The international journal of medical robotics + computer assisted surgery : MRCASBodong Fan, Luhao Xie, Lifeng Zhu, Xiaoliang Jin, Jian Lu, Gaojun Teng, Aiguo Song
BACKGROUND: Teleoperated flexible bronchoscopy lacks distal haptic feedback, increasing the risk of unobservable iatrogenic tissue trauma during endoluminal exploration. METHODS: This study proposes a robot-assisted bronchoscopy system integrated with a dual-modal safety framework. A visual module utilises image moments to provide predictive alerts for collision avoidance. Concurrently, a Transformer-based network estimates distal interaction torques from proximal actuation, enabling real-time haptic perception at the leader console. RESULTS: Phantom validations across fragile tissue rupture, sidewall approximation, and luminal exploration tasks demonstrated the framework's efficacy. The visual warnings helped decrease excessive force contacts, while the learning-based estimator delivered reliable distal force perception. CONCLUSIONS: The proposed dual-modal teleoperated safety architecture resolves the trade-off between operational dexterity and safety in flexible bronchoscopy. By integrating predictive visual warnings and real-time haptic feedback, the system improves the operator's situational awareness, decreasing the risk of iatrogenic trauma during the operation.
Journal of bronchology & interventional pulmonologyPeter C Nauka, S Mehdi Nouraie, John Tepper, Paul Yacono, Matthew Vercauteren, Matthew Schuchert, Rajeev Dhupar, Daniel G Dunlap, Roy Semaan
RATIONALE: Robotic-assisted bronchoscopy platforms are becoming ubiquitous to aid in sampling peripheral pulmonary nodules. A head-to-head performance between the 2 widely available platforms (Ion and Monarch) has not been investigated. OBJECTIVES: To explore differences in diagnostic yield and safety parameters of the Ion and Monarch platforms. A secondary objective was to elucidate radiographic features of nodules that predicted procedural success. METHODS: A retrospective, 2-site cohort study of adult patients scheduled for robotic-assisted bronchoscopy of pulmonary nodules between August 2020 and August 2023. The procedure was performed with either the Ion or Monarch robotic-assisted bronchoscopy platform, depending on the site, with the assistance of standard 2D fluoroscopy. A series of logistic regression models was constructed to explore the effect of platform type on diagnostic yield, after correction of prespecified confounders. We utilized an inferential lasso regression model to explore the predictive properties of nodule radiographic characteristics on yield. RESULTS: A total of 217 cases were analyzed. The median nodule size was 1.4 cm (IQR=1.1 to 2.1), which was similar across both groups. Our parsimonious model suggested no difference in obtaining a positive diagnosis for the Ion platform [OR: 1.5 (0.9-2.7)]. Both nodule size [OR: 1.42 (1.09-1.86)] and presence of a bronchus sign [OR: 2.14 (1.14-4.01)] correlated with diagnostic yield in our inferential model, both in systems and in aggregate. CONCLUSION: Both platforms offer promise in sampling small peripheral nodules. Neither platform appears to improve procedural yield, although caution is advised regarding the generalizability of this finding. Both nodule size and the presence of the bronchus sign may be helpful in preprocedural patient selection.
