RESUMEN
OBJECTIVE: To investigate the effect of improving the operative field and postoperative atelectasis of single-lung ventilation (SLV) in the surgical repair of coarctation of the aorta (CoA) in infants without the use of cardiopulmonary bypass (CPB). METHODS: This was a retrospective cohort study. The clinical data of 28 infants (aged 1 to 4 months, weighing between 4.2 and 6 kg) who underwent surgical repair of CoA without CPB from January 2019 to May 2022 were analyzed. Fourteen infants received SLV with a bronchial blocker (Group S), and the other 14 infants received routine endotracheal intubation and bilateral lung ventilation (Group R). RESULTS: In comparison to Group R, Group S exhibited improved exposure of the operative field, a lower postoperative atelectasis score (P<0.001), reduced prevalence of hypoxemia (P=0.01), and shorter durations of operation, mechanical ventilation, and ICU stay (P=0.01, P<0.001, P=0.03). There was no difference in preoperative information or perioperative respiratory and circulatory indicators before SLV, 10 minutes after SLV, and 10 minutes after the end of SLV between the two groups (P>0.05). Intraoperative bleeding, intraoperative positive end-expiratory pressure (PEEP), and systolic pressure gradient across the coarctation after operation were also not different between the two groups (P>0.05). CONCLUSION: This study demonstrates that employing SLV with a bronchial blocker is consistent with enhanced operative field, reduced operation duration, lower prevalence of intraoperative hypoxemia, and fewer postoperative complications during the surgical repair of CoA in infants without the use of CPB.
Asunto(s)
Coartación Aórtica , Ventilación Unipulmonar , Atelectasia Pulmonar , Lactante , Humanos , Puente Cardiopulmonar , Coartación Aórtica/cirugía , Estudios Retrospectivos , Complicaciones Posoperatorias , Hipoxia , Atelectasia Pulmonar/etiología , Atelectasia Pulmonar/prevención & controlRESUMEN
Chylothorax is the accumulation of lymph in the thoracic cavity, and it has never been reported in neotropical primates. An emperor tamarin died and at necropsy chylothorax associated with pulmonary compressive atelectasis was diagnosed. Idiopathic chylothorax can be a cause of respiratory insufficiency and death in tamarins.
Asunto(s)
Quilotórax , Atelectasia Pulmonar , Animales , Quilotórax/diagnóstico , Quilotórax/etiología , Quilotórax/veterinaria , Saguinus , Pulmón , Atelectasia Pulmonar/etiología , Atelectasia Pulmonar/veterinariaRESUMEN
Abstract Introduction: General anesthesia causes pulmonary atelectasis within few minutes of induction. This can have significant impact on postoperative outcome of cancer patients undergoing prolonged reconstructive surgeries. Objective: The purpose of this study was to evaluate the impact of sonographically detected perioperative atelectasis on the need for postoperative oxygen supplementation, bronchodilator therapy and assisted chest physiotherapy in patients undergoing free flap surgeries for head and neck carcinoma. Methods: Twenty eight head and neck cancer patients underwent bilateral pulmonary ultrasonographic assessments before and after lung surgery. Lung ultrasound scores, serum lactate, and PaO2/FiO2 ratio were measured both at the beginning and at end of the surgery. Patients were scanned in the supine position and the number of single and confluent B lines was noted. These values were correlated with the need for oxygen therapy, requirement of bronchodilators and total weaning time to predict the postoperative outcome. Other factors affecting weaning were also studied. Results: Among twenty eight patients, seven had mean lung ultrasound score of ≥10.5 which correlated with prolonged weaning time (144.56±33.5min vs. 66.7±15.7min; p = 0.005). The change in lung ultrasound score significantly correlated with change in PaO2/FiO2 ratio (r = −0.56, p = 0.03). Elevated total leukocyte count >8200 ΜL and serum lactate >2.1 mmoL/L also predicted prolonged postoperative mechanical ventilation. Conclusion: This preliminary study detected significant levels of perioperative atelectasis using point of care lung ultrasonography in head and neck cancer patients undergoing long duration surgical reconstructions. Higher lung ultrasound scores highlighted the need for frequent bronchodilator nebulizations as well as assisted chest physiotherapy and were associated with delayed weaning. We propose more frequent point of care lung ultrasonographic evaluations and use of recruitment maneuvers to reduce the impact of perioperative pulmonary atelectasis.
