Early respiratory complications after liver transplantation

The poor clinical conditions associated with end-stage cirrhosis,pre-existing pulmonary abnormalities,and high comorbidity rates in patients with high Model for End-Stage Liver Disease scores are all well-recognized factors that increase the risk of pulmonary complications after orthotopic liver transplantation(OLT)surgery.Many intraoperative and postoperative events,such as fluid overload,massive transfusion of blood products,hemodynamic instability,unexpected coagulation abnormalities,renal dysfunction,and serious adverse effects of reperfusion syndrome,are other factors that predispose an individual to postoperative respiratory disorders.Despite advances in surgical techniques and anesthesiological management,the lung may still suffer throughout the perioperative period from various types of injury and ventilatory impairment,with different clinical outcomes.Pulmonary complications after OLT can be classified as infectious or non-infectious.Pleural effusion,atelectasis,pulmonary edema,respiratory distress syndrome,and pneumonia may contribute considerably to early morbidity and mortality in liver transplant patients.It is of paramount importance to accurately identify lung disorders because infectious pulmonary complications warrant speedy and aggressive treatment to prevent diffuse lung injury and the risk of evolution into multisystem organ failure.This review discusses the most common perioperative factors that predispose an individual to postoperative pulmonary complications and these complications’early clinical manifestations after OLT and influence on patient outcome.

Atypical respiratory complications of dengue fever

In last decade,dengue has emerged as one of the most important vector born disease.With increasing cases,uncommon presentations and complications are now commonly recognized.Here,we report two cases of rare pattern of respiratory involvement in dengue:acute respiratory distress syndrome and bronchiolitis with respiratory failure.

Innovative integration of lung ultrasound and wearable monitoring for predicting pulmonary complications in colorectal surgery:A prospective study

BACKGROUND Postoperative pulmonary complications(PPCs)are common in patients who undergo colorectal surgery.Studies have focused on how to accurately diagnose and reduce the incidence of PPCs.Lung ultrasound has been proven to be useful in preoperative monitoring and postoperative care after cardiopulmonary surgery.However,lung ultrasound has not been studied in abdominal surgeries and has not been used with wearable devices to evaluate the influence of postoperative ambulation on the incidence of PPCs.AIM To investigate the relationship between lung ultrasound scores,PPCs,and postoperative physical activity levels in patients who underwent colorectal surgery.METHODS In this prospective observational study conducted from November 1,2019 to August 1,2020,patients who underwent colorectal surgery underwent daily bedside ultrasonography from the day before surgery to postoperative day(POD)5.Lung ultrasound scores and PPCs were recorded and analyzed to investigate their relationship.Pedometer bracelets measured the daily movement distance for 5 days post-surgery,and the correlation between postoperative activity levels and lung ultrasound scores was examined.RESULTS Thirteen cases of PPCs was observed in the cohort of 101 patients.The mean(standard deviation)peak lung ultrasound score was 5.32(2.52).Patients with a lung ultrasound score of≥6 constituted the high-risk group.High-risk lung ultrasound scores were associated with an increased incidence of PPCs after colorectal surgery(logistic regression coefficient,1.715;odds ratio,5.556).Postoperative movement distance was negatively associated with the lung ultrasound scores[Spearman’s rank correlation coefficient(r),-0.356,P<0.05].CONCLUSION Lung ultrasound effectively evaluates pulmonary condition post-colorectal surgery.Early ambulation and respiratory exercises in the initial two PODs will reduce PPCs and optimize postoperative care in patients undergoing colorectal surgery.