Journal of bronchology & interventional pulmonologyZhentao Fei, Zhi Liu, Xue Li, Jiamin Huang, Jingfang Chen, Dan Ye, Yang Yang, Xuhui Liu
BACKGROUND: Post-tuberculosis airway stenosis (PTAS) is an underrecognized complication among TB survivors, especially those with tracheobronchial tuberculosis (TBTB). This study aimed to evaluate the prevalence, clinical features, and long-term outcomes of PTAS in a large real-world cohort. METHODS: We conducted a retrospective cohort study of pulmonary TB patients treated between 2017 and 2022 in Shenzhen, China. PTAS was identified based on bronchoscopy, imaging, and symptom assessment. Clinical data, including modified Medical Research Council (mMRC) dyspnea scores, were collected at baseline and during follow-up. Bronchoscopic intervention outcomes were also evaluated. RESULTS: Among 25,896 pulmonary TB patients, 265 (1%) were diagnosed with PTAS. Of the 98 cases with complete follow-up, 48 (49%) were asymptomatic (mMRC rank 0), and none of them progressed during a median follow-up of 1451 days. Among the 50 symptomatic patients (mMRC rank 1 to 4), 12 (24%) showed clinical deterioration. Baseline symptom severity was significantly associated with disease progression (P<0.001). Bronchoscopic interventions provided symptom relief in most cases, although statistical significance for reduced disease progression was not achieved (P>0.05). CONCLUSION: In this real-world study conducted in southern China, PTAS are observed to be less common yet potentially progressive complications among tuberculosis survivors. These complications can significantly impact the quality of life. The risk of progression may be predicted by baseline airway obstruction scores, which could serve as a basis for developing intervention strategies.
Annals of medicineMeng Yuan, Si-Jin Lv, Meng-Ru Wu, Yu-Chen Lu, Min-Hao Zhang, Jian-Hua He
BACKGROUND: Postoperative pain after thoracic surgery remains common and challenging. Transcutaneous auricular vagus nerve stimulation (taVNS) is a noninvasive neuromodulation technique with potential analgesic effects. This study aimed to evaluate the efficacy and safety of taVNS for postoperative pain management in patients undergoing thoracoscopic partial lung resection. METHODS: Adults undergoing thoracoscopic partial lung resection were randomized to active or sham taVNS. The primary outcome was cough pain intensity at 48h post-surgery, assessed by Numeric Rating Scale (NRS). Secondary outcomes included cough pain at 24h and 72h, resting pain, moderate-to-severe pain incidence, opioid consumption, quality of recovery, postoperative pulmonary complications , chest tube duration, hospital stay, postoperative nausea/vomiting, and adverse events. RESULTS: Among 119 analyzed patients (active n = 60, sham n = 59), active taVNS reduced cough pain scores at 24h, 48h, and 72h postoperatively, as well as resting pain (p < 0.05). It also lowered the incidence of moderate-to-severe cough pain at 24h and 48h, reduced cumulative postoperative opioid use at 24h and 72h, and decreased rescue analgesia on postoperative day 3 (p < 0.05). Active taVNS was associated with a lower incidence of postoperative pneumothorax (p < 0.05). No serious adverse events occurred. CONCLUSION: Perioperative taVNS was associated with a modest analgesic benefit and reduced postoperative opioid requirements after thoracoscopic partial lung resection. The observed reduction in postoperative pneumothorax requires cautious interpretation, and further multicenter trials are needed to determine its clinical utility.
Annals of medicineYu-Hern Tan, Huai-Hsuan Tung, Shih-Chieh Chien, Chen-Yen Chien
OBJECTIVE: The optimal surgical strategy for coronary artery bypass grafting (CABG) in patients with heart failure with reduced ejection fraction (HFrEF) is uncertain. This study aimed to compare postoperative outcomes between off-pump/on-pump CABG (OPCAB vs ONCAB) in patients with HFrEF. METHODS: This retrospective cohort study included adults with HFrEF undergoing CABG from the National Health Insurance Research Database, 2001-2021. Primary outcome was all-cause mortality. Secondary outcomes were postoperative complications. Logistic regression was used to determine associations by estimating odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: Data of 855 patients were analyzed (OPCAB n = 252; ONCAB n = 603). After multivariable adjustment, OPCAB was not significantly associated with all-cause mortality within 30 days compared with ONCAB. OPCAB was also not significantly associated with 31-day to one-year all-cause mortality, overall cardiovascular events, IS/TIA, AKI, infection other than pneumonia, sepsis, or pneumonia compared with ONCAB. In stratified analyses, OPCAB was associated with higher odds of sepsis among patients with less extent of coronary artery disease (<3-vessel disease) (aOR = 3.16, 95% CI: 1.24-8.07) and among those with cerebrovascular disease (aOR = 3.40, 95% CI: 1.13-10.21). CONCLUSIONS: In patients with HFrEF undergoing CABG, surgical approach (OPCAB vs ONCAB) was not independently associated with 30-day mortality, 1-year mortality, or major postoperative complications after adjustment. Further prospective studies with detailed operative and patient-level data are still warranted.
