Negative-pressure Pulmonary Edema And Hemorrhage Associated With Upper Airway Obstruction [edema E Hemorragia Pulmonar Por Pressão Negativa Associados à Obstrução Das Vias Aéreas Superiores]

Negative-pressure pulmonary edema accompanied by hemorrhage as a manifestation of upper airway obstruction is an uncommon problem that is potentially life-threatening. The principal pathophysiological mechanism involved is the generation of markedly negative intrathoracic pressure, which leads to an increase in pulmonary vascular volume and pulmonary capillary transmural pressure, creating a risk of disruption of the alveolar-capillary membrane. We report the case of an adult male with diffuse alveolar hemorrhage following acute upper airway obstruction caused by the formation of a cervical and mediastinal abscess resulting from the insertion of a metallic tracheal stent. The patient was treated through drainage of the abscess, antibiotic therapy, and positive pressure mechanical ventilation. This article emphasizes the importance of including this entity in the differential diagnosis of acute lung injury after procedures involving upper airway instrumentation.346420424Koh, M.S., Hsu, A.A., Eng, P., Negative pressure pulmonary oedema in the medical intensive care unit (2003) Intensive Care Med, 29 (9), pp. 1601-1604Bhavani-Shankar, K., Hart, N.S., Mushlin, P.S., Negative pressure induced airway and pulmonary injury (1997) Can J Anaesth, 44 (1), pp. 78-81Schwartz, D.R., Maroo, A., Malhotra, A., Kesselman, H., Negative pressure pulmonary hemorrhage (1999) Chest, 115 (4), pp. 1194-1197Van Kooy, M.A., Gargiulo, R.F., Postobstructive pulmonary edema (2000) Am Fam Physician, 62 (2), pp. 401-404Pavlin, D.J., Nessly, M.L., Cheney, F.W., Increased pulmonary vascular permeability as a cause of re-expansion edema in rabbits (1981) Am Rev Respir Dis, 124 (4), pp. 422-427Willms, D., Shure, D., Pulmonary edema due to upper airway obstruction in adults (1988) Chest, 94 (5), pp. 1090-1092Guffin, T.N., Har-el, G., Sanders, A., Lucente, F.E., Nash, M., Acute postobstructive pulmonary edema (1995) Otolaryngol Head Neck Surg, 112 (2), pp. 235-237McGowan, F.X., Kenna, M.A., Fleming, J.A., O'Connor, T., Adenotonsillectomy for upper airway obstruction carries increased risk in children with a history of prematurity (1992) Pediatr Pulmonol, 13 (4), pp. 222-226Ikeda, H., Asato, R., Chin, K., Kojima, T., Tanaka, S., Omori, K., Negative-pressure pulmonary edema after resection of mediastinum thyroid goiter (2006) Acta Otolaryngol, 126 (8), pp. 886-888West, J.B., Mathieu-Costello, O., Stress failure of pulmonary capillaries: Role in lung and heart disease (1992) Lancet, 340 (8822), pp. 762-767Rocker, G.M., Mackenzie, M.G., Williams, B., Logan, P.M., Noninvasive positive pressure ventilation: Successful outcome in patients with acute lung injury/ARDS (1999) Chest, 115 (1), pp. 173-177Butterell, H., Riley, R.H., Life-threatening pulmonary oedema secondary to tracheal compression (2002) Anaesth Intensive Care, 30 (6), pp. 804-806Antonelli, M., Conti, G., Moro, M.L., Esquinas, A., Gonzalez-Diaz, G., Confalonieri, M., Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: A multi-center study (2001) Intensive Care Med, 27 (11), pp. 1718-1728Adolph, M.D., Oliver, A.M., Dejak, T., Death from adult respiratory distress syndrome and multiorgan failure following acute upper airway obstruction (1994) Ear Nose Throat J, 73 (5), pp. 324-327Westreich, R., Sampson, I., Shaari, C.M., Lawson, W., Negative-pressure pulmonary edema after routine septorhinoplasty: Discussion of pathophysiology, treatment, and prevention (2006) Arch Facial Plast Surg, 8 (1), pp. 8-15Ackland, G.L., Mythen, M.G., Negative pressure pulmonary edema as an unsuspected imitator of acute lung injury/ARDS (2005) Chest, 127 (5), pp. 1867-186

