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Singh G, Pujara J, Trivedi V, Uday DD, Masaniya J, Babu MJ, Bhandari CD. Correlation of venous to arterial carbon dioxide partial pressure difference with other cardiac output indices in patients undergoing intracardiac repair for tetralogy of fallot. Ann Card Anaesth 2023; 26:171-176. [PMID: 37706382 PMCID: PMC10284487 DOI: 10.4103/aca.aca_53_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/15/2022] [Accepted: 06/25/2022] [Indexed: 09/15/2023] Open
Abstract
Background Clearance of tissue carbon dioxide by circulation is measured by venous to arterial carbon dioxide partial pressure difference (AVCO2) and is correlated with cardiac output (CO) in critically ill adult patients. This study aimed to correlate AVCO2 with other CO indices like arteriovenous oxygen saturation difference (AVO2), central venous oxygen saturation (ScVO2), and serum lactate in pediatric patients undergoing intracardiac repair (ICR) for tetralogy of Fallot (TOF). Methods We conducted a prospective observational study in 50 patients, of age 5 months to 5 years, undergoing ICR for TOF and analyzed AVO2, AVCO2, ScVO2, and lactate from arterial and venous blood gas pairs obtained at different time intervals from admission to pediatric intensive care unit (PICU) (T0), at 6 h (T1), 12 h (T2), 24 h (T3), and 48 h (T4) postoperatively. Bivariate correlations were analyzed using Pearson for parametric variables. Results Admission AVCO2 was not correlated with AVO2 (R2 = 0.166, P = 0.246), ScVO2 (R2 = -2.2, P = 0.124), and lactate (R2 = -0.07, P = 0.624). At T1, AVCO2 was correlated with AVO2 (R2 = 0.283, P = 0.0464) but not with ScVO2 (R2 = - 0.25, P = 0.079) and lactate (R2 = -0.07, P = 0.623). At T2, T3 and T4, AVCO2 was correlated with AVO2 (R2 = 0.338,0.440 & 0.318, P = 0.0162, 0.0013, and 0.024), ScVO2 (R2 = - 0.344, - 0.488, and -0.366; P = 0.0143, <0.0001, and 0.017), and lactate (R2 = 0.305, 0.467 and 0.607; P = 0.0314, 0.00062 and <0.0001). AVCO2 was negatively correlated with ScVO2. No correlation observed between admission AVCO2 and mechanical ventilation duration. Two nonsurvivors had higher value of admission AVCO2 compared to survivors. Conclusion AVCO2 is correlated with other CO surrogates like AVO2, ScVO2, and lactate in pediatric patients undergoing ICR for TOF.
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Affiliation(s)
- Guriqbal Singh
- Department of Cardiac Anesthesia, U. N. Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmadabad, Gujarat, India
| | - Jigisha Pujara
- Department of Cardiac Anesthesia, U. N. Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmadabad, Gujarat, India
| | - Visharad Trivedi
- Department of Cardiac Anesthesia, U. N. Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmadabad, Gujarat, India
| | - Dhawalikar Deepti Uday
- Department of Cardiac Anesthesia, U. N. Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmadabad, Gujarat, India
| | - Jyoti Masaniya
- Department of Cardiac Anesthesia, U. N. Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmadabad, Gujarat, India
| | - Mittapalli Jeevan Babu
- Department of Cardiac Anesthesia, U. N. Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmadabad, Gujarat, India
| | - Chanchal Daulal Bhandari
- Department of Cardiac Anesthesia, U. N. Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmadabad, Gujarat, India
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Radiologic evaluation of compensatory lung growth using computed tomography by comparison with histological data from a large animal model. Sci Rep 2022; 12:2520. [PMID: 35169160 PMCID: PMC8847356 DOI: 10.1038/s41598-022-06398-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 01/11/2022] [Indexed: 11/08/2022] Open
Abstract
Non-invasive analysis using computed tomography (CT) data may be a promising candidate to evaluate neo-alveolarization in adult lungs following lung resection. This study evaluates and compares the validity of CT analysis with histologic morphometry for compensatory lung growth in a large animal model. We calculated the radiologic tissue volume and the radiologic lung weight from CT data taken at 1, 3, and 6 months post-surgery on 15 male beagle dogs that had a right thoractotomy, bilobectomy, or pneumonectomy (n = 5 in each group). Results were analyzed using one-way ANOVA and were subsequently compared to histologic findings of tissue samples at 6 months post-surgery using Pearson's correlation. An increase in radiologic tissue volume and radiologic lung weight was identified, which was positively correlated with histologic lung parenchymal amounts (correlation coefficient = 0.955 and 0.934, respectively, p < 0.001). Histology of lung specimens at 6 months post-surgery revealed an increase in the tissue amount in both Bilobectomy and Peumonectomy groups, which was consistent with compensatory lung growth. Radiologic tissue volume and radiologic lung weight reflected compensatory lung growth following lung resection. Radiologic assessment using CT data can be a promising clinical modality to evaluate postoperative lung growth.
