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إلى مقارنة فعالية التنبيب الرغامي مع التهوية الميكانيكية والتهوية غير الباضعة كأكثر الطرق شيوعًا المستخدمة في إدارة مرضى صدمات الصدر في وحدة العناية المركزة. شارك في هذه الدراسة 68 مريضًا يعانون من صدمة في الصدر تبلغ أعمارهم 20-70 عامًا لمدة 2 عامًا. حضر المرضى قسم جراحة القلب والصدر بمستشفى جامعة الزقازيق. تم تقسيم المرضى المسجلين في هذه الدراسة إلى مجموعتين: الأولى تلقت تنبيبًا داخل الرقاقة باستخدام التهوية الميكانيكية (مجموعة MV) (المجموعة 1، n = 34) والأخرى تلقت تهوية غير جراحية (مجموعة NV) (المجموعة 2، n = 34). تمت مراقبة جميع المرضى المسجلين بمعايير سريرية بما في ذلك RR و HR و MAP و SpO2. واستخدمت برمجيات SPSS في التحليل الإحصائي. اعتبرت قيمة P < 0.05 ذات دلالة إحصائية. نتج عن هذه الدراسة أن متوسط نسبة HH و HR و pO2 و pCO2 و P/F قد تم تحسينها في مجموعة MV وكذلك في مجموعة NV ولكن هذا التحسن لم يكن كبيرًا. إن استخدام التهوية غير الباضعة يقلل من الوفيات والأضرار والمضاعفات بالإضافة إلى طول فترة الإقامة في العناية المركزة (ICU)، مما يؤدي إلى انخفاض التكلفة
July 2017 Interactive CardioVascular and Thoracic Surgery, Volume 25, Issue 6, December 2017, Pages 1012–1013,
2020; 68(05): 410-416 MEDICAL SCIENCE
Abstract Background: Adequate pain control after cardiac surgery is essential. Paravertebral block is a simple technique and avoids the potential complications of epidural catheters. The objective of this study is to compare the effect of ultrasound-guided bilateral thoracic paravertebral block with thoracic epidural block on pain control after cardiac surgery. Materials and methods: Between March 2016 and 2017, 145 patients who had cardiac surgery through median sternotomy were randomized by stratified blocked randomization into two groups. Group I (n = 70 patients) had bilateral ultrasound-guided thoracic paravertebral block and Group II (n = 75 patients) had thoracic epidural analgesia. The primary end point was the postoperative visual analogue scale (VAS). The duration of mechanical ventilation, intensive care unit (ICU), and hospital stay were the secondary end points. The study design is a randomized parallel superiority clinical trial. Results: Both groups had similar preoperative and operative characteristics. No significant difference in VAS measured immediately after endotracheal extubation then after 12, 24, and 48 hours between groups (p = 0.45). Pain score significantly declined with the repeated measures (p < 0.001) and the decline was not related to the treatment group. Postoperative pain was significantly related to diabetes mellitus (p = 0.039). Six patients in group I (8.5%) required an additional dose of morphine versus three patients (4%) in group II (p = 0.30). Patients in group I had significantly shorter ICU stay (p = 0.005) and lower incidence of urinary retention (p = 0.04) and vomiting (p = 0.018). No difference was found in operative complications between groups. Conclusion: This randomized parallel controlled trial demonstrates that ultrasound-guided paravertebral block is safe and effective method for relieving post-cardiac surgery sternotomy pain compared with thoracic epidural analgesia but not superior to it.
ABSTRACT Background: Chylothorax is a rare complication after adult cardiovascular surgery. Chylothorax directly affects postoperative course and morbidity. Methods: Data for this prospective study was collected between July 2017 and August 2021. Twenty patients who had adult cardiac surgery were included in our study. Demographic characteristics, operative and postoperative data were collected and analyzed. Somatostatin injections were used to control chyle leakage. Failure of conservative treatment was the indication of surgery. Results: This study included 20 patients, 13 males and 7 females, who recently underwent adult cardiovascular surgery. The mean age was 47.7±13.27 years. The mean duration for chyle effusion was 4.35±1.98 days, while the mean duration of drainage was 12.15±2.56 days. Analysis of pleural fluid revealed mean pH value = 7.3±0.05, mean total protein =2.7±0.3 g/dL, mean pleural glucose concentrations =123±33 mg/dl, mean cholesterol level =43±17 mg/dL, mean triglyceride level =489±39 mg/dL, and mean chylomicron level =7±0.4 mg/dl. There was a statistical significance regarding the response of postoperative chylothorax to somatostatin therapy (p=0.001). Surgery (mass ligation) was indicated in 4 cases secondary to failure of conservative treatment. There was a significant difference between ICT drainage/day in patients who were managed conservatively and those who were managed surgically (p =0.0001). Conclusion: Chylothorax is more common following CABG and Aortic arch surgeries, and it has a significant impact on the postoperative course and morbidity. The diagnosis and therapy should be initiated as soon as possible. Conservative management is feasible in 80% of cases.
