Assessment of chest wall movement following thoracotomy: a systematic review

Pulmonary and chest wall function in obese adults

Obesity is frequently associated with breathing disorders. To investigate if and how the highest levels of obesity impact respiratory function, 17 subjects with obesity (median age: 49 years; BMI: 39.7 kg/m2, 8 females) and 10 normal-weighted subjects (49 years; 23.9 kg/m2, 5 females) were studied. The abdominal volume occupied 41% in the obese group, being higher (p < 0.001) than the normal-weighted group (31%), indicating accumulation of abdominal fat. Restrictive lung defect was present in 17% of subjects with obesity. At rest in the supine position, subjects with obesity breathed with higher minute ventilation (11.9 L/min) and lower ribcage contribution (5.7%) than normal weighted subjects (7.5 L/min, p = 0.001 and 31.1%, p = 0.003, respectively), thus indicating thoracic restriction. Otherwise healthy obesity might not be characterized by a systematic restrictive lung pattern. Despite this, another sign of restriction could be poor thoracic expansion at rest in the supine position, resulting in increased ventilation. Class 3 obesity made respiratory rate further increased. Opto-electronic plethysmography and its thoraco-abdominal analysis of awake breathing add viable and interesting information in subjects with obesity that were complementary to pulmonary function tests. In addition, OEP is able to localize the restrictive effect of obesity.

Risk stratification of postoperative pulmonary complications in elderly patients undergoing lung cancer resection: a propensity score-matched study

BACKGROUND

In China, lung cancer mainly affects the elderly population. Surgery remains the standard treatment for lung cancer in elderly patients, however, postoperative pulmonary complications (PPCs) are major contributors to morbidity and mortality following lung resection. This study aimed to identify perioperative predictors of PPCs among elderly patients undergoing pulmonary resection for lung cancer to provide evidence for better prevention and intervention for PPCs.

METHODS

A retrospective study was conducted with 456 patients (age >65 years) undergoing pulmonary resection for lung cancer in Yunnan, China from January 2016 to March 2019. Propensity score matching (PSM) was performed to compare preoperative data and clinical characteristics between the PPC and non-PPC groups, followed by binary logistic regression to evaluate predictors of PPCs.

RESULTS

Pulmonary complications occurred in 142/456 (31.1%) patients age >65 years, with pneumonia being the most common event (21.7%). Both PSM and binary logistic regression analysis identified American Society of Anesthesiologists (ASA) class

CONCLUSIONS

PPCs following lung cancer resection in elderly patients were associated with a higher ASA classification and open thoracotomy. An adequate and comprehensive evaluation of the operative strategies and enhanced recovery methods should be implemented among elderly patients undergoing lung resection with an ASA class > II or those undergoing an open thoracotomy to help prevent the occurrence of PPCs.

Collapse

Key Words

• American Society of Anesthesiologists classification (ASA classification)
• Lung cancer surgery
• postoperative pulmonary complications (PPCs)
• thoracotomy

Collapse

MESH Headings Collapse

Grants Collapse

Affiliation(s)

Qiubo Huang Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
Ritika Rauniyar Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
Jiao Yang Department of Nursing, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
Chen Zhou Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
Dezhong Cai Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
Toyofumi Fengshi Chen-Yoshikawa Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
Yojiro Yutaka Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
Riccardo Orlandi Department of Thoracic Surgery, IRCCS San Gerardo Hospital, ASST-Monza, Monza, Italy
Travis C. Geraci Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA
Jules Lin Section of Thoracic Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
Huilian Hu Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
Ziqi Jiang Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
Guangqiang Zhao Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
Lianhua Ye Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China

Collapse

Combined Ultrasound-Guided Thoracic Paravertebral Nerve Block with Subcostal Transversus Abdominis Plane Block for Analgesia After Total Minimally Invasive Mckeown Esophagectomy: A Randomized, Controlled, and Prospective Study

INTRODUCTION

Thoracic paravertebral block (TPVB) and subcostal transverse abdominis plane block (TAP) have been considered to provide an effective analgesic effect for laparoscopic and thoracoscopic surgery, respectively. The purpose of this randomized, controlled, and prospective study was to evaluate the analgesic effect of TPVB combined with TAP in patients undergoing total minimally invasive Mckeown esophagectomy.

