Value of Peak Expiratory Flow Rate in Evaluating Cough Ability in Patients Undergoing Lung Surgery

Introduction. Postoperative ineffective cough is easy to occur after thoracic surgery, and it is also a risk factor for postoperative pulmonary complications (PPCs). Objectives. To explore the value of peak expiratory flow rate (PEF) in evaluating cough ability in patients undergoing lung surgery and evaluate the effectiveness of chest wall compression during the expiratory phase by PEF. Methods. From September 2020 to May 2021, the researchers collected the data of patients who underwent lung surgery. Eventually, 153 patients who met the criteria were included, 102 cases were included in the effective cough group and 51 cases were included in the ineffective cough group. The receiver working curve (ROC curve) was used to analyze whether PEF could evaluate cough ability. At the same time, the researchers collected the pulmonary function data of the first 30 patients of the ineffective cough group while compressing the chest wall during the expiratory phase to evaluate the effectiveness of chest wall compression. Results. The area under the curve (AUC) of postoperative PEF to evaluate the postoperative cough ability was 0.955 (95% CI: 0.927–0.983, P < 0.001 ). The values of PEF (127.17 ± 34.72 L/min vs. 100.70 ± 29.98 L/min, P < 0.001 , 95% CI: 18.34–34.59) and FEV1 (0.72 (0.68–0.97) L vs. 0.64 (0.56–0.82) L, P < 0.001 ) measured while compressing the chest wall were higher than those without compression. Conclusions. PEF can be used as a quantitative indicator of cough ability. Chest wall compression could improve cough ability for patients who have ineffective cough.

Effectiveness and safety of povidone iodine for prolonged lung air-leak after lung surgery

Background Pulmonary surgery is often associated with postoperative prolonged parenchymal air-leak. The purpose of this study was to determine efficacy and safety of povidone iodine as treatment of prolonged parenchymal air-leak following all-types of lung surgery. Methods This prospective trial was conducted from June 2019 to December 2020, and designed under PanAfrican Clinical Trials Registry requirements. Patients having prolonged parenchymal air-leak were randomly allocated to povidone iodine protocol (Group A) or surveillance without povidone iodine (Group B). We collected the number of povidone iodine injections required before bubbling stopped, total drainage period, tolerance after injection, complications and side-effects. Comparative study was performed to evaluate povidone iodine efficacy. Results Following randomization, Group A included 19 patients, and Group B 21. Both groups were comparable. The mean drainage period was 9.21 days in Group A (6–14 days) and 15.62 days in Group B (7–31 days) ( p = 0.001). The mean hospitalization period was 11.05 days in Group A (7–16 days) and 18.9 days in Group B (9–38 days) ( p < 0.0001). The mean follow-up period was 6.8 months (3–18 months). No deaths were noted in either groups. Four side-effects were reported in Group A (21%) and four serious complications were noticed in Group B (19%). No recurrences were reported in Group A versus one recurrence of homolateral pneumothorax in Group B (4.76%). Conclusions Povidone iodine is an effective and safe solution for pleurodesis. It is associated with a low complication rate that remains acceptable, and could be proposed as treatment of prolonged parenchymal air-leak after lung resections.

Upfront Brain Treatments Followed by Lung Surgery Improves Survival for Stage IV Non-small Cell Lung Cancer Patients With Brain Metastases: A Large Cohort Analysis

Background: Current treatment guidelines for stage IV non-small cell lung cancer (NSCLC) with brain metastases recommend brain treatments, including surgical resection and radiotherapy (RT), in addition to resection of the primary lung tumor. Here, we investigate the less-studied impact of treatment sequence on the overall survival.Methods: The National Cancer Database was queried for NSCLC patients with brain metastases who underwent surgical resection of the primary lung tumor (n = 776). Kaplan-Meier survival curves with log-rank test and propensity score stratified Cox regression with Wald test were used to evaluate the associations between various treatment plans and overall survival (OS).Results: Compared to patients who did not receive any brain treatment (median OS = 6.05 months), significantly better survival was observed for those who received brain surgery plus RT (median OS = 26.25 months, p &lt; 0.0001) and for those who received brain RT alone (median OS = 14.49 months, p &lt; 0.001). Patients who received one upfront brain treatment (surgery or RT) before lung surgery were associated with better survival than those who received lung surgery first (p &lt; 0.05). The best survival outcome (median OS 27.1 months) was associated with the sequence of brain surgery plus postoperative brain RT followed by lung surgery.Conclusions: This study shows the value of performing upfront brain treatments followed by primary lung tumor resection for NSCLC patients with brain metastases, especially the procedure of brain surgery plus postoperative brain RT followed by lung surgery.

