Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · May 2008
ReviewShould adrenaline be routinely used by the resuscitation team if a patient suffers a cardiac arrest shortly after cardiac surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether adrenaline might be a useful addition to a protocol for the management of cardiac arrests for patients shortly after cardiac surgery. Altogether 889 papers were found using the reported search, of which 16 represented the best evidence to answer the clinical question. ⋯ However, they acknowledge that the evidence behind this recommendation is lacking and based entirely on animal studies which have as yet not been successfully replicated in human studies to show a benefit of survival to hospital discharge. They acknowledge that the current evidence is insufficient to support or refute the use of adrenaline in arrests and the International Liaison Committee on Resuscitation grade the recommendation to give adrenaline in cardiac arrests as 'indeterminate'. Thus, in the particular situation of a patient who arrests shortly after cardiac surgery where the chance of restoring sinus rhythm either by defibrillation or by an emergency re-sternotomy is high, and where adrenaline could in this situation be highly dangerous once sinus rhythm is restored, we recommend that 1 mg of adrenaline forms no part of the resuscitation protocol for patients who arrest after cardiac surgery.
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A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: does re-expansion pulmonary oedema exist? Altogether 233 papers were found using the reported search, of which 13 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. ⋯ The British Thoracic Society guidelines suggest <1.5 l pleural fluid should be drained at a time. Provided no respiratory symptoms occur it is not unreasonable to drain larger volumes to dryness: caution should be taken to avoid high negative intrapleural pressures. Patients who appear to be at higher risk, which may warrant more gradual evacuation, are: those who have had large pneumothoraces; young patients; patients in whom the lung has been down for >7 days; and possibly those who need >3 l of pleural fluid drained.
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Interact Cardiovasc Thorac Surg · May 2008
Case ReportsSurgical repair of post-traumatic lung hernia using a video-assisted open technique.
Post-traumatic lung herniation through a defect in the chest wall is an uncommon injury, with only about 300 reported in the literature. Various methods of treatment and repair have been described, including both purely thoracoscopic to full open techniques. We repaired a case by using a combination of minithoracotomy and video-assistance through the minithoracotomy wound. The patient did well and there was minimal postoperative pain.