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Total laparoscopic resection by medial-retroperitoneal approach using virtual navigation: two case reports of primary retroperitoneal schwannoma. World J Surg Oncol 2022; 20:3. [PMID: 34980150 PMCID: PMC8725496 DOI: 10.1186/s12957-021-02483-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/21/2021] [Indexed: 11/28/2022] Open
Abstract
Background We report two rare cases of retroperitoneal schwannoma completely resected by a laparoscopic medial-retroperitoneal approach aided by virtual navigation. Three-dimensional images have been used in liver and lung surgery, but there are few prior reports on retroperitoneal surgery. Case presentation These two case reports are of a 60-year-old man and a 40-year-old man with asymptomatic retroperitoneal schwannoma. In both cases, the tumors were located in the right renal hilum and were close to the duodenum, right ureter, and inferior vena cava. Simulation using three-dimensional images was performed before surgery, and a medial-retroperitoneal approach was performed to secure a wide surgical field. During the operation, we confirmed the location of the main feeder and the relationship between the tumor and organs with those shown on the three-dimensional images and performed total laparoscopic resection. Conclusion The medial-retroperitoneal approach provides operative safety. Preoperative simulation and intraoperative navigation with three-dimensional images, which can be freely rotated and interactively visualized from any angle, are useful methods to enhance the surgeon’s understanding of a patient’s specific anatomy and are especially effective when resecting a retroperitoneal tumor that is located in an anatomically deep and complex location.
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Akca HS, Akca H, Yapici N. Effect of delta carbon dioxide and lactate on prognosis in patients undergoing open-heart surgery. Niger J Clin Pract 2022; 25:1398-1404. [DOI: 10.4103/njcp.njcp_1328_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wang S, Wang D, Huang X, Wang H, Le S, Zhang J, Du X. Development and validation of a nomogram model for early postoperative hyperlactatemia in patients undergoing cardiac surgery. J Thorac Dis 2021; 13:5395-5408. [PMID: 34659806 PMCID: PMC8482329 DOI: 10.21037/jtd-21-1004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/13/2021] [Indexed: 12/17/2022]
Abstract
Background Postoperative hyperlactatemia (POHL) is common in patients undergoing cardiac surgery, associated with adverse outcomes. The aim of this study was to identify predictors for POHL after cardiac surgery and to develop and validate a predictive model. Methods Adult patients who underwent open heart surgery at our institution between 2016 and 2019 were retrospectively included. The patients were randomly divided into training and validation groups at a 2:1 ratio. Multivariate logistic regression was performed to identify independent predictors for POHL in the training set. A nomogram was then constructed and was validated in the validation set. Results POHL developed in 713 of the 5,323 patients (13.4%). The mortality rate was higher in patients with POHL compared with patients without that (9.5% vs. 2.1%, P<0.001). Age, white blood cell (WBC) count, left ventricular ejection fraction, renal insufficiency, cardiac surgery history, red blood cell (RBC) transfusion, and cardiopulmonary bypass (CPB) time were identified as independent risk factors. The nomogram based on these predictors indicated good discrimination in both the training (c-index: 0.787) and validation (c-index: 0.820) sets. The calibration was reasonable by both visual inspection and goodness-of-fit test. The decision and clinical impact curves demonstrated good clinical utility. Conclusions We identified 7 independent risk factors and derived a prediction model for POHL in patients undergoing cardiac surgery. The model may contribute significantly to early risk assessment and clinical intervention.