International journal of pediatric otorhinolaryngologySara O'Sullivan-Bakshi, Henry Diamond-Pott, Diego F Kaune, Francesca Lanni, Jacob Riordan, Jaime P Doody
INTRODUCTION: Foreign body aspiration (FBA) is a serious and potentially life-threatening pediatric emergency. When promptly diagnosed and managed, outcomes are usually favorable, but delayed recognition can result in pneumonia, acute respiratory distress and even death. Prior studies show that language barriers and limited English proficiency (LEP) are associated with delayed diagnosis, increased risk of high-severity aspirations (e.g., nuts), and disparities in perioperative and emergency care. However, few investigations have directly examined the relationship between language barriers and clinical outcomes in pediatric FBA. This study sought to evaluate these associations in a large national cohort. METHODS: We conducted a retrospective cohort study using the TriNetX research network. Pediatric patients (<18 years) with an index diagnosis of FBA were included. Exclusion criteria were age ≥18, prior history of FBA, asthma, or neuromuscular disorders. Two cohorts were created: children with FBA and a documented ICD code for acculturation difficulty (language barrier group) and children with FBA without such documentation (control group). Summary statistics were generated, and cohorts were propensity matched via multivariate linear regression based on age, age at index event, gender, race, and ethnicity. Outcomes compared included pneumonia, bronchoscopy, prolonged hospital stay, chest radiograph utilization, acute respiratory distress, dyspnea, and critical care services. RESULTS: After propensity score matching for age, age at index event, sex, race, and ethnicity, 880 pediatric patients with foreign body aspiration (FBA) and documented language barriers were compared with 880 matched controls. Patients with language barriers experienced significantly higher rates of pneumonia (39.0% vs 21.8%; OR 2.29, 95% CI 1.86-2.82; p < 0.0001) and prolonged hospital stay (6.93% vs 2.16%; OR 3.38, 95% CI 2.00-5.70; p < 0.0001). Respiratory complications were also more common, including acute respiratory distress (8.64% vs 1.93%; OR 4.80, 95% CI 2.81-8.19; p < 0.0001) and dyspnea (13.1% vs 3.86%; OR 3.74, 95% CI 2.52-5.55; p < 0.0001). Chest radiograph utilization (26.5% vs 14.0%; OR 2.22, 95% CI 1.74-2.82; p < 0.0001) and critical care use (6.93% vs 2.05%; OR 3.57, 95% CI 2.09-6.09; p < 0.0001) were higher among language barrier patients, while bronchoscopy rates were similar between groups (4.21% vs 3.30%; OR 1.29, 95% CI 0.79-2.11; p = 0.32). DISCUSSION: This national analysis demonstrates that pediatric patients with language barriers face significantly higher morbidity and resource utilization following FBA. These findings reinforce evidence that LEP contributes to delayed recognition, higher complication rates, and disparities in perioperative and emergency care. In the context of FBA, where timely diagnosis is critical, language barriers may affect survival and recovery. Standardized use of professional interpreters and culturally tailored caregiver education represent actionable strategies to reduce these inequities and potentially improve outcomes in this vulnerable population. To our knowledge, this is the first large-scale national study to directly examine language barriers and pediatric FBA outcomes.
