The Annals of thoracic surgery
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Coronavirus 2019 (COVID-19) is a worldwide pandemic, with many patients requiring prolonged mechanical ventilation. Tracheostomy is not recommended by current guidelines as it is considered a superspreading event owing to aerosolization that unduly risks health care workers. ⋯ Our percutaneous tracheostomy technique appears to be safe and effective for COVID-19 patients and safe for health care workers.
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When conservative therapy for thoracic outlet syndrome fails, scalenectomy with or without first-rib resection (FRR) is the treatment of choice. We measured pressure in the costoclavicular space before and after FRR at time of neurogenic thoracic outlet syndrome release to evaluate whether FRR is required to completely decompress the costoclavicular space. ⋯ Supraclavicular first rib resection for management of neurogenic thoracic outlet syndrome can be safely performed with favorable outcomes. The pressure increase in the costoclavicular space caused by arm abduction and external rotation was significantly reduced only after FRR, raising concerns about potential incomplete costoclavicular space decompression with scalenectomy alone for neurogenic thoracic outlet syndrome management.
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Acute pulmonary embolism (PE) is associated with significant mortality. Surgical embolectomy is a viable treatment option; however, it remains controversial as a result of variable outcomes. This review investigates patient outcomes after surgical embolectomy for acute PE. ⋯ Surgical embolectomy is an acceptable treatment option with favorable outcomes.
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Cases of vaporizer-induced acute lung injury are increasing in frequency as the use of these recreational products have become more popular. Such pathology can result in life-threatening conditions for otherwise healthy patients, with diagnostic difficulties and complex treatment plans. Presented is a case of severe acute lung injury caused by vaporizing substances in a young man requiring extracorporeal membranous oxygenation (ECMO) as a bridge to recovery. Recovery was successful despite rapid-onset of adult respiratory distress syndrome with prompt use of ECMO and appropriate lung-protective strategies.
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Reducing inpatient readmissions is a national priority for improving healthcare quality and decreasing costs. Previous studies have shown that readmissions after surgical aortic valve replacement are frequent and contribute to increased healthcare costs, yet no studies have analyzed risk factors for readmission. ⋯ Using a national inpatient database, we found readmission after surgical aortic valve replacement to be common and resource-intensive. Enhanced management of comorbidities and targeted postdischarge interventions for patients at high risk of readmission may help decrease healthcare utilization.