Effect of Placing Double-lumen Irrigation-suction Tube on Spontaneous Closure of Anastomotic Leakage Following Rectal Cancer Surgery

Purpose: This study aimed to explore the effect of placement of double-lumen irrigation-suction tubes (DLIST) on the spontaneous closure of anastomotic leakages (AL) after rectal cancer surgery. Methods: The study was performed at two centers which was managed by the same chief. The treatment in the two center were same. From January 2011 to June 2020, patients with postoperative AL after rectal cancer surgery were eligible. Patients were divided into a passive drainage (PD) group and a DLIST group according to whether the PD,placed during the rectal cancer surgery, had been replaced with the DLIST. The effect of DLIST on the AL was evaluated.Result: There were 76 patients in the DLIST group and 52 in the PD group. The DLIST group was more inclined to achieve spontaneous closure of AL (HR =3.048; 95% CI: 1.787-5.197; P<0.001). Both length of stay and costs of the treatment in the DLIST group were lower (54 [41.25-117] days vs. 112 [66.75-127.75] days, P =0.005; and $18,721 [$14,982-44,960] vs. $40,840 [$20,932-50,529], P < 0.001).Conclusion: Placement of DLIST is an effective method for treating AL following rectal cancer surgery. Compared with PD, the cost of DLIST in the treatment of AL is lower and the length of stay is shorter.

Stapling of an endobronchial suction tube with the bronchus during robot-assisted right lower lobectomy: a case report

Background Troubleshooting intraoperative complications requires careful management, and the safest technique should be chosen. We recently experienced a unique intraoperative bronchial complication during pulmonary lobectomy in robot-assisted thoracic surgery (RATS). There is no consensus on whether to continue RATS or convert to a more familiar technique, such as video-assisted thoracic surgery (VATS) or thoracotomy, for intraoperative complications that occur during RATS, and the decision should be determined individually. Case presentation A 74-year-old woman with primary lung adenocarcinoma (clinical stage IA2) underwent robot-assisted right lower lobectomy under one-lung ventilation and CO2 insufflation. Intraoperatively, the anesthesiologist placed the endobronchial suction tube in the right bronchus with intention of maintaining the right lung collapse, which was simultaneously stapled with the right lower bronchus during the right lower lobe bronchial closure using a robotic stapler. During robot-assisted manipulation, we removed the staples involved with the suction tube, one by one, using robotic-arm forceps and sutured the partially opened stump. Subsequently, the bronchial stump was covered with a pedicled pericardial fat pad. The postoperative course was uneventful, and the patient developed no complications when followed up 8 months after discharge. Hence, we could rectify this intraoperative bronchial complication using a robot-assisted technique and avoid conversion to VATS or thoracotomy. Conclusion The precise manipulation techniques in RATS contributed to facilitate the successful execution of surgical procedures, such as staple removal and re-suturing of the bronchial stump and may be a useful as a method for such troubleshooting such intraoperative complications.

Endoscopic ‘suction room’ to treat complex enteral stump leaks after upper gastrointestinal surgery

Leaks/dehiscence of the enteral stump associated with infected peri-enteric collections after upper gastrointestinal surgery are a life-threatening adverse event, not usually endoscopically treatable.We describe a new endoscopic approach to treat complex entero-cutaneous fistulas (CECF) by creating a “suction room” through placement of multiple stents (enteral, biliary and/or pancreatic) and a large nose-enteral suction tube inside the enteral stent maintained on a continuous negative aspiration suction.Between January 2016 and December 2019, six consecutive patients referred to our unit with CECF of the enteral stump after failed redo surgeries underwent creation of a “suction room.” In five patients, enteral, biliary and pancreatic stents were positioned before a nose-to-stent or nose-to-collection large 18 Fr tube placement. In one patient, a pancreatic stent was not placed. Technical and clinical success were achieved in all patients. Mean and median times of aspiration were 49 and 27 days, respectively, with a mean hospital stay of 56 days after the endoscopic procedure. Stents were successfully removed. Mean post-procedural follow-up was 17.3 months.Endoscopic creation of the “suction room” offers the unique possibility of treating complex entero-cutaneous fistulas in surgically altered sites, which are difficult to manage with standard endoscopic methods.

