1
|
Suleiman A, Azizi BA, Munoz-Acuna R, Ahrens E, Tartler TM, Wachtendorf LJ, Linhardt FC, Santer P, Chen G, Wilson JL, Gangadharan SP, Schaefer MS. Intensity of one-lung ventilation and postoperative respiratory failure: A hospital registry study. Anaesth Crit Care Pain Med 2023; 42:101250. [PMID: 37236317 DOI: 10.1016/j.accpm.2023.101250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/10/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Studies linked a high intensity of mechanical ventilation, measured as high mechanical power (MP) to postoperative respiratory failure (PRF) in the setting of two-lung ventilation. We investigated whether a higher MP during one-lung ventilation (OLV) is associated with PRF. METHODS In this registry-based study, adult patients who underwent general anesthesia with OLV for thoracic surgeries between 2006 and 2020 at a New England tertiary healthcare network were included. The association between MP during OLV and PRF (emergency non-invasive ventilation or reintubation within seven days) was assessed in a cohort weighted through a generalized propensity score conditional on a priori defined preoperative and intraoperative factors. Dominance of components of MP and intensity of OLV versus two-lung ventilation in predicting PRF was investigated. RESULTS Out of 878 included patients, 106 (12.1%) developed PRF. The median (IQR) MP during OLV was 9.8 J/min (7.5-11.8) and 8.3 J/min (6.6-10.2) in patients with and without PRF respectively. A higher MP during OLV was associated with PRF (ORadj 1.22 per 1 J/min increase; 95%CI 1.13-1.31; p < 0.001) and characterized by a U-shaped dose-response curve, with the lowest probability of PRF (7.5%) at 6.4 J/min. Dominance analysis of PRF predictors showed a stronger contribution of driving pressure over respiratory rate and tidal volume, the dynamic over the static component of MP, and MP during OLV over two-lung ventilation (contribution to Pseudo-R2: 0.017, 0.021, and 0.036, respectively). CONCLUSION A higher intensity of OLV, mainly driven by driving pressure, is dose-dependently associated with PRF and might constitute a target for mechanical ventilation.
Collapse
Affiliation(s)
- Aiman Suleiman
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Basit A Azizi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ricardo Munoz-Acuna
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Elena Ahrens
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tim M Tartler
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Luca J Wachtendorf
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Felix C Linhardt
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Peter Santer
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Guanqing Chen
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jennifer L Wilson
- Division of Thoracic Surgery and Interventional Pulmonology, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Sidhu P Gangadharan
- Division of Thoracic Surgery and Interventional Pulmonology, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Maximilian S Schaefer
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany.
| |
Collapse
|
2
|
Barbagallo M, Schiappa E. Noninvasive Positive Pressure Ventilation in Patients Undergoing Lung Resection Surgery. NONINVASIVE MECHANICAL VENTILATION 2023:645-654. [DOI: 10.1007/978-3-031-28963-7_62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
|
3
|
[Efficacy Analysis of High-flow Nasal Oxygen Therapy in Patients
Accepting Single-port Video-assisted Thoracoscopic Lobectomy]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2022; 25:642-650. [PMID: 36172728 PMCID: PMC9549426 DOI: 10.3779/j.issn.1009-3419.2022.102.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Patients who underwent lobectomy resection are prone to hypoxemia, and the vast majority present with type I respiratory failure. Thus, improvement of hypoxemia is one of the most important factors to facilitate postoperative recovery of patients. In this study, the superiority-inferiority of different oxygen inhalation methods were compared with high-flow nasal oxygen therapy (HFNO), noninvasive mechanical ventilation (NIMV) and nasal oxygen breath (NOB) in patients with hypoxemia after single-port video-assisted thoracoscopic (VATS) lobectomy, and the clinical efficacy of HFNO in these patients was further investigated. METHODS A total of 180 patients from the Second Affiliated Hospital of Soochow University in China with hypoxemia who accepting single-port VATS lobectomy from June 2021 to March 2022 were randomly divided into three groups (n=60), which were treated with HFNO, NIMV and NOB, respectively. The results of arterial blood gas analysis, patient's comfort score and incidence of complications were observed before, 1 h, 6 h-12 h and after use. Statistical analyses were conducted using statistical program for social sciences 25.0 (SPSS 25.0), and P<0.05 was considered as statistical significance. RESULTS For patients with hypoxemia after accepting single-port VATS lobectomy, HFNO was no less effective than NIMV (P=0.333), and both of whom could fast increase patients' partial pressure of oxygen/fraction of inspiration O₂ (PaO₂/FiO₂) compared to NOB (P<0.001). Besides, HFNO shows a great advantage in comfort degree and stay length (P<0.001, P=0.004), and incidence of complications were slightly lower than other groups (P=0.232). But it is worthy to note that HFNO is still slightly less effective than NIMV in patients with postoperative hypoxemia accompanied by elevated partial pressure of carbon dioxide (PaCO₂). CONCLUSIONS For patients with hypoxemia who accepting single-port VATS lobectomy, HFNO can be used as the first choice. However, for patients with postoperative hypoxemia accompanied by elevated PaCO₂, NIMV is still recommended to improve oxygenation.
