BACKGROUND: Respiratory functions may be impaired in cesarean section (C/S) delivery performed under spinal anesthesia (SA) and oxygen supplementation may be required. Therefore, we conducted a randomized controlled study aimed to evaluate the effects of different oxygen administrations in pregnant women on the lungs during C/S under SA using ultrasound and oxygen reserve index (ORI).
METHODS: We conducted a randomized, controlled, single-center study from May 1, 2021, to March 31, 2022. A total of 90 patients scheduled for C/S under SA were randomly divided into 3 groups. Following the SA, patients in group 0 were treated with room air, in Group 3 were administered 3 L/min O₂ with a nasal cannula (NC), in Group 6 were administered 6 L/min O₂ with a simple face mask. In addition to routine monitoring, ORI values were measured. Lung aeration was evaluated through the modified lung ultrasound score (LUS) before the procedure (T0), at minute 0 (T1), 20 (T2), and hour 6 (T3) after the procedure, and ∆LUS values were recorded.
RESULTS: After SA, the ORI values of Group 3 were higher than Group 0 at all times (p < 0.05), while the intraoperative 1st minute and the 10th, 25th and 40th minutes after delivery (p = 0.001, p = 0.027, p = 0.001, p = 0.019) was higher than Group 6. When the LUS values of each group were compared with the T0 values a decrease was observed in Group 3 and Group 6 (p < 0.001, p = 0.016). While ∆LUS values were always higher in Group 3 than in Group 0, they were higher only in T1 and T2 in Group 6.
CONCLUSIONS: We determined that it would be appropriate to prefer 3 L/min supplemental oxygen therapy with NC in C/S to be performed under SA.

OBJECTIVE: To explore the application value of a gradient boosting decision tree (GBDT) in predicting postoperative atelectasis in patients with destroyed lungs.
METHODS: A total of 170 patients with damaged lungs who underwent surgical treatment in Chest Hospital of Guangxi Zhuang Autonomous Region from January 2021 to May 2023 were retrospectively selected. The patients were divided into a training set (n = 119) and a validation set (n = 51). Both GBDT algorithm model and Logistic regression model for predicting postoperative atelectasis in patients were constructed. The receiver operating characteristic (ROC) curve, calibration curve and decision curve were used to evaluate the prediction efficiency of the model.
RESULTS: The GBDT model indicated that the relative importance scores of the four influencing factors were operation time (51.037), intraoperative blood loss (38.657), presence of lung function (9.126) and sputum obstruction (1.180). Multivariate Logistic regression analysis revealed that operation duration and sputum obstruction were significant predictors of postoperative atelectasis among patients with destroyed lungs within the training set (P = 0.048, P = 0.002). The ROC curve analysis showed that the area under the curve (AUC) for GBDT and Logistic model in the training set was 0.795 and 0.763, and their AUCs in the validation set were 0.776 and 0.811. The GBDT model\'s predictions closely matched the ideal curve, showing a higher net benefit than the reference line.
CONCLUSIONS: GBDT model is suitable for predicting the incidence of complications in small samples.