METHODS

Between February 2020 and December 2021, a total of 168 esophageal cancer patients undergoing McKeown esophagectomy at the Cancer Center of Sun Yat-Sen University, China, were randomly assigned to receive patient-controlled epidural analgesia alone (group PCEA, n = 56), patient-controlled intravenous analgesia alone (group PCIA, n = 56), and TPVB combined with TAP and patient-controlled intravenous analgesia (group PVB, n = 56). The primary outcome was a visual analogue scale (VAS) pain score on movement 48 h postoperatively. Secondary endpoints were pain scores at other points, intervention-related side effects, surgical complications, and length of intensive care unit and hospital stay. For the VAS pain score, the Kruskal-Wallis method was conducted for comparison of 3 treatment groups and further pairwise comparison with Bonferroni correction.

RESULTS

On movement, the VAS in the PVB group was higher than that in the PCEA group at 48 h, 72 h, 96 h, and 120 h postoperatively (p < 0.05) except in the postoperative anesthesia care unit (PACU) and 24 h postoperatively. The VAS in the PCIA group was higher than the PCEA and PVB groups in the first 4 days after surgery. The pulmonary complication rate in the PCIA group was significantly higher than the rate in the PCEA [95% Confidence Interval 0.214 (0.354, 0.067), p = 0.024].

CONCLUSIONS

Combined TPVB and TAP was more effective than intravenous opioid analgesia alone, while PCEA was more effective than TPVB combined with TAP and intravenous opioid analgesia for patients after McKeown esophagectomy.

TRIAL REGISTRATION

Chinese Clinical Trial Registry; ChiCTR2000029588.

Quantitative Analysis by 3D Graphics of Thoraco-Abdominal Surface Shape and Breathing Motion

Chest wall motion can provide information on respiratory muscles' action and on critical vital signs, like respiration and cardiac activity. The chest wall is a structure with three compartments that are independent to each other and can move paradoxically according to the pathophysiology of the disease. Opto-electronic plethysmography (OEP) allows for non-invasively 3D tracking of body movements. We aimed to extend the characteristics of OEP analysis to local analyses of thoraco-abdominal surface geometry and kinematics during respiration. Starting from the OEP output file, the 3D markers’ coordinates were combined with a triangulation matrix. A smoothing procedure (an automatic and iterative interpolation process to increase the number of vertices from 93 to 548) was applied to allow for precise local analysis of the thoraco-abdominal surface. A series of measurements can be performed to characterize the geometry of the trunk and its three compartments, in terms of volumes, height, diameters, perimeters, and area. Some shape factors, such as surface-to-volume ratio or height-to-perimeter ratio, can be also computed. It was also possible to build the vector field associated with the breathing motion of all the vertices, in terms of magnitude and motion direction. The vector field data were analyzed and displayed through two graphic tools: a 3D heatmap, in which the magnitude of motion was associated to different colors, and a 3D arrow plot, that allowed us to visualize both the magnitude and the direction of motion with color-coded arrows. The methods were applied to 10 healthy subjects (5 females) and also applied to two cases: a pregnant woman at each trimester of gestation and a patient before and after a demolition thoracic surgery. The results proved to be coherent with the physiology of healthy subjects and the physiopathology of the cases. We developed a new non-invasive method for respiratory analysis that allowed for the creation of realistic 3D models of the local and global trunk surface during respiration. The proposed representation constituted a very intuitive method to visualize and compare thoraco-abdominal surface movements within and between subjects, therefore enforcing the potential clinical translational value of the method.

Use of carbon nanotube sensor for detecting postoperative abnormal respiratory waveforms

Background

This feasibility study aimed to detect respiratory waveforms from thoracic movements and evaluate if postoperative complications could be predicted using a carbon nanotube sensor.

Methods

Fifty patients who underwent lung resection for lung tumors were enrolled. The lung monitoring system of the carbon nanotube sensor was placed on bilateral chest walls across the 6^th–9^th ribs to measure chest wall motion. We examined the respiratory waveform in relation to surgical findings, postoperative course, and complications using Hilbert transform and Fast Fourier Transform (FFT).

