariable regression. Adults undergoing major elective abdominal surgery. Experimental participants received a single preoperative session with a physiotherapist within 4 weeks of surgery and educated on PPC prevention with breathing exercises and early mobilisation. They were taught breathing exercises and instructed to start them immediately on waking from surgery. The control group received no preoperative or postoperative physiotherapy, or early ambulation alone. PPC, hospital length of stay and 12-month mortality. Participants who received preoperative physiotherapy had 47% lower odds of developing a PPC (adjusted OR 0.53, 95% CI 0.34 to 0.85). This effect was stable regardless of PPC definition. Effects were greatest in participants who smoked, were aged ≤ 45 years, had abnormal body weight, had multiple comorbidities, or were undergoing bariatric or upper gastrointestinal surgery. Participants having operations ≤ 3 hours in duration were least responsive to preoperative physiotherapy. Participants with multiple comorbidities were more likely to have a shorter hospital stay if provided with preoperative physiotherapy (adjusted MD –3.2 days, 95% CI –6.2 to –0.3). Effects on mortality were uncertain. There is strong evidence to support preoperative physiotherapy in preventing PPCs after elective abdominal surgery. [ABSTRACT FROM AUTHOR]

Crack is the most potent form of cocaine. It directly affects lungs if inhaled and the damage may include barotrauma, acute pulmonary edema, alveolar hemorrhage, bronchiolitis obliterans with organizing pneumonia, or vasculitis. The diagnosis of cocaine-related lung damage is based on clinical symptoms and radiological findings. When young individuals develop respiratory symptoms, investigation into cocaine use is necessary. We report the case of a young man with a history of cocaine use who presented for respiratory and neurological symptoms revealing crack lung and toxic cerebral vasculitis.

Objective: Pulmonary complications, which are occasionally severe, are common adverse events following the administration of clazosentan. This study aimed to identify factors associated with severe pulmonary adverse events due to clazosentan after aneurysmal subarachnoid hemorrhage (aSAH). Methods: We conducted a retrospective study of 59 patients transported to our hospital and diagnosed with aSAH between April 2022 and May 2023. Results: The analysis included 33 patients who were treated with clazosentan. Pulmonary complications occurred in 20 patients (61 %) and clazosentan administration was discontinued due to severe pulmonary complications in 7 patients (21 %). The cardiothoracic ratio on admission was significantly higher (57 % vs. 49 %, p = 0.0081) and clazosentan was initiated earlier after aSAH onset (42 vs. 66 h, p = 0.047) in patients who discontinued clazosentan compared with patients who completed administration of clazosentan. The median duration of clazosentan administration was 3.2 days in the discontinuation group. No significant associations were found between the time of clazosentan initiation and the incidence of angiographic vasospasm, delayed cerebral ischemia, or 90-day modified Rankin scale. Conclusions: The risk of severe pulmonary complications is higher in patients with high cardiothoracic ratios on admission, and delaying clazosentan initiation may prevent pulmonary complications even in high-risk cases.

Pulmonary complications (PC) are common after esophagectomy and their impact on long-term survival is not defined yet. The present study aimed to assess the effect of postoperative PCs on long-term survival after esophagectomy for cancer. Systematic review of the literature through February 1, 2023, was performed. The included studies evaluated the effect of PC on long-term survival. Primary outcome was long-term overall survival (OS). Cancer-specific survival (CSS) and disease-free survival (DFS) were secondary outcomes. Restricted mean survival time difference (RMSTD), hazard ratio (HR), and 95% confidence intervals (CI) were used as pooled effect size measures. Eleven studies were included (3423 patients). Overall, 674 (19.7%) patients developed PC. The RMSTD analysis shows that at 60-month follow-up, patients not experiencing PC live an average of 8.5 (95% CI 6.2–10.8; p < 0.001) months longer compared with those with PC. Similarly, patients not experiencing postoperative PC seem to have significantly longer CSS (8 months; 95% CI 3.7–12.3; p < 0.001) and DFS (5.4 months; 95% CI 1.6–9.1; p = 0.005). The time-dependent HRs analysis shows a reduced mortality hazard in patients without PC at 12 (HR 0.6, 95% CI 0.51–0.69), 24 (HR 0.64, 95% CI 0.55–0.73), 36 (HR 0.67, 95% CI 0.55–0.79), and 60 months (HR 0.69, 95% CI 0.51–0.89). This study suggests a moderate clinical impact of PC on long-term OS, CSS, and DFS after esophagectomy. Patients not experiencing PC seem to have a significantly reduced mortality hazard up to 5 years of follow-up. [ABSTRACT FROM AUTHOR]

