scholarly journals P085: Potential benefits of incentive spirometry following a rib fracture: a propensity-score analysis

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S87-S87
Author(s):  
M. Emond ◽  
A. Laguë ◽  
B. Batomen Kuimi ◽  
V. Boucher ◽  
C. Guimont ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Analysis ◽  
Pulmonary Complications ◽  
Rib Fractures ◽  
Rib Fracture ◽  
Thoracic Injury ◽  
Main Complaint ◽  
Score Analysis ◽  
Discharged Patients ◽  
Incentive Spirometry

Introduction: Incentive spirometry (IS) is commonly used in post-operative patients for respiratory recovery. Literature suggest that it can possibly improve lung function and reduce post-operative pulmonary complication. There is no recommendation about the use of IS in the emergency department (ED). However, rib fractures, a common complaint, increase the risk of pulmonary complications. There is heterogeneous ED practice for the management of rib fractures. The objective of this study is to assess the benefits of IS to reduce potential delayed complications in ED discharged patients with confirmed rib fracture. Methods: This is a prospective observational planned sub-study in 4 canadians ED between November 2006 and May 2012. Non-admitted patients over 16 y.o. with a main complaint of minor thoracic injury and at least one suspected/confirmed rib fracture on radiographs were included. Discharge recommendations of IS use was left to attending physician. IS training was done by ED nurses. Main outcomes were pneumonia, atelectasis and hemothorax within 14 days. Analyses were made with propensity score matching. Results: 450 patients with at least one rib fracture were included. Of these, 182 (40%) received IS with a mean age of 57.0 y.o. Patients with IS seem to have worse condition. 61 (33.5%) had 3 fractures comparatively to 56 (20.9) for patient without IS. Although, the groups were similar for mean age, sex and mechanism of injury. There were in total 76 cases of delayed hemothorax (16.9%), 69 cases of atelectasis (15.3%) and five cases of pneumonia (1.1%). The use of IS was not protector for delayed hemothorax (RR= 0.80, 95% CI [0.45 1.36]) and nor for atelectasis or pneumonia (RR=0.74, 95% CI [0.45 1.36]) Conclusion: Our results suggest that unsupervised and broad incentive spirometry use does not seem to add a protective effect against the development of delayed pulmonary complications after a rib fracture. Further study should be made to assess the usefulness of IS in specific injured population in the ED.

scholarly journals Potential benefits of incentive spirometry following a rib fracture: a propensity score analysis

CJEM ◽  
2019 ◽  
Vol 21 (4) ◽  
pp. 464-467 ◽  
Author(s):  
Brice Lionel Batomen Kuimi ◽  
Antoine Lague ◽  
Valérie Boucher ◽  
Chantal Guimont ◽  
Jean-Marc Chauny ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Analysis ◽  
Pulmonary Complications ◽  
Rib Fracture ◽  
Score Analysis ◽  
Potential Benefits ◽  
Observational Cohort ◽  
Respiratory Recovery ◽  
Attending Physician ◽  
Incentive Spirometry

ABSTRACTObjectivesIncentive Spirometry is commonly used for respiratory recovery. The literature on incentive spirometry and its impact on patients with rib fracture is unclear and there are no recommendations regarding its use in the Emergency Department (ED), particularly in rib fracture patients, which are known for increasing the risk of pulmonary complication. Therefore, the objective of this study was to assess the use of incentive spirometry and to measure its impacts on delayed complications in patients discharged from the ED with confirmed rib fracture.MethodsThis is a planned sub-study of a prospective observational cohort recruited in 4 Canadians ED between November 2006 and May 2012. Non-admitted patients over 16 y.o. with at least one confirmed rib fracture on radiographs were included. Prescription of incentive spirometry was left to attending physician. Main outcomes were development of pneumonia, atelectasis, and hemothorax within 14 days. Propensity score matching analyses were performed.Results439 patients were included and 182 (41.5%) patients received incentive spirometry. There were 99 cases of hemothorax (22.6%), 103 cases of atelectasis (23.5%) and 4 cases of pneumonia (0.9%). The use of incentive spirometry was not protector for hemothorax [RR = 1.03 (0.66–1.64)] and atelectasis or pneumonia [RR = 1.07 (0.68–1.72)].ConclusionsOur results suggest that unsupervised incentive spirometry use does not have a protective effect against delayed pulmonary complications after rib fracture. Further research should be conducted to assess the usefulness of incentive spirometry in specific injured population in the ED.

