Abstract:
:Alteration of tissue perfusion is a main contributor to organ dysfunction in high-risk surgical patients. The difference between venous carbon dioxide and arterial carbon dioxide pressure (pCO2 gap) has been described as a parameter reflecting tissue hypoperfusion in critically ill patients who are insufficiently resuscitated. The pCO2 gap/CavO2 ratio has also been described as an indicator of the respiratory quotient, thus the relationship between DO2 and VO2. Most of the knowledge about the pCO2 gap and the pCO2 gap/CavO2 ratio has come from studies in the literature on animal models or intensive care unit (ICU) patients. To date, publications pertaining to the operative setting are sparse. In the present review, we will first discuss the physiological background of the pCO2 gap and CO2-O2 derived parameters used in the operating room. Few studies have focused on the clinical relevance of the pCO2 gap in high-risk non-cardiac surgical patients. Prospective observational studies with a small sample size and retrospective studies have shown that the pCO2 gap may be a useful complementary tool to identify patients who remain insufficiently optimized hemodynamically. In a few studies, a high pCO2 gap was associated with postoperative complications following non-cardiac high-risk surgery. Results of observational studies conducted in patients undergoing cardiac surgery are contradictory. We focused on the divergence between non-cardiac surgery, cardiac surgery, and septic critically ill patients. When analyzing the literature, we can find some explanations for the discrepancies in the published results between cardiac and non-cardiac surgery. Finally, we will discuss the clinical utility of the pCO2 gap in high-risk surgical patients.
journal_name
J Thorac Disjournal_title
Journal of thoracic diseaseauthors
Huette P,Ellouze O,Abou-Arab O,Guinot PGdoi
10.21037/jtd.2019.01.109subject
Has Abstractpub_date
2019-07-01 00:00:00pages
S1551-S1557issue
Suppl 11eissn
2072-1439issn
2077-6624pii
jtd-11-S11-S1551journal_volume
11pub_type
杂志文章,评审abstract:BACKGROUND:Video-assisted thoracic surgery (VATS) emerged as a minimally invasive surgery for diseases in the field of thoracic surgery. We herein reviewed our experience on thoracoscopic lobectomy for early lung cancer and evaluated Health System use. METHODS:A cost-effectiveness study was performed comparing VATS vs...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd.2017.07.51
更新日期:2017-08-01 00:00:00
abstract:BACKGROUND:Rapid on-site evaluation (ROSE) of cytologic specimens is a useful ancillary technique in needle aspiration procedures of pulmonary/mediastinal lesions, but few reports had been carried out to confirm the utility in the diagnosis of peripheral pulmonary lesions (PPLs) by radial probe endobronchial ultrasound...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.3978/j.issn.2072-1439.2015.12.13
更新日期:2015-12-01 00:00:00
abstract::Cases of tracheobronchial foreign body aspiration are frequently encountered emergency cases of childhood; and, delays in its recognition and treatment do result in serious morbidity and mortality. Diagnosis mainly relies on taking history which should indicate what the foreign body is, when it has been aspirated and ...
journal_title:Journal of thoracic disease
pub_type: 杂志文章,评审
doi:10.21037/jtd.2016.12.69
更新日期:2016-12-01 00:00:00
abstract:BACKGROUND:Data on advantages of video-assisted thoracoscopic surgery (VATS) lobectomies has been accumulated during the last 10 years then number of thoracoscopic anatomic pulmonary resections rapidly increased. But still there is no agreement about limitations of the method. The most popular "technical contraindicati...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.3978/j.issn.2072-1439.2014.10.11
更新日期:2014-10-01 00:00:00
abstract:BACKGROUND:Unilateral video-assisted thoracoscopic (VATS) thymectomy features less operative trauma, improved cosmesis, and similar efficiency compared with transsternal (TS) thymectomy for treatment of patients with myasthenia gravis (MG). Unilateral VATS thymectomy can be easily performed from either side of the thor...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.3978/j.issn.2072-1439.2016.01.40
更新日期:2016-01-01 00:00:00
abstract:Background:Fungal sensitization is a risk factor for severe asthma. Colonization in the lower respiratory tract is one of the forms of fungal exposure, and it is related to fungal sensitization. Pulmonary emphysema was recently reported to be an underlying disease of fungal colonization. The aim of study was to evaluat...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd-20-995
更新日期:2020-10-01 00:00:00