OBJECTIVES Evaluating the diffusing capacity for carbon monoxide (DLco) is crucial for patients with lung cancer and interstitial lung disease. However, the clinical significance of assessing exercise oxygen desaturation (EOD) remains unclear. METHODS We retrospectively analysed 186 consecutive patients with interstitial lung disease who underwent lobectomy for non-small-cell lung cancer. EOD was assessed using the two-flight test (TFT), with TFT positivity defined as ≥5% SpO2 reduction. We investigated the impact of EOD and predicted postoperative (ppo)%DLco on postoperative complications and prognosis. RESULTS A total of 106 (57%) patients were identified as TFT-positive, and 58 (31%) patients had ppo% DLco < 30%. Pulmonary complications were significantly more prevalent in TFT-positive patients than in TFT-negative patients (52% vs 19%, P < 0.001), and multivariable analysis revealed that TFT-positivity was an independent risk factor (odds ratio 3.46, 95% confidence interval 1.70–7.07, P < 0.001), whereas ppo%DLco was not (P = 0.09). In terms of long-term outcomes, both TFT positivity and ppo%DLco < 30% independently predicted overall survival. We divided the patients into 4 groups based on TFT positivity and ppo%DLco status. TFT-positive patients with ppo%DLco < 30% exhibited the significantly lowest 5-year overall survival among the 4 groups: ppo%DLco ≥ 30% and TFT-negative, 54.2%; ppo%DLco < 30% and TFT-negative, 68.8%; ppo%DLco ≥ 30% and TFT-positive, 38.1%; and ppo%DLco < 30% and TFT-positive, 16.7% (P = 0.001). CONCLUSIONS Incorporating EOD evaluation was useful for predicting postoperative complications and survival outcomes in patients with lung cancer and interstitial lung disease. [ABSTRACT FROM AUTHOR]

Background: Pulmonary complications pose significant challenges in renal transplant recipients due to immunosuppression and diverse underlying renal diseases. Understanding their epidemiology, clinical presentation, microbial spectrum, and risk factors is crucial for optimal management. Methods: We conducted a prospective observational study over 24 months, following 458 renal transplant recipients. Data on demographics, clinical presentation, underlying renal diseases, and microbial spectrum were collected. Risk factors influencing pulmonary complications were analyzed. Results: Among the cohort, 45 incidents (9.8%) of pulmonary complications occurred, with fever (66.7%) being the most common symptom. The majority of complications (51%) occurred over six months post-transplantation, with infectious complications predominating (89%). Risk factors included leucopenia (24.4%), CMV infection (8.9%), HCV infection (8.9%), ART (20%), and NODAT (11.1%). Conclusion: Early detection and targeted antimicrobial therapy are essential in managing pulmonary complications in renal transplant recipients. Multidisciplinary approaches are crucial for optimizing patient outcomes. Further research is needed to explore the long-term implications on graft function and survival. [ABSTRACT FROM AUTHOR]

Background: Postoperative air leak (PAL) is a frequent and potentially serious complication following thoracic surgery, characterized by the persistent escape of air from the lung into the pleural space. It is associated with extended hospitalizations, increased morbidity, and elevated healthcare costs. Understanding the mechanisms, risk factors, and effective management strategies for PAL is crucial in improving surgical outcomes. Aim: This review seeks to synthesize all known data concerning PAL, including its etiology, risk factors, diagnostic approaches, and the range of available treatments from conservative measures to surgical interventions, with a special focus on the use of autologous plasma. Materials and Methods: A comprehensive literature search of databases such as PubMed, Cochrane Library, and Google Scholar was conducted for studies and reviews published on PAL following thoracic surgery. The selection criteria aimed to include articles that provided insights into the incidence, mechanisms, risk assessment, diagnostic methods, and treatment options for PAL. Special attention was given to studies detailing the use of autologous plasma in managing this complication. Results: PAL is influenced by a variety of patient-related, surgical, and perioperative factors. Diagnosis primarily relies on clinical observation and imaging, with severity assessments guiding management decisions. Conservative treatments, including chest tube management and physiotherapy, serve as the initial approach, while persistent leaks may necessitate surgical intervention. Autologous plasma has emerged as a promising treatment, offering a novel mechanism for enhancing pleural healing and reducing air leak duration, although evidence is still evolving. Conclusions: Effective management of PAL requires a multifaceted approach tailored to the individual patient's needs and the specifics of their condition. Beyond the traditional treatment approaches, innovative treatment modalities offer the potential to improve outcomes for patients experiencing PAL after thoracic surgery. Further research is needed to optimize treatment protocols and integrate new therapies into clinical practice. [ABSTRACT FROM AUTHOR]

