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    ABSTRACT: Thoracotomy is a common procedure. However, thoracotomy leads to lung atelectasis and deteriorates pulmonary gas exchange in operated side. Therefore, different positions with operated side lowermost or uppermost may lead to different gas exchange after thoracotomy. Besides, PEEP (positive end-expiratory pressure) influence lung atelectasis and should influence gas exchange. The purpose of this study was to determine the physiological changes in different positions after thoracotomy. In addition, we also studied the influence of PEEP to positional effects after thoracotomy. There were eight pigs in each group. Group I received left thoracotomy with zero end-expiratory pressure (ZEEP), and group II with PEEP; group III received right thoracotomy with ZEEP and group IV with PEEP. We changed positions to supine, LLD (left lateral decubitus) and RLD (right lateral decubitus) in random order after thoracotomy. PaO2 was decreased after thoracotomy and higher in RLD after left thoracotomy and in LLD after right thoracotomy. PaO2 in groups II and IV was higher than in groups I and III if with the same position. In group I and III, PaCO2 was increased after thoracotomy and was higher in LLD after left thoracotomy and in RLD after right thoracotomy. In groups II and IV, there were no PaCO2 changes in different positions after thoracotomy. Lung compliance (Crs) was decreased after thoracotomy in groups I and III and highest in RLD after left thoracotomy and in LLD after right thoracotomy. In groups II and IV, there were no changes in Crs regardless of the different positions. There were significant changes with regards to pulmonary gas exchange, hemodynamics and Crs after thoracotomy. The best position was non-operated lung lowermost Applying PEEP attenuates the positional effects.
    Annals of Thoracic Medicine 03/2014; 9(2):112-119. DOI:10.4103/1817-1737.128860 · 1.34 Impact Factor
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    ABSTRACT: Background Blunt chest injury is not uncommon in trauma patients. Hemothorax and pneumothorax may occur in these patients, and some of them will develop retained pleural collections. Video-assisted thoracoscopic surgery (VATS) has become an appropriate method for treating these complications, but the optimal timing for performing the surgery and its effects on outcome are not clearly understood. Materials and Methods In this study, a total of 136 patients who received VATS for the management of retained hemothorax from January 2003 to December 2011 were retrospectively enrolled. All patients had blunt chest injuries and 90% had associated injuries in more than two sites. The time from trauma to operation was recorded and the patients were divided into three groups: 2–3 days (Group 1), 4–6 days (Group 2), and 7 or more days (Group 3). Clinical outcomes such as the length of stay (LOS) at the hospital and intensive care unit (ICU), and duration of ventilator and chest tube use were all recorded and compared between groups. Results The mean duration from trauma to operation was 5.9 days. All demographic characteristics showed no statistical differences between groups. Compared with other groups, Group 3 had higher rates of positive microbial cultures in pleural collections and sputum, longer duration of chest tube insertion and ventilator use. Lengths of hospital and ICU stay in Groups 1 and 2 showed no statistical difference, but were longer in Group 3. The frequency of repeated VATS was lower in Group 1 but without statistically significant difference. Discussion This study indicated that an early VATS intervention would decrease chest infection. It also reduced the duration of ventilator dependency. The clinical outcomes were significantly better for patients receiving VATS within 3 days under intensive care. In this study, we suggested that VATS might be delayed by associated injuries, but should not exceed 6 days after trauma.
    Injury 09/2014; 45(9). DOI:10.1016/j.injury.2014.05.036 · 2.46 Impact Factor
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    Revista do Colégio Brasileiro de Cirurgiões 08/2012; 39(4):344-9. DOI:10.1590/S0100-69912012000400017