Use Of A One-way Flutter Valve Drainage System In The Postoperative Period Following Lung Resection [utilização Da Válvula Unidirecional De Tórax Como Sistema De Drenagem No Pós-operatório De Ressecç ões Pulmonares]

Objective: To evaluate pleural drainage using a one-way flutter valve following elective lung resection. Methods: This was a prospective study, with descriptive analysis, of 39 lung resections performed using a one-way flutter valve to achieve pleural drainage during the postoperative period. Patients less than 12 years of age were excluded, as were those submitted to pneumonectomy or emergency surgery, those who were considered lost to follow-up and those in whom water-seal drainage was used as the initial method of pleural drainage. Lung expansion, duration of the drainage, hospital stay and postoperative complications were noted. Results: A total of 36 patients were included and analyzed in this study. The mean duration of pleural drainage was 3.0 ± 1.6 days. At 30 days after the surgical procedure, chest X-ray results were considered normal for 34 patients (95.2%). Postoperative complications occurred in 8 patients (22.4%) and were related to the drainage system in 3 (8.4%) of those. Conclusions: The use of a one-way flutter valve following elective lung resection was effective, was well tolerated and presented a low rate of complications.348559566Kenyon, J.H., Traumatic Hemothorax: Siphon drainage (1916) Ann Surg, 64, pp. 728-729Lilienthal, H., Resection of the lung for suppurative infections with a report based on 31 operative cases in which resection was done or intended (1922) Ann Surg, 75 (3), pp. 257-320Heimlich, H.J., Valve drainage of the pleural cavity (1968) Dis Chest, 53 (3), pp. 282-287Waller, D.A., Edwards, J.G., Rajesh, P.B., A physiological comparison of flutter valve drainage bags and underwater seal systems for postoperative air leaks (1999) Thorax, 54 (5), pp. 442-443Lima, A.G., Rocha, E.R., Santos, N.A., Seabra, J.C., Mussi, R.K., Santos, J.G., Avalia̧ão do uso da bra̧adeira ou "clamp" na drenagem pleural fechada subaquática. Estudo prospectivo aleatorizado. (2007) J Bras Pneumol, 33 (SUPL 1R), pp. R13Vuorisalo, S., Aarnio, P., Hannukainen, J., Comparison between flutter valve drainage bag and underwater seal device for pleural drainage after lung surgery (2005) Scand J Surg, 94 (1), pp. 56-58Graham, A.N., Cosgrove, A.P., Gibbons, J.R., McGuigan, J.A., Randomised clinical trial of chest drainage systems (1992) Thorax, 47 (6), pp. 461-462Bar-El, Y., Lieberman, Y., Yellin, A., Modified urinary collecting bags for prolonged underwater chest drainage (1992) Ann Thorac Surg, 54 (5), pp. 995-996Ortega, H.A.V., Lima, M.P., Denadai, J.O., Válvula unidirecional aplicada ao tratamento ambulatorial do pneumotórax. (1996) J Pneumol, 22 (4), pp. 177-180Figueiredo Pinto, J.A., Leite, A.G., Cavalet, D., Drenagem torácica: Princípios básicos (2001) Manual de cirurgia torácica, pp. 109-125. , Pinto Filho DR, Cardoso PF, Figueiredo Pinto JA, Scheineider A, editors, Rio de Janeiro: Revinter;Gŕgoire, J., Deslauries, J., Closed drainage and suction systems (2002) Thoracic Surgery, pp. 1281-1297. , Pearson FG, Deslauries J, Ginsberg RJ, Hiebert CA, Mckneally MF, Urschel HC, editors, New York: Churchill Livingstone;Marshall, M.B., Deeb, M.E., Bleier, J.I., Kucharczuk, J.C., Friedberg, J.S., Kaiser, L.R., Suction