OBJECTIVE: During laparoscopic surgery, the role of PEEP to improve outcome is controversial. Mechanistically, PEEP benefits depend on the extent of alveolar recruitment, which prevents ventilator-induced lung injury by reducing lung dynamic strain. The hypotheses of this study were that pneumoperitoneum-induced aeration loss and PEEP-induced recruitment are inter-individually variable, and that the recruitment-to-inflation ratio (R/I) can identify patients who benefit from PEEP in terms of strain reduction.
METHODS: Sequential study.
METHODS: Operating room.
METHODS: Seventeen ASA I-III patients receiving robot-assisted prostatectomy during Trendelenburg pneumoperitoneum.
METHODS: Patients underwent end-expiratory lung volume (EELV) and respiratory/lung/chest wall mechanics (esophageal manometry and inspiratory/expiratory occlusions) assessment at PEEP = 0 cmH2O before and after pneumoperitoneum, at PEEP = 4 and 12 cmH2O during pneumoperitoneum. Pneumoperitoneum-induced derecruitment and PEEP-induced recruitment were assessed through a simplified method based on multiple pressure-volume curve. Dynamic and static strain changes were evaluated. R/I between 12 and 4 cmH2O was assessed from EELV. Inter-individual variability was rated with the ratio of standard deviation to mean (CoV).
RESULTS: Pneumoperitoneum reduced EELV by (median [IqR]) 410 mL [80-770] (p < 0.001) and increased dynamic strain by 0.04 [0.01-0.07] (p < 0.001), with high inter-individual variability (CoV = 70% and 88%, respectively). Compared to PEEP = 4 cmH2O, PEEP = 12 cmH2O yielded variable amount of recruitment (139 mL [96-366] CoV = 101%), causing different extent of dynamic strain reduction (median decrease 0.02 [0.01-0.04], p = 0.002; CoV = 86%) and static strain increases (median increase 0.05 [0.04-0.07], p = 0.01, CoV = 33%). R/I (1.73 [0.58-3.35]) estimated the decrease in dynamic strain (p ≤0.001, r = -0.90) and the increase in static strain (p = 0.009, r = -0.73) induced by PEEP, while PEEP-induced changes in respiratory and lung mechanics did not.
CONCLUSIONS: Trendelenburg pneumoperitoneum yields variable derecruitment: PEEP capability to revert these phenomena varies significantly among individuals. High R/I identifies patients in whom higher PEEP mostly reduces dynamic strain with limited static strain increases, potentially allowing individualized settings.

OBJECTIVE: This study aims to evaluate the impact of Supreme™ laryngeal masks versus endotracheal tubes on atelectasis during general anesthesia using lung ultrasound (LUS), and provide evidence for respiratory management.
METHODS: A single-center, double-blind, randomized controlled trial was conducted.
METHODS: The study was conducted in both the operating room and the post-anesthesia care unit, with follow-up assessments performed in the ward.
METHODS: Enrollment included 180 cases undergoing non-laparoscopic surgeries in gynecology, urology, and orthopedic limb surgeries.
METHODS: Patients were randomly assigned 1:1 to the endotracheal intubation or laryngeal mask group.
METHODS: LUS scores were recorded across 12 lung regions at baseline, 15 min after airway establishment, at the end of surgery, and 30 min following airway removal. Outcome measures encompassed the oxygenation index, dynamic lung compliance, incidence of postoperative pulmonary complications, throat pain, and other postoperative complications assessed at 24 and 48 h postoperatively. The primary outcome focused on the LUS score in all 12 lung regions at 15 min after airway establishment.
RESULTS: Intention-to-treat analysis of 177 subjects revealed endotracheal intubation led to significantly higher LUS scores at 15 min {P < 0.001, mean difference 4.15 ± 0.60, 95% CI [2.97, 5.33]}, end of surgery (P < 0.001, mean difference 3.37 ± 0.68, 95% CI [2.02, 4.72]), and 30 min post-removal (P < 0.001, mean difference 2.63 ± 0.48, 95% CI [1.68, 3.58]). No major complications occurred in the two groups.
CONCLUSIONS: Compared to endotracheal intubation, laryngeal masks effectively reduce atelectasis formation and progression in gynecological, urological non-laparoscopic, and orthopedic limb surgeries. However, caution is warranted when generalizing these findings to surgeries with a higher risk of laryngeal mask leakage or obese patients. Additionally, the efficacy of laryngeal masks in reducing postoperative atelectasis remains uncertain when comprehensive monitoring of muscle relaxation and reversal therapy is employed.