Collapse
|
4
|
Ohchi Y, Kuribayashi Y, Makino T, Yasuda N, Kitano T. Nasal pillow noninvasive ventilation versus high-flow nasal therapy after extubation in surgical intensive care patients: A propensity-matched cohort study. J Int Med Res 2022; 50:3000605221112777. [PMID: 35866425 PMCID: PMC9310252 DOI: 10.1177/03000605221112777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective To evaluate the tolerability and efficacy of nasal pillow-noninvasive ventilation (NP-NIV) compared with high-flow nasal therapy (HFNT) in postsurgical patients. Methods This propensity score-matched retrospective study enrolled postoperative patients that received NP-NIV (NP-NIV group) or HFNT (HFNT group) in the intensive care unit. Data were collected from their medical records and the tolerability and respiratory status before and after extubation were compared between the two groups. Results The study enrolled 83 patients in the NP-NIV group and 27 patients in the HFNT group. After propensity score matching, there were 19 patients in each group. After matching, there were no significant differences in the baseline demographic and clinical characteristics before extubation. The tolerability was similar in both groups. When the NP-NIV group was compared with the HFNT group, the respiratory rate was significantly lower (median 16 [interquartile range, 14–17] versus median 19 [interquartile range, 18–26], respectively) and the partial pressure of arterial oxygen/fraction of inspired oxygen ratio was significantly higher (median 205 [174–256] versus median 155 [130–192], respectively) at 1 h after extubation. Conclusion NP-NIV was equally well tolerated and provided better respiratory support than HFNT in postsurgical patients.
Collapse
Affiliation(s)
- Yoshifumi Ohchi
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Oita University, Yufu, Japan
| | - Yoshihide Kuribayashi
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Oita University, Yufu, Japan
| | - Takenori Makino
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Oita University, Yufu, Japan
| | - Norihisa Yasuda
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Oita University, Yufu, Japan
| | - Takaaki Kitano
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Oita University, Yufu, Japan
| |
Collapse
|
5
|
Razafimanjato N, Rakotoson J, Ravoatrarilandy M, Andrianasolo R, Rajaonera A, Raveloson N, Rakotovao H. [Severity Factors of Pulmonary Aspergilloma in the Surgical Intensive Care Unit of Joseph Ravoahangy Andrianavalona Hospital, Antananarivo, Madagascar]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2021; 1:E9QE-PV02. [PMID: 35586637 PMCID: PMC9022768 DOI: 10.48327/e9qe-pv02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 02/06/2021] [Indexed: 11/18/2022]
Abstract
Objective This retrospective study was designed to study the clinical profile, post-operative outcome with analysis of severity factors of pulmonary aspergilloma operated in our institute. Patients and methodology During a 5-year period (June 2009 to June 2014), 34 patients underwent surgery for pulmonary aspergilloma and were admitted in the surgical intensive care unit of the CHU/JRA Antananarivo. Results The group consist of 23 male patients and 11 female patients with a mean age of 42 ± 9.9 years. In 29.4% of cases, it was a complex aspergilloma. The procedures performed were segmental resection (n = 3), lobectomy (n = 21), bi-lobectomy (n = 2), pneumonectomy (n = 7) and cavernostomy (n = 1). Median hospital stay was 4.5 ± 3 days. The postoperative lethality rate was 14.7% caused by respiratory failure, infection and underlying diseases. Main complications included bleeding, respiratory failures, and pulmonary infection. Conclusion Factors associated to increased postoperative complications included: the ASA score, decreased preoperative lung function, urgent procedures, smoking, postoperative mechanical ventilation, bleeding, hyperleukocytosis and surgery duration.
Collapse
Affiliation(s)
- N.N.M. Razafimanjato
- USFR de chirurgie thoracique, Hôpital universitaire Joseph Ravoahangy Andrianavalona (HUJRA), Faculté de médecine d'Antananarivo, Madagascar,*
| | - J.M. Rakotoson
- USFR d'anesthésie-réanimation chirurgicale, Hôpital universitaire Joseph Ravoahangy Andrianavalona (HJRA). Faculté de médecine d'Antananarivo, Madagascar
| | - M. Ravoatrarilandy
- USFR de chirurgie thoracique, Hôpital universitaire Joseph Ravoahangy Andrianavalona (HUJRA), Faculté de médecine d'Antananarivo, Madagascar
| | - R.L. Andrianasolo
- USFR de maladie infectieuse et tropicale, Hôpital universitaire Joseph Raseta Befelatanana (HJRB). Faculté de médecine d'Antananarivo, Madagascar