vs water seal after pulmonary resection: A randomized prospective study (2002) Chest, 121 (3), pp. 831-835McKenna Jr, R.J., Fischel, R.J., Brenner, M., Gelb, A.F., Use of the Heimlich valve to shorten hospital stay after lung reduction surgery for emphysema (1996) Ann Thorac Surg, 61 (4), pp. 1115-1117Okamoto, J., Okamoto, T., Fukuyama, Y., Ushijima, C., Yamaguchi, M., Ichinose, Y., The use of a water seal to manage air leaks after a pulmonary lobectomy: A retrospective study (2006) Ann Thorac Cardiovasc Surg, 12 (4), pp. 242-244Cerfolio, R.J., Bass, C., Katholi, C.R., Prospective randomized trial compares suction versus water seal for air leaks (2001) Ann Thorac Surg, 71 (5), pp. 1613-1617Antanavicius, G., Lamb, J., Papasavas, P., Caushaj, P., Initial chest tube management after pulmonary resection (2005) Am Surg, 71 (5), pp. 416-419Lima, A.G., Contrera Toro, I.F., Tincani, A.J., Barreto, G., A drenagem pleural pré-hospitalar: Apresentação de mecanismo de válvula unidirecional. (2006) Rev Col Bras Cir, 33 (2), pp. 101-106Ponn, R.B., Silverman, H.J., Federico, J.A., Outpatient chest tube management (1997) Ann Thorac Surg, 64 (5), pp. 1437-1440Campisi, P., Voitk, A.J., Outpatient treatment of spontaneous pneumothorax in a community hospital using a Heimlich flutter valve: A case series (1997) J Emerg Med, 15 (1), pp. 115-119Williams, J.G., Riley, T.R., Moody, R.A., Resuscitation experience in the Falkland Islands campaign (1983) Br Med J (Clin Res Ed), 286 (6367), pp. 775-777Schweitzer, E.J., Hauer, J.M., Swan, K.G., Bresch, J.R., Harmon, J.W., Graeber, G.M., Use of the Heimlich valve in a compact autotransfusion device (1987) J Trauma, 27 (5), pp. 537-542Beyruti, R., Villiger, L.E., Campos, J.R., Silva, R.A., Fernandez, A., Jatene, F.B., A válvula de Heimlich no tratamento do pneumotórax. (2002) J Pneumol, 28 (3), pp. 115-119Mainini, S.E., Johnson, F.E., Tension pneumothorax complicating small-caliber chest tube insertion (1990) Chest, 97 (3), pp. 759-760Lodi, R., Stefani, A., A new portable chest drainage device (2000) Ann Thorac Surg, 69 (4), pp. 998-1001Sanches, P.G., Vendrame, G.S., Madke, G.R., Pilla, E.S., Camargo, J.J., Andrade, C.F., (2006) Lobectomy for treating bronchial carcinoma: Analysis of comorbidities and their impact on postoperative morbidity and mortality J Bras Pneumol, 32 (6), pp. 495-504Lang-Lazdunski, L., Chapuis, O., Bonnet, P.M., Pons, F., Jancovici, R., Videothoracoscopic bleb excision and pleural abrasion for the treatment of primary spontaneous pneumothorax: Long-term results (2003) Ann Thorac Surg, 75 (3), pp. 960-965Russo, L., Wiechmann, R.J., Magovern, J.A., Szydlowski, G.W., Mack, M.J., Naunheim, K.S., Early chest tube removal after video-assisted thoracoscopic wedge resection of the lung (1998) Ann Thorac Surg, 66 (5), pp. 1751-1754Watanabe, A., Watanabe, T., Ohsawa, H., Mawatari, T., Ichimiya, Y., Takahashi, N., Avoiding chest tube placement after video-assisted thoracoscopic wedge resection of the lung (2004) Eur J Cardiothorac Surg, 25 (5), pp. 872-876Molins, L., Fibla, J.J., Ṕrez, J., Sierra, A., Vidal, G., Siḿn, C., Outpatient thoracic surgical programme in 300 patients: Clinical results and economic impact (2006) Eur J Cardiothorac Surg, 29 (3), pp. 271-275Tang, A.T., Velissaris, T.J., Weeden, D.F., An evidence-based approach to drainage of the pleural cavity: Evaluation of best practice (2002) J Eval Clin Pract, 8 (3), pp. 333-34

Bronchoscopy For Foreign Body Removal: Where Is The Delay? [broncoscopia Para Remoção De Corpo Estranho: Onde Está O Atraso?]

