Positive end-expiratory pressure attenuates positional effect after thoracotomy

Thoracotomy is a common procedure. However, thoracotomy leads to lung atelectasis and deteriorates pulmonary gas exchange in operated side. Therefore, different positions with operated side lowermost or uppermost may lead to different gas exchange after thoracotomy. Besides, PEEP [positive end-expiratory pressure] influence lung atelectasis and should influence gas exchange. The purpose of this study was to determine the physiological changes in different positions after thoracotomy. In addition, we also studied the influence of PEEP to positional effects after thoracotomy. There were eight pigs in each group. Group I received left thoracotomy with zero end-expiratory pressure [ZEEP], and group II with PEEP; group III received right thoracotomy with ZEEP and group IV with PEEP. We changed positions to supine, LLD [left lateral decubitus] and RLD [right lateral decubitus] in random order after thoracotomy. PaO[2] was decreased after thoracotomy and higher in RLD after left thoracotomy and in LLD after right thoracotomy. PaO[2] in groups II and IV was higher than in groups I and III if with the same position. In group I and III, PaCO[2] was increased after thoracotomy and was higher in LLD after left thoracotomy and in RLD after right thoracotomy. In groups II and IV, there were no PaCO[2] changes in different positions after thoracotomy. Lung compliance [Crs] was decreased after thoracotomy in groups I and III and highest in RLD after left thoracotomy and in LLD after right thoracotomy. In groups II and IV, there were no changes in Crs regardless of the different positions. There were significant changes with regards to pulmonary gas exchange, hemodynamics and Crs after thoracotomy. The best position was non-operated lung lowermost Applying PEEP attenuates the positional effects

Traumatic pseudoaneurysm from the aorta to the left common carotid artery presenting as widened mediastinum

Diagnosis of pseudoaneurysm of the aorta or its main branches is a challenge in patients with blunt chest trauma. Computed tomography helps to demonstrate intrathoracic hemorrhage and suspected great vascular injury when a chest radiograph reveals widening of the mediastinum. Aortic angiography remains the gold standard in the determination of the site, and severity of vascular injury for definitive surgical intervention. Timing of surgical repair is controversial. Delayed repair of traumatic pseudoaneurysm of the aorta after primary control of associate injuries decreases mortality significantly, thus improving prognosis. We report a case of successful repair of a traumatic pseudoaneurysm of the aortic arch with extension to the left common carotid artery in an 18-year-old female patient. The diagnosis, surgical approaches, and timing of operation are discussed along with case presentation