| | - A.T. Rajaonera
- USFR d'anesthésie-réanimation chirurgicale, Hôpital universitaire Joseph Ravoahangy Andrianavalona (HJRA). Faculté de médecine d'Antananarivo, Madagascar
| | - N.E. Raveloson
- USFR de réanimation médicale, Hôpital universitaire Joseph Raseta De Befelatanana (HJRB). Faculté de médecine d'Antananarivo, Madagascar
| | - H.J.L. Rakotovao
- USFR de chirurgie thoracique, Hôpital universitaire Joseph Ravoahangy Andrianavalona (HUJRA), Faculté de médecine d'Antananarivo, Madagascar
| |
Collapse
|
6
|
Berna P, Quesnel C, Assouad J, Bagan P, Etienne H, Fourdrain A, Le Guen M, Leone M, Lorne E, Nguyen YNL, Pages PB, Roz H, Garnier M. Guidelines on enhanced recovery after pulmonary lobectomy. Anaesth Crit Care Pain Med 2021; 40:100791. [PMID: 33451912 DOI: 10.1016/j.accpm.2020.100791] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To establish recommendations for optimisation of the management of patients undergoing pulmonary lobectomy, particularly Enhanced Recovery After Surgery (ERAS). DESIGN A consensus committee of 13 experts from the French Society of Anaesthesia and Intensive Care Medicine (Soci,t, franOaise d'anesth,sie et de r,animation, SFAR) and the French Society of Thoracic and Cardiovascular Surgery (Soci,t, franOaise de chirurgie thoracique et cardiovasculaire, SFCTCV) was convened. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. METHODS Five domains were defined: 1) patient pathway and patient information; 2) preoperative management and rehabilitation; 3) anaesthesia and analgesia for lobectomy; 4) surgical strategy for lobectomy; and 5) enhanced recovery after surgery. For each domain, the objective of the recommendations was to address a number of questions formulated according to the PICO model (Population, Intervention, Comparison, Outcome). An extensive literature search on these questions was carried out and analysed using the GRADE® methodology. Recommendations were formulated according to the GRADE® methodology, and were then voted by all experts according to the GRADE grid method. RESULTS The SFAR/SFCTCV guideline panel provided 32 recommendations on the management of patients undergoing pulmonary lobectomy. After two voting rounds and several amendments, a strong consensus was reached for 31 of the 32 recommendations and a moderate consensus was reached for the last recommendation. Seven of these recommendations present a high level of evidence (GRADE 1+), 23 have a moderate level of evidence (18 GRADE 2+ and 5 GRADE 2-), and 2 correspond to expert opinions. Finally, no recommendation was provided for 2 of the questions. CONCLUSIONS A strong consensus was expressed by the experts to provide recommendations to optimise the whole perioperative management of patients undergoing pulmonary lobectomy.
Collapse
Affiliation(s)
- Pascal Berna
- Department of Thoracic Surgery, Amiens University Hospital, 80000 Amiens, France
| | - Christophe Quesnel
- Sorbonne Universit,, APHP, DMU DREAM, Service d'Anesth,sie-R,animation et M,decine P,riop,ratoire, H"pital Tenon, 75020 Paris, France
| | - Jalal Assouad
- Department of Thoracic Surgery, Tenon University Hospital, Sorbonne Universit,, 75020 Paris, France
| | - Patrick Bagan
- Department of Thoracic and Vascular Surgery, Victor Dupouy Hospital, 95100 Argenteuil, France
| | - Harry Etienne
- Department of Thoracic Surgery, Tenon University Hospital, Sorbonne Universit,, 75020 Paris, France
| | - Alex Fourdrain
- Department of Thoracic Surgery, Amiens University Hospital, 80000 Amiens, France
| | - Morgan Le Guen
- D,partement d'Anesth,sie, H"pital Foch, Universit, Versailles Saint Quentin, 92150 Suresnes, France; INRA UMR 892 VIM, 78350 Jouy-en-Josas, France
| | - Marc Leone
- Aix Marseille Universit, - Assistance Publique H"pitaux de Marseille - Service d'Anesth,sie et de R,animation - H"pital Nord - 13005 Marseille, France
| | - Emmanuel Lorne
- Departement d'Anesth,sie-R,animation, Clinique du Mill,naire, 34000 Montpellier, France
| | - Y N-Lan Nguyen
- Anaesthesiology and Critical Care Department, APHP Centre, Paris University, 75000 Paris, France
| | - Pierre-Benoit Pages
- Department of Thoracic Surgery, Dijon Burgundy University Hospital, 21000 Dijon, France; INSERM UMR 1231, Dijon Burgundy University Hospital, University of Burgundy, 21000 Dijon, France
| | - Hadrien Roz
- Unit, d'Anesth,sie R,animation Thoracique, H"pital Haut Leveque, CHU de Bordeaux, 33000 Bordeaux, France
| | - Marc Garnier
- Sorbonne Universit,, APHP, DMU DREAM, Service d'Anesth,sie-R,animation et M,decine P,riop,ratoire, H"pital Tenon, 75020 Paris, France.
