Clinical analysis of thoracoscopic surgery combined with intraoperative autologous blood transfusion in the treatment of traumatic hemothorax.

From January 2013 to January 2015, 19 patients of traumatic hemothorax with hemorrhagic shock were treated in our department by thoracoscopic surgery combined with autologous blood transfusion. This study retrospectively analyzed the therapeutic effect and shared our experience. The average amount of blood transfused back was 662.41 ml ± 269.15 ml. None of the patients developed transfusion reaction and were all discharged uneventfully. Thoracoscopic surgery combined with autologous blood trans- fusion is effective in the rescue of patients with progressive hemothorax and hemorrhagic shock. When corresponding indications are well managed, treatment for these patients is quicker, safer, and more effective.

[Effect of prone position on the oxygenation of patients with acute respiratory distress syndrome after failure recruitment maneuvers at high altitudes].

OBJECTIVE: To assess the effect of prone position on the oxygenation of patients with acute respiratory distress syndrome (ARDS) after recruitment maneuvers (RM) failure at high altitudes. METHODS: Forty-one ARDS patients who were invalid for RM therapy at the altitude of 2260 metres area hospital were enrolled[mean oxygenation index (PaO(2)/FiO(2)) increased than RM<20% considered as RM invalid]. All were divided into acute respiratory distress syndrome (ARDSp) and extra-acute respiratory distress syndrome (ARDSexp) based on different etiology, and each group was randomly divided into the supine and the prone position group, i.e. that ARDSp prone position group (n=11), ARDSp supine group (n=9), ARDSexp prone position group (n=10), and ARDSexp supine group (n=11). Before ventilation and 1, 2, 3, 4 hours after ventilation, arterial partial pressure of oxygen (PaO(2)), PaO(2)/FiO(2), static lung compliance (Cst), airway resistance (Raw) were monitored. RESULTS: One hour after ventilation in ARDSexp prone position group, PaO(2)/FiO(2) was significantly higher than before ventilation (157.4±40.6 mm Hg vs. 129.3±48.7 mm Hg, P<0.05), and increased by ventilation time, peaked at 4 hours (219.1±41.1 mm Hg). Within 3 hours ventilation in ARDSexp prone position group, PaO(2)/FiO(2) was significantly higher compared with the other three groups, and there were no significant differences among the other three groups. PaO(2)/FiO(2) in ARDSp prone position group and ARDSexp prone position group at 4 hours of ventilation were significantly higher compared with the corresponding supine group (208.8±39.7 mm Hg vs. 127.4±47.1 mm Hg, 219.1±41.1 mm Hg vs. 124.9±50.8 mm Hg, both P<0.05). There was no statistically significant difference in Cst before and after ventilation, and there was no significant changes among the groups. Raw in ARDSp prone position group at 4 hours of ventilation were significantly reduced than before ventilation (6.8±1.7 cm H(2)O×L(-1)×s(-1) vs. 10.7±1.8 cm H(2)O×L(-1)×s(-1), P<0.05), and significantly lower than the other three groups. There was no statistically significant difference in RAW among other three groups at each time point. CONCLUSION: Prone position can improve RM oxygenation invalid ARDS patients at high altitudes.