This was a retrospective analysis of the medical charts of 145 patients treated at the Bronchoscopy and Thoracic Surgery Clinic of the Hospital das Clínicas da Universidade Estadual de Campinas (HC-Unicamp, State University of Campinas Hospital das Clínicas) over a period of 10 years. There was a significant difference related to the site of first medical visit (Unicamp-HC versus other institutions) in terms of the time elapsed between the suspicion of bronchial aspiration and the actual respiratory endoscopic examination. However, no significant difference was found in the rate of positive results. The low number of referral centers that provide emergency respiratory endoscopy can negatively influence the treatment of patients under suspicion of bronchial aspiration, jeopardizing the overall recovery in the mid- and long-term.3411956958Zerella, J.T., Dimler, M., McGill, L.C., Pippus, K.J., Foreign body aspiration in children: Value of radiography and complications of bronchoscopy (1998) J Ped Surg, 33 (11), pp. 1651-1654Fraga, A.M., Reis, M.C., Zambon, M.P., Toro, I.C., Ribeiro, J.D., Baracat, E.C., Foreign body aspiration in children: Clinical aspects, radiological aspects and bronchoscopic treatment (2008) J Bras Pneumol, 34 (2), pp. 74-82Swanson, K.L., Prakash, U.B., Midthun, D.E., Edell, E.S., Utz, J.P., McDougall, J.C., Flexible bronchoscopic management of airway foreign bodies in children (2002) Chest, 121 (5), pp. 1695-1700Pritt, B., Harmon, M., Schwartz, M., Cooper, K., A tale of three aspirations: Foreign bodies in the airway (2003) J Clin Pathol, 56 (10), pp. 791-794Cataneo, A.J., Reibscheid, S.M., Ruiz Júnior, R.L., Ferrari, G.F., Foreign body in the tracheobronchial tree (1997) Clin Pediatr (Phila), 36 (12), pp. 701-706Applegate, K.E., Dardinger, J.T., Lieber, M.L., Herts, B.R., Davros, W.J., Obuchowski, N.A., Spiral CT scanning technique in the detection of aspiration of LEGO foreign bodies (2001) Pediatr Radiol, 31 (12), pp. 836-840Lima, J.A., Fischer, G.B., Felicetti, J.C., Flores, J.A., Penna, C.N., Ludwig, E., Aspiração de corpo estranho na árvore traqueobrônquica em crianças: Avaliação de seqüelas através de exame cintilográfico. (2000) J Pneumol, 26 (1), pp. 20-24Cassol, V., Pereira, A.M., Zorzela, L.M., Becker, M.M., Barreto, S.S., Corpo estranho na via aérea de crianças. (2003) J Pneumol, 29 (3), pp. 139-144Fraga, J.C., Nogueira, A., Palombini, B.C., Corpo estranho em via aérea de criança. (1994) J Pneumol, 20 (3), pp. 107-111Piva, J., Giugno, K., Maia, T., Mascarenhas, T., Nogueira, A., Kalil, L., Aspiração de corpo estranho: Revisão de 19 casos. (1989) J Pediat, 65 (10), pp. 399-403Inglis Jr, A.F., Wagner, D.V., Lower complication rates associated with bronchial foreign bodies over the last 20 years (1992) Ann Otol Rhinol Laryngol, 101 (1), pp. 61-66Davies, H., Gordon, I., Matthew, D.J., Helms, P., Kenney, I.J., Lutkin, J.E., Long term follow up after inhalation of foreign bodies (1990) Arch Dis Child, 65 (6), pp. 619-621Black, R.E., Choi, K.J., Syme, W.C., Johnson, D.G., Matlak, M.E., Bronchoscopic removal of aspirated foreign bodies in children (1984) Am J Surg, 148 (6), pp. 778-78

Postintubation Injuries And Open Surgical Tracheostomy: Should We Always Perform Isthmectomy? [sequelas Pós-intubação E Traqueostomia Cirúrgica Aberta: Devemos Sempre Fazer A Istmectomia?]