| |
Collapse
|
7
|
Pennisi MA, Bello G, Congedo MT, Montini L, Nachira D, Ferretti GM, Meacci E, Gualtieri E, De Pascale G, Grieco DL, Margaritora S, Antonelli M. Early nasal high-flow versus Venturi mask oxygen therapy after lung resection: a randomized trial. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:68. [PMID: 30819227 PMCID: PMC6396480 DOI: 10.1186/s13054-019-2361-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/17/2019] [Indexed: 02/08/2023]
Abstract
Background Data on high-flow nasal oxygen after thoracic surgery are limited and confined to the comparison with low-flow oxygen. Different from low-flow oxygen, Venturi masks provide higher gas flow at a predetermined fraction of inspired oxygen (FiO2). We conducted a randomized trial to determine whether preemptive high-flow nasal oxygen reduces the incidence of postoperative hypoxemia after lung resection, as compared to Venturi mask oxygen therapy. Methods In this single-center, randomized trial conducted in a teaching hospital in Italy, consecutive adult patients undergoing thoracotomic lung resection, who were not on long-term oxygen therapy, were randomly assigned to receive high-flow nasal or Venturi mask oxygen after extubation continuously for two postoperative days. The primary outcome was the incidence of postoperative hypoxemia (i.e., ratio of the partial pressure of arterial oxygen to FiO2 (PaO2/FiO2) lower than 300 mmHg) within four postoperative days. Results Between September 2015 and April 2018, 96 patients were enrolled; 95 patients were analyzed (47 in high-flow group and 48 in Venturi mask group). In both groups, 38 patients (81% in the high-flow group and 79% in the Venturi mask group) developed postoperative hypoxemia, with an unadjusted odds ratio (OR) for the high-flow group of 1.11 [95% confidence interval (CI) 0.41–3] (p = 0.84). No inter-group differences were found in the degree of dyspnea nor in the proportion of patients needing oxygen therapy after treatment discontinuation (OR 1.34 [95% CI 0.60–3]), experiencing pulmonary complications (OR 1.29 [95% CI 0.51–3.25]) or requiring ventilatory support (OR 0.67 [95% CI 0.11–4.18]). Post hoc analyses revealed that PaO2/FiO2 during the study was not different between groups (p = 0.92), but patients receiving high-flow nasal oxygen had lower arterial pressure of carbon dioxide, with a mean inter-group difference of 2 mmHg [95% CI 0.5–3.4] (p = 0.009), and were burdened by a lower risk of postoperative hypercapnia (adjusted OR 0.18 [95% CI 0.06–0.54], p = 0.002). Conclusions When compared to Venturi mask after thoracotomic lung resection, preemptive high-flow nasal oxygen did not reduce the incidence of postoperative hypoxemia nor improved other analyzed outcomes. Further adequately powered investigations in this setting are warranted to establish whether high-flow nasal oxygen may yield clinical benefit on carbon dioxide clearance. Trial registration ClinicalTrials.gov, NCT02544477. Registered 9 September 2015. Electronic supplementary material The online version of this article (10.1186/s13054-019-2361-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Mariano Alberto Pennisi
- Dipartimento delle Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, UOC di Anestesia, Rianimazione, Terapia Intensiva e Tossicologia Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Anestesia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Bello
- Dipartimento delle Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, UOC di Anestesia, Rianimazione, Terapia Intensiva e Tossicologia Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. .,Istituto di Anestesia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Maria Teresa Congedo
- Dipartimento delle Scienze Cardiovascolari e Toraciche, UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Istituto di Patologia Speciale Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Montini
- Dipartimento delle Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, UOC di Anestesia, Rianimazione, Terapia Intensiva e Tossicologia Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Anestesia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Dania Nachira
- Dipartimento delle Scienze Cardiovascolari e Toraciche, UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Istituto di Patologia Speciale Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gian Maria Ferretti
- Dipartimento delle Scienze Cardiovascolari e Toraciche, UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Istituto di Patologia Speciale Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisa Meacci
- Dipartimento delle Scienze Cardiovascolari e Toraciche, UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Istituto di Patologia Speciale Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisabetta Gualtieri
- Dipartimento delle Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, UOC di Anestesia, Rianimazione, Terapia Intensiva e Tossicologia Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Anestesia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gennaro De Pascale
- Dipartimento delle Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, UOC di Anestesia, Rianimazione, Terapia Intensiva e Tossicologia Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Anestesia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico Luca Grieco
- Dipartimento delle Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, UOC di Anestesia, Rianimazione, Terapia Intensiva e Tossicologia Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Anestesia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Margaritora
- Dipartimento delle Scienze Cardiovascolari e Toraciche, UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Istituto di Patologia Speciale Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimo Antonelli
- Dipartimento delle Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, UOC di Anestesia, Rianimazione, Terapia Intensiva e Tossicologia Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Anestesia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
8
|
Blanc K, Dechartres A, Zaimi R, Lefebvre A, Janet-Vendroux A, Fournel L, Dermine H, Lorut C, Becanne X, Hamelin-Canny E, Bobbio A, Roche N, Regnard JF, Alifano M, Rabbat A. Patients experiencing early acute respiratory failure have high postoperative mortality after pneumonectomy. J Thorac Cardiovasc Surg 2018; 156:2368-2376. [PMID: 30449587 DOI: 10.1016/j.jtcvs.2018.08.113] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/05/2018] [Accepted: 08/17/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Post-pneumonectomy acute respiratory failure leading to invasive mechanical ventilation carries a severe prognosis especially when acute respiratory distress syndrome occurs. The aim of this study was to describe risk factors and outcome of acute respiratory failure. METHODS We retrospectively reviewed clinical files of all patients who underwent pneumonectomy in a single center between 2005 and 2015. Risk factors and outcome of acute respiratory failure were assessed in univariate and multivariate analysis. RESULTS Among the 543 patients who underwent pneumonectomy in the period of study, 89 (16.4%) needed reintubation within the 30th postoperative day and 60 of these (11% of all pneumonectomies) developed acute respiratory distress syndrome. In multivariate analysis, right-side of pneumonectomy (odds ratio [OR], 2.29; 95% confidence interval [CI], 1.24-4.22), chronic cardiac disease (OR, 2.15; 95% CI, 1.08-4.25), Charlson Comorbidity Index (OR, 1.35; 95% CI, 1.14-1.61), carinal resection (OR, 3.23; 95% CI, 1.26-8.29), and extrapleural pneumonectomy (OR, 8.36; 95% CI, 3.31-21.11) were identified as independent risk factors of reintubation. Thirty-day mortality was 7.7% for all pneumonectomies, 41.6% (37/89) in the invasive ventilation group, and 53.3% (32/60) in patients with acute respiratory distress syndrome. In non-reintubated patients, 30-day mortality was 1.1% (5/454). In reintubated patients, 5-year survival was 27.1% (95% CI, 17.8-41.4). CONCLUSIONS Early acute respiratory failure requiring reintubation remains a severe complication of pneumonectomy with a poor outcome.