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Affiliation(s)
- Su Wang
- Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dashuai Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaofan Huang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongfei Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sheng Le
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinnong Zhang
- Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinling Du
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Elevated serum lactate as a predictor of outcomes in patients following major abdominal surgery at a tertiary hospital in Uganda. BMC Surg 2021; 21:319. [PMID: 34364375 PMCID: PMC8348842 DOI: 10.1186/s12893-021-01315-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Major abdominal surgery is still a great contributor to postoperative morbidity and mortality in developing countries. Major abdominal surgery leads to hypoperfusion, which has an impact on postoperative morbidity and mortality. Lactate, a biomarker for hypoperfusion is under utilized in Uganda. The study aimed to investigate the association between elevated serum lactate and outcomes (in-hospital mortality, SSI and length of hospital stay) in patients following major abdominal surgery. Methods A prospective observational cohort study was done with 246 eligible patients recruited. Stratified sampling was carried out till desired sample size was achieved. Demographic and perioperative data were collected, serum lactate levels were measured at induction and immediately after surgery with serial measurements being done after 12, 24 h post operatively. Participants were followed up to assess outcomes. Data analysis was done using STATA version 14.0. Results A total of 130 patients (52.8%) had elevated serum lactate levels. Elevated serum lactate predicted in-hospital mortality and surgical site infection. The accuracy of elevated serum lactate to predict mortality with AUROC of 0.7898 was exhibited by the 24 h lactate values. Elevated serum lactate predicted surgical site infection accurately with AUROC 0.6432. Length of hospital is strongly associated with elevated serum lactate with p-value of 0.043. Patients with elevated serum lactate on average have a longer length of hospital stay at 5.34 ± 0.69. Conclusion Elevated serum lactate was associated with in-hospital mortality, surgical site infection and longer length of hospital stay. Serum lactate levels done at 24 h were most predictive of mortality and surgical site infection.
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Fujimoto R, Nakajima D, Tanaka S, Yamada Y, Yutaka Y, Ohsumi A, Hamaji M, Menju T, Date H. Efficacy of three-dimensional computed tomography volumetry for recipients in downsizing oversized grafts in brain-dead donor lung transplantation. Gen Thorac Cardiovasc Surg 2021; 69:1112-1117. [PMID: 33506436 PMCID: PMC7840616 DOI: 10.1007/s11748-021-01591-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 01/06/2021] [Indexed: 11/20/2022]
Abstract
Objective Brain-dead donor lung transplantation frequently requires reduction in the size of oversized lung grafts for patients with a small chest cavity. We focused on the role of three-dimensional computed tomography (3D-CT) volumetry for recipients on downsizing oversized lung grafts. Methods We performed 53 brain-dead donor bilateral lung transplantations, including 15 lobar lung transplants (Lobar group) and 38 standard lung transplants with full-sized grafts (Full group), between December 2010 and December 2018. Recipient chest volume before transplantation was measured using 3D-CT volumetry, and donor lung volume was evaluated by predicted total lung capacity. Post-transplant outcomes and pulmonary function were retrospectively compared between the groups. Results The ratio of the recipient chest volume to the donor lung volume was significantly lower in the Lobar group (0.42 ± 0.15) than in the Full group (0.77 ± 0.30, P < 0.01). The calculated size matching between the donor and recipient after downsizing the grafts was significantly correlated to the ratio of the recipient chest volume to the donor lung volume (Spearman r = 0.69; P < 0.01). Early post-transplant outcomes did not significantly differ between the groups. Although the Full group showed slightly better pulmonary function after transplantation, the 1-, 3-, and 5-year overall survival rates were similar to the Lobar group (100%, 93%, and 81% in the Lobar group vs. 92%, 78%, and 70% in the Full group; P = 0.50). Conclusions Brain-dead donor lobar lung transplantation showed favorable post-transplant outcomes. The assessment of recipient chest cavity volume using 3D-CT volumetry may help surgeons precisely downsize oversized lung grafts prior to transplantation.