UNASSIGNED: This study was aimed at examining the effects of the thoracic block technique on vital signs, arterial blood gases, and lung compliance in children with unilateral atelectasis receiving mechanical ventilation.
UNASSIGNED: Forty-four boys and girls with unilateral atelectasis and receiving mechanical ventilation, ranging in age from 4 months to 4 years, were recruited from the Abo El-Reesh Hospital intensive care unit at Cairo University. They were assigned to control and study groups: group A included 22 children receiving chest physical therapy, and group B included 22 children receiving the same chest physical therapy program as well as the thoracic block technique. Electrocardiography, mechanical ventilation, and blood gas analysis were conducted to assess the respiratory and heart rates, dynamic compliance, and arterial blood gases, respectively.
UNASSIGNED: Respiratory rate and heart rate were significantly lower in the study group than the control group (p = 0.03). PaO2 and SaO2 increased in both groups, and the increase was more significant (p = 0.01 and 0.001, respectively) in group B than group A. A significant decrease in PaCO2 was observed in both groups, and the decrease was more significant in group B than group A (p = 0.02). A significant increase in dynamic lung compliance was observed in both groups, and the increase was more significant in group B than group A (p = 0.01).
UNASSIGNED: Applying the thoracic block technique rather than chest physical therapy techniques alone in children with atelectasis receiving mechanical ventilation may lead to improvements in arterial blood gases and dynamic lung compliance, and has no negative effects on heart rate and respiratory rate.
UNASSIGNED: دراسة تأثير تقنية الإحصار الصدري على العلامات الحيوية وغازات الدم الشرياني وامتثال الرئة لدى الأطفال المصابين بالانخماص الأحادي الجانب والذين يتم تهويتهم ميكانيكيا.
UNASSIGNED: أربعة وأربعون طفلا يخضعون للتهوية الميكانيكية بانخماص أحادي الجانب، تراوحت أعمارهم من 4 أشهر إلى 4 سنوات، من كلا الجنسين. تم ضمهم من مستشفى أبوالريش، وحدة العناية المركزة - جامعة القاهرة. تم تقسيمهم إلى مجموعتين ضابطة ودراسة: المجموعة (أ) ضمت اثنين وعشرين طفلا تلقوا برنامج العلاج الطبيعي للصدر، المجموعة (ب) ضمت اثنين وعشرين طفلا تلقوا نفس برنامج العلاج الطبيعي للصدر بالإضافة إلى تقنية الحصار الصدري. تم استخدام أقطاب تخطيط القلب الكهربائي وجهاز التنفس الصناعي الميكانيكي وتحليل غازات الدم لتقييم معدل التنفس ومعدل ضربات القلب والامتثال الديناميكي وغازات الدم الشرياني على التوالي.
UNASSIGNED: أظهرت النتائج انخفاضا ملحوظا في معدل التنفس ومعدل ضربات القلب في مجموعة الدراسة مقارنة بالمجموعة الضابطة. كانت هناك زيادة معنوية في ضغط الأوكسجين في الدم الشرياني و تشبع الدم بالأكسجين في كلا المجموعتين، وكانت هذه الزيادة أكثر وضوحا في المجموعة (ب) من المجموعة (أ) على التوالي. كان هناك انخفاض كبير في الضغط الجزئي لثاني أوكسيد الكربون في كلا المجموعتين، وكان هذا الانخفاض أكثر أهمية في المجموعة (ب) من المجموعة (أ) وزيادة كبيرة في امتثال الرئة الديناميكي في كلا المجموعتين، وكانت هذه الزيادة أكثر أهمية في المجموعة (ب) من المجموعة (أ).
UNASSIGNED: قد يؤدي تطبيق تقنية الإحصار الصدري على الأطفال المصابين بالانخماص على التهوية الميكانيكية إلى تحسن غازات الدم الشرياني، والامتثال الديناميكي للرئة وليس له أي تأثير سلبي على معدل ضربات القلب ومعدل التنفس مقارنة بتقنيات العلاج الطبيعي للصدر فقط.