Resumo Introdução: A anestesia geral causa atelectasia pulmonar poucos minutos após sua indução. Isso pode ter um impacto significativo no resultado pós-operatório de pacientes com câncer submetidos a cirurgias reconstrutivas prolongadas. Objetivo: Avaliar o impacto das atelectasias perioperatórias detectadas por ultrassonografia na necessidade de suplementação pós-operatória de oxigênio, terapia broncodilatadora e fisioterapia respiratória assistida em pacientes com carcinoma de cabeça e pescoço submetidos a cirurgias com uso de retalho livre. Método: Foram submetidos a avaliações ultrassonográficas pulmonares bilaterais antes e após a cirurgia 28 pacientes com câncer de cabeça e pescoço. Os escores de ultrassonografia pulmonar, lactato sérico, razão PaO2/FiO2 foram medidos no início e no fim da cirurgia. Os pacientes foram avaliados na posição supina e o número de linhas B confluentes e únicas foi observado. Esses valores foram correlacionados com a necessidade de oxigenoterapia, necessidade de broncodilatadores e tempo total de desmame para predizer o resultado pós-operatório. Outros fatores que afetam o desmame também foram estudados. Resultados: Entre os 28 pacientes, sete apresentaram escore médio de ultrassonografia pulmonar ≥ 10,5, que se correlacionou com o tempo de desmame prolongado (144,56 ± 33,5 minutos vs. 66,7 ± 15,7 minutos; p = 0,005). A mudança no escore de ultrassonografia pulmonar correlacionou-se significantemente com a mudança na razão PaO2/FiO2 (r = −0,56, p = 0,03). A contagem total elevada de leucócitos > 8200 uLe o nível de lactato sérico >2,1 mmoL/L também previram ventilação mecânica pós-operatória prolongada. Conclusão: Este estudo preliminar detectou um nível significante de atelectasia perioperatória com ultrassonografia pulmonar no local de atendimento em pacientes com câncer de cabeça e pescoço submetidos a reconstruções cirúrgicas de longa duração. Escores mais altos de ultrassonografia pulmonar enfatizaram a necessidade de nebulizações broncodilatadoras frequentes e fisioterapia respiratória assistida e foram associados a desmame tardio. Propomos avaliações ultrassonográficas pulmonares mais frequentes no local de atendimento e o uso de manobras de recrutamento para reduzir o impacto das atelectasias pulmonares perioperatórias.
Asunto(s)
Humanos , Atelectasia Pulmonar/etiología , Atelectasia Pulmonar/terapia , Atelectasia Pulmonar/diagnóstico por imagen , Procedimientos de Cirugía Plástica/efectos adversos , Colgajos Tisulares Libres , Neoplasias de Cabeza y Cuello/cirugía , Neoplasias de Cabeza y Cuello/complicaciones , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Complicaciones Posoperatorias , Broncodilatadores , Ultrasonografía/efectos adversos , Lactatos , PulmónRESUMEN
INTRODUCTION: General anesthesia causes pulmonary atelectasis within few minutes of induction. This can have significant impact on postoperative outcome of cancer patients undergoing prolonged reconstructive surgeries. OBJECTIVE: The purpose of this study was to evaluate the impact of sonographically detected perioperative atelectasis on the need for postoperative oxygen supplementation, bronchodilator therapy and assisted chest physiotherapy in patients undergoing free flap surgeries for head and neck carcinoma. METHODS: Twenty eight head and neck cancer patients underwent bilateral pulmonary ultrasonographic assessments before and after lung surgery. Lung ultrasound scores, serum lactate, and PaO2/FiO2 ratio were measured both at the beginning and at end of the surgery. Patients were scanned in the supine position and the number of single and confluent B lines was noted. These values were correlated with the need for oxygen therapy, requirement of bronchodilators and total weaning time to predict the postoperative outcome. Other factors affecting weaning were also studied. RESULTS: Among twenty eight patients, seven had mean lung ultrasound score of ≥10.5 which correlated with prolonged weaning time (144.56±33.5min vs. 66.7±15.7min; p=0.005). The change in lung ultrasound score significantly correlated with change in PaO2/FiO2 ratio (r=-0.56, p=0.03). Elevated total leukocyte count >8200µL and serum lactate >2.1mmoL/L also predicted prolonged postoperative mechanical ventilation. CONCLUSION: This preliminary study detected significant levels of perioperative atelectasis using point of care lung ultrasonography in head and neck cancer patients undergoing long duration surgical reconstructions. Higher lung ultrasound scores highlighted the need for frequent bronchodilator nebulizations as well as assisted chest physiotherapy and were associated with delayed weaning. We propose more frequent point of care lung ultrasonographic evaluations and use of recruitment maneuvers to reduce the impact of perioperative pulmonary atelectasis.