International journal of pediatric otorhinolaryngologyMelissa Ameloti Gomes Avelino, Marina Nahas Dafico Bernardes, Luiza Avelino Ferri, Marina Emília de Matos Moraes, Celso Gonçalves de Castro Filho, Thalles Edua…
OBJECTIVE: To describe a percutaneous contralateral vocal fold lateralization as an endoscopic technical modification procedure originally described by Lichtenberger for the management of pediatric bilateral vocal fold paralysis (BVFP), employing readily available materials, and to evaluate clinical outcomes in a public tertiary referral center. METHODS: This longitudinal observational case series included nine pediatric patients diagnosed with BVFP who had previously undergone tracheostomy and were managed at a tertiary university hospital in Central-West Brazil. Endoscopic vocal fold lateralization was performed using a 16-gauge peripheral intravenous catheter (Abocath®) as a substitute for the conventional Lichtenberger endo-extralaryngeal needle carrier. All procedures were conducted under general anesthesia with suspension laryngoscopy and endoscopic guidance. Postoperative primary outcome included respiratory status following decannulation over a minimum follow-up of six months, and secondary outcomes: phonatory quality, swallowing function, evidence of aspiration and other complications. RESULTS: The mean age at surgery was 4 years. The predominant etiology was idiopathic (7 cases), one neurologic and other cardiac causes. All patients achieved successful decannulation (100%). Transient postoperative dysphonia was observed in all cases. No major complications, including aspiration pneumonia or lower airway infections, were documented. Two patients required revision surgery, one with contralateral and other ipsilateral lateralization. Adequate glottic airway patency was achieved in all cases, with preservation of swallowing function and satisfactory phonatory outcomes. CONCLUSION: The proposed adaptation of the Lichtenberger vocal fold lateralization technique using a 16-gauge intravenous catheter is a safe, effective, and reproducible alternative for pediatric patients with BVFP. This low-cost modification facilitates successful decannulation while preserving laryngeal function, representing a valuable strategy in resource-limited settings and supporting vocal fold lateralization as a first-line surgical option in tracheostomized children with BVFP.
BACKGROUND: To identify latent profiles of resilience and fear of progression in patients undergoing lung resection and evaluate their relationships with discharge symptoms and postoperative frailty. METHODS: This two-wave longitudinal observational study enrolled 387 patients undergoing video-assisted thoracic surgery. Preoperative psychological constructs (resilience and fear of progression) were assessed at admission (T1), while postoperative symptoms and frailty status were evaluated at the time of discharge (T2). Latent profile analysis and the robust three-step approach were used to identify unobserved patient subgroups. Multivariable linear and logistic regression analyses were then applied to evaluate the independent associations between these psychological profiles and discharge symptom burden as well as postoperative frailty status, after adjusting for perioperative clinical covariates. RESULTS: Three distinct profiles were identified: "Low Resilience-High Fear Group" (Profile 1, 24.3%), "Balanced Group" (Profile 2, 39.0%), and "High Resilience-Low Fear Group" (Profile 3, 36.7%). Living alone was a significant covariate associated with profile membership (P < 0.05). For discharge symptoms, using Profile 1 as the reference, membership in Profile 2 (b = -4.89) and Profile 3 (b = -16.95) was significantly associated with lower symptom scores (both P < 0.05). Regarding postoperative frailty at discharge, patients in Profile 3 had a 77% lower likelihood of worsening frailty status than those in Profile 1 (OR = 0.23, 95% CI: 0.13-0.40, P < 0.001). Additionally, primary caregiver type, preoperative frailty, and surgical procedures were independently related to discharge frailty status (all P < 0.05). CONCLUSIONS: Preoperative psychological stratification serves as an independent indicator of discharge symptoms and frailty status. These findings confirm that classification based on psychological variables provides critical clinical information not captured by standard surgical indices. Prioritizing psychological risk stratification in thoracic surgical workflows is necessary to guide targeted perioperative interventions and improve recovery outcomes.
