ObjectiveTo investigate the variation regularity about volume of drainage after initial thyroidectomy, and to find out the time points of safety extubation and the time points of risk extubation.
MethodsBetween September 2013 and April 2014, the clinical date of 71 cases of thyroid tumor who underwent thyroidectomy were prospectively analyzed and completely random designed. The patients were indwelling drain after thyroidectomy, the volume of drainage liquid were registered at each point of time in period of 48 hours after operation and analyzed its the variation regularity.
ResultsThe volume of drainage fluid in 48 h after operation was gradually decreased in 71 patients. The reduce speed of volume of drainage fluid in the 12 h after operation was faster, then was significantly slower, and gradually stabilized. The amount of the drainage fluid reached the peak in 2 h after operation in 22 cases, and then gradually decreased and reached the stabilization.
ConclusionsThe 2 hours after thyroidectomy is the risk drainage removing time when is relatively safe. The 12 hours after thyroidectomy is the safety drainage removing time, after that there is no longer any meaning to keep drainage tube.
Tracheotomy is a commonly used measure in clinical rescue of critically ill patients, and it has an important impact on the survival outcome of patients. The time of extubation directly affects the recovery process of the patient. This article reviews the research progress of extubation management of tracheotomy patients at home and abroad, and mainly summarizes and elaborates from four aspects, including the role of the multidisciplinary team in tracheostomy management, where tracheostomy patients are extubated, conditions for extubation in tracheotomy patients, and wound care after extubation in tracheotomy patients. The purpose is to provide a reference for the selection of extubation timing and extubation management for patients with tracheotomy, to improve the success rate of extubation and improve the quality of life of patients.
ObjectiveTo investigate the effect of timing of removal of drainage tube on complications after radical thyroidectomy by da Vinci robot.MethodsThree hundred and fifteen patients with thyroid cancer treated by da Vinci robot from July 2014 to December 2018 in our department were reviewed. The patients were divided into two groups according to the amount of drainage fluid at extubation: observation group (99 cases) and control group (216 cases). The extubation indication: in the observation group, the drainage volume was less than 20 mL for 24 hours in two days; in the control group, according to most clinical concepts, the drainage volume was less than 10 mL for 24 hours in two days. The infection rate of wound and tunnel, the incidence of hematoma, wound healing, the time of drainage tube removal and the time of hospitalization were observed.ResultsThere were no significant difference in infection rate, hematoma incidence and wound healing rate between the observation group and the control group (P>0.05). The postoperative extubation time and hospitalization time in the observation group was significantly shorter than that in the control group (P<0.05).ConclusionsAfter the radical operation of thyroid cancer by Leonardo da Vinci robot, taking the amount of wound drainage fluid less than 20 mL/24 hours for 2 days as the time of extubation does not increase the incidence of complications, but it can significantly shorten the time of extubation and hospitalization of patients, which can be widely used in clinical practice.
ObjectiveTo explore the feasibility of early chest tube removal following single-direction uniportal video-assisted thoracoscopic surgery (S-UVATS) anatomical lobectomy. MethodsThe clinical data of consecutive VATS lobectomy by different surgeons in Xuzhou Central Hospital between May 2019 and February 2022 were retrospectively reviewed. Finally, the data of 1 084 patients were selected for analysis, including 538 males and 546 females, with a mean age of 61.0±10.1 years. These patients were divided into a S-UVATS group with 558 patients and a conventional group (C-UVATS) with 526 patients according to the surgical procedures. The perioperative parameters such as operation time, blood loss were recorded. In addition, we assessed the amount of residual pleural effusion and the probability of secondary thoracentesis when taking 300 mL/d and 450 mL/d as the threshold of chest tube removal. ResultsTumor-negative surgical margin was achieved without mortality in this cohort. As compared with the C-UVATS group, patients in the S- UVATS group demonstrated significantly shorter operation time (P<0.001), less blood loss (P=0.002), lower rate of conversion to multiple-port VATS or thoracotomy (P=0.003), but more stations and numbers of dissected lymph nodes as well as less suture staplers (P<0.001). Moreover, patients in the S-UVATS demonstrated shorter chest tube duration, less total volume of thoracic drainage and shorter postoperative hospital stay, with statistical differences (P<0.001). After excluding patients of chylothorax and prolonged air leaks>7 d, subgroup analysis was performed. First, assuming that 300 mL/d was the threshold for chest tube removal, as compared with the C-UVATS group, patients in the S-UVATS group would report less residual pleural effusion and less necessitating second thoracentesis with residual pleural effusion>500 mL (P<0.05). Second, assuming that 450 mL/d was the threshold for chest tube removal, as compared with the C-UVATS group, the S-UVATS group would also report less residual pleural effusion and less necessitating second thoracentesis with residual pleural effusion>500 mL (P<0.05). Further multivariable logistic regression analysis indicated that S-UVATS was significantly negatively related to drainage volume>1 000 mL (P<0.05); whereas combined lobectomy, longer operation time, more blood loss and air leakage were independent risk factors correlated with drainage volume>1 000 mL following UVATS lobectomy (P<0.05). ConclusionThe short-term efficacy of S-UVATS lobectomy is significantly better than that of the conventional group, indicating shorter operation time and less chest drainage. However, early chest tube removal with a high threshold of thoracic drainage volume probably increases the risk of secondary thoracentesis due to residual pleural effusion.