Asunto(s)
Colgajos Tisulares Libres , Neoplasias de Cabeza y Cuello , Procedimientos de Cirugía Plástica , Atelectasia Pulmonar , Broncodilatadores , Neoplasias de Cabeza y Cuello/complicaciones , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Lactatos , Pulmón , Complicaciones Posoperatorias , Atelectasia Pulmonar/diagnóstico por imagen , Atelectasia Pulmonar/etiología , Atelectasia Pulmonar/terapia , Procedimientos de Cirugía Plástica/efectos adversos , Ultrasonografía/efectos adversosRESUMEN
OBJECTIVE: To describe clinical, radiological and treatment characteristics in pediatric patients with SLS. MATERIAL AND METHODS: This is a descriptive and retrospective study in patients under 16 years old with the diagnosis of SLE complicated by SLS at the General Hospital. National Medical Center La Raza. Clinical, radiological and treatment variables were analyzed. Results are shown in frequencies and percentages. RESULTS: Data from 11 patients, 9 females and 2 males were collected. Mean age at diagnosis of SLS was 12.2 years. Age at diagnosis of SLE was 11.1 years. SLEDAI 17.3. Renal desease 72%, hematological 91%, lymphopenia 63%, mucocutaneous 72%, neurological 9%, arthritis 54%, serositis 91%, fever 81%, secondary antiphospholipid syndrome, low C3 72%, low C4 81%, positive ANA 91%, positive anti-DNA 91%. Regarding clinical manifestations of SLE: cough 81%, dyspnea 91%, hipoxemia 81%, pleuritic pain 71%, average oxygen saturation 83%. Chest X-rays findings: right hemidiaphragm affection 18%, left 63%, bilateral 18%. Elevated hemidiaphragm 91%, atelectasis 18%, pleural effusion 91%, over one third of the cardiac silhouette under the diphragm 36%, bulging diaphragm 45%, 5th. anterior rib that crosses over the diaphragm 91%. M-mode ultrasound: diaphragmatic hypomotility 100%, pleural effusion 63%. Pulmonary function tests: restrictive pattern in 45% of the cases. Treatment was with supplementary oxygen 100%, intubation 18%, antibiotics 100%, steroids 100%, intravenous immunoglobulin 54%, plasmapheresis 18%, cyclophosphamide 54% and rituximab 18%. The clinical course was favorable in 81%. CONCLUSIONS: SLS should be suspected in patients with SLE and active disease who present hipoxemia, pleuritic pain, cough, dyspnea, pleural effusion and signs of restriction on chest X-rays. Therefore, a diaphragmatic M-mode ultrasound should be performed in order to establish the diagnosis.
Asunto(s)
Diafragma/anomalías , Diafragma/fisiopatología , Enfermedades Pulmonares/etiología , Enfermedades Pulmonares/fisiopatología , Lupus Eritematoso Sistémico/complicaciones , Adolescente , Antibacterianos/uso terapéutico , Síndrome Antifosfolípido/complicaciones , Síndrome Antifosfolípido/diagnóstico , Síndrome Antifosfolípido/inmunología , Dolor en el Pecho/etiología , Niño , Terapia Combinada/métodos , Ciclofosfamida/uso terapéutico , Diafragma/diagnóstico por imagen , Disnea/etiología , Femenino , Humanos , Hipoxia/etiología , Inmunoglobulinas Intravenosas/uso terapéutico , Factores Inmunológicos/uso terapéutico , Inmunosupresores/uso terapéutico , Intubación Intratraqueal/métodos , Enfermedades Pulmonares/terapia , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/inmunología , Masculino , México/epidemiología , Oxígeno/administración & dosificación , Oxígeno/uso terapéutico , Plasmaféresis/métodos , Pleuresia/complicaciones , Atelectasia Pulmonar/etiología , Estudios Retrospectivos , Rituximab/uso terapéutico , Esteroides/uso terapéutico , Ultrasonografía/métodosRESUMEN
BACKGROUND: Patients with decreased consciousness are prone to prolonged bed rest and respiratory complications. If effective in reducing atelectasis, lung expansion maneuvers could be used to prevent these complications. In comatose, bedridden subjects, we aimed to assess the acute effect on regional lung aeration of 2 lung expansion techniques: expiratory positive airway pressure and the breath-stacking maneuver. Our secondary aim was to evaluate the influence of these lung expansion techniques on regional ventilation distribution, regional ventilation kinetics, respiratory pattern, and cardiovascular system. METHODS: We enrolled 10 subjects status post neurosurgery, unable to follow commands, and with prolonged bed rest. All subjects were submitted to both expansion techniques in a randomized order. Regional lung aeration, ventilation distribution, and regional ventilation kinetics were measured with electrical impedance tomography. RESULTS: Lung aeration increased significantly during the application of both expiratory positive airway pressure and breath-stacking (P < .001) but returned to baseline values seconds afterwards. The posterior lung regions had the largest volume increase (P < .001 for groups). Both maneuvers induced asynchronous inflation and deflation between anterior and posterior lung regions. There were no significant differences in cardiovascular variables. CONCLUSIONS: In comatose subjects with prolonged bed rest, expiratory positive airway pressure and breath-stacking promoted brief increases in lung aeration. (ClinicalTrials.gov registration NCT02613832.).
Asunto(s)
Reposo en Cama , Atelectasia Pulmonar , Coma/etiología , Coma/terapia , Impedancia Eléctrica , Humanos , Pulmón , Respiración con Presión Positiva , Atelectasia Pulmonar/etiologíaRESUMEN
BACKGROUND Primary ciliary dyskinesia (PCD) is a disease characterized by motor ciliary dysfunction, which leads to the accumulation of secretions in the lower airways and, consequently, to atelectasis and repeated infections. During the neonatal period, diagnosis can be difficult because the symptoms are frequently associated with other respiratory diseases common in neonates. The laterality defects should warn the clinician of the need for further investigation using clinical criteria, but the confirmation depends on a genetic test. CASE REPORT The objective of this report is to present a case of PCD manifesting in the neonatal period that was diagnosed due to respiratory failure associated with recurrent atelectasis and situs inversus totalis. CONCLUSIONS This disease is not well known by neonatologists, but early diagnosis decreases morbidity and improves patient quality of life.
