Bibliographic record
Abstract
To the Editor: The reported case of a tension pneumothorax during pneumonectomy by Finlayson et al. raises a number of issues related to the use of right-sided double-lumen tubes (DLTs) as well as that of a different presentation in the setting of an open hemithorax.1 First, right-sided DLTs are more difficult to place because of the need to line up the lateral bronchial orifice with the right upper lobe (RUL) take-off and clinical placement of right DLTs has been shown to result in malposition in 73%–89% of cases.2,3 This malposition rate may potentially be decreased when using a modified DLT,4 however fiberoptic confirmation is mandatory for exact tube placement, particularly when relying on the RUL for ventilation as during right one-lung ventilation (OLV). Proceeding with a right OLV case without fiberoptic confirmation of patency of the RUL take-off is likely to have been the cause of the pneumothorax in this case of OLV in a patient with no underlying lung disease. Second, a sudden increase in airway pressure during OLV is often due to partial airway obstruction. With a left DLT, it may indicate left upper lobe obstruction during left OLV or bronchial cuff herniation during right OLV. With a right DLT, it may indicate RUL obstruction during right OLV or bronchial cuff herniation during left OLV. Bronchoscopic confirmation of DLT position, including patency of the RUL orifice, should therefore immediately be performed, along with resuming two-lung ventilation if necessary. Third, tension pneumothorax should in most cases be a rather simple diagnosis during open thoracotomy as any expansion of the dependent hemithorax pushes the mediastinum towards the operating surgeon. In addition to the facility of diagnosing a tension pneumothorax, the surgeon is also in a unique position of easy access to the dependent hemithorax for decompression. The anterior pleural reflection of the dependent lung is readily accessible across the anterior retrosternal mediastinum and can be opened for immediate decompression, stabilizing the patient for eventual chest tube placement. Jens Lohser, MD, MSc, FRCPC Anesthesiology, Pharmacology and Therapeutics Department University of British Columbia British Columbia, Canada [email protected]
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.018 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.004 | 0.001 |
| Research integrity | 0.017 | 0.012 |
| Insufficient payload (model declined to judge) | 0.002 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".