Journal of thoracic disease
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Thoracotomy leads to chronic neuropathic pain in up to 50% of patients and is responsible for an impaired quality of life. Intercostal nerve injury has been suggested to be responsible for this pain. In the present study the impact of paravertebral intercostal neurectomy on post thoracotomy pain was assessed. ⋯ Neurectomy was not shown to reduce the post thoracotomy pain syndrome in patients with anatomical lung resection following anterolateral muscle sparing thoracotomy.
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Noninvasive ventilation (NIV) is commonly used to prevent endotracheal intubation in patients with acute respiratory distress syndrome (ARDS). Patients with hypoxemic acute respiratory failure who fail an NIV trial carry a worse prognosis as compared to those who succeed. Additional factors are also knowingly associated with worse outcomes: higher values of ICU severity score, presence of severe sepsis, and lower ratio of arterial oxygen tension to fraction of inspired oxygen. ⋯ In a recent paper published in JAMA, "Effect of Noninvasive Ventilation Delivered by Helmet vs. Face Mask on the Rate of Endotracheal Intubation in Patients with Acute Respiratory Distress Syndrome: A Randomized Clinical Trial", Patel et al. evaluated ARDS patients submitted to NIV and drew attention to the importance of the NIV interface. We discussed their interesting findings focusing also on the ventilator settings and on the current barriers to lung protective ventilation in ARDS patients during NIV.
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Minimally invasive repair of pectus excavatum (MIRPE) is now performed in adults. Managing adult patients' pain postoperatively has been challenging due to increased chest wall rigidity and the pressure required for supporting the elevated sternum. The optimal pain management regimen has not been determined. We designed this prospective, randomized trial to compare postoperative pain management and outcomes between thoracic epidural analgesia (TEA) and bilateral subcutaneous infusion pump catheters (On-Q). ⋯ Postoperative pain management in adults after MIRPE can be difficult. Both continuous local anesthetic delivery by TEA and On-Q catheters with concomitant, intravenous, patient-controlled anesthesia maintained acceptable analgesia with a reasonable LOS. In our cohort, there was preference for the On-Q system for pain management.
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A recent cohort study of Charbonney et al. indicates that multiple trauma patients develop endotoxemia also in the absence of Gram-negative infection. This is most probably due to an increase of gut permeability. Non-survivors as well as patients with cardiovascular dysfunction and multiple organ failure (MOF) show significantly higher endotoxin levels at 24 h after injury compared to survivors and patients without MOF. ⋯ Of interest, other multiple trauma patient studies in the nineties have shown endogenous anti-endotoxin antibody production in survivors and reduced antibody production in non-survivors, which died from MOF. Although all these studies have pointed towards a mechanistic role of endotoxin in the fatal outcome after multiple injuries, clinical anti-endotoxin studies are still lacking. Thus, the future perspective must be prospective randomized multicenter trials, which have to elucidate the capability of anti-endotoxin treatment strategies to improve outcome in multiple trauma patients.
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Turkey with a population of 78 million is located between Asia and Europe geographically and culturally. There are 577 active pure thoracic surgeon and 37 thoracic surgery teaching units. ⋯ Minimally invasive thoracic surgery has been a new approach which is being adapted by increasingly more surgeons. There are a number of reasons to predict that the number of thoracic surgical cases will be increased and new generation of thoracic surgeons will be operating more minimally invasive resectional surgeries for most lung cancer in future.