Asunto(s)
Trastornos de la Motilidad Ciliar/complicaciones , Trastornos de la Motilidad Ciliar/terapia , Atelectasia Pulmonar/etiología , Atelectasia Pulmonar/terapia , Síndrome de Dificultad Respiratoria del Recién Nacido/etiología , Síndrome de Dificultad Respiratoria del Recién Nacido/terapia , Administración por Inhalación , Presión de las Vías Aéreas Positiva Contínua , Diagnóstico Diferencial , Humanos , Recién Nacido , Masculino , Situs InversusRESUMEN
The infection by Nocardia spp is not common in immunocompetent patients. The empirical antimicrobial treatment directed by anatomical regions does not contemplate the particularities of the germ and the microbiological analysis is necessary for the specific treatment. We present the case of a previously healthy and immunocompetent patient, without known risk factors for Nocardia spp. infection, with evidence of involvement of the pulmonary parenchyma and the skin and subsequent development of multiple brain abscesses.
La infección por Nocardia spp. no es común en pacientes inmunocompetentes. El tratamiento antimicrobiano empírico dirigido según las regiones anatómicas, no contempla las particularidades del germen y el análisis microbiológico se hace necesario para el tratamiento específico. A continuación, se presenta el caso de una paciente previamente sana, inmunocompetente y sin factores de riesgo conocidos para la infección por Nocardia spp., con evidencia de compromiso en el parénquima pulmonar y la piel, que posteriormente desarrolló varios abscesos cerebrales.
Asunto(s)
Absceso Encefálico/microbiología , Nocardiosis/diagnóstico , Neumonía Bacteriana/diagnóstico , Antibacterianos/uso terapéutico , Absceso Encefálico/diagnóstico por imagen , Absceso Encefálico/tratamiento farmacológico , Ceftriaxona/uso terapéutico , Quimioterapia Combinada , Femenino , Cefalea/etiología , Humanos , Inmunocompetencia , Imagen por Resonancia Magnética , Persona de Mediana Edad , Neuroimagen , Nocardiosis/tratamiento farmacológico , Neumonía Bacteriana/complicaciones , Neumonía Bacteriana/diagnóstico por imagen , Atelectasia Pulmonar/diagnóstico por imagen , Atelectasia Pulmonar/etiología , Tomografía Computarizada por Rayos X , Combinación Trimetoprim y Sulfametoxazol/uso terapéuticoRESUMEN
Sclerosing mediastinitis (SM), previously named chronic fibrosing mediastinitis, is an inflammatory process that in its end-stage results to sclerosis around the mediastinal structures. SM is quite rare and has been correlated with inflammatory and autoimmune diseases, as well as malignancy. SM may either present in a mild form, with minor symptoms and a benign course or in a more aggressive form with severe pulmonary hypertension and subsequent higher morbidity and mortality. The diagnosis of SM may be difficult and quite challenging, as symptoms depend on the mediastinal structure that is mainly involved; quite often the superior vena cava. However, practically any mediastinal structure may be involved by the fibrotic process, such as the central airways, as well as the pulmonary arteries and veins, leading to obstruction or total occlusion. The latter may be impossible to undergo proper surgical excision of the lesion, and is considered to be a real challenge to the surgeon. We herein report a case of SM that presented with arterial and venous compression. The imaging appearance was that of unilateral pulmonary edema, associated with lung collapse. The case is supplemented by a non-systematic review of the relevant literature.
Asunto(s)
Mediastinitis/complicaciones , Atelectasia Pulmonar/etiología , Edema Pulmonar/etiología , Esclerosis/complicaciones , Adulto , Biopsia , Constricción Patológica/diagnóstico por imagen , Constricción Patológica/patología , Femenino , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/patología , Humanos , Mediastinitis/diagnóstico por imagen , Mediastinitis/patología , Atelectasia Pulmonar/diagnóstico por imagen , Atelectasia Pulmonar/patología , Edema Pulmonar/diagnóstico por imagen , Edema Pulmonar/patología , Radiografía Torácica , Esclerosis/diagnóstico por imagen , Esclerosis/patología , Tomografía Computarizada por Rayos XRESUMEN
Abstract Sclerosing mediastinitis (SM), previously named chronic fibrosing mediastinitis, is an inflammatory process that in its end-stage results to sclerosis around the mediastinal structures. SM is quite rare and has been correlated with inflammatory and autoimmune diseases, as well as malignancy. SM may either present in a mild form, with minor symptoms and a benign course or in a more aggressive form with severe pulmonary hypertension and subsequent higher morbidity and mortality. The diagnosis of SM may be difficult and quite challenging, as symptoms depend on the mediastinal structure that is mainly involved; quite often the superior vena cava. However, practically any mediastinal structure may be involved by the fibrotic process, such as the central airways, as well as the pulmonary arteries and veins, leading to obstruction or total occlusion. The latter may be impossible to undergo proper surgical excision of the lesion, and is considered to be a real challenge to the surgeon. We herein report a case of SM that presented with arterial and venous compression. The imaging appearance was that of unilateral pulmonary edema, associated with lung collapse. The case is supplemented by a non-systematic review of the relevant literature.
