Effects of early mobilization on the incidence of postoperative complications in patients undergoing thoracoscopy: a randomized controlled trial

BACKGROUND: mobilization is crucial for reducing postoperative complications. In literature no precise inidications exist regarding mobilization timing and posture after thoracoscopy. This study aims to compare the effects of early Fowler’s position (first 6 hours after surgery) with bedrest in supine position for the first 24 hours. METHODS: open-label clinical trial, on 28 patients undergoing thoracoscopy. The subjects were randomly allocated to be mobilized in Fowler's position within 45min after surgery up to 6h (study group) or to maintain recumbent position until the first postoperative day. Forced vital expiration (FEV1) was measured after 6 and 24 hours from surgery. Chest X-ray was performed immediately after surgery and on the first postoperative day. RESULTS: the cases of atelectasis in the study group decreased from 53.3% to 20.0% (control group: from 69.2% to 46.2%). FEV1 showed statistically significant improvement in the study group both after 6 and 24 hours from surgery (p<.001). CONCLUSIONS: early mobilization in Fowler's position improves respiratory outcomes by reducing the episodes of atelectasis. It also results in clinically relevant improvement in FEV1 if compared to recumbent position.INTRODUZIONE: la mobilizzazione è fondamentale per ridurre le complicanze postoperatorie. In letteratura non esistono criteri precisi per quanto riguarda i tempi di mobilizzazione e la postura dopo la toracoscopia. Questo studio mira a confrontare gli effetti della mobilizzazione precoce (entro le prime 6 ore dopo l'intervento chirurgico) in posizione di Fowler  e la posizione supina per le prime 24 ore. METODI: studio sperimentale a due bracci, in aperto con arruolamento di 28 pazienti sottoposti a toracoscopia. I soggetti sono stati assegnati in modo casuale alla mobilizzazione in posizione di Fowler entro 45 minuti dopo l'intervento chirurgico fino a 6 ore (gruppo di studio) o per mantenere la posizione supina fino al primo giorno postoperatorio. La variabile dipendente studiata era il volume espiratorio massimo nel 1° secondo (FEV1) dopo 6 e 24 ore dall'intervento chirurgico. La radiografia del torace è stata eseguita subito dopo l'intervento chirurgico e il primo giorno postoperatorio. RISULTATI: i casi di atelettasia nel gruppo di studio sono diminuiti dal 53.3% al 20.0% (gruppo di controllo: dal 69.2% al 46.2%). Il FEV1 ha mostrato un miglioramento statisticamente significativo nel gruppo di studio sia dopo 6 che dopo 24 ore dall'intervento chirurgico (p<.001). CONCLUSIONI: la mobilizzazione precoce nella posizione di Fowler sembra migliorare i risultati respiratori riducendo gli episodi di atelettasia; si traduce anche in un miglioramento clinicamente rilevante del FEV1 rispetto alla posizione supina. I risultati attuali devono essere confermati su campioni ampi e stratificati

Multiple right-sided pulmonary nodules: metastatic cancer or resectable early stage tumor?

The aim of this paper is to focus attention on complex cases of lung disease that may benefit from being managed outside formal guidelines. A 52 year-old man who had previously undergone a laryngectomy for squamous cell carcinoma, presented with a 1.2 cm nodule in the right upper pulmonary lobe. Three months later a new CT scan found that the nodule had slightly increased in size and also detected two new smaller nodules in the middle lobe. A PET/CT scan showed metabolic hyperactivity of all nodules. Since needle aspiration of the upper one revealed malignant cells, the patient was considered to be suffering from metastatic cancer and started on chemotherapy. At follow-up both CT and PET scans found a significant reduction in volume and activity of the lower nodules but no change in the upper one. At diagnostic thoracoscopy, histology demonstrated that the upper nodule was an adenocarcinoma while the lower ones were inflammatory. An upper lobectomy and systematic nodal dissection were therefore performed. Histology established a diagnosis of upper pulmonary adenocarcinoma and sarcoidosis. Our report suggests that in complicated oncologic cases in which non-invasive diagnostic tools yield incongruous results surgery should be considered without delay

Editorial: Rethink Thoracic Surgery as a Whole After the Pandemic. How to Optimize Resources and Deliver Excellent Patient Care

10.3389/fsurg.2022.920626FRONTIERS IN SURGERY