Annals of medicineLiyuan Ren, Zhenhua Nan, Yanshuang Li, Yanping Wang
OBJECTIVE: To evaluate the analgesic efficacy of thoracic paravertebral block (TPVB) with different doses of liposomal bupivacaine (LB) or ropivacaine in patients undergoing single-port thoracoscopic lung surgery. METHODS: A total of 105 patients scheduled for video-assisted single-port thoracoscopic lung surgery were randomized in a 1:1:1 ratio into three groups: low-dose LB group (group LL), high-dose LB group (group HL), or ropivacaine group (group R). All received ultrasound-guided TPVB at the T5/6 level preoperatively. The primary outcome was the area under the curve (AUC) of NRS of pain at activity (AUC-aNRS) from 1 to 72 h postoperatively. Secondary outcomes included the AUC of NRS of pain at rest (AUC-rNRS) from 1 to 72 h postoperatively, NRS of pain at rest and at activity at 1, 6, 24, 48, and 72 h postoperatively, and the cumulative opioid consumption at 24, 48, and 72 h postoperatively. Additionally, postoperative recovery and adverse events were assessed. RESULTS: AUC-aNRS differed significantly among groups (p = 0.0092), with high-dose LB lower than low-dose LB (p = 0.0071), but not versus ropivacaine. No significant difference was found in AUC-rNRS (p > 0.05). The group-by-time interactions for NRS of pain at rest and at activity were not significant (p > 0.05). Cumulative opioid consumption at 24, 48, and 72 h was lower in group HL versus group LL (all p < 0.017), but not versus ropivacaine. Postoperative recovery and adverse events showed no differences (p > 0.05). CONCLUSION: LB combined with TPVB is not superior to ropivacaine for postoperative analgesia in single-port thoracoscopic lung resection.
Postcardiotomy shock (PCS) is a complex, high-mortality complication following cardiac surgery, driven by cardiopulmonary bypass-related inflammation, vasoplegia, myocardial dysfunction, and pulmonary hypertension. Conventional shock definitions are poorly applicable to this population; a vasoactive inotropic score greater than 20 to 25 with evidence of hypoperfusion is proposed as a practical operational definition. Overlapping PCS phenotypes (cardiogenic, vasoplegic, obstructive, arrhythmic, mixed) necessitate multimodal hemodynamic profiling incorporating pulmonary artery catheter data, echocardiography, and dynamic perfusion indices. Management focuses on judicious fluid and blood product administration, phenotype-directed inotropes and vasopressors, lung-protective ventilation, and early initiation of temporary mechanical circulatory support.
Cardiology clinicsJared Mortus, Derek Chen, Moe Ameri, Austin Niu, Mohammed H Merchant, Mourad H Senussi
Point-of-care ultrasound (POCUS) is an essential tool in perioperative and cardiac critical care, providing rapid, bedside evaluation of cardiac function, pulmonary pathology, and volume status. This article introduces a protocolized, whole-body POCUS approach centered on the sonographic congestion cascade, conceptualizing the cardiopulmonary venous system as a continuous physiologic unit. By integrating cardiac, lung, and multisite venous Doppler findings, clinicians can identify shock etiologies, characterize congestion phenotypes, and guide individualized, physiology-driven management in patients with undifferentiated shock and respiratory failure.
Cardiology clinicsDaniel Catena, Lorenzo Germinario, Ghaith Mohsen, Nicolas Hellner, Semiha Apaydin, Christian Stoppe
Cardiac surgery patients increasingly present with frailty, sarcopenia, malnutrition, anemia, and psychological distress, contributing to high perioperative risk and impaired recovery. Prehabilitation has emerged within Enhanced Recovery after Surgery cardiac frameworks as a proactive strategy to enhance physiologic and psychological resilience before surgery. This article summarizes current evidence on risk stratification and the core components of multimodal prehabilitation, including nutrition, exercise, patient blood management, and psychological support. Emphasis is placed on phenotype-driven patient selection and intervention tailoring, as well as practical considerations and future directions for integrating prehabilitation into routine cardiac surgical care.