Asunto(s)
Humanos , Femenino , Adulto , Edema Pulmonar/etiología , Atelectasia Pulmonar/etiología , Esclerosis/complicaciones , Mediastinitis/complicaciones , Edema Pulmonar/diagnóstico por imagen , Atelectasia Pulmonar/patología , Atelectasia Pulmonar/diagnóstico por imagen , Biopsia , Radiografía Torácica , Tomografía Computarizada por Rayos X , Constricción Patológica/patología , Constricción Patológica/diagnóstico por imagen , Atrios Cardíacos/patología , Atrios Cardíacos/diagnóstico por imagen , Mediastinitis/patología , Mediastinitis/diagnóstico por imagenRESUMEN
RESUMEN En la aspiración por cuerpo extraño en vías respiratoria, los síntomas van desde el paro cardiorrespiratorio, tos de intensidad y características variables como obstrucción bronquial difusa o localizada. Como complicación puede aparecer la neumonía y atelectasias. La atelectasia es el colapso de una parte periférica del pulmón o de todo el pulmón, debido a la obstrucción de la vía aérea en bronquios o bronquiolos. El objetivo de este trabajo es presentar un caso clínico y la importancia de la intervención de Enfermería en una Transicional, de 1 año y 9 meses de edad, sexo femenino. Ingresó en la Unidad de Terapia Intensiva del Hospital Pediátrico Provincial de Matanzas, con diagnóstico de aspiración de cuerpo extraño en vías aéreas. El desarrollo de las habilidades prácticas del enfermero intensivista fomenta el razonamiento crítico en aras de brindar cuidados con calidad y enfoque científico que repercuten en la mejoría de los pacientes (AU).
ABSTRACT This paper´s aim is to present a clinical case and the importance of the nursing interventions in a female transitional patient, aged 1 years and 9 months. She entered the Intensive Care Unit of the Provincial Pediatric Hospital of Matanzas, with a diagnosis of foreign body aspiration in the airways. The development of the intensive care nurses´ practical skills promotes the critical reasoning for the sake of giving qualitative care with a scientific approach striking on the improvement of the patients (AU).
Asunto(s)
Humanos , Femenino , Lactante , Calidad de la Atención de Salud , Atelectasia Pulmonar/diagnóstico , Morbilidad , Obstrucción de las Vías Aéreas/complicaciones , Unidades de Cuidados Intensivos , Atención de Enfermería , Terapia por Inhalación de Oxígeno , Atelectasia Pulmonar/complicaciones , Atelectasia Pulmonar/enfermería , Atelectasia Pulmonar/etiología , Atelectasia Pulmonar/terapia , Obstrucción de las Vías Aéreas/etiología , Obstrucción de las Vías Aéreas/epidemiología , AtragantamientoRESUMEN
RESUMEN En la aspiración por cuerpo extraño en vías respiratoria, los síntomas van desde el paro cardiorrespiratorio, tos de intensidad y características variables como obstrucción bronquial difusa o localizada. Como complicación puede aparecer la neumonía y atelectasias. La atelectasia es el colapso de una parte periférica del pulmón o de todo el pulmón, debido a la obstrucción de la vía aérea en bronquios o bronquiolos. El objetivo de este trabajo es presentar un caso clínico y la importancia de la intervención de Enfermería en una Transicional, de 1 año y 9 meses de edad, sexo femenino. Ingresó en la Unidad de Terapia Intensiva del Hospital Pediátrico Provincial de Matanzas, con diagnóstico de aspiración de cuerpo extraño en vías aéreas. El desarrollo de las habilidades prácticas del enfermero intensivista fomenta el razonamiento crítico en aras de brindar cuidados con calidad y enfoque científico que repercuten en la mejoría de los pacientes (AU).
ABSTRACT This paper´s aim is to present a clinical case and the importance of the nursing interventions in a female transitional patient, aged 1 years and 9 months. She entered the Intensive Care Unit of the Provincial Pediatric Hospital of Matanzas, with a diagnosis of foreign body aspiration in the airways. The development of the intensive care nurses´ practical skills promotes the critical reasoning for the sake of giving qualitative care with a scientific approach striking on the improvement of the patients (AU).
