New models for prediction of postoperative pulmonary complications in lung resection candidates.

Introduction: In recent years, ventilatory efficiency (minute ventilation (')/carbon dioxide production (' ) slope) and partial pressure of end-tidal carbon dioxide ( ) have emerged as independent predictors of postoperative pulmonary complications (PPC). Single parameters may give only partial information regarding periprocedural hazards. Accordingly, our aim was to create prediction models with improved ability to stratify PPC risk in patients scheduled for elective lung resection surgery.

Subpleural pulmonary nodule marking with patent blue V dye prior to surgical resection.

Background And Objective: Subpleural located pulmonary nodules are perioperatively invisible to the surgeon. Their precise identification is conventionally possible by palpation, but often at the cost of performing a thoracotomy. The aim of the study was to evaluate the success rate and feasibility of the pre-operative CT-guided marking subpleural localized nodule using a mixture of Patent Blue V and an iodine contrast agent prior to the extra-anatomical video-assisted thoracoscopic surgery (VATS) resection in patients for whom the primary anatomical resection in terms of segmentectomy or lobectomy was not indicated.

Endobronchial cryobiopsy may shorten the time to cancer diagnosis: a retrospective study.

https://bit.ly/3NkyJ98.

Hyperoxemia post thoracic surgery - Does it matter?

Introduction: Post-operative oxygen therapy is used to prevent hypoxemia and surgical site infection. However, with improvements of anesthesia techniques, post-operative hypoxemia incidence is declining and the benefits of oxygen on surgical site infection have been questioned. Moreover, hyperoxemia might have adverse effects on the pulmonary and cardiovascular systems.

The risk of post-operative pulmonary complications in lung resection candidates with normal forced expiratory volume in 1 s and diffusing capacity of the lung for carbon monoxide: a prospective multicentre study.

Introduction: According to the guidelines for preoperative assessment of lung resection candidates, patients with normal forced expiratory volume in 1 s (FEV) and diffusing capacity of the lung for carbon monoxide ( ) are at low risk for post-operative pulmonary complications (PPC). However, PPC affect hospital length of stay and related healthcare costs. We aimed to assess risk of PPC for lung resection candidates with normal FEV and (>80% predicted) and identify factors associated with PPC.

Ventilatory efficiency is superior to peak oxygen uptake for prediction of lung resection cardiovascular complications.

Introduction: Ventilatory efficiency (VE/VCO2 slope) has been shown superior to peak oxygen consumption (VO2) for prediction of post-operative pulmonary complications in patients undergoing thoracotomy. VE/VCO2 slope is determined by ventilatory drive and ventilation/perfusion mismatch whereas VO2 is related to cardiac output and arteriovenous oxygen difference. We hypothesized pre-operative VO2 predicts post-operative cardiovascular complications in patients undergoing lung resection.

Prediction of Postoperative Complications: Ventilatory Efficiency and Rest End-tidal Carbon Dioxide.

Background: Cardiopulmonary exercise testing parameters including ventilatory efficiency (V/VCO slope) are used for risk assessment of lung resection candidates. However, many patients are unable or unwilling to undergo exercise. V/VCO slope is closely related to the partial pressure of end-tidal carbon dioxide (PCO).

Cerebral air embolism complicating transbronchial lung biopsy: A case report.

Background: In this case report we describe an extremely rare case of cerebral air embolism following transbronchial lung biopsy (TBLB). Only a few cases of this rare complication were described previously. Every bronchologist should recognize this severe adverse event.

Extracorporeal Membrane Oxygenation Use in Thoracic Surgery.

This narrative review is focused on the application of extracorporeal membrane oxygenation (ECMO) in thoracic surgery, exclusive of lung transplantation. Although the use of ECMO in this indication is still rare, it allows surgery to be performed in patients where conventional ventilation is not feasible-especially in single lung patients, sleeve lobectomy or pneumonectomy and tracheal or carinal reconstructions. Comparisons with other techniques, various ECMO configurations, the management of anticoagulation, anesthesia, hypoxemia during surgery and the use of ECMO in case of postoperative respiratory failure are reviewed and supported by two cases of perioperative ECMO use, and an overview of published case series.

Mitigation of Exercise Oscillatory Ventilation Score by Cardiac Resynchronization Therapy.

Background: Exercise oscillatory ventilation (EOV) is a consequence of ventilatory control system instability and is commonly observed in patients with advanced heart failure (HF); it is associated with adverse prognosis. The goal of this study was to evaluate the effects of cardiac resynchronization therapy (CRT) on oscillatory ventilation as quantified by a proposed EOV score.

Methods And Results: Consecutive patients with HF (N = 35) who underwent clinically indicated CRT, cardiopulmonary exercise testing and carbon dioxide (CO) chemosensitivity by rebreathe before and 4-6 months after CRT were included in this post hoc analysis.

Poor ventilatory efficiency during exercise may predict prolonged air leak after pulmonary lobectomy.

Unlabelled: Poor ventilatory efficiency, defined as the increase in minute ventilation relative to carbon dioxide production during exercise (VE/VCO2 slope), may be associated with dynamic hyperinflation and thereby promote the development of prolonged air leak (PAL) after lung resection. Consecutive lung lobectomy candidates (n = 96) were recruited for this prospective two-centre study. All subjects underwent pulmonary function tests and cardiopulmonary exercise testing prior to surgery.

Pulmonary Limitations in Heart Failure.