abstract:Background:Anterior mediastinal tumours account for 50% of all mediastinal masses. Surgical intervention is the standard approach for their diagnosis or treatment. Minimally invasive techniques have gained significant popularity in the last few decades due to the obvious advantages that they offer. We will describe a s...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd-19-3310b
更新日期:2020-05-01 00:00:00
abstract:Background:Esophageal squamous cell carcinoma (ESCC) as the main subtype of esophageal cancer (EC) is a leading cause of cancer-related death worldwide. Despite advances in early diagnosis and clinical management, the long-term survival of ESCC patients remains disappointing, due to a lack of full understanding of the ...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd.2020.01.33
更新日期:2020-06-01 00:00:00
abstract:BACKGROUND:Ground glass opacity (GGO) generally associated with the lepidic component of lung adenocarcinoma. However, in some cases, GGO nodules have been associated with invasive adenocarcinomas, where a lepidic component is minimal or absent. The purpose of this study is to evaluate the clinicopathological character...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd.2016.08.46
更新日期:2016-09-01 00:00:00
abstract:Background:Allergic asthma is a complex genetic disorder that involves interactions between genetic and environmental factors. Usage of PTEN may be a good therapeutic strategy for the management of allergic inflammation. Thus, the present study aims to explore the effects of phosphatase and tensin homolog (PTEN) gene s...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd.2017.12.104
更新日期:2018-01-01 00:00:00
abstract::Thoracic damage control surgery (TDCS) is a decision making tool and derivate of the damage control concept (DCC), where physiological stabilization has a priority over anatomical reconstruction under the pressure of time. Intrathoracic haemorrhage control and pleural decompression are the two main immediate tasks of ...
journal_title:Journal of thoracic disease
pub_type: 杂志文章,评审
doi:10.21037/jtd.2018.11.32
更新日期:2019-02-01 00:00:00
abstract::An 85-year-old woman was found to have a nodule in the left S6 of the lung on computed tomography (CT); the pathological diagnosis from the CT-guided biopsy was adenoid cystic carcinoma. We accordingly performed left lower lobectomy. Pathologically, the biphasic cell population showed admixtures in varying proportions...
journal_title:Journal of thoracic disease
pub_type:
doi:10.21037/jtd.2018.07.82
更新日期:2018-08-01 00:00:00
abstract:Background:Acute myocardial infarction (AMI) is an acute disease with high mortality and seriously threatens human health. The identification of new effective biological markers for AMI is a prerequisite for treatment. Most proteomic studies have focused on atherosclerotic plaques, vascular cells, monocytes and platele...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd.2019.08.100
更新日期:2019-09-01 00:00:00
abstract:BACKGROUND:Although N-ERC/mesothelin (N-ERC) is an attractive diagnostic and treatment monitoring biomarker for malignant pleural mesothelioma (MPM), its clinical utility for predicting the prognosis has not yet been clarified. The aim of this study is to investigate whether the serum N-ERC level can accurately predict...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.3978/j.issn.2072-1439.2013.03.03
更新日期:2013-04-01 00:00:00
abstract:Background:Small pulmonary nodules have been detected frequently by computed tomography (CT). Lung cancers with cavity formation are also easily detected. There are a few reports focused on the cavity wall, although cancer cells exist along the cavity wall, not inside. We evaluated the impact of cavity wall thickness o...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd.2018.01.61
更新日期:2018-02-01 00:00:00
abstract:BACKGROUND:The aim of the present study was to identify specious radiologic and/or physiologic prognostic marker(s), which lead to optimize of the patient follow-up frequency. METHODS:Eighty consecutive patients with newly diagnosed pulmonary sarcoidosis. Patients underwent chest radiography, high-resolution computed ...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd.2017.01.17
更新日期:2017-01-01 00:00:00
abstract::The severity of the clinical condition and co-morbidities of the patients for esophagectomy require a complex assessment and risk stratification before the operation, and most of the cases need complex management. We did a literature search and considered the data on risk stratification and complex management of patie...
journal_title:Journal of thoracic disease
pub_type: 杂志文章,评审
doi:10.21037/jtd.2018.12.11
更新日期:2019-04-01 00:00:00
abstract::Obstructive sleep apnea (OSA) is probably the most common respiratory disorder, with recent data from the United States and Europe suggesting that between 14% and 49% of middle-aged men have clinically significant OSA. The intimate relationship between OSA and obesity means that its prevalence will only increase as th...