Objective: To evaluate the influence of the surgical team (general surgery or thoracic surgery) and the surgical technique (with or without isthmectomy) on the incidence of postintubation injuries in the airways of tracheostomized patients. Methods: Between January 1st and August 31st, 2007, 164 patients admitted to the adult intensive care unit and tracheally intubated for more than 24 h were studied prospectively at the Sumaré State Hospital, located in the city of Sumaré, Brazil. When tracheostomy was necessary, these patients were randomly assigned to thoracic or general surgery teams. All of the patients were submitted to fiberoptic tracheoscopy for decannulation or late evaluation of the airway. Results: Of the 164 patients in the study, 90 (54.88%) died (due to causes unrelated to the procedure), 67 (40.85%) completed follow-up, and 7 (4.27%) were lost to follow-up. Of the 67 patients who completed follow-up, 32 had undergone tracheostomy (21 by the general surgery team and 11 by the thoracic surgery team), and 22 had been submitted to isthmectomy (11 by the general surgery team and 11 by the thoracic surgery team). There was no difference between the surgical teams in terms of the incidence of stoma complications. However, there was a significant difference when the surgical techniques (with or without isthmectomy) were compared. Conclusions: Not performing isthmectomy in parallel with tracheostomy leads the surgeon to open the tracheal stoma more distally than expected. In such cases, there were more stoma complications.353227233Maddaus, M.A., Pearson, F.G., Postintubation injury (2002) Pearson's Thoracic and Esophageal Surgery, pp. 300-314. , In: Pearson FG, Patterson GA, editors, Philadelphia: Churchill Livingstone/ElsevierStreitz Jr, J.M., Shapshay, S.M., Airway injury after tracheotomy and endotracheal intubation (1991) Surg Clin North Am, 71 (6), pp. 1211-30Park, M., Brauer, L., Sanga, R.R., Kajdacsy-Balla, A.C., Ladeira, J.P., Azevedo, L.C., Percutaneous Tracheostomy in Critically-ill Patients: The Experience of a Medical Intensive Care Unit (2004) J Bras Pneumol., 30 (3), pp. 237-242Ciaglia, P., Firsching, R., Syniec, C., Elective percutaneous dilatational tracheostomy. A new simple bedside procedurepreliminary report (1985) Chest, 87 (6), pp. 715-9Epstein, S.K., Late complications of tracheostomy (2005) Respir Care, 50 (4), pp. 542-9Pearson, F.G., Goldberg, M., da Silva, A.J., A prospective study of tracheal injury complicating tracheostomy with a cuffed tube (1968) Ann Otol Rhinol Laryngol, 77 (5), pp. 867-82Braz, J.R., Navarro, L.H., Takata, I.H., Nascimento Júnior, P., Endotracheal tube cuff pressure: Need for precise measurement (1999) Sao Paulo Med J, 117 (6), pp. 243-7Goldstraw, P., Morgam, C., Tracheostomy (2002) Pearson's Thoracic and Esophageal Surgery, pp. 375-383. , In: Pearson FG, Patterson GA, editors, Philadelphia: Churchill Livingstone/ ElsevierPutnam Jr., J.B., Traquéia (2005) Sabiston Tratado De Cirurgia, pp. 1792-1793. , In: Townsend MC, editor, Rio de Janeiro: ElsevierVianna, A., Tracheostomy in patients on mechanical ventilation: When is it indicated? (2007) J Bras Pneumol., 33 (6), pp. xxxvii-xxxviiiPerfeiro, J.A., Mata, C.A., Forte, V., Carnaghi, M., Tamura, N., Leão, L.E., Tracheostomy in the ICU: Is it worthwhile? (2007) J Bras Pneumol., 33 (6), pp. 687-90Leite, A.G., Kussler, D., Management of recurrent distal tracheal stenosis using an endoprosthesis: A case report (2008) J Bras Pneumol., 34 (2), pp. 121-5Arabi, Y., Haddad, S., Shirawi, N., Al Shimemeri, A., Early tracheostomy in intensive care trauma patients improves resource utilization: A cohort study and literature review (2004) Crit Care, 8 (5), pp. R347-52Croshaw, R., McIntyre, B., Fann, S., Nottingham, J., Bynoe, R., Tracheostomy: Timing revisited (2004) Curr Surg, 61 (1), pp. 42-8Walts, P.A., Murthy, S.C., Arroliga, A.C., Yared, J.P., Rajeswaran, J., Rice, T.W., Tracheostomy after cardiovascular surgery: An assessment of long-term outcome (2006) J Thorac Cardiovasc Surg, 131 (4), pp. 830-7Plummer, A.L., Gracey, D.R., Consensus conference on artificial airways in patients receiving mechanical ventilation (1989) Chest, 96 (1), pp. 178-80Leung, R., Macgregor, L., Campbell, D., Berkowitz, R.G., Decannulation