Effect of Right Supine Tracheal Extubation on Respiratory Complications and Airway Pressure in the Waking Period of General Anesthesia in Pediatric Stomatology

Objective: The purpose of this study was to investigate the effect of right supine endotracheal intubation on respiratory complications and airway pressure of general anesthesia, and to provide guidance for clinical application. Methods: Seventy-two children who received oral treatment under general anesthesia from November 2020 to November 2021 in Yantai Stomatological Hospital were randomly divided into three groups, 24 cases in each group. All three groups of children entered the PACU after the surgery. The children in Group I were extubated in the supine position, the children in Group II were immediately changed to the right decubitus after extubation in the horizontal position, and the children in Group III were extubated in the right decubitus. HR, MAP and SpO2 of T1 (the time point at the beginning of surgery), T2 (the time point at 1 hour after surgery), T3 (the time point after extubation), T4 (the time point at 1 minute after extubation), T5 (the time point at 3 minutes after extubation) in the three groups were observed, t1 (operation time) and t2 (the time of leaving the PACU) were recorded. The airway pressure (P1) in the recumbent position and the airway pressure (P2) in the right decubitus position before extubation were recorded in Group III. The number of sputum suction and complications after extubation were counted. Results: The t2 in Group III was shorter than that in Groups I and II, and the number of sputum suction in Group III was less than that in Groups I and II (P < 0.05). The HR at T3, T4 and T5 in Group III was lower than that in Group I, and the HR at T4 and T5 was lower than that in Group II (P < 0.05). There were significant differences in the incidence of respiratory complications among the three groups (P < 0.05). The incidence of asphyxia, bucking and glossocoma postoperative agitation in Group III was significantly lower than that in Group I, and the incidence of asphyxia and choking was lower than that in Group II (P < 0.05). The incidence of glossoptosis in Group II was significantly lower than that in Group I (P < 0.05). In Group III, the airway pressure P2 in the right decubitus position during endotracheal intubation was higher than that of P1 in the supine position during endotracheal intubation (P < 0.05). The 95% Confidence Interval (CI) of airway pressure difference was 1.416 - 1.834 cmH2O. Conclusion: For children undergoing intraoral therapy under general anesthesia, tracheal extubation in the right decubitus position can improve the circulation fluctuation before and after extubation, reducing the number of sputum suction and respiratory tract-related complications, and can shorten the departure time. The body position change during the tracheal intubation will slightly increase the airway pressure, but the supine position after extubation can better ensure the smooth spontaneous breathing of children, which can provide the reference for clinical application.

CT Manifestations of Lung Changes and Complications in Patients with Severe Acute Respiratory Syndrome

Objective:To investigate the rol e of CT scanning in diagnosing severe acute respiratory syndrome(SARS). Methods: One hundred and twelve times of spiral CT scanning, 106 t imes on the chest with standard pulmonary and mediastinal window, 5 on the brain and once on the abdomen, were performed in 82 patients (37 males and 45 females ) of SARS. Results: Bilateral shadows showed in 66 patients (80.48%) and unil ateral shadow in 16 (19.52%). The lung CT findings were sub pleural focal con solidation in 26 patients (31.70%), flaky cloudy opacity in 53 (64.63%), large a rea consolidation in 9 (10.97%), ground glass blurry shadow in 31 (37.80%), a lveolar substantive shadow in 14 (17.07%) and interstitial changes in 16 (19.51% ). The pulmonary CT signs of SARS were relatively characterized by: (1) The lesi ons tending to multiply occur, mostly to be bilaterally distributed and commonly involved in the lower lung field. (2) The lung shadows mostly showed as sub pleural focal consolidation, flaky cloudy shadow, large area consolidation, grou nd glass blurry shadow, and often accompanied with signs of broncho inflat ion. (3) Having opacified nodular shadows in the alveolar cavities. (4) Rapid pr ogressions or changes on the size, amount, and distribution of the lesions likel y to be found in dynamic observation of chest X ray and CT scanning, i.e., ma rkedly dynamic changes found within 24 to 48 hrs. Lesions with these characteris tics may be recognized as pulmonary changes possibly induced by SARS. Complicati ons were found in 6 patients (7.31%), including tuberculosis of lung and brain a ccompanied with pneumomediastinum in one patient, secondary infection of lung in 2, pneumothorax in 1, pulmonary fungus in 1, and pyothorax in 1.Conclusion: CT scanning is a sensitive method for diagnosis of SAR S, by which more accurate assessment of the abnormal changes of lung and occurre nce of complications in SARS patients can be made.

Does Obstructive Sleep Apnea (OSA) Increase the Risk of Post-Operative Respiratory Complications after Bariatric Surgery?