The heart and lungs are intimately linked. Hence, impaired function of one organ may lead to changes in the other. Accordingly, heart failure is associated with airway obstruction, loss of lung volume, impaired gas exchange, and abnormal ventilatory control.

Cardiopulmonary exercise testing for identification of patients with hyperventilation syndrome.

Introduction: Measurement of ventilatory efficiency, defined as minute ventilation per unit carbon dioxide production (VE/VCO2), by cardiopulmonary exercise testing (CPET) has been proposed as a screen for hyperventilation syndrome (HVS). However, increased VE/VCO2 may be associated with other disorders which need to be distinguished from HVS. A more specific marker of HVS by CPET would be clinically useful.

Ventilatory Efficiency Identifies Patients Prone to Hypoxemia During One-Lung Ventilation.

Objectives: One-lung ventilation (OLV) may be complicated by hypoxemia. Ventilatory efficiency, defined as the ratio of minute ventilation to carbon dioxide output (V/VCO), is increased with ventilation/perfusion mismatch and pulmonary artery hypertension, both of which may be associated with hypoxemia. Hence, the authors hypothesized increased V/VCO will predict hypoxemia during OLV.

Transbronchial biopsy from the upper pulmonary lobes is associated with increased risk of pneumothorax - a retrospective study.

Background: Pneumothorax (PTX) is one of the most common complications of transbronchial biopsy (TBB). Previous research suggests that upper pulmonary lobe TBB may be associated with increased risk of PTX development. The aim of this study was to compare the risk of PTX after TBB performed from different pulmonary lobes.

Increased microcirculatory heterogeneity in patients with obstructive sleep apnea.

Introduction: Obstructive sleep apnea (OSA) is the most common form of sleep disordered breathing and has been associated with major cardiovascular comorbidities. We hypothesized that the microcirculation is impaired in patients with OSA and that the magnitude of impairment correlates to OSA severity.

Methods: Subjects were consecutive patients scheduled for routine diagnostic polysomnography (PSG).

Is it intestinal tuberculosis again? Case report.

This case report focuses on an immigrant admitted to the Department of Respiratory Diseases, University Hospital Brno due to suspicion of relapsing intestinal tuberculosis. The patient presented with fever, night sweat, weight loss, diarrhea, and a history of several tuberculosis attacks in the last few years. None of the examinations confirmed the presence of active tuberculosis but raised suspicion of hematological malignancy.

Low leptin concentration may identify heart failure patients with central sleep apnea.

Low leptin concentration has been shown to be associated with central sleep apnea in heart failure patients. We hypothesized that low leptin concentration predicts central sleep apnea. Consecutive ambulatory New York Heart Association (NYHA) classes I-IV heart failure patients were studied prospectively, including measurement of serum leptin, echocardiography and polysomnography.

Sex differences in leptin modulate ventilation in heart failure.

Background: Leptin modulates ventilation and circulating levels are higher in normal women than men.

Objectives: The aim of this study was to compare exercise ventilation and gas exchange in men and women with heart failure (HF) and their relation to circulating leptin concentration.

Methods: Consecutive HF patients were studied by cardiopulmonary exercise testing and assay of circulating leptin concentration.

Respiratory induced heart rate variability during slow mechanical ventilation : Marker to exclude brain death patients.

Background: Respiratory induced heart rate variability (rHRV) was analysed in mechanically ventilated patients during two levels of sedation and brain death. Our aim was to determine whether rHRV can distinguish between different levels of sedation and especially between brain death and sedated patients.

Methods: In this study 30 critically ill and 23 brain death patients were included and four respiratory rates of 15, 12, 8 and 6 breaths per minute, each lasting 5 min were used.

The utility of perioperative polygraphy in the diagnosis of obstructive sleep apnea.

Objective/background: Obstructive sleep apnea (OSA) is highly prevalent and often undiagnosed in surgical patients. The aim of this study was to compare polygraphy (PG) performed on sedated patients during surgery to overnight polysomnography (PSG). It was hypothesized that perioperative PG may be used to diagnose OSA.

Resting End-Tidal Carbon Dioxide Predicts Respiratory Complications in Patients Undergoing Thoracic Surgical Procedures.

Background: Ventilatory efficiency (V˙e/V˙co slope [minute ventilation to carbon dioxide output slope]) has been shown to predict morbidity and mortality in lung resection candidates. Patients with increased V˙e/V˙co during exercise also exhibit an increased V˙e/V˙co ratio and a decreased end-tidal CO at rest. This study hypothesized that ventilatory values at rest predict respiratory complications and death in patients undergoing thoracic surgical procedures.

The impact of sedation on pulse pressure variation.

Objective: Pulse pressure variations (PPV) are mainly influenced by ventilation. The impact of sedation on PPV is not known. The aim of the study was to test the influence of sedation on pulse pressure variation in mechanically ventilated critically ill patients and to compare PPV in critically ill and brain dead patients.

Exercise end-tidal CO2 predicts central sleep apnea in patients with heart failure.

Background: Increased CO2 chemosensitivity and augmented exercise ventilation are characteristic of patients with heart failure (HF) with central sleep apnea (CSA). The aim of this study was to test the hypothesis that decreased end-tidal CO2 by cardiopulmonary exercise testing predicts CSA in patients with HF.

Methods: Consecutive ambulatory patients with New York Heart Association II to III HF were prospectively evaluated by CO2 chemosensitivity by rebreathe, cardiopulmonary exercise testing, and polysomnography (PSG).