Laryngeal suction tube: A novel technique for tracheal ventilation in an obstructed airway in a child with respiratory papillomatosis

Background Airway obstruction in a child requires expedite management in addition to comprehensive discussion between the Otolaryngology and Anaesthesiology team to formulate a treatment plan to ensure safe airway. Juvenile-onset recurrent respiratory papillomatosis (JORRP) is an exophytic benign laryngeal lesion which poses a great challenge when presented with respiratory distress. Objective: This paper presents a novel, safe and cost-effective approach to temporary tracheal ventilation of the obstructed airway in a child with juvenile-onset recurrent respiratory papillomatosis using the laryngeal suction tube connected to general anaesthetic (GA) machine. Result and Conclusion Rigid laryngeal suction tube is placed through the side-port of Lindholm laryngoscope and connected to breathing circuit of GA machine via modification of the suction tubing and endotracheal tube (ETT) 15mm male connector. Manual bagging ventilation with 100% FiO2 achieved good oxygenation throughout the debulking of the papilloma without hindering the surgical field. Our technique utilizes the readily available equipment whilst enabling safe anaesthesia and providing good surgical field during excision of obstructive papillomatous airway lesion.

Nursing in Intensive Care Unit: Exploring Factors Related to Ventilator-Associated Pneumonia

Background:Most patients hospitalized intensive care units require mechanical ventilation.Ventilator-associated pneumonia is the most common and severe complication of mechanical ventilation.Nursing factors are closely related to the incidence of this type of pneumonia.Objectives:To explore nursing risk factors associated with ventilator-associated pneumonia(VAP ).Committing to provide the basis for future nursing training and quality control for technical offices.Methods:Through the quality control platform of Hebei province, questionnaires were sent to the intensive care nurses in 37 tertiary hospitals(5 hospitals were excluded due to incomplete information) in Hebei province,China, to collect the incidence of VAP and the nursing status of them from January to December 2019. All date was analyzed using an independent t-test, ANOVA, and Pearson correlation.Resluts:Two central themes were derived from the data analysis:Nurse human resources and standard of nursing practice.The incidence of VAP was higher when the proportion of nurses working less than five years and the number of nurses working night shifts increased(P = 0.000). The incidence of VAP was lower when the sputum suction tube radius was smaller and the selected oral care solution had disinfection effect(P = 0.000).Conclusions:The incidence of VAP is closely related to nursing factors.Choose different thickness of sputum suction tube and oral nursing liquid will lead to different outcomes.In addition, different nursing staff structure and scheduling mode will directly affect the incidence of VAP.Therefore, we should continue to standardize and unify nursing operation, and optimize nursing staff structure and scheduling mode.

Design, concept and first in-vitro results of the percutaneous, pulsatile left ventricular assist device-PERKAT LV

Introduction A very high morbidity and mortality is associated with cardiogenic shock due to left ventricular failure despite encouraging developments in interventional cardiology. Patients suffering from cardiogenic shock often require temporary mechanical circulatory support to stabilize organ perfusion. In addition, an increasing number of patients with complex multi-vessel diseases cannot undergo surgical myocardial revascularization as recommended by recent guidelines due to their comorbidities. Those patients could benefit from a protected PCI approach using a temporary mechanical assist device. The available LVAD systems have specific advantages and disadvantages. Purpose It was our aim to develop a percutaneous, pulsatile assist device that unloads the left ventricle in a physiologic way. Methods The PERKAT-LV (“PERkutane KATheterpumptechnologie”) device consists of a self-expanding nitinol pump chamber which is covered by foils. Those foils carry multiple outflow valves at the proximal part of the pump chamber. A flexible suction tube with a pigtail-shaped tip and inflow holes are attached to its distal part. The system is designed for 16F percutaneous implantation via the femoral artery. Pulling back the outer sheath unfolds the nitinol chamber in the descending aorta while the flexible suction tube bypasses the aortic arch and ascending aorta with its tip in the left ventricle. In the second implantation step, a standard IABP balloon is placed into the pumping chamber and is connected to an external IABP console. Balloon deflation generates a blood flow from the left ventricle into PERKAT LV. During balloon inflation, blood leaves the system through the outflow foil valves in the descending aorta. Positioning and schematic drawing of PERKAT-LV is demonstrated in Figure 1. Results Preliminary in-vitro studies using a prototype of the PERKAT LV device were performed. It was tested in different afterload settings (0, 40, 80 and 120 mmHg) using a standard 30 ccl IABP balloon and varying inflation/deflations rates (70, 80, 90, 100, 110 and 120/min). We detected flow rates ranging from 2.0 to 3.0 L/min depending on the afterload setting and inflation/deflation rate. Conclusion The novel percutaneously implantable and pulsatile working PERKAT-LV device offers left ventricular unloading and circulatory support of up to 3.0 L/min in a first feasibility study. At the moment, the system is extensively studied under in vitro conditions. First in vivo evaluation will follow in the near future. Based on the current results, we believe that the system is a promising novel approach for percutaneous application of temporary left ventricular mechanical support. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): German Federal Ministry of Education and Research