Collapse
Affiliation(s)
- Kim Blanc
- Department of Chest Disease and Respiratory Intensive Care, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Agnès Dechartres
- Department of Clinic Epidemiology Center, Hôtel Dieu, HUPC, APHP, Paris Descartes University, Paris, France
| | - Rym Zaimi
- Department of Thoracic Surgery, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Aurélie Lefebvre
- Department of Chest Disease and Respiratory Intensive Care, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Aurélie Janet-Vendroux
- Department of Thoracic Surgery, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Ludovic Fournel
- Department of Thoracic Surgery, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Hervé Dermine
- Department of Anesthesia and Surgical Intensive Care, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Christine Lorut
- Department of Chest Disease and Respiratory Intensive Care, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Xavier Becanne
- Department of Anesthesia and Surgical Intensive Care, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Emelyne Hamelin-Canny
- Department of Thoracic Surgery, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Antonio Bobbio
- Department of Thoracic Surgery, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Nicolas Roche
- Department of Chest Disease and Respiratory Intensive Care, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Jean-François Regnard
- Department of Thoracic Surgery, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Marco Alifano
- Department of Thoracic Surgery, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France.
| | - Antoine Rabbat
- Department of Chest Disease and Respiratory Intensive Care, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| |
Collapse
|
9
|
Kuckelman J, Cuadrado DG. Care of the Postoperative Pulmonary Resection Patient. SURGICAL CRITICAL CARE THERAPY 2018. [PMCID: PMC7120963 DOI: 10.1007/978-3-319-71712-8_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Patients undergoing pulmonary resection all exhibit, to some degree, a level of pulmonary dysfunction. This is due to the physiologic stress of the procedure performed, the patient’s comorbidities, and preexisting cardiopulmonary reserve. Although prognostic factors for intensive care requirement exist, to date, there is no consensus for postoperative admission. Institutional practices vary across the country, with patients often admitted to intensive care for surveillance. Guidelines published from the American Thoracic Society in 1999 emphasize that admission to the ICU be reserved for those patients requiring care and monitoring for severe physiologic instability. Admissions following pulmonary resection are typically due to respiratory complications and are an independent predictor of mortality. The following chapter will review the indications for admission to the ICU and common issues encountered following pulmonary resection and conclude with a discussion of the management of patients undergoing pulmonary transplantation.
Collapse
|
10
|
Gilliland S, Brainard J. Postoperative Noninvasive Ventilation Following Cardiothoracic Surgery. Semin Cardiothorac Vasc Anesth 2015; 19:302-8. [DOI: 10.1177/1089253215572699] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Postoperative pulmonary complications following cardiac and thoracic surgery are common and associated with significant morbidity and mortality. Noninvasive ventilation has emerged as a successful and well-validated strategy to treat various acute medical conditions. More recently, noninvasive ventilation has been studied in selective surgical patient populations with the goal of preventing postoperative complications and treating acute respiratory failure. In this clinical review, we will briefly examine the incidence of pulmonary complications following cardiothoracic surgery and the physiology and mechanics of acute respiratory failure and noninvasive ventilation. We then present a systematic review of the indications, patient selection, and current literature investigating the specific use of noninvasive ventilation in this population.
Collapse
|
11
|
Lefebvre A, Rabbat A. Ventilation non invasive et patients immunodéprimés. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1096-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
12
|
Abstract
PURPOSE OF REVIEW This article reviews the use of noninvasive ventilation (NIV) in patients with acute respiratory failure (ARF), with a critical review of the most recent literature in this setting. RECENT FINDINGS The efficacy of NIV is variable depending on the cause of the episode of ARF. In community-acquired pneumonia, NIV is often associated with poor response, with better response in patients with preexisting cardiac or respiratory disease. In patients with pandemic influenza H1N1 and severe ARF, NIV has been associated with high failure rates but relatively favorable mortality. In acute respiratory distress syndrome, NIV should be used very cautiously and restricted to patients with mild-moderate acute respiratory distress syndrome without shock or metabolic acidosis due to the high failure rate observed in several reports. Despite limited evidence, NIV may improve the outcomes of patients with chest trauma and severe ARF. In postoperative ARF, both continuous positive airway pressure and NIV are effective to improve clinical outcomes, particularly in those with abdominal, cardiac, and thoracic surgery. SUMMARY Although patients with severe hypoxemic ARF are, in general, less likely to be intubated when NIV is used, the efficacy is different among these heterogeneous populations. Therefore, NIV is not routinely recommended in all patients with severe hypoxemic ARF.
