The Annals of thoracic surgery
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Case Reports
Rewarming a patient with accidental hypothermia and cardiac arrest using thoracic lavage.
The optimal treatment for severe accidental hypothermia is cardiopulmonary bypass because this offers the most rapid rate of rewarming. However, cardiopulmonary bypass therapy is not available in every hospital. In these circumstances, rewarming has to be achieved with other methods. We present a patient who was successfully rewarmed with thoracic lavage after he had been found with a core temperature of 21°C and asystole.
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Case Reports
Pulmonary patch repair of tracheobronchial necrosis with perforation secondary to caustic ingestion.
Corrosive aerodigestive injury complicated by tracheobronchial necrosis is a rare complication after caustic ingestion that carries a high risk of mortality and morbidity. If left untreated, tracheobronchial necrosis results in perforation, mediastinitis, and death. ⋯ Frequent endoscopic surveillance leads to early diagnosis and prompt operative management to prevent significant morbidity. We describe a pulmonary patch repair of a patient who had stage 3b necrosis of the esophagus and the stomach with tracheobronchial necrosis and perforation after caustic ingestion.
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Multicenter Study Clinical Trial
Serum brain natriuretic peptide and risk of acute kidney injury after cardiac operations in children.
Acute kidney injury (AKI) after pediatric cardiac operations is associated with poor outcomes and is difficult to predict. We conducted a prospective study to evaluate whether preoperative brain natriuretic peptide (BNP) levels predict postoperative AKI among children undergoing cardiac operations. ⋯ Preoperative BNP levels did not predict postoperative AKI in this cohort of children undergoing cardiac operations. Both preoperative and postoperative BNP levels are associated with postoperative outcomes. Clinical Trial Registration at Clinicaltrials.gov as NCT00774137.
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Comparative Study
A propensity-matched comparison of pleurodesis or tunneled pleural catheter for heart failure patients with recurrent pleural effusion.
Patients with severe heart failure often have recurrent pleural effusions that produce dyspnea and shortness of breath. It is unclear whether chemical pleurodesis or the placement of a tunneled pleural catheter that can be used for intermittent pleural drainage produces superior palliation, a shorter hospital stay, and less morbidity. This investigation compares these two treatments. ⋯ This investigation found that a tunneled pleural catheter provided palliation of patients' pleural effusions and freedom from reintervention equal to that of talc pleurodesis using thoracoscopy while resulting in a shorter mean length of hospital stay. Lower rates of operative morbidity and readmission related to the pleural effusion were also seen in the tunneled catheter treatment group. This method of palliation of recurrent pleural effusion should be considered for symptomatic patients with advanced heart failure.