Annals of palliative medicine
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Recently, robot-assisted thoracic surgery (RATS) is increasingly applied to lung or mediastinal tumor surgery. However, appropriate methods of postoperative analgesia for RATS have not been studied. ⋯ Compared with PCA, TEA provided better analgesia after RATS in terms of less pain scores, less rescue analgesic requirements, and similar side effect profiles. TEA with a hydrophilic opioid and local anesthetic seemed an appropriate method of postoperative analgesia in patients undergoing RATS.
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Despite the clear benefits of palliative care, surgical patients are less likely to receive palliative care consultations when compared to their medical counterparts. In this context, we conducted semi-structured interviews with a diverse range of practicing surgeons to better understand surgeon attitudes and experiences with both palliative care approaches and specialty services. ⋯ Among our cohort of surgeons, several key factors influenced their use of palliative approaches and specialty palliative care services. A better understanding of surgeon-perceived barriers may lead to future work aimed at creating meaningful, surgeon-specific interventions that address the underuse of this important care for surgical patients and patients being considered for surgery.
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Observational Study
Lung aeration and ventilation after general anesthesia in left lateral position: a prospective observational study using electrical impedance tomography.
Endoscopic submucosal dissection (ESD) under general anesthesia in left lateral position may lead to transient impairment of pulmonary function. We used electrical impedance tomography (EIT), an increasingly implied non-invasive instrument for bedside real-time monitoring regional changes in ventilation, to assess the changes of regional lung aeration and ventilation in patients undergoing ESD. ⋯ In patients with left lateral position undergoing ESD, left lung was characterized by decreased ventilation and more inhomogeneity while right lung was opposite after intubation. ESD procedure with carbon dioxide insufflation did not lead to significant changes in either regional ventilation or homogeneity. And the change of lung inhomogeneity during ESD procedure is transient.
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During veno-venous extracorporeal membrane oxygenation (VV-ECMO), systemic anticoagulation is required to prevent thrombotic complications within the circuit and oxygenator. The unfractionated heparin (UFH) is commonly administered as a standard anticoagulant, but in our institute recombinant human thrombomodulin (rhTM), instead of UFH, is used as an anticoagulant for VV-ECMO. In the present study, we reviewed whether rhTM could be applied effectively and safely as an anticoagulant agent during VV-ECMO. ⋯ In this retrospective study, we analyzed 15 patients with severe respiratory failure who were administered rhTM as an anticoagulant during VV-ECMO and found that anticoagulation therapy with rhTM is maybe a feasible option which allows for effective and safe VV-ECMO.
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Meta Analysis
Risk predictive models for delirium in the intensive care unit: a systematic review and meta-analysis.
An emerging approach to prevent delirium in an intensive care unit is the use of risk prediction models. At present, there is no scientific comparison of the predictive effect of the prediction model. This systematic review and meta-analysis aimed to compare the performance of available delirium risk prediction models for intensive care units. ⋯ The E-PRE-DELIRIC model, PRE-DELIRIC model, or both are recommended to predict ICU delirium risk. However, the recommendation should be considered with caution because of substantial heterogeneity. The protocol was registered with PROSPERO (CRD42019130802).