ABSTRACT Background: Nowadays, video-assisted thoracoscopic surgery (VATS) is the management of choice for primary spontaneous pneumothorax (PSP). This prospective study was designed to address the efficacy and the possible advantages of using uniportal VATS when compared with triportal VATS in management of PSP. Method: A total of 80 VATS procedures were randomly done for PSP. 40 procedures were performed with uniportal VATS compared to 40 procedures performed with triportal VATS in the management of PSP. Patients were followed-up for 12 months postoperatively. Results: Both uniportal and triportal VATS have the same efficacy in managing PSP. There is no difference between both techniques regarding postoperative bleeding and air-leak (p=1.0). Uniportal VATS has a shorter operative time (66.32±3.46 vs 72.95±6.08 minutes, p<0.001). Adding another port wasn’t needed in uniportal VATS, while it was needed in 6 (15%) patients in triportal VATS group (p=0.026). Uniportal VATS has a statistically significant difference regarding postoperative pain duration (3.80±1.04 vs 4.32±0.47 days, p=0.005), early postoperative pain scale by visual analogue pain scale (1.77±1.02 vs 2.37±1.25, p=0.022), chest tube duration (4.85±0.57 vs 5.07±0.26 days, p=0.029), postoperative paresthesia (0.05±0.22 vs 0.90±0.74, p<0.001), postoperative hospital stay (5.45±0.50 vs 5.87±0.75 days, p=0.004), and better cosmesis (2.35±0.62 vs 1.92±0.65 on scale 1-3, p=0.004). Conclusions: Uniportal VATS is a safe and a feasible approach in management of PSP. Uniportal VATS is a good alternative to triportal VATS due to its efficacy in decreasing postoperative pain, paresthesia, total duration of hospital stay and in providing better cosmesis.
ABSTRACT Background: Pleural drainage is the preferred treatment for patients with symptomatic malignant pleural effusion. Insertion of a large bore chest tube for drainage prior to chemical pleurodesis is a standard treatment procedure. Small sized catheters (pigtail) are another option. However, for use in pleural drainage and pleurodesis, the optimal size of chest drains is still debatable. The aim of the study: Comparing the consequences and efficacy of bleomycin in pleurodesis using small sized pigtail (10-12 Fr) versus chest tube (24-30 Fr) in malignant pleural effusion. Patients and methods: A total of 130 patients with malignant pleural effusion were enrolled in this study. The patients were divided into two categories, Group A: a small sized pigtail catheter (10-12 French) was used in 72 patients and group B: a chest tube (24-30 French) was used in 58 patients. Male patients were 19 in group A and 18 in group B, with nearly same age range (51-67) and (55-70) year, respectively. All patients with manifested coagulopathy, loculated effusion or serious comorbidity were excluded. Results: Comparative results found that lung cancer was the main cause in both groups: adenocarcinoma 38.9 % in group A and 37.9 % in group B, followed by squamous cell carcinoma 11.1 % versus 6.9 %, respectively. Most body cancers were presented in both groups except stomach cancer was 0 % in both groups. Total success was slightly higher in group A 75 % compared to 72.4 % in group B but not statistically significant. Total hospital stay, postoperative pain score and dyspnea incidence were significantly less in group A where small pigtails were inserted. Conclusion: The chemical pleurodesis with bleomycin using small pore catheter (Pigtail) in MPE management is more effective, more patient- tolerable, than chest tube method. It is recommended to use of the pigtail drainage system rather than a chest tube in the treatment of MPE.

الابحاث العلمية

1 - Chylothorax complicating adult cardiovascular surgery: Multi-centres experience (2022).

2 - Comparative study between. uniportal and triportal VATS in. the management of primary. spontaneous pneumothorax (2021).

3 - Validity of pleurodesis with bleomycin by pigtail versus chest tube in malignant pleural effusion. (2021).

4 - Comparison between intubation and noninvasive ventilation in management of ICU chest trauma patients (2020).

5 - Impact of Thoracoscopic T2 Sympathectomy on Patients With Primary Palmar and Axillary Hyperhidrosis (2018).

6 - bilateral Paravertebral Block versus Thoracic Epidural Analgesia for Pain Control Post Cardiac Surgery: A Randomized Controlled Trial (2018).

7 - Bilateral uniportal video-assisted thoracoscopic lung resections (2012).

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