Collapse
|
13
|
La ventilation non invasive en chirurgie pulmonaire. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1021-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
14
|
Meert AP, Berghmans T, Sculier JP. [The patient with lung cancer in intensive care]. Rev Mal Respir 2014; 31:961-74. [PMID: 25496791 DOI: 10.1016/j.rmr.2014.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 04/28/2014] [Indexed: 12/17/2022]
Abstract
In Western countries, lung cancer (LC) is the most common cause of cancer death. It is present in 15-20% of patients admitted to the ICU with a neoplastic condition. The purpose of this article is to review the causes of admission to ICU of patients with LC, their prognosis and the results of different life-support techniques. Most studies include mixed populations of non-small cell (NSCLC) and small-cell lung cancers (SCLC). However, there is preponderance of NSCLC (70%) and LC of advanced or metastatic stages, reflecting the distribution in the general population of LC. The cause of admission of LC patients to ICU is most often of respiratory origin. The ICU mortality rate currently ranges from 13 to 47% and the hospital mortality rate from 24 to 65%. The predictors of in-hospital mortality are mainly severity scores, organ dysfunction, general condition (performance status), respiratory distress and the need for mechanical ventilation or vasopressor drugs. When considering the long-term mortality, it is the features of the cancer (presence of metastases, cancer progression) that are important predictive factors.
Collapse
Affiliation(s)
- A-P Meert
- Service des soins intensifs et urgences oncologiques et oncologie thoracique, université libre de Bruxelles (ULB), institut Jules-Bordet, 1, rue Heger-Bordet, 1000 Brussel, Belgique.
| | - T Berghmans
- Service des soins intensifs et urgences oncologiques et oncologie thoracique, université libre de Bruxelles (ULB), institut Jules-Bordet, 1, rue Heger-Bordet, 1000 Brussel, Belgique
| | - J-P Sculier
- Service des soins intensifs et urgences oncologiques et oncologie thoracique, université libre de Bruxelles (ULB), institut Jules-Bordet, 1, rue Heger-Bordet, 1000 Brussel, Belgique
| |
Collapse
|
15
|
Jaber S, De Jong A, Castagnoli A, Futier E, Chanques G. Non-invasive ventilation after surgery. ACTA ACUST UNITED AC 2014; 33:487-91. [DOI: 10.1016/j.annfar.2014.07.742] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
16
|
Hamaji M, Keegan MT, Cassivi SD, Shen KR, Wigle DA, Allen MS, Nichols FC, Deschamps C. Outcomes in patients requiring mechanical ventilation following pneumonectomy. Eur J Cardiothorac Surg 2014; 46:e14-9. [DOI: 10.1093/ejcts/ezu208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
17
|
Preventive or curative postoperative noninvasive ventilation after thoracic surgery: still a grey zone? Intensive Care Med 2014; 40:280-283. [PMID: 24445592 DOI: 10.1007/s00134-014-3213-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 01/16/2014] [Indexed: 10/25/2022]
|
18
|
Roceto LDS, Galhardo FDM, Saad IAB, Toro IFC. Continuous positive airway pressure (CPAP) after lung resection: a randomized clinical trial. SAO PAULO MED J 2014; 132:41-7. [PMID: 24474079 PMCID: PMC10889452 DOI: 10.1590/1516-3180.2014.1321525] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 06/14/2013] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Noninvasive mechanical ventilation during the postoperative period (PO) following lung resection can restore residual functional capacity, improve oxygenation and spare the inspiratory muscles. The objective of this study was to assess the efficacy of continuous positive airway pressure (CPAP) associated with physiotherapy, compared with physiotherapy alone after lung resection. DESIGN AND SETTING Open randomized clinical trial conducted in the clinical hospital of Universidade Estadual de Campinas. METHOD Sessions were held in the immediate postoperative period (POi) and on the first and second postoperative days (PO1 and PO2), and the patients were reassessed on the discharge day. CPAP was applied for two hours and the pressure adjustment was set between 7 and 8.5 cmH2O. The oxygenation index (OI), Borg scale, pain scale and presence of thoracic drains and air losses were evaluated. RESULTS There was a significant increase in the OI in the CPAP group in the POi compared to the Chest Physiotherapy (CP) group, P = 0.024. In the CP group the OI was significantly lower on PO1 (P = 0,042), than CPAP group. The air losses were significantly greater in the CPAP group in the POi and on PO1 (P = 0.001, P = 0.028), but there was no significant difference between the groups on PO2 and PO3. There was a statistically significant difference between the groups regarding the Borg scale in the POi (P < 0.001), but there were no statistically significant differences between the groups regarding the pain score. CONCLUSION CPAP after lung resection is safe and improves oxygenation, without increasing the air losses through the drains. CLINICAL TRIAL REGISTRATION NCT01285648.
