Cerebral oximeters enable continuous non-invasive monitoring of cerebral oxygenation.• Cerebral oximeters utilize similar physical principles to pulse oximeters.

There is paucity of data on the impact of surgical incision and analgesia on relevant outcomes. A retrospective STROBE-compliant cohort study was performed between July 2007 and August 2017 of patients undergoing lung transplantation. Gender, age, indication for lung transplantation, and the 3 types of surgical access (Thoracotomy (T), Sternotomy (S), and Clamshell (C)) were used, as well as 2 analgesic techniques: epidural and intravenous opioids. Outcome variables were: pain scores; postoperative hemorrhage in the first 24 hours, duration of mechanical ventilation, and length of stay at intensive care unit (ICU). Three hundred forty-one patients were identified. Thoracotomy was associated with higher pain scores than Sternotomy (OR 1.66, 95% CI: 1.01; 2.74, P : .045) and no differences were found between Clamshell and Sternotomy incision. The median blood loss was 800 mL [interquartile range (IQR): 500; 1238], thoracotomy patients had 500 mL [325; 818] ( P < .001). Median durations of mechanical ventilation in Thoracotomy, Sternotomy, and Clamshell groups were 19 [11; 37] hours, 34 [IQR 16; 57.5] hours, and 27 [IQR 15; 50.5] hours respectively. Thoracotomy group were discharged earlier from ICU ( P < .001). Thoracotomy access produces less postoperative hemorrhage, duration of mechanical ventilation, and lower length of stay in ICU, but higher pain scores and need for epidural analgesia.

Central venoarterial extracorporeal membrane oxygenation has been used since the 1970s to support patients with cardiogenic shock following cardiac surgery. Despite this, in-hospital mortality is still high, and although rare, thrombus within the cardiac chambers or within the extracorporeal membrane oxygenation circuit is often fatal. Aprotinin is an antifibrinolytic available in Europe and Canada, though not currently in the United States. Due to historical safety concerns, use of aprotinin is generally limited and is commonly reserved for patients with the highest bleeding risk. Given the limited availability of aprotinin over the last decade, it is not surprising to find a complete absence of literature describing the use of venoarterial extracorporeal membrane oxygenation in the presence of aprotinin. We present three consecutive cases of rapid fatal intraoperative intracardiac thrombosis associated with post-cardiotomy central venoarterial extracorporeal membrane oxygenation in patients receiving aprotinin.

Background: Lung transplantation is the ultimate treatment for end stage lung disease. There is paucity of data on the impact of surgical incision and analgesia on clinically relevant outcomes. Methods: A single centre retrospective study was performed between July 2007 and August 2017 of patients undergoing single or double lung transplantation. Gender, age, indication for lung transplantation, and the three types of surgical access (Thoracotomy (T), Sternotomy (S) and Clamshell (C)) were used, as well as two analgesic techniques: epidural and intravenous opioids. Outcome variables of the study were: Pain scores; Postoperative hemorrhage in the first 24 hours, duration of mechanical ventilation and length of stay at ICU. Results: 341 patients were identified. Thoracotomy was associated with higher pain scores than Sternotomy (OR 1.66, 95% CI: 1.01;2.74, p: 0.045) and no differences were found between Clamshell and Sternotomy incision.The median blood loss was 800 ml [IQR: 500; 1238], thoracotomy patients had 500 ml [325;818] (p < 0.001). Median duration of mechanical ventilation in Thoracotomy, Sternotomy and Clamshell groups were 19 [11; 37] hours, 34 [IQR 16; 57.5] hours and 27 [IQR 15; 50.5] hours respectively. Thoracotomy group were discharged earlier from ICU (p<0.001). Conclusions : Thoracotomy access produces less postoperative hemorrhage, duration of mechanical ventilation and lower length of stay in ICU, but higher pain scores and need for epidural analgesia.

No abstract