Cardiology clinicsDaniel Catena, Lorenzo Germinario, Ghaith Mohsen, Nicolas Hellner, Semiha Apaydin, Christian Stoppe
Cardiac prehabilitation can be structured as a continuous "Prehab Loop" integrating risk stratification, tailored multimodal interventions, reassessment, and timely surgery. This approach aligns with Enhanced Recovery After Surgery cardiac principles and supports individualized optimization through exercise, nutrition, inspiratory muscle training, and psychological support. Flexible delivery models-including outpatient, home-based, and digital pathways-improve accessibility while maintaining quality. Successful implementation depends on multidisciplinary coordination and system-level solutions to logistical and financial barriers. Addressing these factors enables pragmatic integration of prehabilitation into routine cardiac surgical care and supports ongoing program refinement.
Cardiology clinicsAlexander Ambrosini, Valentina Jaramillo-Restrepo, Alexandra Schwann, Israel Safiriyu, Carlos L Alviar, P Elliott Miller
Patients admitted to contemporary cardiac intensive care units (ICUs) increasingly present with complex low-flow states and multisystem organ dysfunction, particularly in the perioperative cardiac surgery setting. This article outlines a systematic, organ-based approach to optimizing extracardiac organ function in patients with shock, emphasizing respiratory, renal, vascular, neurologic, hematologic, gastrointestinal, and endocrine management. Key principles include understanding cardiopulmonary interactions, minimizing secondary organ injury, tailoring supportive therapies to physiologic profiles, and applying ICU best practices. Coordinated, multidisciplinary optimization of noncardiac organ systems is essential to improve surgical candidacy, reduce complications, and enhance outcomes in this high-risk population.
Cardiology clinicsGraeme Prosperi-Porta, Garima Dahiya, Benjamin Hibbert, Jacob C Jentzer
Valvular heart disease is an uncommon but high-risk cause of cardiogenic shock requiring rapid, multidisciplinary management aimed at bridging patients to definitive surgical or transcatheter valve intervention. Early comprehensive Doppler echocardiography is essential, as clinical signs may be subtle. Distinguishing decompensated chronic valvular disease from acute unstable lesions guides urgency and treatment strategy. Medical stabilization and mechanical circulatory support vary markedly between stenotic and regurgitant lesions, and standard shock therapies may be harmful in specific contexts. Transcatheter approaches are preferred when feasible, though their expanding use introduces added complexity in cardiac intensive care.
The Journal of emergency medicineYahya El-Tahlawy, Mohammad Abir Mamum, Omar Lubbad, Wajeeh Ullah Mahmood, Goldie Khera, Muhammad S Sajid
BACKGROUND: Mechanical cardiopulmonary resuscitation (CPR) devices are increasingly used during cardiac arrest to provide consistent chest compressions; however, concerns persist regarding their potential to cause traumatic injuries compared with manual CPR. OBJECTIVES: To compare the cardiothoracic and abdominal injuries caused by mechanical versus manual CPR. METHODS: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. MEDLINE, EMBASE, PubMed, and the Cochrane Library were searched up to October 2025 for randomized controlled trials (RCTs) comparing mechanical with manual CPR in adults. Injury outcomes were grouped into clinically relevant categories and analyzed using Review Manager 5.4 with a random-effects model. RESULTS: Ten RCTs were included. There was no statistically significant difference between mechanical and manual CPR for liver injuries (odds ratio [OR]: 1.59, 95% confidence interval [CI]: 0.47-5.31, Z = 0.75, p = 0.46), rib and sternal fractures (OR 0.99, 95% CI 0.57-1.71; Z = 0.05, p = 0.96), thoracic or pleural injuries (OR: 0.97, 95% CI: 0.80-1.19, Z = 0.28, p = 0.78), or vascular and hemorrhagic complications (OR: 1.02, 95% CI: 0.20-5.13, Z = 0.02, p = 0.98). Subgroup analysis showed no difference for rib fractures or sternal fractures individually. CONCLUSION: Across all pooled injury categories, mechanical CPR did not demonstrate a significantly different injury profile to manual CPR; however, the low to very low certainty of evidence and absence of any low risk of bias trials mean these findings should be interpreted with caution and do not confirm safety equivalence.