Background: OSA affects up to quarter of general population. It is associated with morbid obesity with a higher morbidity and mortality rates. STOP Bang questionnaire is a validated method for OSA screening. OSA patients are at high risk of developing airway obstruction, cardiac events, congestive heart failure, stroke and desaturation post operatively. The aim of this study is to evaluate adverse respiratory events in patients undergoing bariatric surgery in relation to risk of OSA using Stop Bang questionnaire. Methods: This prospective double cohort study was conducted in Tanta University Hospital from Marchto August 2017. During the preoperative assessment, STOP-BANG questionnaire was performed. After extubation, patients were transferred to PACU unit. Respiratory complications were assessed thereafter. Based on STOP-BANG score, patients were divided into two groups, high risk of OSA with STOP-BANG > 3 (Group I) and low risk of OSA with STOP-BANG Results: 104 patients were included in this study. Group I had more comorbidities in the form of CAD (15% versus 2%, P 0.001). Higher number of respiratory complications was noted in high-risk group (31 patients, 59%) compared to (24 patients, 46%) in group II yet, it was not significant. Conclusion: Obese patients with STOP-BANG score > 3 undergoing bariatric surgery are associated with hypertension, dyslipidemia, CAD, and renal insufficiency. High-risk OSA obese patients are at higher risk of developing respiratory compilations like inability to breathe deeply and hypoxia in postoperatively.

Recent Progress in the Study of Respiratory Complications Correlated with TACE for HCC

Due to the insidious clinical symptoms of early hepatocellular carcinoma (HCC), most of the patients diagnosed at intermediate-to-advanced stage HCC, and they lost the opportunity for curative treatment. Comprehensive interventional therapy plays an important role in prolonging the median survival of patients with intermediate-to-advanced stage HCC, among which transcatheter hepatic artery chemoembolization (TACE) is the most commonly used minimally invasive treatment. However, TACE may cause many postoperative complications such as liver function damage, biliary tract injury, upper gastrointestinal bleeding. Among them, TACE-related respiratory complications have been reported in a few articles, which are extremely rare but serious, and there are still many uncertainties about their occurrence mechanisms and risk factors. This article is aim to focus on the research progress of the respiratory complications of TACE, thus making progress on TACE-treatment aftercare.

Analysis of the impact of ERAS-based respiratory function training on older patients’ability to prevent pulmonary complications after abdominal surgery

BACKGROUND In China,as the population grows older,the number of elderly people who have died from respiratory problems has increased.AIM To investigate whether enhanced recovery after surgery(ERAS)-based respiratory function training may help older patients who had abdominal surgery suffer fewer pulmonary problems,shorter hospital stays,and improved lung function.METHODS The data of 231 elderly individuals having abdominal surgery was retrospectively analyzed.Based on whether ERAS-based respiratory function training was provided,patients were divided into ERAS group(n=112)and control group(n=119).Deep vein thrombosis(DVT),pulmonary embolism(PE),and respiratory tract infection(RTI)were the primary outcome variables.Secondary outcome variables included the Borg score Scale,FEV1/FVC and postoperative hospital stay.RESULTS The percentage of 18.75%of ERAS group participants and 34.45%of control group participants,respectively,had respiratory infections(P=0.007).None of the individuals experienced PE or DVT.The ERAS group’s median postoperative hospital stay was 9.5 d(3-21 d)whereas the control groups was 11 d(4-18 d)(P=0.028).The Borg score decreased on the 4th d following surgery in the ERAS group compared to the 2nd d prior(P=0.003).The incidence of RTIs was greater in the control group than in the ERAS group among patients who spent more than 2 d in the hospital before surgery(P=0.029).CONCLUSION ERAS-based respiratory function training may reduce the risk of pulmonary complications in older individuals undergoing abdominal surgery.