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Affiliation(s)
- Ryo Fujimoto
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawarahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Daisuke Nakajima
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawarahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Satona Tanaka
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawarahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshito Yamada
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawarahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yojiro Yutaka
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawarahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Akihiro Ohsumi
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawarahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawarahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Toshi Menju
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawarahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawarahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Central venous-to-arterial CO 2 difference is a poor tool to predict adverse outcomes after cardiac surgery: a retrospective study. Can J Anaesth 2021; 68:467-476. [PMID: 33403551 PMCID: PMC7785330 DOI: 10.1007/s12630-020-01881-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/26/2020] [Indexed: 12/29/2022] Open
Abstract
PURPOSE The venous-to-arterial carbon dioxide partial pressure difference (CO2 gap) has been reported to be a sensitive indicator of cardiac output adequacy. We aimed to assess whether the CO2 gap can predict postoperative adverse outcomes after cardiac surgery. METHODS A retrospective study was conducted of 5,151 patients from our departmental database who underwent cardiac surgery from 1 January 2008 to 31 December 2018. Lactate level (mmol·L-1), central venous oxygen saturation (ScVO2) (%), and the venous-to-arterial carbon dioxide difference (CO2 gap) were measured at intensive care unit (ICU) admission and on days 1 and 2 after cardiac surgery. The following postoperative adverse outcomes were collected: ICU mortality, hemopericardium or tamponade, resuscitated cardiac arrest, acute kidney injury, major bleeding, acute hepatic failure, mesenteric ischemia, and pneumonia. The primary outcome was the presence of at least one postoperative adverse outcome. Logistic regression was used to assess the association between ScVO2, lactate, and the CO2 gap with adverse outcomes. Their diagnostic performance was compared using a receiver operating characteristic (ROC) curve. RESULTS There were 1,933 patients (38%) with an adverse outcome. Cardiopulmonary bypass (CPB) parameters were similar between groups. The CO2 gap was slightly higher for the "adverse outcomes" group than for the "no adverse outcomes" group. Arterial lactate at admission, day 1, and day 2 was also slightly higher in patients with adverse outcomes. Central venous oxygen saturation was not significantly different between patients with and without adverse outcomes. The area under the ROC curve to predict outcomes after CPB for the CO2 gap at admission, day 1, and day 2 were 0.52, 0.55, and 0.53, respectively. CONCLUSION After cardiac surgery with CPB, the CO2 gap at ICU admission, day 1, and day 2 was associated with postoperative adverse outcomes but showed poor diagnostic performance.
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Tonello M, Barina A, Turchet F, De Simoni O, Alfieri R, Franzato B, Gruppo M, Dengo B, Deffenu D, Di Pasquale D, Fiore T, Pietropaoli C, Munaron S, Zanardo G, Sommariva A, Pilati P. Clinical and predictive value of blood lactate levels during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC): a comparative analysis. Updates Surg 2020; 73:313-319. [PMID: 33146888 DOI: 10.1007/s13304-020-00908-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/21/2020] [Indexed: 12/26/2022]
Abstract
Postoperative outcome after cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is strongly related to surgical and anesthesiologic expertise. This study aims to evaluate the clinical significance and prognostic value of lactate levels (LL) measured during CRS-HIPEC on postoperative outcome compared to similar major surgical procedures. Patients who were treated between January and September 2019 at our Institute and met the inclusion criteria were selected. Patients were divided into three groups: group 1: patients who underwent major surgical procedures; group 2: patients who underwent CRS without HIPEC; group 3: patients who underwent CRS with HIPEC. Intraoperative LL were analyzed and correlated with surgical procedure and postoperative outcome. We observed a significant increase of LL during surgical/CRS phase (group 1: p = 0.0001; group 2: p = 0.001; group 3: p = 0.057), rather than during the HIPEC phase in group 3 (p = ns). In patients undergoing CRS and peritonectomies, the mean LL were significantly higher compared to group 1 (p = 0.05). Although not statistically significant, the complication rate was higher in patients with end-CRS lactate values > 2 mMol/l, especially in the group undergoing CRS plus HIPEC. Our pilot study shows that higher LL during peritoneal cancer surgery are expected compared to major surgical procedures. Cytoreductive phase, rather than HIPEC, is related to an increase of LL. The role of LL as an early marker of postoperative complications after CRS-HIPEC should be further verified in properly designed studies.
