Journal of thoracic disease
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In this review, we discuss common difficulties that clinicians may encounter while managing patients treated with venovenous (VV) extracorporeal membrane oxygenation (ECMO). ECMO is an increasingly important tool for managing severe respiratory failure that is refractory to conventional therapies. Its overall goal is to manage respiratory failure-induced hypoxemia and hypercarbia to allow "lung rest" and promote recovery. ⋯ These difficulties include ventilation issues, hypoxemia (especially as related to recirculation or low ECMO-flow-to-cardiac-output ratio), sepsis, malfunctioning critical circuit components, lack of clarity regarding optimal hemoglobin levels, hematological/anticoagulation complications, and right ventricular (RV) dysfunction. A culture of safety should be emphasized to optimize patient outcomes. A properly functioning team-not only the bedside clinician, but also nurses, perfusionists, respiratory therapists, physical therapists, pharmacists, nutritionists, and other medical specialists and allied health personnel-is vital for therapeutic success.
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Idiopathic pulmonary fibrosis (IPF) is an advancing and fatal lung disease with increasing incidence and prevalence. Nintedanib and pirfenidone were approved by the FDA for the treatment of IPF in 2014 based on positive phase 3 trials, and both of these antifibrotic drugs are conditionally recommended in the 2015 ATS/ERS/JRS/ALAT Clinical Practice Guideline. Although an improvement over previously suggested therapies, their capacity to reduce, but not completely arrest or improve, lung function over time presents an opportunity for novel or add-on pharmacologic agents. ⋯ Results of treatments directed at gastro-esophageal reflux in patients with IPF have also been published. Currently, monotherapy with pirfenidone or nintedanib is the mainstay of pharmacological treatment for IPF. Innovative therapies along with combinations of pharmacological agents hold great promise for the future.
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We compared and analyzed differences between repair vs. replacement of mitral valves on severe rheumatic mitral stenosis by looking at mid-term clinical outcomes. ⋯ Selecting suitable patients for mitral valve repair is feasible even for patients with severe rheumatic mitral stenosis. In our study, compared with prosthetic valve replacement in these patients, valve repair still significantly reduced the valve-related complications rates and improved the quality of life during the follow-up.
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The amplitude spectrum area (AMSA), a frequency-domain ventricular fibrillation (VF) waveform metric, can predict successful defibrillation and the return of spontaneous circulation (ROSC) after defibrillation attempts. We aimed to investigate the validation of Spectral Energy for the quantitative analysis of the VF waveform to guide defibrillation in a porcine model of cardiac arrest and compare it with the AMSA metric. In addition, we sought to determine the effects of epinephrine and cardiopulmonary resuscitation (CPR) on AMSA and Spectral Energy. ⋯ Both the Spectral Energy and AMSA methods accurately predict successful defibrillation. Moreover, increases in the value of either Spectral Energy or AMSA after application of CPR and epinephrine may also predict successful defibrillation.
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In the last decade, uniportal VATS has increasingly been used for major lung resections as it has revolutionised the way thoracic surgeons treat pulmonary lesions. Uniportal VATS has represented an authentic innovation in thoracic surgery because it represents an ideal link between reduced morbidity and enhanced recovery. From the first feasibility studies, Uniportal VATS has been assessed in terms of postoperative morbidity, mortality, and overall oncologic value yielding similar outcomes compared to open thoracotomy or three-port VATS. ⋯ The first consensus paper among international experts in uniportal VATS lobectomy was obtained through a Delphi process through three rounds of voting to enhance its validity. The Delphi process was used to define the procedure and to optimise the indications, perioperative management and training of Uniportal VATS. The main features of this process including the anonymity of participants, the iterative process, and, controlled feedback were reported in the consensus statement.