BACKGROUND: For patients receiving one lung ventilation in thoracic surgery, numerous studies have proved the superiority of lung protective ventilation of low tidal volume combined with recruitment maneuvers (RM) and individualized PEEP. However, RM may lead to overinflation which aggravates lung injury and intrapulmonary shunt. According to CT results, atelectasis usually forms in gravity dependent lung regions, regardless of body position. So, during anesthesia induction in supine position, atelectasis usually forms in the dorsal parts of lungs, however, when patients are turned into lateral decubitus position, collapsed lung tissue in the dorsal parts would reexpand, while atelectasis would slowly reappear in the lower flank of the lung. We hypothesize that applying sufficient PEEP without RM before the formation of atelectasis in the lower flank of the lung may beas effective to prevent atelectasis and thus improve oxygenation as applying PEEP with RM.
METHODS: A total of 84 patients scheduled for elective pulmonary lobe resection necessitating one lung ventilation will be recruited and randomized totwo parallel groups. For all patients, one lung ventilation is initiated the right after patients are turned into lateral decubitus position. For patients in the study group, individualized PEEP titration is started the moment one lung ventilation is started, while patients in the control group will receive a recruitment maneuver followed by individualized PEEP titration after initiation of one lung ventilation. The primary endpoint will be oxygenation index measured at T4. Secondary endpoints will include intrapulmonary shunt, respiratory mechanics, PPCs, and hemodynamic indicators.
CONCLUSIONS: Numerous previous studies compared the effects of individualized PEEP applied alone with that applied in combination with RM on oxygenation index, PPCs, intrapulmonary shunt and respiratory mechanics after atelectasis was formed in patients receiving one lung ventilation during thoracoscopic surgery. In this study, we will apply individualized PEEP before the formation of atelectasis while not performing RM in patients allocated to the study group, and then we\'re going to observe its effects on the aspects mentioned above. The results of this trial will provide a ventilation strategy that may be conductive to improving intraoperative oxygenation and avoiding the detrimental effects of RM for patients receiving one lung ventilation.
BACKGROUND: www.Chictr.org.cn ChiCTR2400080682. Registered on February 5, 2024.

UNASSIGNED: This study aims to explore the clinical application of bronchial artery chemoembolization (BACE) in managing refractory central lung cancer with atelectasis.
UNASSIGNED: The retrospective case series includes patients diagnosed with refractory central lung cancer and atelectasis who underwent BACE treatment at Yueyang Integrated Traditional Chinese and Western Medicine Hospital, affiliated with Shanghai University of Traditional Chinese Medicine, from January 2012 to December 2021.
UNASSIGNED: All 30 patients with lung cancer successfully underwent BACE procedures. Their ages ranged from 62 to 88 years, with an average age of 67.53. The treatment interval was 21 days, and the treatment cycle ranged from 2 to 12 times, averaging 4.13 times. During the BACE procedures, the Karnofsky Performance Status (KPS) score after 2 to 3 BACE cycles showed a significant improvement (82.0 ± 10.1 vs 68.3 ± 14.0, P < 0.001) than that of before BACE. Only nutritional support and symptomatic treatment were performed after BACE, and no major hemoptysis were observed. During follow-up, 23 cases resulted in mortality, while seven survived. The median progression-free survival (PFS) and overall survival (OS) were 7.0 (95% CI: 4.6-9.4) and 10.0 (95% CI: 6.2-13.8) months, respectively, with 1-, 2-, and 3-year survival rates of 84.0%, 53.5%, and 11.3%, respectively. Eight cases exhibited bronchial recanalization and relief of atelectasis. According to the RECIST scale, there were 4 cases of complete response (CR), 16 cases of partial response (PR), 9 cases of stable disease (SD), and 1 case of progressive disease (PD). No serious adverse events were reported.
UNASSIGNED: BACE might be a safe intervention for refractory central lung cancer accompanied by atelectasis. The procedure exhibits satisfactory outcomes in tumor control, atelectasis relief, and enhancement of quality of life, warranting further investigation.

