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Liu B, Wang Y, Li L, Xiong W, Feng Y, Liu Y, Jin X. The effects of laryngeal mask versus endotracheal tube on atelectasis after general anesthesia induction assessed by lung ultrasound: A randomized controlled trial. J Clin Anesth 2024; 98:111564. [PMID: 39089119 DOI: 10.1016/j.jclinane.2024.111564] [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: 10/09/2023] [Revised: 03/05/2024] [Accepted: 07/21/2024] [Indexed: 08/03/2024]
Abstract
STUDY OBJECTIVE This study aims to evaluate the impact of Supreme™ laryngeal masks versus endotracheal tubes on atelectasis during general anesthesia using lung ultrasound (LUS), and provide evidence for respiratory management. DESIGN A single-center, double-blind, randomized controlled trial was conducted. SETTING The study was conducted in both the operating room and the post-anesthesia care unit, with follow-up assessments performed in the ward. PATIENTS Enrollment included 180 cases undergoing non-laparoscopic surgeries in gynecology, urology, and orthopedic limb surgeries. INTERVENTIONS Patients were randomly assigned 1:1 to the endotracheal intubation or laryngeal mask group. MEASUREMENTS LUS scores were recorded across 12 lung regions at baseline, 15 min after airway establishment, at the end of surgery, and 30 min following airway removal. Outcome measures encompassed the oxygenation index, dynamic lung compliance, incidence of postoperative pulmonary complications, throat pain, and other postoperative complications assessed at 24 and 48 h postoperatively. The primary outcome focused on the LUS score in all 12 lung regions at 15 min after airway establishment. MAIN RESULTS Intention-to-treat analysis of 177 subjects revealed endotracheal intubation led to significantly higher LUS scores at 15 min {P < 0.001, mean difference 4.15 ± 0.60, 95% CI [2.97, 5.33]}, end of surgery (P < 0.001, mean difference 3.37 ± 0.68, 95% CI [2.02, 4.72]), and 30 min post-removal (P < 0.001, mean difference 2.63 ± 0.48, 95% CI [1.68, 3.58]). No major complications occurred in the two groups. CONCLUSIONS Compared to endotracheal intubation, laryngeal masks effectively reduce atelectasis formation and progression in gynecological, urological non-laparoscopic, and orthopedic limb surgeries. However, caution is warranted when generalizing these findings to surgeries with a higher risk of laryngeal mask leakage or obese patients. Additionally, the efficacy of laryngeal masks in reducing postoperative atelectasis remains uncertain when comprehensive monitoring of muscle relaxation and reversal therapy is employed.
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Affiliation(s)
- Bin Liu
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Yaxin Wang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Ling Li
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Wei Xiong
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Yifan Feng
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Yan Liu
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Xu Jin
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; Department of Anesthesiology, Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100191, China.
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Boden I, Hackett C. Clinimetrics: The Melbourne Group Scale. J Physiother 2024:S1836-9553(24)00070-5. [PMID: 39327176 DOI: 10.1016/j.jphys.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 07/02/2024] [Indexed: 09/28/2024] Open
Affiliation(s)
- Ianthe Boden
- School of Health Sciences, University of Tasmania, Launceston, Australia; Department of Physiotherapy, Launceston General Hospital, Launceston, Australia; Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Claire Hackett
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia; Department of Physiotherapy, Princess Alexandra Hospital, Brisbane, Australia
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Vermeulen TD, Hol L, Swart P, Hiesmayr M, Mills GH, Putensen C, Schmid W, Serpa Neto A, Severgnini P, Vidal Melo MF, Wrigge H, Hollmann MW, Gama de Abreu M, Schultz MJ, Hemmes SN, van Meenen DM. Sex dependence of postoperative pulmonary complications - A post hoc unmatched and matched analysis of LAS VEGAS. J Clin Anesth 2024; 99:111565. [PMID: 39316931 DOI: 10.1016/j.jclinane.2024.111565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 07/18/2024] [Accepted: 07/23/2024] [Indexed: 09/26/2024]
Abstract
STUDY OBJECTIVE Male sex has inconsistently been associated with the development of postoperative pulmonary complications (PPCs). These studies were different in size, design, population and preoperative risk. We reanalysed the database of 'Local ASsessment of Ventilatory management during General Anaesthesia for Surgery study' (LAS VEGAS) to evaluate differences between females and males with respect to PPCs. DESIGN, SETTING AND PATIENTS Post hoc unmatched and matched analysis of LAS VEGAS, an international observational study in patients undergoing intraoperative ventilation under general anaesthesia for surgery in 146 hospitals across 29 countries. The primary endpoint was a composite of PPCs in the first 5 postoperative days. Individual PPCs, hospital length of stay and mortality were secondary endpoints. Propensity score matching was used to create a similar cohort regarding type of surgery and epidemiological factors with a known association with development of PPCs. MAIN RESULTS The unmatched cohort consisted of 9697 patients; 5342 (55.1%) females and 4355 (44.9%) males. The matched cohort consisted of 6154 patients; 3077 (50.0%) females and 3077 (50.0%) males. The incidence in PPCs was neither significant between females and males in the unmatched cohort (10.0 vs 10.7%; odds ratio (OR) 0.93 [0.81-1.06]; P = 0.255), nor in the matched cohort (10.5 vs 10.0%; OR 1.05 [0.89-1.25]; P = 0.556). New invasive ventilation occurred less often in females in the unmatched cohort. Hospital length of stay and mortality were similar between females and males in both cohorts. CONCLUSIONS In this conveniently-sized worldwide cohort of patients receiving intraoperative ventilation under general anaesthesia for surgery, the PPC incidence was not significantly different between sexes. REGISTRATION LAS VEGAS was registered at clinicaltrial.gov (study identifier NCT01601223).