This review investigates and contrasts the effects of various preoperative chest rehabilitation techniques in patients undergoing coronary artery bypass graft (CABG) surgery, both on-pump and off-pump. Utilizing databases such as Pedro, Cochrane, and PubMed, a comprehensive literature review was conducted, focusing on studies published between 2017 and 2023. We identified 14 relevant articles that met specific inclusion and exclusion criteria, examining the effects of preoperative physiotherapy in adult patients undergoing CABG surgery. Preoperative physiotherapy encompasses a variety of approaches, including counselling, cardiovascular exercise, instruction on breathing techniques, and inspiratory muscle training (IMT). Numerous studies have highlighted the benefits of integrating these methods, such as reducing the risk of postoperative pulmonary complications, shortening hospital stays, achieving earlier extubation, and decreasing anxiety. Despite these findings, further research is needed to evaluate the effectiveness of combination therapies, particularly those involving IMT, in preoperative physical therapy. The goal is to develop a comprehensive understanding of the mechanisms through which these treatments reduce pulmonary complications post -surgery. [ABSTRACT FROM AUTHOR]

Abstract Objectives Haematopoietic stem cell transplant (HCT) is a cellular therapy that, whilst curative for a child's underlying disease, carries significant risk of mortality, including because of pulmonary complications. The aims of this study were to describe the burden of pulmonary complications post‐HCT in a cohort of Australian children and identify risk factors for the development of these complications. Methods Patients were identified from the HCT databases at two paediatric transplant centres in Australia. Medical records were reviewed, and demographics, HCT characteristics and pulmonary complications documented. Relative risk ratio was used to identify risk factors for developing pulmonary complications prior to first transplant episode, and survival analysis performed to determine hazard ratio. Results In total, 243 children underwent transplant during the study period, and pulmonary complications occurred in 48% (117/243) of children. Infectious complications were more common (55%) than non‐infective complications (18%) and 26% of patients developed both. Risk factors for the development of pulmonary complications included the following: diagnoses of MPAL (RR 2.16, P = 0.02), matched unrelated donor (RR1.34, P = 0.03), peripheral blood (RR 1.36, P = 0.028) or cord blood (RR 1.73, P = 0.012) as the stem cell source and pre‐existing lung disease (RR1.72, P

Abstract Limited information is available regarding the association between preoperative lung function and postoperative pulmonary complications (PPCs) in patients with esophageal cancer who undergo esophagectomy. This is a retrospective cohort study. Patients were classified into low and high lung function groups by the cutoff of the lowest fifth quintile of forced expiratory volume in 1 s (FEV1) %predicted (%pred) and diffusing capacity of the carbon monoxide (DLco) %pred. The PPCs compromised of atelectasis requiring bronchoscopic intervention, pneumonia, and acute lung injury/acute respiratory distress syndrome. Modified multivariable-adjusted Poisson regression model using robust error variances and inverse probability treatment weighting (IPTW) were used to assess the relative risk (RR) for the PPCs. A joint effect model considered FEV1%pred and DLco %pred together for the estimation of RR for the PPCs. Of 810 patients with esophageal cancer who underwent esophagectomy, 159 (19.6%) developed PPCs. The adjusted RR for PPCs in the low FEV1 group relative to high FEV1 group was 1.48 (95% confidence interval [CI] = 1.09–2.00) and 1.98 (95% CI = 1.46–2.68) in the low DLco group relative to the high DLco group. A joint effect model showed adjusted RR of PPCs was highest in patients with low DLco and low FEV1 followed by low DLco and high FEV1, high DLco and low FEV1, and high DLco and high FEV1 (Reference). Results were consistent with the IPTW. Reduced preoperative lung function (FEV1 and DLco) is associated with post-esophagectomy PPCs. The risk was further strengthened when both values decreased together.

