The effectiveness of high dependency unit in the management of high risk thoracic surgical cases

Ghosh, Shilajit; Steyn, Richard; Marzouk, J.F.K.; Collins, Frank J.; Rajesh, P.

doi:10.1016/s1010-7940(03)00610-9

Cited by 27 publications

(13 citation statements)

References 4 publications

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“…Previous studies have indicated that concomitant diseases, such as ischemic heart disease, diabetes mellitus, or chronic obstructive lung disease, represent significant risk factors for an adverse outcome, and performance status, ASA score, and CCI were reported as useful parameters for postoperative complications [4,10-13]. However, in this study, these parameters were not statistically significant prediction factors.…”

Section: Discussioncontrasting

confidence: 68%

Immediate Postoperative Care in the General Thoracic Ward Is Safe for Low-risk Patients after Lobectomy for Lung Cancer

Park

Hwang

et al. 2011

Korean J Thorac Cardiovasc Surg

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BackgroundFollowing major lung resection, patients have routinely been monitored in the intensive care unit (ICU). Recently, however, patients are increasingly being placed in a general thoracic ward (GTW). We investigated the safety and efficacy of the GTW care after lobectomy for lung cancer.Materials and Methods316 patients who had undergone lobectomy for lung cancer were reviewed. These patients were divided into two groups: 275 patients were cared for in the ICU while 41 patients were care for in the GTW immediately post-operation. After propensity score matching, postoperative complications and hospital costs were analyzed. Risk factors for early complications were analyzed with the whole cohort.ResultsEarly complications (until the end of the first postoperative day) occurred in 11 (3.5%) patients. Late complications occurred in 42 patients (13.3%). After propensity score matching, the incidence of early complications, late complications, and mortality were not different between the two groups. The mean expense was higher in the ICU group. Risk factors for early complications were cardiac comorbidities and low expected forced expiratory volume in one second. The location of postoperative care had no influence on outcome.ConclusionImmediate postoperative care after lobectomy for lung cancer in a GTW was safe and cost-effective without compromising outcomes in low-risk patients.

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Section: Discussioncontrasting

confidence: 68%

Immediate Postoperative Care in the General Thoracic Ward Is Safe for Low-risk Patients after Lobectomy for Lung Cancer

Park

Hwang

et al. 2011

Korean J Thorac Cardiovasc Surg

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“…However, observational studies have demonstrated the appropriateness and advantages of the HDU as reflected by low mortality and morbidity rates (2-3% and 10-20%, respectively) while the admission rate to ICU remained ,2% [169,[188][189][190][191].…”

Section: Do We Need To Send All Thoracotomies To the Icu?mentioning

confidence: 99%

ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy)

Brunelli¹,

Charloux²,

Bolliger³

et al. 2009

Eur Respir J

768

550

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A collaboration of multidisciplinary experts on the functional evaluation of lung cancer patients has been facilitated by the European Respiratory Society (ERS) and the European Society of Thoracic Surgery (ESTS), in order to draw up recommendations and provide clinicians with clear, up-to-date guidelines on fitness for surgery and chemo-radiotherapy.The subject was divided into different topics, which were then assigned to at least two experts. The authors searched the literature according to their own strategies, with no central literature review being performed. The draft reports written by the experts on each topic were reviewed, discussed and voted on by the entire expert panel. The evidence supporting each recommendation was summarised, and graded as described by the Scottish Intercollegiate Guidelines Network Grading Review Group. Clinical practice guidelines were generated and finalised in a functional algorithm for risk stratification of the lung resection candidates, emphasising cardiological evaluation, forced expiratory volume in 1 s, systematic carbon monoxide lung diffusion capacity and exercise testing.Contrary to lung resection, for which the scientific evidences are more robust, we were unable to recommend any specific test, cut-off value, or algorithm before chemo-radiotherapy due to the lack of data. We recommend that lung cancer patients should be managed in specialised settings by multidisciplinary teams.

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“…However, other reports have identified both the hospital volume as well as the specialization of the surgeon in only noncardiac thoracic surgery as important prognostic factors, [20][21][22] as well as the existence of specialized teams and postoperative monitoring and treatment units. 23 Our institution and its support staff have specific expertise in pneumonectomies because of our high volume of extrapleural pneumonectomies for mesothelioma (90 performed in 2006) and have published improvements in the surgical techniques of these patients. 5,24,25 Whether this experience in mesothelioma translates to an improved outcome in the management of pneumonectomy patients after chemoradiation in NSCLC is unknown.…”

Section: Discussionmentioning

confidence: 99%

Pneumonectomy after chemoradiation

Allen

Mentzer

Yeap

et al. 2008

Cancer

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Acute lymphoblastic leukemia (ALL) is the most common cancer in children. The current treatment protocol for ALL involves an intense chemotherapy regimen yielding cure rates of nearly 80%. However, new therapies need to be designed not only to increase the survival rate but also to combat the risk of severe therapy associated toxicities including secondary malignancies, growth problems, organ damage, and infertility. The c‐Myb proto‐oncogene is highly expressed in immature hematopoietic cells. In this study, we demonstrate that loss of c‐Myb itself decreased the viability of these leukemic cells. Additionally, the inhibition of c‐Myb caused a decrease in cell proliferation, significantly increased the number of cells in G0/G1 phase of the cell cycle, increased the sensitivity of pre‐B‐ALL cells to cytotoxic agents in vitro, and significantly delayed disease onset in a mouse model of leukemia. Furthermore, we demonstrate that Bcl‐2 is a target of c‐Myb in pre‐B‐ALL cells. Our results identify c‐Myb as a potential therapeutic target in pre‐B‐ALL and suggest that suppression of c‐Myb levels or activity, in combination with currently used therapies and/or dose reduction, may lead to a decrease in toxicity and an increase in patient survival rates. Because c‐Myb is aberrantly expressed in several other malignancies, targeting c‐Myb will have broad clinical applications. Am. J. Hematol., 2012. © 2012 Wiley Periodicals, Inc.

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The effectiveness of high dependency unit in the management of high risk thoracic surgical cases

Cited by 27 publications

References 4 publications

Immediate Postoperative Care in the General Thoracic Ward Is Safe for Low-risk Patients after Lobectomy for Lung Cancer

Immediate Postoperative Care in the General Thoracic Ward Is Safe for Low-risk Patients after Lobectomy for Lung Cancer

ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy)

Pneumonectomy after chemoradiation

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