journal_title:Journal of thoracic disease
pub_type: 杂志文章,评审
doi:10.3978/j.issn.2072-1439.2015.04.52
更新日期:2015-05-01 00:00:00
abstract::Performing dual point 18F-FDG PET scans of solitary pulmonary nodules at an initial SUV (max) <2.5 is a useful technique. However, prolonging second image acquisition from 120 to 180 min does not appear to improve accuracy. Dual time 18F-FDG PET is not useful in differentiating benign and malignant pulmonary nodules w...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.3978/j.issn.2072-1439.2013.06.05
更新日期:2013-06-01 00:00:00
abstract::The main reasons of emergent conversion during thoracoscopic lobectomy included tumor invasion, hilar lymph node (LN) metastasis, and lymphoid tuberculosis. We presented a video which depicted a three-portal thoracoscopic left upper lobectomy with dissection of large LNs. Severe adhesions between a large LN and the fi...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd.2016.03.56
更新日期:2016-05-01 00:00:00
abstract:Background:To compare the clinical outcomes between multiple arterial (MA) and single arterial (SA) off-pump coronary artery bypass grafting (OPCAB) when applied to left main coronary disease or three-vessel disease. Methods:A total of 537 patients with left main coronary disease or three-vessel disease underwent MA O...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd.2019.01.101
更新日期:2019-03-01 00:00:00
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journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd.2018.06.107
更新日期:2018-07-01 00:00:00
abstract::While ionizing radiotherapy (RT) can provide durable local control, the relative radiosensitivity of surrounding organs such as the lungs and heart and the distributed nature of the pleura limit the ability to safely deliver RT for patients with malignant pleural mesothelioma (MPM). Recent advances in the technologica...
journal_title:Journal of thoracic disease
pub_type: 杂志文章,评审
doi:10.21037/jtd.2018.07.65
更新日期:2018-08-01 00:00:00
abstract:BACKGROUND:Studies on diagnostic tests for exercise-induced bronchoconstriction (EIB) have centered around the asthmatic and elite athletic population. Traditionally, the exercise challenge test (ET) was recommended to assess EIB. We aimed to compare the performance of surrogate testing, mainly the hypertonic saline (H...
journal_title:Journal of thoracic disease
pub_type: 杂志文章
doi:10.21037/jtd.2017.02.70
更新日期:2017-03-01 00:00:00
abstract::Germ cell tumors, like teratoma, typically occur in young adults in their second to fourth decade with equal sex distribution. We firstly report a very rare case of a huge tumor compressed the vital structures of the mediastinum that was diagnosed in a 21-year-old woman at 39 weeks of gestation during a routine prenat...
journal_title:Journal of thoracic disease
pub_type:
doi:10.3978/j.issn.2072-1439.2014.08.46
更新日期:2014-10-01 00:00:00
abstract::The development of advanced radiation technologies, including intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT) and proton therapy, has resulted in increasingly conformal radiation treatments. Recent evidence for the importance of minimizing dose to normal critical structures inc...
journal_title:Journal of thoracic disease
pub_type: 杂志文章,评审
doi:10.21037/jtd.2018.01.155
更新日期:2018-08-01 00:00:00
abstract::Minimally invasive extracorporeal circulation (MiECC) technology is characterized by improved biocompatibility due to closed-loop design, minimized priming, and markedly reduced artificial surface. Despite well-evidenced clinical advantages in coronary surgery, MiECC penetration in complex open-heart surgery is low. C...
journal_title:Journal of thoracic disease
pub_type: 杂志文章,评审
doi:10.21037/jtd.2019.02.04
更新日期:2019-06-01 00:00:00
abstract::Chronic dyspnoea, or breathlessness for more than four weeks duration, is a common symptom in adults presenting to primary and tertiary care. It often presents a diagnostic challenge due to the wide spectrum of underlying disease, which is multifactorial in approximately one third of cases. Challenges in diagnosis inc...
journal_title:Journal of thoracic disease
pub_type: 杂志文章,评审
doi:10.21037/jtd.2019.10.53
更新日期:2019-10-01 00:00:00
abstract::Recent studies have demonstrated that there are differences among races in efficacy, tolerance and other outcomes in oncologic care. Some of these differences may be explained by different pharmacogenetics; however, social and environmental factors that can affect oncology practice are relatively underestimated. In th...
journal_title:Journal of thoracic disease
pub_type: 杂志文章,评审
doi:10.21037/jtd.2019.07.70
更新日期:2020-07-01 00:00:00
abstract::Diagnosing pleural effusion is challenging, especially in patients with malignant or benign fibrothorax, which is difficult to sample using standard flexible forceps (SFF) via flex-rigid pleuroscopy. An adequate sample is crucial for the differential diagnosis of malignant fibrothorax (malignant pleural mesothelioma, ...
journal_title:Journal of thoracic disease
pub_type:
doi:10.21037/jtd.2016.11.92
更新日期:2016-11-01 00:00:00