Lung volume reduction − old and new approaches
Claudio F. Donner, Nicolino Ambrosino, Roger S. Goldstein in Pulmonary Rehabilitation, 2020
Although EBV placement is associated with less morbidity than LVRS, there are significant complications associated with the procedure. The two most common complications include AECOPD and pneumothorax. Table 43.3 lists the rates for these complications for the RCTs that enrolled patients with intact fissures. Most studies have reported a pneumothorax rate of 25%–34% (51–55,57,58). The REACH trial did have fewer episodes of pneumothorax compared to other reports (53). Although the reason for this finding is not clear, the investigators suggest that it may be due to conservative post-procedure care (6-day hospitalization and bed rest), less emphysema in ipsilateral lobe relative to treatment lobe or possibly due to lack of experience with EBV placement, since there was less TLVR compared to other trials. Most, but not all, of the pneumothoraces required placement of a chest tube, and there are published guidelines on when valves should be removed or if surgical intervention is required (59). Mortality does occur following EBV placement, and the largest trial to date had mortality rate of 3.1%, with most of the mortality associated with pneumothorax (52). The majority of pneumothoraces occur within the first few days, and for this reason patients are usually admitted to hospital following the procedure for 3 or 4 days to monitor for development of pneumothorax. Other complications that have been reported include haemoptysis, valve migration/expectoration, pneumonia and formation of granulation tissue.
Thoracic trauma
Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven in Succeeding in Paediatric Surgery Examinations, 2017
In the trauma bay, orotracheal intubation needs to be performed if oxygenation does not improve with supplemental oxygen, if the patient cannot adequately protect the airway (classically for GCS score <8) or if the patient is in shock. Once an airway is established, one must address immediately-life-threatening conditions such as tension pneumothorax and cardiac tamponade. Tension pneumothorax is a clinical rather than a radiological diagnosis, and needle decompression followed by chest tube insertion should be done rapidly. A chest tube should be inserted for simple and open pneumothorax. It is important to remember that a simple pneumothorax can be quickly converted into a tension pneumothorax with initiation of positive-pressure ventilation.
Breast
Tor Wo Chiu in Stone’s Plastic Surgery Facts, 2018
Disadvantages: Veins in particular can be very fragile. This, the depth and respiratory movement may make microanastomosis difficult.Potentially compromises blood supply to sternum and removes an option for future bypass grafting.Risk of iatrogenic pneumothorax.Removal of cartilage leads to visible contour deformity.
Optimization of pleural multisite anesthetic technique during CT-guide microwave ablation of peripheral lung malignancy for improving treatment tolerance
Published in International Journal of Hyperthermia, 2022
Hao Hu, Fulei Gao, Jinhe Guo, Gaojun Teng, Zhi Wang, Bo Zhai, Rong Liu, Jiachang Chi
The development of intraoperative pain during the MWA results in a more technically challenging procedure, and quick-acting analgesic should necessitate hospital admission. Various technical approaches have been published to reduce the incidence of pain, with a focus on reduction of the pleural stimulation. In 2005, Yasui et al. found that epidural anesthesia could not reduce the incidence of severe pain during ablation [9]. In a review of the literature, general anesthesia was found to be used for thermal ablation in approximately half of the centers involved in the studies reviewed. General anesthesia could be associated with various complications and additional expenditure [10]. A number of subsequent studies have reported variable results on the effects of artificial pneumothorax during ablation [11,12]. Artificial pneumothorax is demonstrated to thermal ablation for relieving chest pain and protecting the mediastina and the chest wall [13]; however, studies using this technique may not achieve the satisfactory safety [14–19]. Artificial pneumothorax need compress the pulmonary parenchyma and decrease alveolar air. Decreased alveolar air can alter electrical and thermal conductivity, affecting the ablation zone. Patients with pleural adhesions occurring after pulmonary surgery or lung cancer radiotherapy are also not suitable for this therapy.
Percutaneous thermal ablation of hepatocellular carcinomas located in the hepatic dome using artificial carbon dioxide pneumothorax: retrospective evaluation of safety and efficacy
Published in International Journal of Hyperthermia, 2018
Margaux Hermida, Christophe Cassinotto, Lauranne Piron, Eric Assenat, Georges-Philippe Pageaux, Laure Escal, Marie-Ange Pierredon-Foulongne, Daniel Verzilli, Samir Jaber, Boris Guiu
The technique of artificially induced pneumothorax was first described in 6 patients by De Baere et al. [3]. In this article, the authors used a 18 G epidural needle to access the pleural space and injected air through a microporous system to create the pneumothorax. Although they reported a technical success rate of 100% without any complications, we chose (as suggested in their discussion section) a Veress needle to access the pleural cavity. Because of the needle design, <1 min was necessary to reach the pleural cavity compared to up to 8 min with the 18 G epidural needle [3]. The Veress needle, which was developed in 1932 by Dr. Jano Veress to create pneumothorax to collapse lungs infected by tuberculosis, is now mainly used to induce pneumoperitoneum [21]. A disposable Veress needle is an inexpensive and safe material to access the pleural cavity because of its blunt-stylet design that prevent tears in the visceral pleura or the lung parenchyma, which may occur with an 18 G epidural needle. Thus, there is no risk of alveolar bleeding or persistent pneumothorax compared to the transpulmonary approach [22].
Interventional pulmonary medicine
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2020
Erik Vakil, Alain Tremblay
A meta-analysis of bronchoscopic lung volume reduction (BLVR) by van Geffen et al. showed that the Zephyr endobronchial valves (Pulmonx Inc., Redwood City, CA, USA) reduce residual volume in select patients without collateral ventilation by 0.57 l and improve FEV1 by 22%, 6-minute walk test distance by 49 m, and quality of life by 9.13 points on the Saint George Respiratory Questionnaire.11 Endobronchial coils and sclerosants did not perform as well and were associated with more adverse events. These results are similar to another 2019 meta-analysis and the potential benefit of endobronchial valves in patients with emphysema was recognized by a Canadian Agency for Drugs and Technologies in Health rapid response report.12,13 While the Zephyr valves, as well as the Spiration Valve System (Spiration Inc., Redmond, WA, USA), are currently United States Food and Drug Administration (FDA) approved for BLVR, neither have received Health Canada clearance (the Spiration Valve System is Health Canada approved for the treatment of persistent air leaks secondary to broncho-pleural fistula). No cost-effectiveness analyses have been performed but the valves are being employed with increasing frequency in Europe and the United States as part of clinical practice in highly selected patients. Complications with pneumothorax seem to be the greatest concern.
Related Knowledge Centers
- Chest Pain
- Hypotension
- Shortness of Breath
- Thoracic Wall
- Tissue
- Atelectasis
- Hypoxia
- Pleural Cavity
- Lung
- Obstructive Shock
- Shortness of Breath