André Schmidt

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Background: Postoperative pulmonary complications (PPCs) are common after thoracic surgery performed with one-lung ventilation (OLV). Although risk scores such as ARISCAT, ASA physical status, and LAS VEGAS are used to predict PPC in general surgery, their performance in thoracic surgery remains unclear. This study aimed to evaluate the ability of these scores to predict PPCs. Methods: This prospective observational study included 115 adult patients undergoing noncardiac thoracic surgery requiring OLV. The primary outcome was the incidence of in-hospital PPCs within 30 days. We assessed the discriminatory ability of risk scores using receiver operating characteristic curve analysis (area under the curve (AUC)) and identified independent predictors with multivariable logistic regression. Results: PPCs occurred in 43 patients (37.4%). The LAS VEGAS score demonstrated the best discriminatory performance (AUC = 0.648, p = .005), followed by ARISCAT (AUC = 0.598, p = .067) and ASA (AUC = 0.562, p = .123). Independent predictors of PPCs were preoperative hemoglobin (OR 0.77, 95% CI 0.62–0.95) and intraoperative noradrenaline use (OR 5.93, 95% CI 2.36–15.95). A combined model including these two variables achieved an AUC of 0.772, which was significantly superior to the individual scores. Conclusions: The ARISCAT, ASA, and LAS VEGAS scores showed only weak-to-moderate predictive performance for PPCs after thoracic surgery with OLV. These findings do not support their routine use in this setting and highlight the need for thoracic surgery-specific risk prediction tools.

Background: Vitamin K antagonist (VKA) therapy requires frequent monitoring. Although telemedicine has expanded, evidence on its effectiveness in public health systems of developing countries remains limited. We evaluated the safety, quality of anticoagulation control, and cost-effectiveness of telemedicine-based versus in-person follow-up in a Brazilian tertiary public center. Methods: This retrospective observational study at a Brazilian tertiary university hospital compared an in-person phase with the telemedicine phase initiated in April 2020. Outcomes were time in therapeutic range (TTR), all-cause and anticoagulation-related mortality, and direct healthcare costs. TTR was compared within patients ( n = 661 followed regularly in both phases); mortality was compared as phase-specific annualized rates among all patients followed in each phase (1313 in-person; 1086 telemedicine). Results: Median TTR did not differ between the in-person and telemedicine phases (58% vs. 60%; p = .35). Annualized all-cause mortality (69 vs. 77 deaths per 1000 person-years; p = .43) and anticoagulation-related mortality (13 vs. 11 per 1000 person-years; p = .61) were also comparable. Cost-minimization analysis showed that telemedicine reduced annual direct expenditures by 10% (USD 4473; 95% CI: 2904–6030). Discussion: Telemedicine-based monitoring for patients on VKAs is as safe and clinically effective as traditional in-person care. Furthermore, telemedicine offers lower direct costs, proving to be a viable alternative to optimize resource allocation and enhance efficiency within the public health system.

Background and Objective: Postoperative pulmonary complications (PPC) are linked to higher morbidity and healthcare costs. High‐flow nasal cannula (HFNC) oxygen therapy may mitigate PPC by enhancing oxygenation and easing respiratory effort. This study assessed HFNC's efficacy versus conventional oxygen therapy in reducing PPC during anesthetic induction and extubation in elective thoracic surgery for lung resection. Methods: In a single‐center randomized clinical trial, 90 patients undergoing elective thoracic surgery were randomized (1:1) to HFNC or conventional oxygen therapy during induction and extubation. The primary outcome was in‐hospital PPC incidence within 30 days. Secondary outcomes included intubation hypoxemia, 30‐day mortality, and ICU admission. Poisson regression identified PPC predictors. Results: PPC rates were 20.0% in the HFNC group and 26.7% in controls (relative risk [RR] 0.75, 95% CI 0.35–1.60, p = 0.455), with no significant difference. Poisson regression revealed independent predictors: chronic obstructive pulmonary disease, preoperative SpO ₂ ≤ 94%, surgery > 2 h, and left lung ventilation ( p < 0.05). No differences occurred in intubation hypoxemia (0% both groups), 30‐day mortality (2.22% HFNC vs. 4.44% controls, p = 0.553), or ICU admission (13.33% HFNC vs. 17.78% controls, p = 0.526). HFNC was well‐tolerated without device issues. Conclusion: HFNC, applied during intubation and extubation, did not significantly reduce the incidence of PPC or secondary outcomes compared to conventional oxygen therapy in patients undergoing elective thoracic surgery. Further research is needed to explore HFNC's potential in high‐risk populations or with optimized protocols, such as extended application periods or varied flow rates, to enhance perioperative respiratory management.

Background: Combining lidocaine with bupivacaine in brachial plexus blocks seeks to blend rapid onset with extended duration; yet, clinical advantages are uncertain. This systematic review assesses their efficacy against bupivacaine alone in ultrasound-guided brachial plexus blocks. Methods: A systematic search of PubMed, EMBASE, and Cochrane databases was conducted in May 2025. Randomized controlled trials (RCTs) comparing lidocaine-bupivacaine mixtures with bupivacaine alone in ultrasound-guided brachial plexus blocks were included. The primary outcome was sensory block onset time. Secondary outcomes included motor block onset time, sensory and motor block durations, and conversion to general anesthesia. Data were analyzed using a random-effects model, with heterogeneity assessed via I² statistics.Results: Of 1,490 identified articles, 7 RCTs (358 patients) met the inclusion criteria. No significant difference was found in sensory block onset time (mean difference [MD] –1.81 min, 95% confidence interval [CI] –3.92 to 0.29; P = 0.09; I² = 98%) or motor block onset time (MD 0.02 min, 95% CI –2.34 to 2.39; P = 0.99; I² = 95%) between groups. The mixture reduced sensory (MD –172.88 min, 95% CI –215.18 to –130.59; P<0.00001; I² = 90%) and motor block durations (MD –212.13 min, 95% CI –374.99 to –49.28; P = 0.01; I² = 93%). Conclusions: No clinical benefit was observed from combining lidocaine with bupivacaine, as there was no improvement in block onset times and a reduction in block durations. Given the very low certainty of evidence, these findings should be interpreted with caution, and further high-quality RCTs are needed.