Asunto(s)
Humanos , Femenino , Lactante , Calidad de la Atención de Salud , Atelectasia Pulmonar/diagnóstico , Morbilidad , Obstrucción de las Vías Aéreas/complicaciones , Unidades de Cuidados Intensivos , Atención de Enfermería , Terapia por Inhalación de Oxígeno , Atelectasia Pulmonar/complicaciones , Atelectasia Pulmonar/enfermería , Atelectasia Pulmonar/etiología , Atelectasia Pulmonar/terapia , Obstrucción de las Vías Aéreas/etiología , Obstrucción de las Vías Aéreas/epidemiología , AtragantamientoRESUMEN
Resumen Objetivo: Determinar la frecuencia, tipo y predictores de complicaciones pleuropulmonares en los primeros 30 días de postoperatorio de pacientes intervenidos de cirugía cardiovascular sin apoyo de circulación extracorpórea. Métodos: Se realizó un estudio de cohorte retrospectivo durante el periodo comprendido del 1 de enero de 2013 al 31 de diciembre 2014. Incluyó a todos los pacientes portadores de cardiopatías congénitas intervenidos de cirugía cardiaca con abordaje esternal o torácico, sin soporte de circulación extracorpórea con ingreso registrado a Unidad de Cuidados Intensivos del Hospital de Pediatría del Centro Médico Nacional Siglo XXI, IMSS. Se cuantificó la frecuencia de eventos de las complicaciones pleuropulmonares y se realizó un análisis multivariado de regresión logística para identificar los factores de riesgo asociados a complicaciones pleuropulmonares, calculándose odds ratio (OR) e intervalos de confianza al 95% (IC 95%). Resultados: Se incluyeron un total de 139 pacientes, en los cuales la frecuencia de complicaciones pleuropulmonares fue del 42.4% (n = 59), y los tipos más frecuentes fueron atelectasia (28 eventos), neumonía asociada a ventilador (24 eventos), neumotórax (20 eventos), pudiéndose encontrar más de una complicación por paciente. Los predictores más significativos de complicaciones pleuropulmonares fueron las cardiopatías congénitas cianógenas (OR = 3.58; IC 95%: 1.10-7.50; p = 0.001), el abordaje por toracotomía (OR = 1.46; IC 95%: 1.18-1.12; p = 0.008) y el evento quirúrgico realizado de urgencia (OR = 3.46; IC 95%: 1.51-7.95; p = 0.002). Conclusiones: La principal complicación pleuropulmonar fue la atelectasia lo cual concuerda con lo reportado en la literatura internacional. Los pacientes que presenten alguno de los predictores identificados en el presente estudio deben ser monitorizados de manera especial para prevenir, detectar y/o tratar oportunamente las complicaciones pleuropulmonares tras cirugía cardiaca.
Abstract Objective: To determine the frequency and type of pleuropulmonary complications and their predictors in the first thirty postoperative days of patients undergoing surgery without cardiopulmonary bypass. Methods: A retrospective cohort study was carried out between January 2013 and December 2014. It included all patients with congenital heart disease who underwent cardiac surgery using a sternal or thoracic approach, without cardiopulmonary bypass with a registered admission to a Neonatal or Paediatric Intensive Care. The frequency of events of pleuropulmonary complications and logistic regression analysis was performed, and the adjusted odds ratio (OR) and confidence intervals at 95% (95% CI) were calculated. Results: A total of 139 patients were included. The frequency of pleuropulmonary complications was 42.4% (N = 59), and the most frequent types were atelectasis (28 events), ventilator-associated pneumonia (24 events), pneumothorax (20 events), with more than one complication per patient occasionally being found. Significant risk factors were cyanogenic congenital heart disease (OR = 3.58, 95% CI: 1.10-7.50, P =.001), thoracotomy approach (OR = 1.46, 95% CI: 1.18-1.12, P = .008), and an emergency surgical event (OR = 3.46, 95% CI: 1.51-7.95, P = .002). Conclusions: The main pleuropulmonary complication was atelectasis, which is consistent with that reported in the international literature. Patients with any of the predictors identified in the present study should be closely monitored in order to prevent, detect and/or treat pleuropulmonary complications in a timely manner after cardiac surgery.
Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Niño , Enfermedades Pleurales/epidemiología , Complicaciones Posoperatorias/epidemiología , Procedimientos Quirúrgicos Cardíacos/métodos , Enfermedades Pulmonares/epidemiología , Enfermedades Pleurales/etiología , Enfermedades Pleurales/fisiopatología , Complicaciones Posoperatorias/fisiopatología , Atelectasia Pulmonar/etiología , Atelectasia Pulmonar/epidemiología , Unidades de Cuidado Intensivo Pediátrico , Unidades de Cuidado Intensivo Neonatal , Modelos Logísticos , Estudios Retrospectivos , Estudios de Cohortes , Cardiopatías Congénitas/cirugía , Enfermedades Pulmonares/etiología , Enfermedades Pulmonares/fisiopatologíaRESUMEN
OBJECTIVE: Pulmonary impairment is a common complication after coronary artery bypass graft procedure and may be prevented or treated by noninvasive ventilation. Recruitment maneuvers include sustained airway pressure with high levels of positive end-expiratory pressure in patients with hypoxemia, favoring homogeneous pulmonary ventilation and oxygenation. This study aimed to evaluate whether noninvasive ventilation with recruitment maneuver could safely improve oxygenation in patients with atelectasis and hypoxemia who underwent a coronary artery bypass grafting procedure. METHODS: Thirty-four patients admitted to our intensive care unit undergoing mechanical ventilation after surgery, with ratio of arterial oxygen partial pressure to fraction of inspired oxygen < 300 and radiologic atelectasis score ≥2, were included. The control group consisted of 16 randomized patients and the recruitment group consisted of 18 patients. After extubation, noninvasive ventilation was applied for 30 minutes 3 times a day with positive end-expiratory pressure of 8 cm H2O. The recruitment group received recruitment maneuver with positive end-expiratory pressure of 15 cm H2O and 20 cm H2O for 2 minutes each during noninvasive ventilation. We analyzed the arterial oxygen partial pressure in room air, radiologic atelectasis score, hemodynamic stability, and adverse events from extubation until discharge. RESULTS: Arterial oxygen partial pressure increased 12.6% ± 6.8% in the control group and 23.3% ± 8.5% in the recruitment group (P < .001). The radiologic atelectasis score was completely improved for 94.4% of the recruitment group with no adverse events, whereas 87.5% of the control group presented some atelectasis (P < .001). CONCLUSIONS: Noninvasive ventilation with recruitment maneuvers is safe, improves oxygenation, and reduces atelectasis in patients undergoing coronary artery bypass.