and survival following tracheostomy in an intensive care unit (2003) Ann Otol Rhinol Laryngol., 112 (10), pp. 853-8Pinet, C., Quenee, V., Sainty, J.M., Significance of systematic endoscopic decannulation. Retrospective study on intensive care patients [Article in French] (1998) Rev Pneumol Clin., 54 (2), pp. 81-4Nouraei, S.A., Singh, A., Patel, A., Ferguson, C., Howard, D.J., Sandhu, G.S., Early endoscopic treatment of acute inflammatory airway lesions improves the outcome of postintubation airway stenosis (2006) Laryngoscope., 116 (8), pp. 1417-21Coelho, M.S., Zampier, J.A., Zanin, S.A., Silva, E.M., Guimarães, P.S., Fístula traqueoesofágica como complicação tardia de traqueostomia (2001) J Pneumol., 27 (2), pp. 119-22Grillo, H.C., Mathisen, D.J., Wain, J.C., Laryngotracheal resection and reconstruction for subglottic stenosis (1992) Ann Thorac Surg., 53 (1), pp. 54-63Saueressig, M.G., Macedo-Neto, A.V., Moreschi, A.H., Xavier, R.G., Sanches, P.R., A correção das estenoses traqueobrônquicas mediante o emprego de órteses (2002) J Pneumol., 28 (2), pp. 84-93Terra, R.M., Minamoto, H., Tedde, M.L., Almeida, J.L., Jatene, F.B., Self-expanding stent made of polyester mesh with silicon coating (Polyflex®) in the treatment of inoperable tracheal stenoses (2007) J Bras Pneumol., 33 (3), pp. 241-7Gravvanis, A.I., Tsoutsos, D.A., Iconomou, T.G., Papadopoulos, S.G., Percutaneous versus Conventional Tracheostomy in Burned Patients with Inhalation Injury (2005) World J Surg., 29 (12), pp. 1571-5Karagiannidis, C., Velehorschi, V., Obertrifter, B., Macha, H.N., Linder, A., Freitag, L., High-level expression of matrix-associated transforming growth factor-beta1 in benign airway stenosis (2006) Chest., 129 (5), pp. 1298-30

The influence of clamp usage on clot deposit formation inside thoracic drains

Background: A prospective study was done to evaluate the influence of clamp usage on clot formation inside thoracic drains. Methods: Each drain was weighed soon after removal; they were then washed, dried and weighed again. The difference between the first andsecondw eights was taken as the amount of clot deposit formed. Results: We found more clots accumulated inside the drains that were temporarily obstructed by the clamp. Conclusion: In this study, there were more clots formation inside thoracic drains clamped, even if they were occluded intermottently. This can lead thoracic drains to function improperly. The discussion about the correct usage of thoracic drains must he a subject for educational programs for physicians and nurses, to aim for the safest use of this widely used and highly efficient system.Conduziu-se este estudo prospectivo a fim de avaliar-se a influência do uso da braçadeira sobre o acúmulo de coágulos dentro dos drenos pleurais. Os drenos pleurais foram pesados logo após sua retirada, lavados e secados e pesados novamente. A diferença entre a primeira e a segunda pesagem foi admitida como a quantidade de coágulos acumulada. Houve maior acúmulo de coágulo nos drenos temporariamente obstruídos por braçadeira em relação àqueles não obstruídos. Notou-se, neste estudo, maior acúmulo de coágulo dentro de drenos pleurais obstruídos, mesmo que intermitentemente, o que pode levar ao mau funcionamento de todo o sistema de drenagem. A discussão sobre o correto uso dos drenos pleurais deve ser constante e fazer parte de programas de educação continuada para médicos e enfermagem, a fim de que este sistema, amplamente utilizado e altamente eficiente, seja otimizado3527982Lima, A.G., Toro, I.F.C., Tincani, A.J., Barreto, G., A drenagem pleural pré-hospitalar: Apresentação de mecanismo de válvula unidirecional. (2006) Rev Col Bras Cir, 33 (2), pp. 101-106Barton, E.D., Epperson, M., Hoyt, D.B., Fortlage, D., Rosen, P., Prehospital needle aspiration and tube thoracostomy in trauma victims: A six-year experience with aeromedical crews (1995) J Emerg Med, 13 (2), pp. 155-163Hyde, J., Sykes, T., Graham, T., Reducing morbidity from chest drains (1997) BMJ, 314 (7085), pp. 914-915McMahon-Parkes, K., Management of pleural drains (1997) Nurs Times, 93 (52), pp. 48-49Wagner, R.B., Slivko, B., Highlights of the history of nonpenetranting chest trauma (1989) Surg Clin