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Affiliation(s)
- Marco Tonello
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Surgical Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Via dei Carpani, 16, 31033, Castelfranco Veneto, TV, Italy.
| | - Andrea Barina
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Surgical Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Via dei Carpani, 16, 31033, Castelfranco Veneto, TV, Italy
| | - Federica Turchet
- Anesthesia and Intensive Care Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Ottavia De Simoni
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Surgical Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Via dei Carpani, 16, 31033, Castelfranco Veneto, TV, Italy
| | - Rita Alfieri
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Surgical Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Via dei Carpani, 16, 31033, Castelfranco Veneto, TV, Italy
| | - Boris Franzato
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Surgical Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Via dei Carpani, 16, 31033, Castelfranco Veneto, TV, Italy
| | - Mario Gruppo
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Surgical Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Via dei Carpani, 16, 31033, Castelfranco Veneto, TV, Italy
| | - Bruno Dengo
- Anesthesia and Intensive Care Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Davide Deffenu
- Anesthesia and Intensive Care Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Daniele Di Pasquale
- Anesthesia and Intensive Care Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Tania Fiore
- Anesthesia and Intensive Care Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Claudia Pietropaoli
- Anesthesia and Intensive Care Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Susanna Munaron
- Anesthesia and Intensive Care Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Giorgio Zanardo
- Anesthesia and Intensive Care Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Antonio Sommariva
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Surgical Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Via dei Carpani, 16, 31033, Castelfranco Veneto, TV, Italy
| | - Pierluigi Pilati
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Surgical Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Via dei Carpani, 16, 31033, Castelfranco Veneto, TV, Italy
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Caviezel C, Froehlich T, Schneiter D, Muehlematter U, Frauenfelder T, Guglielmetti LC, Opitz I, Weder W. Identification of target zones for lung volume reduction surgery using three-dimensional computed tomography rendering. ERJ Open Res 2020; 6:00305-2020. [PMID: 32963992 PMCID: PMC7487346 DOI: 10.1183/23120541.00305-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/04/2020] [Indexed: 11/05/2022] Open
Abstract
Background The key issues for performing lung volume reduction surgery (LVRS) is the identification of the target zones. Recently introduced three-dimensional computed tomography rendering methods are used to identify the morphological distribution and its severity of lung emphysema by densitometry. We demonstrate a new software for emphysema imaging and show the pre- and post-operative results in patients undergoing LVRS planned based on this new technology. Methods A real-time three-dimensional image analysis software system was used pre- and 3 months post-operatively in five patients with heterogeneous emphysema and a single patient with homogeneous morphology scheduled for LVRS. Focus was on low attenuation areas with <950 HU, distribution on both lungs and the value of the three-dimensional images for planning surgery. Functional outcome was assessed by pulmonary function tests after 3 months. Results Five patients underwent bilateral LVRS and one patient had unilateral LVRS. All patients showed a median increase in forced expiratory volume in 1 s of 70% (range 30–120%), compared with baseline values. Hyperinflation (expressed as residual volume/total lung capacity ratio) was reduced by 30% (range 5–32%). In the patients with heterogeneous emphysema, the pre- and post-operative computed tomography scans and the densitometries showed a decrease in low attenuation areas by 23% (right side) and by 17% (left side), respectively. Conclusion We demonstrate three-dimensional computed tomography-rendered images for planning personalised remodelling of hyperinflated lungs using LVRS. This user-friendly software has the potential to assist surgeons and interventional pulmonologists to select patients and to visualise target areas in LVRS procedures. New, user-friendly software with 3D CT-rendered images can be used for planning personalised remodelling of hyperinflated lungs using LVRShttps://bit.ly/3fbICn2