Asunto(s)
Puente de Arteria Coronaria , Hipoxia/terapia , Pulmón/fisiopatología , Ventilación no Invasiva/métodos , Atelectasia Pulmonar/terapia , Ventilación Pulmonar , Anciano , Extubación Traqueal , Brasil , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/mortalidad , Femenino , Humanos , Hipoxia/etiología , Hipoxia/mortalidad , Hipoxia/fisiopatología , Intubación Intratraqueal , Tiempo de Internación , Masculino , Persona de Mediana Edad , Ventilación no Invasiva/efectos adversos , Oxígeno/sangre , Presión Parcial , Atelectasia Pulmonar/etiología , Atelectasia Pulmonar/mortalidad , Atelectasia Pulmonar/fisiopatología , Recuperación de la Función , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
Background Infectious lung cavities are a common entity for the respiratory physician. Sometimes these lesions require surgical treatment, but surgery is challenging, and complications are common. Methods Patients with infectious lung cavities amenable to surgical treatment were included in a case-control study. The control group included patients with no complications. The cases group comprised patients with any of the following complications up to 90 days after surgery: death, persistence of hemoptysis, empyema, operative blood loss > 500 mL, vascular lesion requiring repair, massive transfusion (>5 units of packed red blood cells per 48 h) or reoperation for bleeding, postoperative mechanical ventilation, intensive care unit stay > 48 h, prolonged air leak, and persistent atelectasis. The potential risk factors for complications analyzed were demographic data, exposure to contaminants, comorbidities, preoperative embolization, surgical indication, spirometry results, and sputum test positive for Mycobacterium tuberculosis. Results Forty-five patients were included in the study and divided into 24 cases and 21 controls. We found a significant difference in the time to removal of chest tubes in favor of the noncomplicated cases (6.45 vs. 4.05 days, p = 0.030), and persistent active infection at the time of surgery tended to be a risk factor for complications (odds ratio = 6.6, 95% confidence interval: 0.7-60, p = 0.061). Conclusion The presence of persistent active infection at the time of surgery could be a risk factor for complications in resection surgery for infectious lung cavities.
Asunto(s)
Neumonectomía/efectos adversos , Complicaciones Posoperatorias/etiología , Infecciones del Sistema Respiratorio/cirugía , Pérdida de Sangre Quirúrgica , Distribución de Chi-Cuadrado , Empiema Pleural/etiología , Transfusión de Eritrocitos/efectos adversos , Femenino , Hemoptisis/etiología , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Neumonectomía/mortalidad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/terapia , Hemorragia Posoperatoria/etiología , Atelectasia Pulmonar/etiología , Respiración Artificial/efectos adversos , Infecciones del Sistema Respiratorio/complicaciones , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/mortalidad , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: To determine the frequency and type of pleuropulmonary complications and their predictors in the first thirty postoperative days of patients undergoing surgery without cardiopulmonary bypass. METHODS: A retrospective cohort study was carried out between January 2013 and December 2014. It included all patients with congenital heart disease who underwent cardiac surgery using a sternal or thoracic approach, without cardiopulmonary bypass with a registered admission to a Neonatal or Paediatric Intensive Care. The frequency of events of pleuropulmonary complications and logistic regression analysis was performed, and the adjusted odds ratio (OR) and confidence intervals at 95% (95% CI) were calculated. RESULTS: A total of 139 patients were included. The frequency of pleuropulmonary complications was 42.4% (N=59), and the most frequent types were atelectasis (28 events), ventilator-associated pneumonia (24 events), pneumothorax (20 events), with more than one complication per patient occasionally being found. Significant risk factors were cyanogenic congenital heart disease (OR=3.58, 95% CI: 1.10-7.50, P=.001), thoracotomy approach (OR=1.46, 95% CI: 1.18-1.12, P=.008), and an emergency surgical event (OR=3.46, 95% CI: 1.51-7.95, P=.002). CONCLUSIONS: The main pleuropulmonary complication was atelectasis, which is consistent with that reported in the international literature. Patients with any of the predictors identified in the present study should be closely monitored in order to prevent, detect and/or treat pleuropulmonary complications in a timely manner after cardiac surgery.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Enfermedades Pulmonares/epidemiología , Enfermedades Pleurales/epidemiología , Complicaciones Posoperatorias/epidemiología , Niño , Preescolar , Estudios de Cohortes , Femenino , Cardiopatías Congénitas/cirugía , Humanos , Lactante , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Unidades de Cuidado Intensivo Pediátrico , Modelos Logísticos , Enfermedades Pulmonares/etiología , Enfermedades Pulmonares/fisiopatología , Masculino , Enfermedades Pleurales/etiología , Enfermedades Pleurales/fisiopatología , Complicaciones Posoperatorias/fisiopatología , Atelectasia Pulmonar/epidemiología , Atelectasia Pulmonar/etiología , Estudios RetrospectivosRESUMEN