Abstract Background Pulmonary complications after thoracic surgery are common and associated with significant morbidity and high cost of care. Goal-directed fluid therapy (GDFT) could reduce the incidence of postoperative pulmonary complications (PPCs) and facilitate recovery in patients undergoing major abdominal surgery. However, whether GDFT could reduce the incidence of PPCs in patients undergoing thoracic surgery was unclear. The present meta-analysis was designed to assess the impact of Goal-directed Fluid Therapy on PPCs in patients undergoing thoracic surgery. Methods Randomized controlled trials (RCTs) comparing GDFT with other conventional fluid management strategies in adult patients undergoing thoracic surgery were identified. Databases searched included PubMed, Web of Science, Embase, and Cochrane Library databases. Review Manager 5.4 (The Cochrane Collaboration, Oxford, UK) software was used for statistical analysis. Heterogeneity was analyzed using I2 statistics, and a standardized mean difference with 95% CI and P value was used to calculate the treatment effect for outcome variables. The primary study outcomes were the incidence of PPCs. Secondary outcomes were the total volume infused, the length of hospitalization, the incidence of cardiac complications, and the incidence of renal dysfunction. Subgroup analysis was planned to verify the definite role of GDFT. Results A total of 6 RCTs consisting of 680 patients were included in this meta-analysis, which revealed that GDFT did not reduce the incidence of PPCs in patients undergoing thoracic surgery (RR, 0.57; 95% CI 0.29–1.14). However, GDFT decreased the total intra-operative fluid input (MD, − 244.40 ml; 95% CI − 397.06 to − 91.74). There was no statistical difference in the duration of hospitalization (MD; − 1.31, 95% CI − 3.00 to 0.38), incidence of renal dysfunction (RR, 0.62; 95% CI 0.29–1.35), and incidence of cardiac complications (RR, 0.62; 95% CI 0.27–1.40). Conclusions The results of this meta-analysis indicate that GDFT did not reduce the postoperative incidence of pulmonary complications in individuals undergoing thoracic surgery. However, considering the small number of contributing studies, these results should be interpreted with caution.

Background Over the past three decades, hematopoietic stem cells transplantation (HSCT)has been widely and increasingly used as standard of care for patients with congenital or acquired hematopoietic disorders. Serious systemic complications, especially pulmonary complications (PCs) both infectious and noninfectious, may occur post transplantation and may be fatal. Objective To study the incidence, types, chronology, probable risk factors as well as outcome of posttransplantation PCs in a cohort of HSCT patients who were followed-up for one year. Methods This is a prospective observational study conducted on 80 HSCT recipients who were followed-up for one year for occurrence of any respiratory symptom. A diagnostic algorithm was then followed to reach etiology of both infectious and noninfectious causes. Results Fourteen (17.5%) patients had pulmonary symptoms, 12 (86%) were due to infections and 2 (14%) were due to noninfectious causes (a case of engraftment syndrome and another of pulmonary embolism), 67% of infectious PCs and all of noninfectious PCs occurred within the first 100 days post HSCT, 60% of infectious PCs were mixed, the most common isolated pathogen was Mycoplasma pneumoniae (60%), PCs related mortality was 21%. Conclusion Post HSCT PCs are common, constituting an important cause for mortality, highlighting the necessity for appropriate clinical diagnosis and management.