North Am, 69 (1), pp. 1-14Baumann, M.H., What size chest tube? What drainage system is ideal? And other chest tube management questions (2003) Curr Opin Pulm Med, 9 (4), pp. 276-281Harris, D.R., Graham, T.R., Management of intercostal drains (1991) Br J Hosp Med, 45 (6), pp. 383-386Graham, A.N., Cosgrove, A.P., Gibbons, J.R.P., McGuigan, J.A., Randomised clinical trial of chest drainage systems (1992) Thorax, 47 (6), pp. 461-462Symbas, P.N., Chest drainage valve (1978) Emerg Med Serv, 7 (3), pp. 41-46Munnell, E.R., Thoracic drainage (1997) Ann Thorac Surg, 63 (5), pp. 1497-1502Coughlin, A.M., Parchinsky, C., Go with the flow of chest tube therapy (2006) Nursing, 36 (3), pp. 36-41Shuster, P.M., Chest tubes: To clamp or not to clamp (1998) Nurs Educ, 23 (3), pp. 9-13Tooley, C., The management and care of chest drains (2002) Nurs Times Plus, 98 (26), pp. 49-50Bar-El, Y., Ross, A., Kablawi, A., Egenburg, S., Potentially dangerous negative intrapleural pressures generated by ordinary pleural drainage systems (2001) Chest, 119 (2), pp. 511-514Smith, R.N., Fallentine, J., Kessel, S., Underwater chest drainage: Bringing the facts to the surface (1995) Nursing, 25 (2), pp. 60-63Younes, R.N., Gross, J.L., Aguiar, S., Haddad, F.J., Deheinzelin, D., When to remove a chest tube? A randomised study with subsequent prospective consecutive validation (2002) J Am Coll Surg, 195 (5), pp. 658-662Gambazzi, F., Schirren, J., Thoraxdrainagen, Was its "evidence based"? (2003) Chirurg, 74 (2), pp. 99-107Wallen, M., Morrison, A., Gillies, D., O'Riordan, E., Brigde, C., Stoddart, F., Mediastinal chest drain clearance for cardiac surgery (2006) The Cochrane Library, Issue, 1Tattersall, D.J., Traill, Z.C., Gleeson, F.V., Chest drains: Does size matter? (2000) Clin Radiol, 55 (6), pp. 415-421A prospective study was done to evaluate the influence of clamp usage on clot formation inside thoracic drains. Methods: Each drain was weighed soon after removal; they were then washed, dried and weighed again. The difference between the first andsecondw eights was taken as the amount of clot deposit formed. Results: We found more clots accumulated inside the drains that were temporarily obstructed by the clamp. Conclusion: In this study, there were more clots formation inside thoracic drains clamped, even if they were occluded intermottently. This can lead thoracic drains to function improperly. The discussion about the correct usage of thoracic drains must he a subject for educational programs for physicians and nurses, to aim for the safest use of this widely used and highly efficient syste

Standardization Of A Method Of Prolonged Thoracic Surgery And Mechanical Ventilation In Rats To Evaluate Local And Systemic Inflammation

Purpose: To evaluate the immediate pulmonary and systemic inflammatory response after a long-term operative period. Methods: Wistar rats in the experimental group were anaesthetized and submitted to tracheostomy, thoracotomy and remained on mechanical ventilation during three hours. Control animals were not submitted to the operative protocol. The following parameters have been evaluated: pulmonary myeloperoxidase activity, pulmonary serum protein extravasation, lung wet/dry weight ratio and measurement of levels of cytokines in serum. Results: Operated animals exhibited significantly lower serum protein extravasation in lungs compared with control animals. The lung wet/dry weight ratio and myeloperoxidase activity did not differ between groups. Serum cytokines IL-1β, TNF-α, and IL-10 levels were not detected in groups, whereas IL-6 was detected only in operated animals. Conclusion: The experimental mechanical ventilation in rats with a prolonged surgical time did not produce significant local and systemic inflammatory changes and permit to evaluate others procedures in thoracic surgery.2613843Gothard, J., Lung injury after thoracic and one-lung ventilation (2006) Curr Opin Anaesthesiol, 19 (1), pp. 5-10Matute-Bello, G., Frevert, C.W., Martin, T.R., Animal models of acute lung injury (2008) Am J Physiol Cell Mol Physiol, 295 (3), pp. L379-99Braeuninger, S., Kleinschnitz, C., Rodent models of focal ischemia: Procedural pitfalls and translational problems (2009) Exp Transl Stroke Med, 25, pp. 