Respiratory Complications of Measles in the Pediatric Ward of the Regional Hospital of Kindia/Guinea

Introduction: Measles is a highly contagious infectious disease caused by the measles virus belonging to the morbillivirus genus, the measles morbillivirus species and the Paramyxoviridae families. The aim was to study respiratory complications due to measles in children aged 1 to 15 in the pediatric ward of the Kindia regional hospital. Materials and Methods: A transversal descriptive study was carried out in the pediatrics department of the Kindia Regional Hospital from October 1, 2019, to March 31, 2020, on children aged 1 to 15 years hospitalized for measles with respiratory complications. Results: 53 cases of measles were recorded, i.e. 11.71% of hospital pathologies including 32 cases of respiratory complications, i.e. 60.38% with an M/F sex ratio of 1.66, male predominance of 62.5%, and a mean age of 4.10 ± 2.8 years. The outcome was favorable in 90.62% of our patients. The mortality was 9.38% with an average hospital stay of 6.8 ± 3.04 days. Conclusion: The respiratory complication of measles is a serious pathology due to the risk of mortality that it can cause, a consultation followed by rapid treatment can contribute to a reduction in complications and a faster cure.

Strategies to reduce pulmonary complications after esophagectomy

Esophagectomy,the surgical removal of all or part of the esophagus,is a surgical procedure that is associated with high morbidity and mortality.Pulmonary complications are an especially important postoperative problem.Therefore,many perioperative strategies to prevent pulmonary complications after esophagectomy have been investigated and introduced in daily clinical practice.Here,we review these strategies,including improvement of patient performance and technical advances such as minimally invasive surgery that have been implemented in recent years.Furthermore,interventions such as methylprednisolone,neutrophil elastase inhibitor and epidural analgesia,which have been shown to reduce pulmonary complications,are discussed.Benefits of the commonly applied routine nasogastric decompression,delay of oral intake and prophylactic mechanical ventilation are unclear,and many of these strategies are also evaluated here.Finally,we will discuss recent insights and new developments aimed to improve pulmonary outcomes after esophagectomy.

Pathophysiology of pulmonary complications of acute pancreatitis

Acute pancreatitis in its severe form is complicated by multiple organ system dysfunction, most importantly by pulmonary complications which include hypoxia, acute respiratory distress syndrome, atelectasis, and pleural effusion. The pathogenesis of some of the above complications is attributed to the production of noxious cytokines. Clinically significant is the early onset of pleural effusion, which heralds a poor outcome of acute pancreatitis. The role of circulating trypsin, phospholipase A2, platelet activating factor, release of free fatty acids, chemoattractants such as tumor necrsosis factor （TNF）- alpha, interleukin （IL）-1, IL-6, IL-8, fMet-leu-phe （a bacterial wall product）, nitric oxide, substance P, and macrophage inhlbitor factor is currently studied. The hope is that future management of acute pancreatitis with a better understanding of the pathogenesis of lung injury will be directed against the production of noxious cytokines.

Pulmonary complications of transcatheter arterial chemoembolization for hepatocellular carcinoma

Transcatheter arterial chemoembolization(TACE) is an effective palliative intervention that is widely accepted for the management of hepatocellular carcinoma(HCC). Post-TACE pulmonary complications resulting in acute lung injury(ALI) or acute respiratory distress syndrome(ARDS) are rare events. Pulmonary complications after TACE are thought to be related to chemical injury subsequent to the migration of the infused ethiodized oil or chemotherapeutic agent to the lung vasculature, facilitated by arteriovenous(AV) shunts within the hyper-vascular HCC. We review herein the literature on pulmonary complications related to TACE for HCC. Post-TACE pulmonary complications have included pulmonary oil embolism, interstitial pneumonitis, chemical pneumonitis, ALI, ARDS, lipoid pneumonia, acute eosinophilic and neutrophilic pneumonia, bilious pleuritis, pulmonary abscess, pulmonary tumor embolism, and possibly pulmonary metastasis with HCC. The risk factors associated with post-TACE pulmonary complications identified in the literature include large hyper-vascular HCC with AV shunts, large-volume Lipiodol infusion, and embolization via the right inferior phrenic artery. However, the absence of known risk factors is not a guarantee against serious complications. An astute awareness of the potential post-TACE pulmonary complications should expedite appropriate therapeutic interventions and increase potential for early recovery.