Background: After surgery, patients are at risk of developing postoperative pulmonary complications (PPCs). Our current understanding of PPCs is based on data from high-income countries (HICs). Methods: A systematic review and meta-analysis was conducted to evaluate the incidence of PPCs in adult postsurgical patients from low- to middle-income countries (LMICs). The protocol was registered on the PROSPERO database (CRD42020212932). The search strategy was performed in 2021 on several electronic databases. Studies were assessed for risk of bias with the modified Newcastle-Ottawa Scale. Forest plots of the event rate for the incidence of PPCs and factors associated with PPCs were created. Results: The search strategy identified 1 052 records. Fifteen studies were included in the final review (total of 4 873 participants). Five studies were of high methodological quality. The overall pooled event rate for the incidence of PPCs was 22.4% (95% confidence interval (CI), 15.76-30.78%). In-hospital mortality in patients who developed PPCs was 33.1%. PPCs were identified as a risk factor for in-hospital mortality (odds ratio (OR) 18.2, CI 11.01-30.09). Insufficient outcome data were available to determine the association of PPCs between elective versus emergency surgery, and cardiothoracic versus non-cardiothoracic surgery. Advanced age was associated with the development of PPCs (MD 4.7, 95% CI 0.63-8.7). Male sex was associated with the development of PPCs (OR 1.5, 95% CI 1.17-2.02). PPCs were associated with increased length of hospital stay (mean difference (MD) 6.5, 95% CI 4.04-8.96). Conclusion: The incidence of PPCs was 22.4% following surgery in adult patients in LMICs and was influenced by differences in the definitions of PPCs used. PPCs were identified as a risk factor for in-hospital mortality. Data on the type of surgery and patient characteristics were poorly reported. Further research on PPCs in LMICs is needed to provide granular data for future use. [ABSTRACT FROM AUTHOR]

Background The use of compression garments in the postoperative period of abdominoplasty seems to be a consensus, but the incidents of complications arising from this have been described, related to an increase in intraabdominal pressure and reduction of the femoral vein blood flow that may facilitate thromboembolic events. There are no studies that have evaluated the isolated effect of postoperative compression garments on respiratory function. Objectives The purpose of this study was to evaluate the effect of compression garments on respiratory function after abdominoplasty. Methods Thirty-four female patients who underwent standard abdominoplasty were divided into 2 groups, the garment group (n = 18) and the no garment group (n = 16). Respiratory function assessment (with spirometry and manovacuometry) was performed in the preoperative and postoperative periods. Results Forced vital capacity assessment revealed a greater ventilatory restriction in the garment group. Forced expiratory volume in 1 second (FEV1) showed differences between the evaluation time points in the garment group; the intergroup comparisons showed that the no garment group had a lower FEV1. Slow vital capacity was evaluated with no significant differences found on both intergroup comparisons. The inspiratory capacity was reduced in the garment group, representing ventilatory restriction. Measurements of the maximum inspiratory pressure showed no significant differences between the groups. The maximum expiratory pressure showed significantly lower values on postoperative day 7 in the garment group. Conclusions The use of compression garments after abdominoplasty impairs ventilatory function. Not wearing this type of garment can improve ventilation, decreasing the risk of pulmonary complications. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

Purpose: This systematic review of randomized-controlled trials (RCTs) with meta-analyses aimed to compare the effects on intraoperative arterial oxygen tension to inspired oxygen fraction ratio (PaO2/FiO2), exerted by positive end-expiratory pressure (PEEP) individualized trough electrical impedance tomography (EIT) or esophageal pressure (Pes) assessment (intervention) vs. PEEP not tailored on EIT or Pes (control), in patients undergoing abdominal or pelvic surgery with an open or laparoscopic/robotic approach. Methods: PUBMED®, EMBASE®, and Cochrane Controlled Clinical trials register were searched for observational studies and RCTs from inception to the end of August 2022. Inclusion criteria were: RCTs comparing PEEP titrated on EIT/Pes assessment vs. PEEP not individualized on EIT/Pes and reporting intraoperative PaO2/FiO2. Two authors independently extracted data from the enrolled investigations. Data are reported as mean difference and 95% confidence interval (CI). Results: Six RCTs were included for a total of 240 patients undergoing general anesthesia for surgery, of whom 117 subjects in the intervention group and 123 subjects in the control group. The intraoperative mean PaO2/FiO2 was 69.6 (95%CI 32.-106.4) mmHg higher in the intervention group as compared with the control group with 81.4% between-study heterogeneity (p < 0.01). However, at meta-regression, the between-study heterogeneity diminished to 44.96% when data were moderated for body mass index (estimate 3.45, 95%CI 0.78–6.11, p = 0.011). Conclusions: In patients undergoing abdominal or pelvic surgery with an open or laparoscopic/robotic approach, PEEP personalized by EIT or Pes allowed the achievement of a better intraoperative oxygenation compared to PEEP not individualized through EIT or Pes. Prospero registration number: CRD 42021218306, 30/01/2023 [ABSTRACT FROM AUTHOR]

