Intraoperative care of elderly patients with COVID-19 undergoing double lung transplantation:Two case reports

BACKGROUND Lung transplantation is considered an effective method for treating patients with end-stage coronavirus disease 2019(COVID-19).The nurses play a pivotal role in lung transplantation for COVID-19 patients.CASE SUMMARY Two elderly patients were admitted to the emergency department due to cough,and the nucleic acid test was positive.The patients were preliminarily diagnosed with COVID-19.The chest computed tomography scan revealed massive lung consolidation,and the patients did not improve after treatment with antiviral drugs,glucocorticoids,antibiotics,and other drugs.Under the support of pure oxygen in extracorporeal membrane oxygenation,the patients’oxygen levels were still poor,indicating that they were in the terminal stage of viral pneumonia.The patients underwent double-lung transplantation and received intraoperative care.The extracorporeal membrane oxygenation device was removed within a week of the surgical procedure,and the respiratory circulation of the patients were stabilized.CONCLUSION High-quality care for COVID-19 patients undergoing lung transplantation ensures patient safety during operation while protecting the safety of the medical staff.

Intraoperative Care of the Conscious Patient from the Perspective of the Operating Theatre Nurse:A Grounded Theory

Introduction: Intraoperative care includes a unique knowledge of how to perform a safe and effective surgery procedure. Surgery performed under regional or local anaesthesia allows the patient to remain conscious during the procedure and is rather common in Swedish healthcare today. Aim: The aim was to obtain a deeper understanding of the main concerns of operating theatre nurses (OTN) when caring for conscious patients during the intraoperative phase. Methods: Interviews were conducted with 23 OTNs from five different hospitals in Sweden and analysed according to grounded theory. Findings: The main concern among the OTNs was to take the patient in consideration. The core category “achieve and maintain ethical treatment of patients” in the operating theatre (OT) was a strategy used throughout the intraoperative process. Ethical treatment was described as moral behaviour at different levels and included the team’s behaviour, respectful and individualised patientcare, and the working-morale of the professionals. Being vigilant and being flexible were the categories related to the core category. The OTNs constantly assessed where to pay most attention as they balanced between the needs of the patient, the team, and the surgery procedure. Conclusion: It is important that every patient is taken into consideration and that ethical principles are held to the highest standards in the OT. A familiar team can facilitate that. The complex skills that operating theatre nurses develop can be added to explain important competencies within the profession.

Perioperative"remote"acute lung injury:recent update

Perioperative acute lung injury（ALI） is a syndrome characterised by hypoxia and chest radiograph changes.It is a serious post-operative complication,associated with considerable mortality and morbidity.In addition to mechanical ventilation,remote organ insult could also trigger systemic responses which induce ALI.Currently,there are limited treatment options available beyond conservative respiratory support.However,increasing understanding of the pathophysiology of ALI and the biochemical pathways involved will aid the development of novel treatments and help to improve patient outcome as well as to reduce cost to the health service.In this review we will discuss the epidemiology of peri-operative ALI;the cellular and molecular mechanisms involved on the pathological process;the clinical considerations in preventing and managing perioperative ALI and the potential future treatment options.

Effect of autologous blood donation on the central venous pressure, blood loss and blood transfusion during living donor left hepatectomy

AIM： Autologous blood donation （ABD） is mainly used to reduce the use of banked blood. In fact, ABD can be regarded as acute blood loss. Would ABD 2-3 d before operation affect the CVP level and subsequently result in less blood loss during liver resection was to be determined.METHODS： Eighty-four patients undergoing living donor left hepatectomy were retrospectively divided as group Ⅰ （GⅠ） and group Ⅱ （GⅡ） according to have donated 250-300 mL blood 2-3 d before living donor hepatectomy or not. The changes of the intraoperative CVP, surgical blood loss,blood products used and the changes of perioperative hemoglobin （Hb） between groups were analyzed and compared by using Mann-Whitney Utest.RESULTS： The results show that the intraoperative CVP changes between GⅠ （n = 35） and GⅡ （n = 49） up to graft procurement were the same, subsequently the blood loss,but ABD resulted in significantly lower perioperative Hb levels in GI.CONCLUSION： Since none of the patients required any blood products perioperatively, all the predonated bloods were discarded after the patients were discharged from the hospital. It indicates that ABD in current series had no any beneficial effects, in term of cost, lowering the CVP, blood loss and reduce the use of banked blood products, but resulted in significant lower Hb in perioperative period.

Inadvertent perioperative hypothermia and surgical site infections after liver resection

Background:In the overall surgical population,inadvertent perioperative hypothermia has been associated with an increased incidence of surgical site infection(SSI).However,recent clinical trials did not validate this notion.This study aimed to investigate the potential correlation between inadvertent perioperative hypothermia and SSIs following liver resection.Methods:This retrospective cohort study included all consecutive patients who underwent liver resection between January 2019 and December 2021 at the First Affiliated Hospital,Zhejiang University School of Medicine.Perioperative temperature managements were implemented for all patients included in the analysis.Estimated propensity score matching(PSM)was performed to reduce the baseline imbalances between the normothermia and hypothermia groups.Before and after PSM,univariate analyses were performed to evaluate the correlation between hypothermia and SSI.Multivariate regression analysis was performed to determine whether hypothermia was an independent risk factor for postoperative transfusion and major complications.Subgroup analyses were performed for diabetes mellitus,age>65 years,and major liver resection.Results:Among 4000 patients,2206 had hypothermia(55.2%),of which 150 developed SSI(6.8%).PSM yielded 1434 individuals in each group.After PSM,the hypothermia and normothermia groups demonstrated similar incidence rates of SSI(7.0%vs.6.3%,P=0.453),postoperative transfusion(13.7%vs.13.3%,P=0.743),and major complications(10.1%vs.9.0%,P=0.309).Univariate regression analysis revealed no significant effects of hypothermia on the incidence of SSI in the group with the highest hypothermia exposure[odds ratio(OR)=1.25,95%confidence interval(CI):0.84-1.87,P=0.266],the group with moderate exposure(OR=1.00,95%CI:0.65-1.53,P=0.999),or the group with the lowest exposure(OR=1.11,95%CI:0.73-1.65,P=0.628).The subgroup analysis revealed similar results.Regarding liver function,patients in the hypothermia group demonstrated lowerγ-glutamyl transpeptidase(37 vs.43 U/L,P<0.001)and alkaline phosphatase(69 vs.72 U/L,P=0.016).However,patients in the hypothermia group exhibited prolonged activated partial thromboplastin time(29.2 vs.28.6 s,P<0.001).Conclusions:In our study of patients undergoing liver resection,we found no significant association between mild perioperative hypothermia and SSI.It might be due to the perioperative temperature managements,especially active warming measures,which limited the impact of perioperative hypothermia on the occurrence of SSI.