Whether Start Time of Elective Lung Surgery Impacts Perioperative Outcomes and Cost?

BackgroundFatigue and long work hours of surgeons attracts increasing concerns in recent years. In clinical practice, most patients prefer to receiving surgery in the morning. So, we aimed to explore whether starting time is associated with perioperative outcomes and hospital cost for elective lung surgery. MethodsA retrospective study was conducted on elective lung surgery patients between September 2019-November 2019. Patients were divided into “early start group” if surgery started before 4pm while “late start group” was after 4pm. Perioperative outcomes and total hospital costs were compared between two groups. Besides, multivariable logistic regression analysis was performed for further analysis.ResultsA total of 398 patients were finally enrolled for analysis in this study. Of all the cases, 295 patients were divided into early start group while 103 patients belonged to late start group. There were no differences in postoperative hospital duration, operation time, complication incidence and total hospital cost. In multivariable logistic regression analysis, surgery start late was still found not to be a risk factor.ConclusionIn elective lung surgery, perioperative outcomes and cost were all similar between early start and late start surgery, it was not necessary to worry about surgery order for these patients.

Feasibility study of a randomised controlled trial of pre and postoperative nutritional supplementation in major lung surgery

ObjectivesMalnutrition and weight loss are important risk factors for complications after lung surgery. However, it is uncertain whether modifying or optimising perioperative nutritional state with oral supplements results in a reduction in malnutrition, complications, and quality of life.DesignA randomised, open label, controlled feasibility study was conducted to assess the feasibility of carrying out a large multicentre randomised trial of nutritional intervention. The intervention consisted of preoperative carbohydrate-loading drinks (4x 200mls evening before surgery and 2x 200mls the morning of surgery), and early postoperative nutritional protein supplement drinks twice a day for 2 weeks following surgery compared to the control group receiving an equivalent volume of water. Qualitative interviews were conducted with participants to help determine the acceptance of the study.SettingSingle adult thoracic centre in the UK.ParticipantsAll patients admitted for major lung surgery. Participants were included if were able to take nutritional drinks prior to surgery and were able to give written informed consent. Patients were excluded if they were likely unable to comply with completion of the study questionnaires, they had a body mass index (BMI) < 18.5 kg/m2, were receiving parenteral nutrition or known pregnancy.ResultsAll patients presenting for major lung surgery were screened over a 6-month period, with 163 patients screened, 99 excluded and 64 (41%) patients randomised. Feasibility criteria were met and the study completed recruitment 5 months ahead of target. The 2 groups were well balanced, and tools used to measure outcomes were robust. 97% of patients were compliant with pre-surgery nutritional drinks and 89% of the questionnaires at 3 months were returned fully completed. The qualitative interviews demonstrated that the trial and the intervention were acceptable to patients. Patients felt the questionnaires used captured their experience of recovery from surgery well.ConclusionA large multicentre randomised controlled trial of nutritional intervention in major lung surgery is feasible. It is possible to randomise eligible patients and follow up with high fidelity. A pre-op carbohydrate-loading and post-surgery supplementation is highly acceptable to patients with good compliance to both intervention and trial measures. A large multi-centre clinical trial is required to test clinical efficacy in improving outcomes after surgery.Trial registration numberISRCTN16535341Strengths and limitation of this studyThis randomised, feasibility study had pre-planned feasibility to assess whether a larger randomised trial would be feasible.The study included a large regional thoracic surgical centre and cohort of patients undergoing major lung surgery predominantly for cancer, which would be representative of full trial national recruitment.The study was not designed and powered to be large enough to provide conclusive evidence to support the use of nutritional intervention in major lung surgery, but provided evidence that a larger, substantive randomised controlled trial is feasible.