Background Over the past three decades, hematopoietic stem cells transplantation (HSCT)has been widely and increasingly used as standard of care for patients with congenital or acquired hematopoietic disorders. Serious systemic complications, especially pulmonary complications (PCs) both infectious and noninfectious, may occur post transplantation and may be fatal. Objective To study the incidence, types, chronology, probable risk factors as well as outcome of posttransplantation PCs in a cohort of HSCT patients who were followed-up for one year. Methods This is a prospective observational study conducted on 80 HSCT recipients who were followed-up for one year for occurrence of any respiratory symptom. A diagnostic algorithm was then followed to reach etiology of both infectious and noninfectious causes. Results Fourteen (17.5%) patients had pulmonary symptoms, 12 (86%) were due to infections and 2 (14%) were due to noninfectious causes (a case of engraftment syndrome and another of pulmonary embolism), 67% of infectious PCs and all of noninfectious PCs occurred within the first 100 days post HSCT, 60% of infectious PCs were mixed, the most common isolated pathogen was Mycoplasma pneumoniae (60%), PCs related mortality was 21%. Conclusion Post HSCT PCs are common, constituting an important cause for mortality, highlighting the necessity for appropriate clinical diagnosis and management. [ABSTRACT FROM AUTHOR]

Introduction: Many noninfectious pulmonary complications occur immediately within the first few weeks after allogeneic hematopoietic stem cell transplantation (allo-HSCT). This study aimed to evaluate the efficacy of chest physical therapy (CPT) performed during the pre-transplant period in terms of spirometric values and respiratory muscle strength (RMS) in patients waiting for allo-HSCT. Material and methods: Fifty patients aged 40 to 55 years who were scheduled for allo-HSCT were randomly allocated into two equal-sized groups, a CPT group and a control group. The CPT group (n = 25) received CPT in addition to routine medical treatment, while the control group (n = 25) received routine medical treatment only. Patients in both groups received standard physical therapy during the inpatient waiting period. Interventions were conducted daily for 3 weeks before allo-HSCT. Pulmonary function (FEV1, FVC, and FEV1/FVC) was measured by spirometry, and RMS was measured by a respiratory pressure meter. A baseline assessment was done 3 weeks before allo-HSCT (T0), then at the end of treatment immediately before allo-HSCT (T1) and the last assessment at 3 weeks after allo-HSCT (T2) for all measured variables. Results: In comparing the two groups at T1 and T2, the mean spirometric values and RMS, maximal inspiratory pressure, and maximal expiratory pressure were all improved significantly in the CPT group in comparison with the control group (p < 0.05). Conclusions: Adding a 3-week CPT intervention to the pre-transplant rehabilitation program seems to be effective and safe for allo-HSCT recipients, as it improves pre-transplant pulmonary function and respiratory muscle strength and prevents their post-transplant decrease. [ABSTRACT FROM AUTHOR]