OBJECTIVE: In this study, the efficacy of thoracic ultrasonography during echocardiography was evaluated in newborns. METHODS: Sixty newborns who had undergone pediatric cardiac surgery were successively evaluated between March 1, 2015, and September 1, 2015. Patients were evaluated for effusion, pulmonary atelectasis, and pneumothorax by ultrasonography, and results were compared with X-ray findings. RESULTS: Sixty percent (n=42) of the cases were male, the median age was 14 days (2-30 days), and the median body weight was 3.3 kg (2.8-4.5 kg). The median RACHS-1 score was 4 (2-6). Atelectasis was demonstrated in 66% (n=40) of the cases. Five of them were determined solely by X-ray, 10 of them only by ultrasonography, and 25 of them by both ultrasonography and X-ray. Pneumothorax was determined in 20% (n=12) of the cases. Excluding one case determined by both methods, all of the 11 cases were diagnosed by X-ray. Pleural effusion was diagnosed in 26% (n=16) of the cases. Four of the cases were demonstrated solely by ultrasonography, three of them solely by X-ray, and nine of the cases by both methods. Pericardial effusion was demonstrated in 10% (n=6) of the cases. Except for one of the cases determined by both methods, five of the cases were diagnosed by ultrasonography. There was a moderate correlation when all pathologies evaluated together (k=0.51). CONCLUSION: Thoracic ultrasonography might be a beneficial non-invasive method to evaluate postoperative respiratory problems in newborns who had congenital cardiac surgery.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/efectos adversos , Derrame Pleural/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Atelectasia Pulmonar/diagnóstico por imagen , Ecocardiografía/métodos , Femenino , Humanos , Síndrome del Corazón Izquierdo Hipoplásico/cirugía , Recién Nacido , Masculino , Atelectasia Pulmonar/etiología , Radiografía Torácica/métodos , Sensibilidad y Especificidad , Transposición de los Grandes Vasos/cirugía , Ultrasonografía/métodosAsunto(s)
Broncoscopía/instrumentación , Enfisema/etiología , Atelectasia Pulmonar/etiología , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico por imagen , Edema Pulmonar/tratamiento farmacológico , Anciano , Broncoscopía/efectos adversos , Diuréticos/uso terapéutico , Enfisema/diagnóstico por imagen , Femenino , Furosemida/administración & dosificación , Furosemida/uso terapéutico , Humanos , Oxihemoglobinas/metabolismo , Atelectasia Pulmonar/diagnóstico por imagen , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Edema Pulmonar/etiología , Pruebas de Función Respiratoria , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
Abstract Objective: In this study, the efficacy of thoracic ultrasonography during echocardiography was evaluated in newborns. Methods: Sixty newborns who had undergone pediatric cardiac surgery were successively evaluated between March 1, 2015, and September 1, 2015. Patients were evaluated for effusion, pulmonary atelectasis, and pneumothorax by ultrasonography, and results were compared with X-ray findings. Results: Sixty percent (n=42) of the cases were male, the median age was 14 days (2-30 days), and the median body weight was 3.3 kg (2.8-4.5 kg). The median RACHS-1 score was 4 (2-6). Atelectasis was demonstrated in 66% (n=40) of the cases. Five of them were determined solely by X-ray, 10 of them only by ultrasonography, and 25 of them by both ultrasonography and X-ray. Pneumothorax was determined in 20% (n=12) of the cases. Excluding one case determined by both methods, all of the 11 cases were diagnosed by X-ray. Pleural effusion was diagnosed in 26% (n=16) of the cases. Four of the cases were demonstrated solely by ultrasonography, three of them solely by X-ray, and nine of the cases by both methods. Pericardial effusion was demonstrated in 10% (n=6) of the cases. Except for one of the cases determined by both methods, five of the cases were diagnosed by ultrasonography. There was a moderate correlation when all pathologies evaluated together (k=0.51). Conclusion: Thoracic ultrasonography might be a beneficial non-invasive method to evaluate postoperative respiratory problems in newborns who had congenital cardiac surgery.