Surgical complications in COVID-19 patients in the setting of moderate to severe disease

The coronavirus disease 2019(COVID-19)pandemic has had a considerable impact on the work of physicians and surgeons.The connection between the patient and the surgeon cannot be replaced by telemedicine.For example,the surgical staff faces more serious difficulties compared to non-surgical specialists during the COVID-19 pandemic.The primary concerns include the safest solutions for protecting healthcare staff and patients and the ability to provide adequate surgical care.Additionally,the adverse effects of any surgery delays and the financial consequences complicate the picture.Therefore,patients’admission during the COVID-19 pandemic should be taken into consideration,as well as preoperative measures.The COVID-19 situation brings particular risk to patients during surgery,where preoperative morbidity and mortality rise in either asymptomatic or symptomatic COVID-19 patients.This review discusses the recent factors associated with surgical complications,mortality rates,outcomes,and experience in COVID-19 surgical patients.

Respiratory failure in the hematopoietic stem cell transplant recipient

The number of patients receiving hematopoietic stem cell transplantation(HSCT) is rapidly rising worldwide. Despite substantial improvements in peri-transplant care, pulmonary complications resulting in respiratory failure remain a major contributor to morbidity and mortality in the post-transplant period, and represent a major barrier to the overall success of HSCT. Infectious complications include pneumonia due to bacteria, viruses, and fungi, and most commonly occur during neutropenia in the early post-transplant period. Non-infectious complications include idiopathic pneumonia syndrome, periengraftment respiratory distress syndrome, diffuse alveolar hemorrhage, pulmonary veno-occlusive disease, delayed pulmonary toxicity syndrome, cryptogenic organizing pneumonia, bronchiolitis obliterans syndrome, and post-transplant lymphoproliferative disorder. These complications have distinct clinical features and risk factors, occur at differing times following transplant, and contribute to morbidity and mortality.

Extracorporeal membrane oxygenation for coronavirus disease 2019-associated acute respiratory distress syndrome:Report of two cases and review of the literature

BACKGROUND Coronavirus disease 2019(COVID-19),caused by severe acute respiratory syndrome coronavirus-2,is a worldwide pandemic.Some COVID-19 patients develop severe acute respiratory distress syndrome and progress to respiratory failure.In such cases,extracorporeal membrane oxygenation(ECMO)treatment is a necessary life-saving procedure.CASE SUMMARY Two special COVID-19 cases—one full-term pregnant woman and one elderly(72-year-old)man—were treated by veno-venous(VV)-ECMO in the Second People’s Hospital of Zhongshan,Zhongshan City,Guangdong Province,China.Both patients had developed refractory hypoxemia shortly after hospital admission,despite conventional support,and were therefore managed by VV-ECMO.Although both experienced multiple ECMO-related complications on top of the COVID-19 disease,their conditions improved gradually.Both patients were weaned successfully from the ECMO therapy.At the time of writing of this report,the woman has recovered completely and been discharged from hospital to home;the man remains on mechanical ventilation,due to respiratory muscle weakness and suspected lung fibrosis.As ECMO itself is associated with various complications,it is very important to understand and treat these complications to achieve optimal outcome.CONCLUSION VV-ECMO can provide sufficient gas exchange for COVID-19 patients with acute respiratory distress syndrome.However,it is crucial to understand and treat ECMO-related complications.

风险等级防控护理对重症肺炎俯卧位通气治疗患者安全性与疗效的影响

目的 探究风险等级防控护理在重症肺炎俯卧位通气治疗患者中的临床应用效果。方法 抽选南通三院在2018年8月—2023年3月期间收治的81例重症肺炎俯卧位通气治疗患者作为观察对象,随机分为对照组和观察组,对照组40例实施常规重症监护室护理措施,观察组41例实施风险等级防控护理措施,于干预前、干预14 d后,对两组患者动脉血气、呼吸力学、临床指标及并发症发生情况进行分析对比。结果 干预前,两组患者动脉血气、呼吸力学等指标相比,差异不具有统计学意义(P>0.05);干预14 d后,两组动脉血气、呼吸力学指标高于干预前,且观察组在动脉血氧分压(PaO2)、肺总量(TLC)、动态顺应性(Cdyn)等指标高于对照组,气道峰值(PIP)低于对照组(P<0.05);观察组在机械通气时间、咳嗽、ICU治疗时间、平均住院时间均低于对照组(P<0.05);观察组在营养不良、呼吸机相关肺炎、呼吸衰竭、压力性损伤等并发症发生率低于对照组(P<0.05)。结论风险等级防控护理有助于改善重症肺炎俯卧位通气治疗患者动脉血气、呼吸力学等指标,缩短机械通气、ICU治疗、平均住院时间,降低机体各器官衰竭评分,减少并发症发生。

