Extra corporal membrane oxygenation in general thoracic surgery: a new single veno-venous cannulation

Extracorporeal membrane oxygenation (ECMO) is used in severe respiratory failure to maintain adequate gas exchange. So far, this technique has not been commonly used in general thoracic surgery. We present a case using ECMO for peri-operative airway management for pulmonary resection, using a novel single-site, internal jugular, veno-venous ECMO cannula

Ex vivo lung graft perfusion

International audienc

Early Unilateral Laryngeal Paralysis After Pulmonary Resection With Mediastinal Dissection for Cancer

International audienceObjective : To document the symptoms, evolution, treatment decision and outcome in a large series of patients with unilateral laryngeal paralysis after mediastinal lymph node dissection and pulmonary resection for cancer. Methods : Retrospective series based on an inception cohort of 122 patients consecutively managed at a single institution. Treatement of the ULNP relied on isolated speech therapy in 38 patients and surgical medialisation of the paralysed vocal cord in 83 patients (37 intracordal injection of autologous fat and 46 type I thyroplasty with implant insertion). In one patient a total laryngectomy was performed. Duration of follow varied from 1-118 month. 94 patients had a minimum of 6 months of follow or were followed until either death or recovery of motion of the paralysed vocal cord occured. Results : Symptoms included swallowing impairment and dysphonia noted in 54.4 % and 99.2 % of patients, respectively. Recovery of motion of the paralysed vocal cord, noted in 25.9 % of patients referred before the sixth month after lung surgery, never occurred past this month and/or if the inferior laryngeal or Xth cranial nerves had been transected at time of lung surgery. In univariate analysis, a surgical medialisation of the paralysed vocal cord was statistically more likely to be performed in patients with swallowing impairment, severe dysphonia or paralysis of the left hemilarynx. When performed, medialisation of the paralysed larynx, resulted in an overall 96.3 % and 98,4 % improvement rate for dysphonia and swallowing impairment, repectively. Conclusions : Such results pledge for a close relationship between the thoracic and head and neck surgeon in patients with cancer amenable to lung resection with mediastinal lymph node dissection in an attempt to avoid the major complications related to aspiration and to improve the quality of life of this population

Complications of surgical and percutaneous tracheostomies, and factors leading to decannulation success in a unique Middle Eastern population.

IntroductionSurgical and percutaneous tracheostomy remains a commonly performed procedure in the intensive care unit (ICU). Given the unique patient population in the Middle East we decided to perform a review of the procedures performed in our hospital over a two-year period.MethodsSingle centre, retrospective observational study. All tracheostomies performed between January 2016 and January 2018 were included in the study. The primary outcome was the rate of tracheostomy complications. Multivariate logistic regression analysis was used to identify the independent factors associated with complications and decannulations.ResultsOne hundred sixty-four patients were included in the study. Percutaneous tracheostomy was performed in 99 patients (60.4%). Complications occurred in thirty-eight patients (23%). Higher Left ventricular ejection fraction (OR = 0.94, 95%CI: [0.898-0.985]) and percutaneous tracheostomy (OR = 0.107, 95%CI: [0.029-0.401]) were associated with lower complications. Good Eastern Cooperative Oncology Group (ECOG) performance status (OR = 4.1, 95%CI: [1.3-13.3]) and downsized tracheostomy tube (OR = 6.5, 95%CI: [2.0-21.0]) were associated with successful decannulations. Successful decannulation was associated with lower hospital mortality when compated to those who could not be decannulated (3.2% vs 33.3% p ConclusionIn our older population with high comorbidities, percutaneous tracheostomies were associated with less complications than surgical tracheostomies. Patients with poor premorbid functional status and those who could not have their tracheostomy tube sucessfuly downsized were less likely to be decannulated, and had a higher mortality. This data enables physicians to inform the families of the added risks involved with tracheostomy in this patient group