Nonintubated Spontaneous Ventilation Offers Better Short-term Outcome for Mediastinal Tumor Surgery

Liang, Hengrui; Li, Jun; Wu, Shilong; Zhang, Yaoliang; Liu, Hui; Yang, Hanyu; Zhao, Yi; Hao, Zhexue; Liang, Wenhua; He, Jianxing

doi:10.1016/j.athoracsur.2019.04.052

Cited by 28 publications

(34 citation statements)

References 23 publications

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“…With the application of tubeless approach, this method resulted in relief of symptoms, low rate of complications and fast recovery (7) . Previous studies showed that patients who underwent non-intubated surgery correlated with shorter postoperative hospital stays and postoperative fasting time, they also exhibited a trend toward lower cardiovascular complication rates (1.45% vs 2.69%) and respiratory complication rates (8.23% vs 11.18%) (8,9) . Compared with multiportal VATS, uniportal VATS might reduce post-operation pain and lead to faster recovery (10) .…”

Section: Discussionmentioning

confidence: 85%

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Tubeless Uniportal Thoracoscopic Wedge Resection with Modified Air Leak Test and Chest Tube Drainage

Liu

Yang

Sun

2020

Preprint

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Background: To investigate whether tubeless uniportal thoracoscopic wedge resection has better short-term outcomes than non-intubated approach with chest tube drainage.Methods: Data were collected retrospectively from January 2017 and December 2019. Tubeless group included 55 patients with pulmonary nodules underwent tubeless uniportal thoracoscopic wedge resection, 211 patients underwent non-intubated uniportal thoracoscopic wedge resection with chest tube drainage were included in drainage group. Perioperative outcomes between two groups were compared. Results: After 1:1 matching, 110 patients remained for analysis, baseline demographic and clinical variables were comparable between the two groups. Mean incision size was 3 cm in both group. Mean operative time was 59.3 minutes in tubeless group and 52.8 minutes in drainage group. The detectable mean lowest SpO2 and mean peak EtCO2 during operation was acceptable in both groups. Conversion to intubated ventilation or thoracotomy was not required. No patient failed the air leak test and did not undergo a tubeless procedure. Mean postoperative hospital stay was 1.5 days in tubeless group and 2.5 days in drainage group. Residual pneumothorax or subcutaneous emphysema was not frequent and mild in tubeless group. The postoperative pain VAS score was pain score was significantly lower in tubeless group in post-operative day 1 and 3. Side effects were rare and mild, including cough and hemoptysis. No reintervention or readmission occurred.Conclusions: Tubeless uniportal thoracoscopic wedge resection with modified air leak test and chest tube drainage is feasible and safe for selected patients with peripheral pulmonary nodules, it might reduce post-operation pain and lead to faster recovery.

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Section: Discussionmentioning

confidence: 85%

“…In tubeless group, the mean diameter of the lesions was 9.8 mm (7)(8)(9)(10)(11)(12)(13)(14). The locations of PPN included right upper lobe, right lower lobe, left upper lobe and left lower lobe.…”

Section: Resultsmentioning

confidence: 99%

Tubeless Uniportal Thoracoscopic Wedge Resection with Modified Air Leak Test and Chest Tube Drainage

Liu

Yang

Sun

2020

Preprint

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“…After 1:1 matching, 110 patients remained for analysis, baseline demographic and clinical variables were comparable between the two groups (Table 1). In tubeless group, the mean diameter of the lesions was 9.8 mm (7)(8)(9)(10)(11)(12)(13)(14). The postoperative VAS score was signi cantly lower in tubeless group than in drainage group in postoperative day 1 and 3.…”

Section: Resultsmentioning

confidence: 90%

Tubeless Uniportal Thoracoscopic Wedge Resection with Modified Air Leak Test and Chest Tube Drainage