人文关怀护理对呼吸衰竭正压通气患者康复情况、负性情绪和并发症的影响

目的探讨人文关怀护理对呼吸衰竭正压通气患者康复情况、负性情绪和并发症的影响。方法将78例呼吸衰竭患者随机分为两组,对照组正压通气治疗期间应用常规护理,观察组应用人文关怀护理。比较两组的治疗时间、住院时间、负性情绪及并发症发生率。结果观察组正压通气治疗时间与住院时间均短于对照组(P<0.05)。护理后,观察组SAS、SDS评分低于对照组(P<0.05)。观察组并发症发生率为7.69%,低于对照组的25.64%(P<0.05)。结论人文关怀护理在呼吸衰竭患者正压通气治疗中的应用效果较好,可缩短患者的治疗时间,提高其康复速度,改善患者的负性情绪,降低相关并发症发生风险。

冰山理论下全方位气道护理在呼吸衰竭患者中的应用

目的探讨冰山理论下全方位气道护理在呼吸衰竭患者中的应用价值。方法选取南阳市第一人民医院2020年3月至2021年8月就诊的呼吸衰竭患者118例,根据护理方法分为研究组(59例)和对照组(59例)。对照组接受常规护理干预,研究组在对照组基础上接受冰山理论下全方位气道护理。比较两组康复相关指标、肺功能[肺总量(TLC)、用力肺活量(FVC)、第1秒最大呼吸容积(FEV_(1))]、护理依从性、负性情绪[焦虑自评量表(SAS)、抑郁自评量表(SDS)]、并发症。结果研究组人机协调时间、机械通气时间、出院时间短于对照组(P<0.05);干预后研究组FEV_(1)、FVC、TLC高于对照组(P<0.05);干预后研究组SAS、SDS评分低于对照组(P<0.05);干预后研究组总依从率高于对照组,并发症总发生率低于对照组(P<0.05)。结论冰山理论下全方位气道护理可提升呼吸衰竭患者肺功能,减轻负性情绪,提升依从性,预防并发症发生,促进患者病情康复。

督导式预警性干预联合密闭式吸痰法在急诊重症肺炎合并呼吸衰竭患者中的应用价值

目的探讨督导式预警性干预联合密闭式吸痰法在急诊重症肺炎合并呼吸衰竭患者中的应用价值。方法回顾性分析,采集2020年5月至2023年4月行机械通气治疗的急诊重症肺炎合并呼吸衰竭患者88例,其中44例实施密闭式吸痰法干预的患者纳入对照组,其余44例实施督导式预警性干预联合密闭式吸痰法干预的患者纳入观察组。比较2组干预前、干预3 d时患者血气指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))]、干预1、3、5 d时痰液黏稠度、干预期间并发症发生情况、住院相关指标(机械通气时间、住ICU时间、住院时间)。结果干预3 d时,2组PaO_(2)均升高,PaCO_(2)均降低,且与对照组比较,观察组PaO_(2)高,PaCO_(2)低(P<0.05)。干预1、3、5 d时观察组痰液黏稠度均优于对照组(P<0.05)。观察组并发症总发生率低于对照组,差异有统计学意义(P<0.05)。观察组机械通气时间、住ICU时间及住院时间均短于对照组(P<0.05)。结论督导式预警性干预联合密闭式吸痰法干预可改善急诊重症肺炎合并呼吸衰竭患者血气指标,改善患者痰液黏稠度、降低并发症发生率,有助于缩短患者机械通气时间及住院时间。