scholarly journals Potential benefits of incentive spirometry following a rib fracture: a propensity-score analysis – CORRIGENDUM

CJEM ◽  
2019 ◽  
Vol 21 (5) ◽  
Author(s):  
Brice Lionel Batomen Kuimi ◽  
Antoine Lague ◽  
Valérie Boucher ◽  
Chantal Guimont ◽  
Jean-Marc Chauny ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Analysis ◽  
Rib Fracture ◽  
Score Analysis ◽  
Potential Benefits ◽  
Incentive Spirometry

Efficacy of variceal embolisation in patients with TIPS implantation: a propensity score analysis

2018 ◽  
Vol 56 (01) ◽  
pp. E2-E89
Author(s):  
M Giesler ◽  
D Bettinger ◽  
M Rössle ◽  
R Thimme ◽  
M Schultheiss
Keyword(s):  
Propensity Score ◽  
Propensity Score Analysis ◽  
Score Analysis

scholarly journals Morbidity and mortality of lobectomy or pneumonectomy after neoadjuvant treatment: an analysis from the ESTS database

2019 ◽  
Author(s):  
Alessandro Brunelli ◽  
Gaetano Rocco ◽  
Zalan Szanto ◽  
Pascal Thomas ◽  
Pierre Emmanuel Falcoz
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Propensity Score ◽  
Propensity Score Analysis ◽  
Bronchopleural Fistula ◽  
Neoadjuvant Treatment ◽  
Mortality Rates ◽  
Induction Treatment ◽  
Score Analysis ◽  
Cardiopulmonary Complications ◽  
Lung Resections

Abstract OBJECTIVES To evaluate the postoperative complications and 30-day mortality rates associated with neoadjuvant chemotherapy before major anatomic lung resections registered in the European Society of Thoracic Surgeons (ESTS) database. METHODS Retrospective analysis on 52 982 anatomic lung resections registered in the ESTS database (July 2007–31 December 2017) (6587 pneumonectomies and 46 395 lobectomies); 5143 patients received neoadjuvant treatment (9.7%) (3993 chemotherapy alone and 1150 chemoradiotherapy). To adjust for possible confounders, a propensity case-matched analysis was performed. The postoperative outcomes (morbidity and 30-day mortality) of matched patients with and without induction treatment were compared. RESULTS 8.2% of all patients undergoing lobectomies and 20% of all patients undergoing pneumonectomies received induction treatment. Lobectomy analysis: propensity score analysis yielded 3824 pairs of patients with and without induction treatment. The incidence of cardiopulmonary complications was higher in the neoadjuvant group (626 patients, 16% vs 446 patients, 12%, P < 0.001), but 30-day mortality rates were similar (71 patients, 1.9% vs 75 patients, 2.0%, P = 0.73). The incidence of bronchopleural fistula and prolonged air leak >5 days were similar between the 2 groups (neoadjuvant: 0.5% vs 0.4%, P = 0.87; 9.2% vs 9.9%, P = 0.27). Pneumonectomy analysis: propensity score analysis yielded 1312 pairs of patients with and without induction treatment. The incidence of cardiopulmonary complications was higher in the treated patients compared to those without neoadjuvant treatment (neoadjuvant 275 cases, 21% vs 18%, P = 0.030). However, the 30-day mortality was similar between the matched groups (neoadjuvant 68 cases, 5.2% vs 5.3%, P = 0.86). Finally, the incidence of bronchopleural fistula was also similar between the 2 groups (neoadjuvant 1.8% vs 1.4%, P = 0.44). CONCLUSIONS Neoadjuvant chemotherapy is not associated with an increased perioperative risk after either lobectomy or pneumonectomy, warranting a more liberal use of this approach for patients with locally advanced operable lung cancer.

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