Collapse
Affiliation(s)
- Lígia dos Santos Roceto
- Clinical Hospital, School of Medical Sciences, Universidade Estadual de Campinas, CampinasSão Paulo, Brazil
| | - Fernanda Diório Masi Galhardo
- Clinical Hospital, School of Medical Sciences, Universidade Estadual de Campinas, CampinasSão Paulo, Brazil, BSc. Physiotherapist (PT), Intensive Care Unit of Clinical Hospital, School of Medical Sciences, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Ivete Alonso Bredda Saad
- Clinical Hospital, School of Medical Sciences, Universidade Estadual de Campinas, CampinasSão Paulo, Brazil, PhD. Physiotherapist (PT), Pulmonary Rehabilitation Department of Clinical Hospital, School of Medical Sciences, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Ivan Felizardo Contrera Toro
- Clinical Hospital, School of Medical Sciences, Universidade Estadual de Campinas, CampinasSão Paulo, Brazil, MD, PhD. Head and Professor of Thoracic Surgery Department of Clinical Hospital, School of Medical Sciences, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil
| |
Collapse
|
19
|
Lorut C, Lefebvre A, Planquette B, Quinquis L, Clavier H, Santelmo N, Hanna HA, Bellenot F, Regnard JF, Riquet M, Magdeleinat P, Meyer G, Roche N, Huchon G, Coste J, Rabbat A. Early postoperative prophylactic noninvasive ventilation after major lung resection in COPD patients: a randomized controlled trial. Intensive Care Med 2013; 40:220-227. [DOI: 10.1007/s00134-013-3150-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 10/28/2013] [Indexed: 01/18/2023]
|
20
|
Abstract
PURPOSE OF REVIEW Pulmonary complications ranging from atelectasis to acute respiratory failure are common causes of poor perioperative outcomes. As the surgical population becomes increasingly at risk for pulmonary dysfunction due to increasing age and weight, development of an approach toward respiratory compromise in these patients is becoming ever more important. Given the utility of noninvasive respiratory support (NRS) in acute respiratory failure, it is likewise likely to also be important in the perioperative period. RECENT FINDINGS NRS is evaluated from preoperative risk assessment to its use in prevention and treatment of acute respiratory failure. Data supporting intraoperative use of NRS including preinduction continuous positive airway pressure and postextubation NRS for high-risk individuals and surgeries are examined. Timing and duration of NRS is also addressed. Finally, NRS is proposed for treatment for postoperative acute respiratory failure as an alternative to invasive rescue maneuvers. SUMMARY Noninvasive respiratory support should be considered an important adjunct in perioperative pulmonary care. Usage should be individually tailored in regard to timing and application modality specific to patient and surgical circumstances. More studies are needed, however, to determine the relationship demonstrated between short-term improvements in lung function and long-term outcomes.
Collapse
|
21
|
Landoni G, Zangrillo A, Cabrini L. Noninvasive Ventilation After Cardiac and Thoracic Surgery in Adult Patients: A Review. J Cardiothorac Vasc Anesth 2012; 26:917-22. [DOI: 10.1053/j.jvca.2011.06.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Indexed: 11/11/2022]
|
22
|
Abstract
General anesthesia and surgery are associated with changes in the shape of the chest that result in atelectasis, a major factor in the development of postoperative respiratory failure. Postoperative noninvasive positive pressure ventilation (NIPPV) has been shown to improve oxygenation and ventilation for high-risk patients. NIPPV has been used as rescue therapy for patients developing acute respiratory distress postoperatively, and appears to be most frequently successful in patients whose problem is atelectasis or obesity. Failure to respond to NIPPV after 20 minutes is usually an indication of intubation, mechanical ventilation, and transfer to the intensive care unit.
Collapse
Affiliation(s)
- Patrick J Neligan
- Department of Anesthesia & Intensive Care, Galway University Hospitals, Newcastle Road, Galway, Ireland.
| |
Collapse
|
23
|
Danner BC, Koerber W, Emmert A, Olgemoeller U, Doerge H, Quintel M, Criée CP, Schoendube FA. Non-Invasive Pressure Support Ventilation in Major Lung Resection for High Risk Patients: Does It Matter? ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ojts.2012.23014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
24
|
Études multicentriques. MEDECINE INTENSIVE REANIMATION 2012. [DOI: 10.1007/s13546-011-0364-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
|
25
|
Abstract
Non-invasive positive pressure ventilation or non-invasive ventilation (NIV) has emerged as a simpler and safer alternative to invasive mechanical ventilation in patients developing acute postoperative respiratory failure. The benefits of NIV as compared to intubation and mechanical ventilation include lower complications, shorter duration of hospital stay, reduced morbidity, lesser cost of treatment and even reduced mortality rates. However, its use may not be uniformly applicable in all patient groups. This article reviews the indications, contraindications and evidence supporting the use of NIV in individual patient groups in the postoperative period. The anaesthesiologist needs to recognise the subset of patients most likely to benefit from NIV therapy so as to apply it most effectively. It is equally important to promptly identify signs of failure of NIV therapy and be prepared to initiate alternate ways of respiratory support. The author searched PubMed and Ovid MEDLINE, without date restrictions. Search terms included Non-invasive ventilation, postoperative and respiratory failure. Foreign literature was included, though only articles with English translation were used.