Cardiology clinicsAmy L Friedman, Marissa W Mery, Christina A Jelly, Bret D Alvis
Heart transplantation is the definitive treatment for end-stage heart failure. Post-transplant care is dynamic and complex, requiring a thoughtful multidisciplinary approach. Invasive hemodynamic monitoring is central to guiding inotrope and vasopressor titration to optimize allograft function and end-organ perfusion. Vigilant assessment for primary graft dysfunction is essential and informs escalation to mechanical circulatory support when needed. As hemodynamics and graft function stabilize, patients are liberated from mechanical ventilation, volume status is optimized, nutrition and mobility are prioritized, and pharmacologic and mechanical supports are weaned. Concurrently, immunosuppression is titrated and patients are monitored closely for infection.
Cardiology clinicsElizabeth J Bashian, Emily Hay-Arthur, Thomas F O'Shea, Jessica Y Rove, Michael T Cain, Nicholas R Teman
Failure to rescue (FTR), defined as mortality after a postoperative complication, is now a central quality metric in cardiac surgery, where high-acuity patients and resource-intensive care increase vulnerability to deterioration. Although complications are common, survival depends on timely recognition, effective escalation, and coordinated multidisciplinary management. This article synthesizes current evidence on the epidemiology, mechanisms, and system-level drivers of FTR, highlighting how patient, provider, and institutional factors influence rescue success. We outline practical, evidence-based strategies to reduce FTR in cardiac surgery after prolonged ventilation, renal failure, stroke, and reoperation, by emphasizing protocolized care, staffing models, team communication, and rapid response infrastructure.
Cardiology clinicsAlexander J Gregory, Christopher D Noss, Michael C Grant
Enhanced recovery after cardiac surgery (ERAS) advocates for consistent and standardized delivery of evidenced-based perioperative care. Multidisciplinary teams deliver integrated patient care elements across all phases of care. Elements include risk-screening, prehabilitation, nutritional support, organ protection, patient blood management, early mobilization, optimal analgesia, and prevention of complications. Implementation of an ERAS program has been shown to improve patient recovery and reduce complications, length of stay, and resource utilization. However, the evidence is inconsistent and often low grade. Ongoing research, education, and institutional commitment remain essential for continued quantification of ERAS and its role in caring for cardiac surgical patients.
Journal of family nursingAnna Drakenberg, Daniel R Smith, Ann-Sofie Sundqvist, Christine Leo Swenne, Elisabeth Ericsson
In this study, a nurse-led supportive family health conversation intervention delivered through one to three video-conferencing sessions was evaluated for patients undergoing open-heart surgery and their self-selected family members. Based on the Family Systems Nursing framework, the intervention aimed to improve family well-being, functioning, and involvement by fostering shared understanding and challenging limiting beliefs. Patients and family members were randomized into two groups. Both received usual surgical care, while the intervention group also participated in digital family health conversations before and after surgery. Participants completed questionnaires at baseline and at 30 and 90 days after discharge. The analysis included 101 patients (control = 54, intervention = 47) and 99 family members (control = 52, intervention = 47). The intervention was not superior to usual care for the primary outcome, family well-being. Most secondary outcomes showed no effect, although some aspects of quality of life improved. Further research should examine long-term effects, feasibility, and appropriate outcome measures.Clinical trials register number and URL: NCT05045196, https://clinicaltrials.gov/study/NCT05045196?cond=NCT05045196&rank=1.