Annals of translational medicine
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The intraoperative lung protective effect of mechanical ventilation of different positive end-expiratory pressure (PEEP) levels on patients undergoing abdominal laparoscopic surgery with the steep Trendelenburg position remains undefined. The purpose of the study was to explore the optimal PEEP. ⋯ A moderate PEEP level (8 cmH2O) with low tidal volume was sufficient to improve Cdyn and to decrease VD/VT without increasing QS/QT, which was suggested to be a good choice of intraoperative lung protective ventilation during abdominal laparoscopic surgery with Trendelenburg position.
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This study aimed to establish a predictive model for prolonged air leak (PAL) after video-assisted thoracic surgery (VATS) lung resection; and additionally, to present a meta-analysis of the relevant literature to estimate the association between various clinical factors and PAL. ⋯ Lung stapling length and early postoperative drainage are important indicators for the evaluation of PAL occurrence. Upper pulmonary resection is a factor with particular regional differences as its association with PAL is not significant within Asian populations. Our nomogram, incorporating multiple factors, provided a simple and practical predictive model with value for clinical application.
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Patients receiving a total knee arthroplasty (TKA) who fail to meet inpatient criteria for outpatient physical therapy or an acute rehabilitation facility are increasingly being discharged to skilled nursing facilities (SNFs). However, in some facilities, postoperative care and therapy may be suboptimal. In order to recognize the circumstances predisposing patients to a SNF discharge and quantify perioperative risks, we used a nationwide TKA database to compare those who were and were not discharged to SNFs with respect to: (I) patient and hospital characteristics; (II) comorbidities; (III) lengths of stay (LOS); and (IV) inpatient complications. ⋯ Patients discharged to SNF had specific demographic characteristics and risk factors, increased LOS, more frequent inpatient medical complications, and greater hospital costs. Knowledge of these risk factors may be critical from the perspective of the new value-based reimbursement system for orthopaedic surgeon to intervene early and appropriately select the patients likely and capable of completing the rigorous postoperative TKA rehabilitation.
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Patients with impaired lung function or chronic obstructive pulmonary disease (COPD) are considered high-risk for intubated general anesthesia, which may preclude them from surgical treatment of their lung cancers. We evaluated the feasibility of non-intubated video-assisted thoracoscopic surgery (VATS) for the surgical management of lung cancer in patients with impaired pulmonary function. ⋯ Non-intubated VATS resection for pulmonary tumors is technically feasible. It may be applied as an alternative to intubated general anesthesia in managing lung cancer in selected patients with impaired pulmonary function.
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Patients undergoing extracorporeal membrane oxygenation (ECMO) treatment often have severe fluid overload and electrolyte imbalances and may even suffer acute kidney injury (AKI). It is often necessary to use continuous renal replacement therapy (CRRT). In this study, we aimed to retrospectively analyze the prognosis of patients treated with ECMO combined with CRRT and to find the independent factors that affect the survival rate. ⋯ The fluid balance at ECMO day 3 and lactate at CRRT initiation are the prognosis independent risk factors for ECMO + CRRT patients.