Collapse
Affiliation(s)
- Ashu S Mathai
- Department of Anaesthesiology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| |
Collapse
|
26
|
Riviere S, Monconduit J, Zarka V, Massabie P, Boulet S, Dartevelle P, Stéphan F. Failure of noninvasive ventilation after lung surgery: a comprehensive analysis of incidence and possible risk factors. Eur J Cardiothorac Surg 2011; 39:769-76. [DOI: 10.1016/j.ejcts.2010.08.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 07/28/2010] [Accepted: 08/10/2010] [Indexed: 11/17/2022] Open
|
27
|
Chiumello D, Chevallard G, Gregoretti C. Non-invasive ventilation in postoperative patients: a systematic review. Intensive Care Med 2011; 37:918-29. [PMID: 21424246 DOI: 10.1007/s00134-011-2210-8] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 01/20/2011] [Indexed: 01/01/2023]
Abstract
BACKGROUND Postoperative pulmonary complications, generally defined as any pulmonary abnormality occurring in the postoperative period, are still a significant issue in clinical practice increasing hospital length of stay, morbidity and mortality. Non-invasive ventilation (NIV), primarily applied in cardiogenic pulmonary edema, decompensated COPD and hypoxemic pulmonary failure, is nowadays also used in perioperative settings. OBJECTIVE Investigate the application and results of preventive and therapeutic NIV in postsurgical patients. DESIGN A systematic review. DATA SOURCES Medical literature databases were searched for articles about "clinical trials," "randomized controlled trials" and "meta-analyses." The keywords "cardiac surgery," "thoracic surgery," "lung surgery," "abdominal surgery," "solid organ transplantation," "thoraco-abdominal surgery" and "bariatric surgery" were combined with any of these: "non-invasive positive pressure ventilation," "continuous positive airway pressure," "bilevel ventilation," "postoperative complications," "postoperative care," "respiratory care," "acute respiratory failure," "acute lung injury" and "acute respiratory distress syndrome." RESULTS Twenty-nine articles (N=2,279 patients) met the inclusion criteria. Nine studies evaluated NIV in post-abdominal surgery, three in thoracic surgery, eight in cardiac surgery, three in thoraco-abdominal surgery, four in bariatric surgery and two in post solid organ transplantation used both for prophylactic and therapeutic purposes. NIV improved arterial blood gases in 15 of the 22 prophylactic and in 4 of the 7 therapeutic studies, respectively. NIV reduced the intubation rate in 11 of the 29 studies and improved outcome in only 1. CONCLUSIONS Despite these limited data and the necessity of new randomized trials, NIV could be considered as a prophylactic and therapeutic tool to improve gas exchange in postoperative patients.
Collapse
Affiliation(s)
- D Chiumello
- U.O. Anestesia e Rianimazione, Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122 Milan, Italy.
| | | | | |
Collapse
|
28
|
Current world literature. Curr Opin Anaesthesiol 2010; 23:283-93. [PMID: 20404787 DOI: 10.1097/aco.0b013e328337578e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
29
|
Jaber S, Michelet P, Chanques G. Role of non-invasive ventilation (NIV) in the perioperative period. Best Pract Res Clin Anaesthesiol 2010; 24:253-65. [DOI: 10.1016/j.bpa.2010.02.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
30
|
|
31
|
Kohlenberg A, Schwab F, Behnke M, Geffers C, Gastmeier P. Pneumonia associated with invasive and noninvasive ventilation: an analysis of the German nosocomial infection surveillance system database. Intensive Care Med 2010; 36:971-8. [PMID: 20309520 DOI: 10.1007/s00134-010-1863-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Accepted: 03/03/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE Pneumonia associated with invasive mechanical ventilation (IMV) is one of the indicator infections of the German Nosocomial Infection Surveillance System. In 2005 surveillance was extended to include pneumonia associated with noninvasive ventilation (NIV). The aim of this study was to determine the utilization of IMV and NIV and the associated incidence densities (IDs) of pneumonia and to compare the characteristics of pneumonia cases and the spectrum of associated pathogens. METHODS We analyzed the pooled data of 400 intensive care units (ICUs) with respect to three categories of pneumonia: pneumonia associated with IMV and NIV and pneumonia not associated with ventilation. Pooled ventilation utilization rates and pneumonia IDs were calculated in total and stratified by hospital size, hospital type and ICU type. RESULTS Four hundred ICUs with 779,500 admitted patients, 1,068,472 IMV days and 101,569 NIV days reported 6,869 cases of pneumonia between 2005 and 2007. Of these, 5,811 cases were associated with IMV, 160 with NIV and 898 were not associated with ventilation. The mean pneumonia IDs were 1.58 and 5.44 cases per 1,000 ventilator days for NIV and IMV, respectively. Pneumonia cases associated with IMV were younger, had a longer ICU stay before onset of pneumonia and were more often associated with gram-negative bacteria than cases associated with NIV; however, there were no differences in the proportion of secondary sepsis and death. CONCLUSIONS This surveillance study including pneumonia associated with IMV and NIV and pneumonia not associated with ventilation shows significant differences of pneumonia IDs, patient characteristics and the spectrum of associated pathogens.
Collapse
Affiliation(s)
- Anke Kohlenberg
- Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, Hindenburgdamm 27, 12203, Berlin, Germany.
| | | | | | | | | |
Collapse
|
32
|
Year in review in Intensive Care Medicine 2009. Part III: mechanical ventilation, acute lung injury and respiratory distress syndrome, pediatrics, ethics, and miscellanea. Intensive Care Med 2010; 36:567-84. [PMID: 20177660 PMCID: PMC2837179 DOI: 10.1007/s00134-010-1781-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 02/08/2010] [Indexed: 02/06/2023]
|