ObjectiveTo retrospectively analyze the causes and risk factors of unplanned extubation (UE) in cancer patients during peripherally inserted central catheter (PICC) retention, so as to provide references for effectively predicting the occurrence of UE. Methods27 998 cancer patients who underwent PICC insertion, maintenance and removal in the vascular access nursing center of our hospital from January 2016 to June 2023 were retrospectively analyzed. General information, catheterization information, and maintenance information were collected. The Chi-squared test was used for univariate analysis, multivariate analysis was used by binary unconditional logistic regression. They were randomly divided into modeling group and internal validation group according to the ratio of 7∶3. The related nomogram prediction model and internal validation were established. ResultsThe incidence of UE during PICC retention in tumor patients was 2.80% (784/27 998 cases). Univariate analysis showed that age, gender, diagnosis, catheter retention time, catheter slipping, catheter related infection, catheter related thrombosis, secondary catheter misplacement, dermatitis, and catheter blockage had an impact on UE (P<0.05). Age, diagnosis, catheter retention time, catheter slipping, catheter related infection, catheter related thrombosis, secondary catheter misplacement, and catheter blockage are independent risk factors for UE (P<0.05). Based on the above 8 independent risk factors, a nomogram model was established to predict the risk of UE during PICC retention in tumor patients. The ROC area under the predicted nomogram was 0.90 (95%CI 0.89 to 0.92) in the modeling group, and the calibration curve showed good predictive consistency. Internal validation showed that the area under the ROC curve of the prediction model was 0.91 (95%CI 0.89 to 0.94), and the trend of the prediction curve was close to the standard curve. ConclusionPatients aged ≥60 years, non chest tumor patients, catheter retention time (≤6 months), catheter slipping, catheter related infections, catheter related thrombosis, secondary catheter misplacement, and catheter blockage increase the risk of UE. The nomogram model established in this study has good predictive ability and discrimination, which is beneficial for clinical screening of patients with different degrees of risk, in order to timely implement targeted prevention and effective treatment measures, and ultimately reduce the occurrence of UE.
ObjectiveTo investigate the application value of noninvasive ventilation (NIV) performed in patients with unplanned extubation (UE) in intensive care unit (ICU).MethodsThis was a retrospective analysis. The clinical data, application of NIV, reintubation rate and prognosis of UE patients in the ICU of this hospital from January 2014 to December 2018 were reviewed, and the patients were assigned to the control group or the NIV group according to the application of NIV after UE. The data between the two groups were compared and the application effects of NIV in UE patients were evaluated.ResultsA total of 66 UE patients were enrolled in this study, including 44 males and 22 females and with an average age of (64.2±16.1) years. Out of them, 41 patients (62.1%) used nasal catheter or mask for oxygenation as the control group, 25 patients (37.9%) used NIV as the NIV group. The Acute Physiology andChronic Health EvaluationⅡ score of the control group and the NIV group were (18.6±7.7) vs. (14.8±6.3), P=0.043. The causes of respiratory failure in the control group and the NIV group were as follows: pneumonia 16 patients (39.0%) vs. 7 patients (28.0%), postoperative respiratory failure 7 patients (17.1%) vs. 8 patients (32.0%), chronic obstructive pulmonary disease 8 patients (19.5%) vs. 6 patients (24.0%), others 5 patients (12.2%) vs. 4 patients (16.0%), heart failure 3 patients (7.3%) vs. 0 patients (0%), nervous system diseases 2 (4.9%) vs. 0 patients (0%), which showed no significant difference between the two groups. Mechanical ventilation time before UE were (12.5±19.8) vs (12.7±15.2) d (P=0.966), PaO2 of the control group and the NIV group before UE was (114.9±37.4) vs. (114.4±46.3)mm Hg (P=0.964), and oxygenation index was (267.1±82.0) vs. (257.4±80.0)mm Hg (P=0.614). Reintubation rate was 65.9% in the control group and 24.0% in the NIV group (P=0.001). The duration of mechanical ventilation was (23.9±26.0) vs. (21.8±26.0)d (P=0.754), the length of stay in ICU was (34.4±36.6) vs. (28.5±25.8)d (P=0.48). The total mortality rate in this study was 19.7%. The mortality rate in the control group and NIV group were 22.0% and 16.0% (P=0.555).ConclusionPatients with UE in ICU may consider using NIV to avoid reintubation.