Rationale: Pulmonary function testing (PFT) is performed to aid patient selection before surgical resection for non-small cell lung cancer (NSCLC). The interpretation of PFT data relies on normative equations, which vary by race, but the relative strength of association of lung function using race-specific or race-neutral normative equations with postoperative pulmonary complications is unknown. Objectives: To compare the strength of association of lung function, using race-neutral or race-specific equations, with surgical complications after lobectomy for NSCLC. Methods: We studied 3,311 patients who underwent lobectomy for NSCLC and underwent preoperative PFT from 2001 to 2021. We used Global Lung Function Initiative equations to generate race-specific and race-neutral normative equations to calculate percentage predicted forced expiratory volume in 1 second (FEV1%). The primary outcome of interest was the occurrence of postoperative pulmonary complications within 30 days of surgery. We used unadjusted and race-adjusted logistic regression models and least absolute shrinkage and selection operator analyses adjusted for relevant comorbidities to measure the association of race-specific and race-neutral FEV1% with pulmonary complications. Results: Thirty-one percent of patients who underwent surgery experienced pulmonary complications. Higher FEV1, whether measured with race-neutral (odds ratio [OR], 0.98 per 1% change in FEV1% [95% confidence interval (CI), 0.98-0.99]; P,0.001) or race-specific (OR, 0.98 per 1% change in FEV1% [95% CI, 0.98-0.98]; P,0.001) normative equations, was associated with fewer postoperative pulmonary complications. The area under the receiver operator curve for pulmonary complications was similar for race-adjusted race-neutral (0.60) and race-specific (0.60) models. Using least absolute shrinkage and selection operator regression, higher FEV1% was similarly associated with a lower rate of pulmonary complications in race-neutral (OR, 0.99 per 1% [95% CI, 0.98-0.99]) and race-specific (OR, 0.99 per 1%; 95% CI, 0.98-0.99) models. The marginal effect of race on pulmonary complications was attenuated in all race-specific models compared with all race-neutral models. Conclusions: The choice of race-specific or race-neutral normative PFT equations does not meaningfully affect the association of lung function with pulmonary complications after lobectomy for NSCLC, but the use of race-neutral equations unmasks additional effects of self-identified race on pulmonary complications. [ABSTRACT FROM AUTHOR]

Trichomonas tenax, an oral commensal parasite commonly found in the human mouth, is associated with periodontitis and poor oral hygiene. However, it has also been identified in the bronchoalveolar lavage fluid (BALF) of individuals with lung diseases. Notably, significant quantities of T. tenax have been isolated following bronchoscopy in cases of empyema and acute respiratory distress syndrome (ARDS). Furthermore, research has demonstrated its ability to induce inflammation in pulmonary epithelial cells. To comprehend the potential role of T. tenax in pneumonia, it is crucial to elucidate the relationship between the parasite and the disease. We investigated the clinical factors associated with T. tenax infection in patients with pneumonia. Employing nested polymerase chain reactions, we amplified nucleic acids from BALF and analyzed the relationships between T. tenax and various clinical factors. Our data revealed a significant association between T. tenax and bacterial infections, high pneumonia severity index (PSI) scores, nasogastric tube feeding, and pulmonary complications. Logistic regression analyses also showed strong associations between T. tenax and these clinical factors in pneumonia patients. These findings suggest that T. tenax infection in pneumonia is accompanied by bacterial infection and severe clinical manifestations.

BACKGROUND. The coronavirus disease (COVID-19), caused by the SARS-CoV-2 coronavirus, continues to pose a serious threat to global health. One of the key characteristic of this disease is its ability to attack the respiratory system, which can lead to pneumonia, especially in severe cases. Patients with diabetes, who already have certain pulmonary risks due to their disease, become particularly vulnerable to these complications. OBJECTIVE. On the basis of data from literary sources, to investigate the most frequent variants of pulmonary complications of COVID-19 in patients with diabetes mellitus (DM). MATERIALS AND METHODS. Object: pulmonological complications, as a result of transferred COVID-19. Research method: a review of literary sources. RESULTS. Among the pulmonological complications of COVID-19 in DM, most often in our practice we can encounter: pneumonia, acute respiratory distress syndrome, pulmonary fibrosis and inflammation of pulmonary vessels with the possible development of thrombosis. CONCLUSIONS. Glycemic control is a key factor to ensure optimal treatment of patients with diabetes with pulmonary complications of COVID-19, for timely correction of the regimen of hypoglycemic therapy. Medical treatment for pulmonary complications may include corticosteroids and anti-inflammatory drugs such as dexamethasone, especially in severe cases. However, it is important to take into account the ability of these drugs to increase glycemia, and accordingly choose treatment taking into account this factor, without excluding the possibility of prescribing insulin therapy. At the stage of recovery, an important role in the treatment of pulmonary complications of COVID-19 in patients with DM is played by a rational diet, physical activity and monitoring of the main indicators.