Results

Of 50 patients (37 males, 13 females), 22 were included in the normal lung function group and 28 were included in the low lung function group. The respiratory rate and waveform indicated a regular pattern in the normal lung function group and the respiratory rate could be detected. Conversely, irregular respiratory pattern was detected in 70% of patients in the low lung function group. There was no significant different overall envelope peak value between operated side and non-operated side (0.195±0.05 and 0.18±0.06). In contrast, there was significantly high peak value in the presence of postoperative complications (P<0.05). And there was a significantly higher peak value in air leakage presence than air leakage absence in operated side (P=0.045).

Conclusions

The present study confirmed the feasibility of the sensor. It is promising in visualizing the respiratory state and detecting respiratory changes postoperatively.

Comparison of multimodal analgesia with thoracic epidural after transthoracic oesophagectomy

BACKGROUND

Thoracic epidural analgesia (TEA) has been regarded as the standard of care after oesophagectomy for pain control, but has several side-effects. Multimodal (intrathecal diamorphine, paravertebral and rectus sheath catheters) analgesia (MA) may facilitate postoperative mobilization by reducing hypotensive episodes and the need for vasopressors, but uncertainty exists about whether it provides comparable analgesia. This study aimed to determine whether MA provides comparable analgesia to TEA following transthoracic oesophagectomy.

METHODS

Consecutive patients undergoing oesophagectomy for cancer between January 2015 and December 2018 were grouped according to postoperative analgesia regimen. Propensity score matching (PSM) was used to account for treatment selection bias. Pain scores at rest and on movement, graded from 0 to 10, were used. The incidence of hypotensive episodes and the requirement for vasopressors were evaluated.

RESULTS

The study included 293 patients; 142 (48.5 per cent) received TEA and 151 (51.5 per cent) MA. After PSM, 100 patients remained in each group. Mean pain scores were significantly higher at rest in the MA group (day 1: 1.5 versus 0.8 in the TEA group, P = 0.017; day 2: 1.7 versus 0.9 respectively, P = 0.014; day 3: 1.2 versus 0.6, P = 0.047). Fewer patients receiving MA had a hypotensive episode (25 per cent versus 45 per cent in the TEA group; P = 0.003) and fewer required vasopressors (36 versus 53 per cent respectively; P = 0.016). There was no significant difference in the overall complication rate (71.0 versus 61.0 per cent; P = 0.136).

CONCLUSION

MA is less effective than TEA at controlling pain, but this difference may not be clinically significant. However, fewer patients experienced hypotension or required vasopressor support with MA; this may be beneficial within an enhanced recovery programme.

Advancements in Methods and Camera-Based Sensors for the Quantification of Respiration

Assessment of respiratory function allows early detection of potential disorders in the respiratory system and provides useful information for medical management. There is a wide range of applications for breathing assessment, from measurement systems in a clinical environment to applications involving athletes. Many studies on pulmonary function testing systems and breath monitoring have been conducted over the past few decades, and their results have the potential to broadly impact clinical practice. However, most of these works require physical contact with the patient to produce accurate and reliable measures of the respiratory function. There is still a significant shortcoming of non-contact measuring systems in their ability to fit into the clinical environment. The purpose of this paper is to provide a review of the current advances and systems in respiratory function assessment, particularly camera-based systems. A classification of the applicable research works is presented according to their techniques and recorded/quantified respiration parameters. In addition, the current solutions are discussed with regards to their direct applicability in different settings, such as clinical or home settings, highlighting their specific strengths and limitations in the different environments.

Modelling of Chest Wall Motion for Cardiorespiratory Activity for Radar-Based NCVS Systems

Chest wall motion can provide information on critical vital signs, including respiration and heartbeat. Mathematical modelling of chest wall motion can reduce an extensive requirement of human testing in the development of many biomedical applications. In this paper, we propose a mathematical model that simulates a chest wall motion due to cardiorespiratory activity. Chest wall motion due to respiration is simulated based on the optimal chemical-mechanical respiratory control-based mechanics. The theory of relaxation oscillation system is applied to model the motion due to cardiac activity. The proposed mathematical chest wall model can be utilized in designing and optimizing different design parameters for radar-based non-contact vital sign (NCVS) systems.