UNASSIGNED: Computed tomography (CT)-body divergence limits the accuracy of electromagnetic navigation bronchoscopy (ENB) in peripheral lung lesions diagnosis. We developed intraprocedural CT-guided navigation with ventilatory strategy for atelectasis (ICNVA) ENB for patients with peripheral lung lesions.
UNASSIGNED: Retrospective observational study in which ten consecutive patients with pulmonary lesions (without bronchial direct connection) underwent ICNVA-ENB was conducted. During ICNVA-ENB, intraoperative CT data were used for ENB path planning, and a new ventilation strategy were employed to help maintain the pulmonary region in a static and inflation state which reduce CT to body divergence. We collected three sets of CT data: preENB CT, post-anesthesia intubation CT, and postENB CT. To evaluate the accuracy of ICNVA-ENB, we measured the distance between the ENB probe and the actual lesion location, but also recorded the results of rapid on-site evaluation (ROSE), and postoperative pathology. To evaluate the impact of CT-body divergence induced by atelectasis, we calculated the mutual position distance of target lesions in preENB CT, post-anesthesia intubation CT and postENB CT. Furthermore, ENB operation time and operative complications were recorded.
UNASSIGNED: Our analysis revealed that the distance between the navigation probe with the actual location of lesion center was 4-10 (5.90±1.73) mm. The ROSE results were consistent with the postoperative pathological diagnosis in 9 out of 10 patients (90%). The ICNVA-ENB atelectasis CT-body divergence was smaller than traditional ENB (12.10±3.67 vs. 6.60±2.59 mm, P<0.01). The ENB operation time was 20-53 (29.30±10.14) minutes and one patient developed slight intrapulmonary hemorrhage.
UNASSIGNED: ICNVA-ENB can reduce the CT-body divergence and appears to be safe and accurate for patients with peripheral lung lesions.

BACKGROUND: Plastic bronchitis (PB) is a clinical-pathological syndrome characterized by the abnormal accumulation of endogenous substances in the bronchial airways, causing partial or complete obstruction and resulting in impaired lung ventilation.
METHODS: In this retrospective analysis, we aim to summarize the clinical manifestations, imaging characteristics, diagnostic methods, and treatment approaches to enhance clinicians\' ability to detect children who are infected with human bocavirus 1 (hBoV 1) and develop PB.
RESULTS: In the period from January 2021 to January 2024, a total of six hBoV 1 infection children were diagnosed with PB through bronchoscopy. The onset of the condition was mainly concentrated between June and December. The detection methods used included metagenomic next-generation sequencing for pathogen identification (three cases) and respiratory pathogen nucleic acid 13-plex detection (oropharyngeal swab) (three cases), both of which confirmed the presence of hBoV 1. Out of the six children with PB, two were girls and four were boys. Their ages ranged from 10 months to 4 years old. Common symptoms reported by all patients included fever, cough, and wheezing. Chest high-resolution computed tomography scans revealed atelectasis in six cases, in addition to pneumonia. After the removal of the plastic bronchi via bronchoscopy, the airway obstruction symptoms in the children were relieved, and no recurrence was observed during the follow-up period. Pathological findings indicated cellulose exudation and inflammatory cell infiltration, consistent with nonlymphatic PB.
CONCLUSIONS: When children infected with hBoV 1 exhibit persistent or worsening symptoms such as cough, fever, and wheezing despite treatment, clinicians should remain highly vigilant for the potential occurrence of PB. Bronchoscopy plays a crucial role not only in diagnosing the presence of a plastic bronchus but also in effectively treating PB.

Anaesthetists may be required to work in hybrid theatres for procedures using fluoroscopic imaging. Adequate knowledge of fluoroscopic images allows prompt and effective emergency management of complications which arise during procedures. Here, we present a case of severe hypotension and hypoxia occurring shortly after induction of anaesthesia. Atelectasis was mistaken for a pneumothorax due to misinterpretation of fluoroscopic imaging, which demonstrated a dark pleural cavity peripheral to a partially collapsed left lung, leading to an incorrect diagnosis. This case highlights the importance of understanding greyscale inversion in fluoroscopy.