Lung resection surgery carries significant risks of postoperative pulmonary complications (PPC). Cardiopulmonary exercise testing (CPET) is performed to predict risk of PPC in patients with severely reduced predicted postoperative forced expiratory volume in one second (FEV1) and diffusion of carbon monoxide (DLCO). Recently, resting end-tidal partial pressure of carbon dioxide (PETCO2) has been shown as a good predictor for increased risk of PPC. However, breath-breath breathing pattern significantly affects PETCO2. Resting physiologic dead space (VD), and physiologic dead space to tidal volume ratio (VD/VT), may be a better predictor of PPC than PETCO2. The objective of this study was to prospectively determine the utility of resting measurements of VD and VD/VT in predicting PPC in patients who underwent robotic-assisted lung resection for suspected or biopsy-proven lung malignancy. Thirty-five consecutive patients were included in the study. Patients underwent preoperative pulmonary function testing, symptom-limited CPET, and a 6-min walk test. In the first 2 min prior to the exercise portion of the CPET, we obtained resting VT, minute ventilation ( V˙ E), VD (less instrument dead space), VD/VT, PETCO2, and arterial blood gases. PPC within 90 days were recorded. Fourteen (40%) patients had one or more PPC. Patients with PPC had significantly elevated resting VD compared to those without (0.318 ± 0.028 L vs. 0.230 ± 0.017 L (± SE), p < 0.006), and a trend toward increased VD/VT (0.35 ± 0.02 vs. 0.31 ± 0.02, p = 0.051). Area under the receiver operating characteristic (ROC) for VD was 0.81 (p < 0.002), VD/VT was 0.68 (p = 0.077), and PETCO2 was 0.52 (p = 0.840). Peak V˙ O2, V˙ E/ V˙ CO2 slope, pulmonary function tests, 6-min walk distance and arterial blood gases were similar between the two groups. Intensive care unit and total hospital length of stay was significantly longer in those with PPC. In conclusion, preoperative resting VD was significantly elevated in patients with PPC. The observed increase in resting VD may be a potentially useful predictor of PPC in patients undergoing robotic-assisted lung resection surgery for suspected or biopsy-proven lung malignancy. A large prospective study is needed for confirmation.

Background: In this study, our aim is to investigate the complications caused by COVID-19 disease in the period of 1 month and 3 months after infection and recovery in patients aged 20 to 80 admitted to the special care department of Shariati Hospital in Tehran. Methods: The information of the patients in this research was collected between 1 and 3 months after discharge non-randomly and from among the samples that are available (consecutive), through phone calls and a prospective questionnaire including questions about complications such as fatigue, body pain, joint pain, anorexia, disorders, sleep, headache, depression, dizziness, palpitations, chest pain, cough, diabetes, skin disease, obesity, imbalance, neuropathy, neurological and mental problems, and other cases are collected. Results: In this study, what was observed was those 4 complications of nausea and vomiting, diabetes, depression, and hypothyroidism were significantly related to hospitalization of COVID-19 patients in the hospital's special care department. The frequency of other complications was also investigated in this study. Conclusions: According to the conducted study as well as previous studies, what is clear is that the frequency of complications caused by COVID-19 in patients admitted to the intensive care unit after discharge is high, and more studies should be done in order to reduce these complications.

The use of lung protective ventilation (LPV) during general anesthesia is an effective strategy among certified registered nurse anesthetists (CRNAs) to reduce and prevent the incidence of postoperative pulmonary complications. The purpose of this project was to implement a LPV protocol, assess CRNA provider adherence, and investigate differences in ventilation parameters and postoperative oxygen requirements. This quality improvement project was conducted using a pre- and postimplementation design. Sixty patients undergoing robotic laparoscopic abdominal surgery and 35 CRNAs at a community hospital participated. An evidence-based intraoperative LPV protocol was developed, CRNA education was provided, and the protocol was implemented. Pre- and postimplementation, CRNA knowledge, and confidence were assessed. Ventilation data were collected at 1-minute intervals intraoperatively and oxygen requirements were recorded in the postanesthesia care unit (PACU). Use of intraoperative LPV strategies increased 2.4%. Overall CRNA knowledge (P =.588), confidence (P =.031), and practice (P <.001) improved from pre- to postimplementation. Driving pressures decreased from pre- to postimplementation (P <.001). Supplemental oxygen use on admission to the PACU decreased from 93.3% to 70.0%. Educational interventions and implementation of a standardized protocol can improve the use of intraoperative LPV strategies and patient outcomes. [ABSTRACT FROM AUTHOR]