1-8Brain, S.D., Williams, T.J., Inflammatory oedema induced by synergism between calcitonin gene-related peptide (CGRP) and mediators of increased vascular permeability (1985) Br J Pharmacol, 86, pp. 855-860Bradley, P.P., Priebat, D.A., Christensen, R.D., Rothstein, G., Measurement of cutaneous inflammation: Estimation of neutrophil content with an enzyme marker (1982) J Invest Dermatol, 78 (3), pp. 206-209Chang, K.P., Huang, S.H., Lin, C.L., Chang, L.L., Lin, S.D., Lai, C.S., An alternative model of composite tissue allotransplantation: Groin-thigh flap (2008) Transpl Int, 21 (6), pp. 564-571Unzueta, M.C., Casas, J.I., Moral, M.V., Pressure-controlled versus volume-controlled ventilation during one-lung ventilation for thoracic surgery (2007) Anesth Analg, 104 (5), pp. 1029-1033Tanaka, S., Tsuchida, H., Nakabayashi, K.-I., Seki, S., Namiki, A., The effects of sevoflurane, isoflurane, halothane, and enflurane on hemodynamic responses during an inhaled induction of anesthesia via a mask in humans (1996) Anesthesia and Analgesia, 82 (4), pp. 821-826. , DOI 10.1097/00000539-199604000-00025Liu, R., Ishibe, Y., Ueda, M., Isoflurane-sevoflurane administration before ischemia attenuates ischemia-reperfusion-induced injury in isolated rat lungs (2000) Anesthesiology, 92 (3), pp. 833-840Lima, R.C., Escobar, M.A.S., Diniz, R., D'Aconda, G., Bergsland, J., Salermo, T., Avaliação hemodinâmica intra-operatória na cirurgia de revascularização do miocárdio sem o auxílio de circulação extracorpórea (2000) Rev Bras Circ Cardiovasc, 15 (3), pp. 201-211Basagan-Mogol, E., Goren, S., Korfali, G., Turker, G., Kaya, F.N., Induction of anesthesia in coronary artery bypass graft surgery: The hemodynamic and analgesic effects of ketamine (2010) Clinics, 65 (2), pp. 133-138Fuentes, J.M., Hanly, E.J., Bachman, S.L., Aurora, A.R., Marohn, M.R., Talamini, M.A., Videoendoscopic endotracheal intubation in the rat: A comprehensive rodent model of laparoscopic surgery (2004) J Surg Res, 122 (2), pp. 240-248Lawrence, T., Wlloughby, D.A., Gilroy, D.W., Anti-inflammatory lipid mediators and insights into the resolution of inflammation (2002) Nat Rev Immunol, 2 (10), pp. 787-795Lewis, C.A., Martin, G.S., Understanding and managing fluid balance in patients with acute lung injury (2004) Curr Opin Crit Care, 10 (1), pp. 13-17Soni, N., Willians, P., Positive pressure ventilation: What is the real cost? 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Continuous Positive Airway Pressure (cpap) After Lung Resection: A Randomized Clinical Trial [pressão Positiva Contínua Nas Vias Aéreas (cpap) Após Ressecção Pulmonar: Ensaio Clínico Randomizado]

CONTEXT AND OBJECTIVE: Noninvasive mechanical ventilation during the postoperative period (PO) following lung resection can restore residual functional capacity, improve oxygenation and spare the inspiratory muscles. The objective of this study was to assess the efficacy of continuous positive airway pressure (CPAP) associated with physiotherapy, compared with physiotherapy alone after lung resection. DESIGN AND SETTING: Open randomized clinical trial conducted in the clinical hospital of Universidade Estadual de Campinas. METHOD: Sessions were held in the immediate postoperative period (POi) and on the first and second postoperative days (PO1 and PO2), and the patients were reassessed on the discharge day. CPAP was applied for two hours and the pressure adjustment was set between 7 and 8.5 cmH2O. The oxygenation index (OI), Borg scale, pain scale and presence of thoracic drains and air losses were evaluated. RESULTS: There was a significant increase in the OI in the CPAP group in the POi compared to the Chest Physiotherapy (CP) group, P = 0.024. In the CP group the OI was significantly lower on PO1 (P = 0,042), than CPAP group. The air losses were significantly greater in the CPAP group in the POi and on PO1 (P = 0.001, P = 0.028), but there was no significant difference between the groups on PO2 and PO3. There was a statistically significant difference between the groups regarding the Borg scale in the POi (P < 0.001), but there were no statistically significant differences between the groups regarding the pain score. 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