Alexandre Garcia de Lima

Broncoscopia para remoção de corpo estranho: onde está o atraso?

This was a retrospective analysis of the medical charts of 145 patients treated at the Bronchoscopy and Thoracic Surgery Clinic of the Hospital das Clínicas da Universidade Estadual de Campinas (HC-Unicamp, State University of Campinas Hospital das Clínicas) over a period of 10 years. There was a significant difference related to the site of first medical visit (Unicamp-HC versus other institutions) in terms of the time elapsed between the suspicion of bronchial aspiration and the actual respiratory endoscopic examination. However, no significant difference was found in the rate of positive results. The low number of referral centers that provide emergency respiratory endoscopy can negatively influence the treatment of patients under suspicion of bronchial aspiration, jeopardizing the overall recovery in the mid- and long-term.

Incidência de pneumotórax residual após simpatectomia torácica videotoracoscópica com e sem drenagem pleural e sua possível influência na dor pós-operatória

OBJECTIVE To determine the incidence of residual pneumothorax after video-assisted thoracic sympathectomy, with and without postoperative pleural drainage, and to evaluate the possible influence of this type of pneumothorax on postoperative pain within the first 28 postoperative days. METHODS All patients presenting symptoms consistent with primary palmoplantar hyperhidrosis and treated at the Thoracic Surgery Outpatient Clinic of the State Hospital of Sumaré between July and December of 2006 were included. All were submitted to sympathectomy up to the third ganglion using video-assisted thoracoscopy and were randomized to receive or not receive postoperative pleural drainage for 3 h. Chest X-rays and low-dose computed tomography scans of the chest were performed on the first postoperative day in order to determine the incidence of residual pneumothorax. At different time points up to postoperative day 28, patient pain was assessed using a visual numeric scale and by measuring the quantity of opioid analgesics required. RESULTS This study comprised 56 patients, 27 submitted to bilateral pleural drainage and 29 not submitted to drainage. There was no statistical difference between the two groups in terms of the incidence of post-sympathectomy residual pneumothorax. Residual pneumothorax diagnosed through any of the methods did not influence pain within the first 28 postoperative days. CONCLUSION Performing closed pleural drainage for 3 h immediately after video-assisted thoracic sympathectomy did not affect lung re-expansion or the incidence of residual pneumothorax. When residual pneumothorax was present, it did not affect pain within the first 28 postoperative days.

A drenagem pleural pré-hospitalar: apresentação de mecanismo de válvula unidirecional

BACKGROUND: The purpose of this study is to present an one-way valve mechanism to replace the underwater seal for pleural drainage, currently used in the prehospital attendance, as well as document preliminary results of its initial use at SAMUCampinas/ SP/Brasil. METHODS: Twenty two pleural drains with the valve were carried out, all of these in prehospital environment, in patients who suffered thoracic trauma or spontaneous pneumothorax, in a prospective not randomized trial. RESULTS: The total volume output drained through the valve ranged from 0 to 1500 ml, mean 700 ± 87,4 ml, in an average time lag of 18 minutes (± 1,1 minutes - ranging from 8 to 26 minutes). The initial and final cardiac frequency was 120 ± 2,7 bpm and 100 ± 2 bpm (p 0,00), respectively , whereas the initial respiratory frequency was 24 ± 0,8 ipm and the final was 15 ± 0,3 ipm (p 0,03). Only two mechanical failures were registered, one of which was corrected by the substitution of the defective valve, showing a 95,4% success ratio. CONCLUSION: Taking into account the initial and final physical examination, as well as the output quantification, it can be concluded that the valve is efficient and functional, and safe in the pre-hospital emergencies.

Postintubation injuries and open surgical tracheostomy: should we always perform isthmectomy?

OBJECTIVE To evaluate the influence of the surgical team (general surgery or thoracic surgery) and the surgical technique (with or without isthmectomy) on the incidence of postintubation injuries in the airways of tracheostomized patients. METHODS Between January 1st and August 31st, 2007, 164 patients admitted to the adult intensive care unit and tracheally intubated for more than 24 h were studied prospectively at the Sumaré State Hospital, located at the city of Sumare, Brazil. When tracheostomy was necessary, these patients were randomly assigned to thoracic or general surgery teams. All of the patients were submitted to fiberoptic tracheoscopy for decannulation or late evaluation of the airway. RESULTS Of the 164 patients in the study, 90 (54.88%) died (due to causes unrelated to the procedure), 67 (40.85%) completed follow-up, and 7 (4.27%) were lost to follow-up. Of the 67 patients who completed follow-up, 32 had undergone tracheostomy (21 by the general surgery team and 11 by the thoracic surgery team), and 22 had been submitted to isthmectomy (11 by the general surgery team and 11 by the thoracic surgery team). There was no difference between the surgical teams in terms of the incidence of stomal complications. However, there was a significant difference when the surgical techniques (with or without isthmectomy) were compared. CONCLUSIONS Not performing isthmectomy in parallel with tracheostomy leads the surgeon to open the tracheal stoma more distally than expected. In such cases, there were more stomal complications.

A influência do uso do "clamp" ou braçadeira no acúmulo de coágulos em drenos pleurais tubulares

OBJETIVO: Conduziu-se este estudo prospectivo a fim de avaliar-se a influencia do uso da bracadeira sobre o acumulo de coagulos dentro dos drenos pleurais. METODO: Os drenos pleurais foram pesados logo apos sua retirada, lavados e secados e pesados novamente. A diferenca entre a primeira e a segunda pesagem foi admitida como a quantidade de coagulos acumulada. RESULTADOS: Houve maior acumulo de coagulo nos drenos temporariamente obstruidos por bracadeira em relacao aqueles nao obstruidos. CONCLUSAO: Notou-se, neste estudo, maior acumulo de coagulo dentro de drenos pleurais obstruidos, mesmo que intermitentemente, o que pode levar ao mau funcionamento de todo o sistema de drenagem. A discussao sobre o correto uso dos drenos pleurais deve ser constante e fazer parte de programas de educacao continuada para medicos e enfermagem, a fim de que este sistema, amplamente utilizado e altamente eficiente, seja otimizado.

A influência do uso do clamp ou braçadeira no acúmulo de coágulos em drenos pleurais tubulares

OBJETIVO: Conduziu-se este estudo prospectivo a fim de avaliar-se a influencia do uso da bracadeira sobre o acumulo de coagulos dentro dos drenos pleurais. METODO: Os drenos pleurais foram pesados logo apos sua retirada, lavados e secados e pesados novamente. A diferenca entre a primeira e a segunda pesagem foi admitida como a quantidade de coagulos acumulada. RESULTADOS: Houve maior acumulo de coagulo nos drenos temporariamente obstruidos por bracadeira em relacao aqueles nao obstruidos. CONCLUSAO: Notou-se, neste estudo, maior acumulo de coagulo dentro de drenos pleurais obstruidos, mesmo que intermitentemente, o que pode levar ao mau funcionamento de todo o sistema de drenagem. A discussao sobre o correto uso dos drenos pleurais deve ser constante e fazer parte de programas de educacao continuada para medicos e enfermagem, a fim de que este sistema, amplamente utilizado e altamente eficiente, seja otimizado.