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Affiliation(s)
- Claudio Caviezel
- Dept of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Tamara Froehlich
- Dept of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Didier Schneiter
- Dept of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Urs Muehlematter
- Institute for Interventional and Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Frauenfelder
- Institute for Interventional and Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Isabelle Opitz
- Dept of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Walter Weder
- Dept of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
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Huette P, Ellouze O, Abou-Arab O, Guinot PG. Venous-to-arterial pCO 2 difference in high-risk surgical patients. J Thorac Dis 2019; 11:S1551-S1557. [PMID: 31388460 DOI: 10.21037/jtd.2019.01.109] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Alteration of tissue perfusion is a main contributor to organ dysfunction in high-risk surgical patients. The difference between venous carbon dioxide and arterial carbon dioxide pressure (pCO2 gap) has been described as a parameter reflecting tissue hypoperfusion in critically ill patients who are insufficiently resuscitated. The pCO2 gap/CavO2 ratio has also been described as an indicator of the respiratory quotient, thus the relationship between DO2 and VO2. Most of the knowledge about the pCO2 gap and the pCO2 gap/CavO2 ratio has come from studies in the literature on animal models or intensive care unit (ICU) patients. To date, publications pertaining to the operative setting are sparse. In the present review, we will first discuss the physiological background of the pCO2 gap and CO2-O2 derived parameters used in the operating room. Few studies have focused on the clinical relevance of the pCO2 gap in high-risk non-cardiac surgical patients. Prospective observational studies with a small sample size and retrospective studies have shown that the pCO2 gap may be a useful complementary tool to identify patients who remain insufficiently optimized hemodynamically. In a few studies, a high pCO2 gap was associated with postoperative complications following non-cardiac high-risk surgery. Results of observational studies conducted in patients undergoing cardiac surgery are contradictory. We focused on the divergence between non-cardiac surgery, cardiac surgery, and septic critically ill patients. When analyzing the literature, we can find some explanations for the discrepancies in the published results between cardiac and non-cardiac surgery. Finally, we will discuss the clinical utility of the pCO2 gap in high-risk surgical patients.
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Affiliation(s)
- Pierre Huette
- Anaesthesiology and Critical Care Department, Cardiothoracic ICU, Amiens University Hospital, Amiens, France
| | - Omar Ellouze
- Anaesthesiology and Critical Care Department, Cardiovascular ICU, Dijon University Hospital, Dijon, France
| | - Osama Abou-Arab
- Anaesthesiology and Critical Care Department, Cardiothoracic ICU, Amiens University Hospital, Amiens, France
| | - Pierre-Grégoire Guinot
- Anaesthesiology and Critical Care Department, Cardiovascular ICU, Dijon University Hospital, Dijon, France
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Kayawake H, Chen-Yoshikawa TF, Aoyama A, Motoyama H, Hijiya K, Menju T, Sato T, Sonobe M, Date H. Excellent outcome of donor lobectomy with various surgical techniques for the interlobar artery. Eur J Cardiothorac Surg 2019; 51:279-283. [PMID: 28186281 DOI: 10.1093/ejcts/ezw298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/05/2016] [Accepted: 07/14/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Akihiro Aoyama
- Department of Thoracic Surgery, Kyoto University, Kyoto, Japan
| | - Hideki Motoyama
- Department of Thoracic Surgery, Kyoto University, Kyoto, Japan
| | - Kyoko Hijiya
- Department of Thoracic Surgery, Kyoto University, Kyoto, Japan
| | - Toshi Menju
- Department of Thoracic Surgery, Kyoto University, Kyoto, Japan
| | - Toshihiko Sato
- Department of Thoracic Surgery, Kyoto University, Kyoto, Japan