Liu

Yang

Sun

2020

Preprint

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Background: To investigate whether tubeless uniportal thoracoscopic wedge resection with modified air leak test and chest tube drainage has better short-term outcomes than non-intubated approach with chest tube drainage.Methods: Data were collected retrospectively from January 2017 and December 2019. Tubeless group included 55 patients with pulmonary nodules underwent tubeless uniportal thoracoscopic wedge resection, 211 patients underwent non-intubated uniportal thoracoscopic wedge resection with chest tube drainage were included in drainage group. Peri-operative outcomes between two groups were compared. Results: After 1:1 matching, 110 patients remained for analysis, baseline demographic and clinical variables were comparable between the two groups. Mean incision size was 3 cm in both group. Mean operative time was 59.3 minutes in tubeless group and 52.8 minutes in drainage group. The detectable mean lowest SpO2 and mean peak EtCO2 during operation was acceptable in both groups. Conversion to intubated ventilation or thoracotomy was not required. No patient failed the air leak test and did not undergo a tubeless procedure. Mean postoperative hospital stay was 1.5 days in tubeless group and 2.5 days in drainage group. Residual pneumothorax or subcutaneous emphysema was not frequent and mild in tubeless group. Side effects were rare and mild, including cough and hemoptysis. No re-intervention or readmission occurred. The postoperative VAS score was significantly lower in tubeless group.Conclusions: Tubeless uniportal thoracoscopic wedge resection with modified air leak test and chest tube drainage is feasible and safe for selected patients with peripheral pulmonary nodules, it might reduce post-operation pain and lead to faster recovery.

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“…Twenty-two studies reported the patient hospital stay after surgery[10–12,15–17,26–29,31–38,41,43–46]. In the primary analysis including these 22 studies, NIA significantly reduced postoperative hospital stay (SMD -0.57 days, 95% CI -0.78 to -0.36, P = 0.000; Fig 4).…”

Section: Resultsmentioning

confidence: 99%

Non-intubated anesthesia in patients undergoing video-assisted thoracoscopic surgery: A systematic review and meta-analysis

Ren

et al. 2019

PLoS ONE

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IntroductionNon-intubated anesthesia (NIA) has been proposed for video-assisted thoracoscopic surgery (VATS), although how the benefit-to-risk of NIA compares to that of intubated general anesthesia (IGA) for certain types of patients remains unclear. Therefore, the aim of the present meta-analysis was to understand whether NIA or IGA may be more beneficial for patients undergoing VATS.MethodsA systematic search of Cochrane Library, Pubmed and Embase databases from 1968 to April 2019 was performed using predefined criteria. Studies comparing the effects of NIA or IGA for adult VATS patients were considered. The primary outcome measure was hospital stay. Pooled data were meta-analyzed using a random-effects model to determine the standard mean difference (SMD) with 95% confidence intervals (CI).Results and discussionTwenty-eight studies with 2929 patients were included. The median age of participants was 56.8 years (range 21.9–76.4) and 1802 (61.5%) were male. Compared to IGA, NIA was associated with shorter hospital stay (SMD -0.57 days, 95%CI -0.78 to -0.36), lower estimated cost for hospitalization (SMD -2.83 US, 95% CI -4.33 to -1.34), shorter chest tube duration (SMD -0.32 days, 95% CI -0.47 to -0.17), and shorter postoperative fasting time (SMD, -2.76 days; 95% CI -2.98 to -2.54). NIA patients showed higher levels of total lymphocytes and natural killer cells and higher T helper/T suppressor cell ratio, but lower levels of interleukin (IL)-6, IL-8 and C-reactive protein (CRP). Moreover, NIA patients showed lower levels of fibrinogen, cortisol, procalcitonin and epinephrine.ConclusionsNIA enhances the recovery from VATS through attenuation of stress and inflammatory responses and stimulation of cellular immune function.

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Nonintubated Spontaneous Ventilation Offers Better Short-term Outcome for Mediastinal Tumor Surgery

Cited by 28 publications

References 23 publications

Tubeless Uniportal Thoracoscopic Wedge Resection with Modified Air Leak Test and Chest Tube Drainage

Tubeless Uniportal Thoracoscopic Wedge Resection with Modified Air Leak Test and Chest Tube Drainage

Tubeless Uniportal Thoracoscopic Wedge Resection with Modified Air Leak Test and Chest Tube Drainage

Non-intubated anesthesia in patients undergoing video-assisted thoracoscopic surgery: A systematic review and meta-analysis

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