| | - Makoto Sonobe
- Department of Thoracic Surgery, Kyoto University, Kyoto, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University, Kyoto, Japan
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Nakane J, Honda N, Tsuchiya K. Computed tomography pulmonary angiography and venography with a low dose of contrast medium. Radiol Phys Technol 2018; 12:61-68. [PMID: 30536083 DOI: 10.1007/s12194-018-00492-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 11/28/2018] [Accepted: 11/28/2018] [Indexed: 11/24/2022]
Abstract
The authors developed a method to ensure sufficient opacification of pulmonary vasculature for separate depiction of arteries and veins in three-dimensional form with a small dose of contrast medium utilizing a test injection to determine optimal timing of computed tomography (CT) scanning. The dose was determined by a simulation based on a pharmacokinetic model. The contrast medium was administered at a rate of 5.0 mL/s for 3 s, followed by helical scanning at the timing determined by a dynamic CT scanning following the test injection. Images of 20 consecutive patients acquired with a 64-row CT scanner were evaluated. Quality of vessel depiction was assessed on the basis of the following: HU values at the main pulmonary artery (MPA) and left atrium (LA), distance between the pleural surface and the distal end of the pulmonary vessels on three-dimensional CT pulmonary arteriography and venography (3D-CTPAV), and subjective visual assessment of quality of the 3D-CTPAV images. Time to generate the 3D-CTPAV images was recorded. The mean ± standard deviation (SD) of the HU values at MPA/LA and the distances to the pleural surface for pulmonary arteries/veins were 448.0 ± 123.1/277.3 ± 60.85 HU and 9.21 ± 3.60/10.7 ± 5.45 mm, respectively. The image quality was visually rated as excellent for all of the patients. The mean time ± SD to generate 3D-CTPAV images was 13.6 ± 6.7 min. In conclusion, three-dimensional images of the pulmonary vasculature can be created using 21 mL (including 6 mL for the test injection) of contrast medium.
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Affiliation(s)
- Jun Nakane
- Radiology Service, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan.
| | - Norinari Honda
- Radiology Service, Division of Nuclear Medicine, Saitama Sekishinkai Hospital, 2-37-20, Irumagawa, Sayama, Saitama, 350-1305, Japan
| | - Kazuhiro Tsuchiya
- Department of Radiology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
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Nakazawa S, Shimizu K, Mogi A, Kuwano H. VATS segmentectomy: past, present, and future. Gen Thorac Cardiovasc Surg 2017; 66:81-90. [PMID: 29255967 DOI: 10.1007/s11748-017-0878-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/05/2017] [Indexed: 12/12/2022]
Abstract
Video-assisted thoracoscopic surgery (VATS) has gradually been implemented in thoracic surgery, and the VATS approach has now been extended to technically challenging procedures, such as segmentectomy. The definition of VATS segmentectomy is changing over time, and the repertoire of segmentectomy is getting wider with increasing reports on atypical segmentectomy. VATS segmentectomy bears surgical, oncological, and technical advantages; however, there are still areas of controversy, particularly regarding oncological outcomes. The indication of VATS segmentectomy is diverse and is used for treating lung cancer, metastatic lung tumors, or a variety of nonmalignant diseases. It is particularly valuable for the lung-sparing resection of deeply located small nodules or repeated surgery for multiple lung lesions. VATS segmentectomy requires a thorough analysis of segmental anatomy and a tailored preoperative planning with the assessment of surgical margins. Technical challenges include intraoperative navigation, methods to identify and dissect the intersegmental plane, and the prevention of air leakage. This review will discuss the present state of VATS segmentectomy, with a focus on past studies, current indications and techniques, and future view.
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Affiliation(s)
- Seshiru Nakazawa
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Kimihiro Shimizu
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Akira Mogi
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hiroyuki Kuwano
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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