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Affiliation(s)
- Tom D Vermeulen
- Amsterdam University Medical Center, Department of Anaesthesiology, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
| | - Liselotte Hol
- Amsterdam University Medical Center, Department of Anaesthesiology, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Pien Swart
- Amsterdam University Medical Center, Department of Intensive Care, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Michael Hiesmayr
- Medical University Vienna, Division Cardiac, Thoracic, Vascular Anaesthesia and Intensive Care, Waehringerguertel 18-20, A-1090 Vienna, Austria
| | - Gary H Mills
- Sheffield Teaching Hospitals, Sheffield and University of Sheffield, Operating Services, Critical Care and Anaesthesia, Royal Hallamshire Hospital, Broomhill, Glossop Road, Sheffield S10 2JF, United Kingdom
| | - Christian Putensen
- University Hospital Bonn, Department of Anaesthesiology and Intensive Care Medicine, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Werner Schmid
- Medical University Vienna, Division Cardiac, Thoracic, Vascular Anaesthesia and Intensive Care, Waehringerguertel 18-20, A-1090 Vienna, Austria; Medical University Vienna, Department of Special Anaesthesia and Pain Therapy, Waehringerguertel 18-20, A-1090 Vienna, Austria
| | - Ary Serpa Neto
- Amsterdam University Medical Center, Department of Intensive Care, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Department of Critical Care Medicine, 553 St Kilda Road, Melbourne, VIC 3004, Australia; Hospital Israelita Albert Einstein, Department of Critical Care, Av. Albert Einstein, 627/701 - Morumbi, São Paulo, SP 05652-900, Brazil
| | - Paolo Severgnini
- University of Insubria - ASST Sette Laghi, Anestesia Rianimazione Cardiologica, Department of Biotechnologies and Sciences of Life, Viale Borri, 57-21100 Varese, VA, Italy
| | - Marcos F Vidal Melo
- Massachusetts General Hospital, Department of Anaesthesia, Critical Care and Pain Medicine, 15 Parkman St, MA 02114 Boston, MA, USA; Columbia University, Department of Anesthesiology, 622 W 168th St, NY 10032, New York, USA
| | - Hermann Wrigge
- Bergmannstrost Hospital Halle, Department of Anaesthesiology, Intensive Care Medicine and Emergency Medicine, Pain Therapy, Merseburger Str. 165, 06112 Halle (Saale), Germany; Martin-Luther-University of Halle-Wittenberg, Medical Faculty, 06108 Halle (Saale), Germany
| | - Markus W Hollmann
- Amsterdam University Medical Center, Department of Anaesthesiology, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Marcelo Gama de Abreu
- University Hospital Carl Gustav Carus, Technical University Dresden, Department of Anaesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, Fetscherstrasse 74, 01307 Dresden, Germany; Cleveland Clinic, Department of Intensive Care and Resuscitation, 9500 Euclid Avenue, OH 44195, Cleveland, USA; Cleveland Clinic, Department of Outcomes Research, 9500 Euclid Avenue, OH 44195, Cleveland, USA; Cleveland Clinic, Department of Cardiothoracic Anaesthesia, 9500 Euclid Avenue, OH 44195, Cleveland, USA
| | - Marcus J Schultz
- Amsterdam University Medical Center, Department of Intensive Care, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands; Medical University Vienna, Division Cardiac, Thoracic, Vascular Anaesthesia and Intensive Care, Waehringerguertel 18-20, A-1090 Vienna, Austria; Mahidol University, Mahidol-Oxford Tropical Medicine Research Unit (MORU), 3rd Floor, 60th, Anniversary Chalermprakiat Building 420/6 Ratchawithi Road, Ratchathewi District, Bangkok 10400, Thailand; University of Oxford, Nuffield Department of Medicine, Campus, Henry Wellcome Building for Molecular Physiology, Old Road, Oxford OX3 7BN, United Kingdom
| | - Sabrine N Hemmes
- Amsterdam University Medical Center, Department of Anaesthesiology, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands; The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Anaesthesiology, Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands
| | - David M van Meenen
- Amsterdam University Medical Center, Department of Anaesthesiology, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands; Amsterdam University Medical Center, Department of Intensive Care, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
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Wang B, Liang HS, Shen JW, An YZ, Feng Y. A Nomogram for Predicting Postoperative Pulmonary Complications in Critical Patients Transferred to ICU After Abdominal Surgery. J Intensive Care Med 2024:8850666241280900. [PMID: 39262206 DOI: 10.1177/08850666241280900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
OBJECTIVE The purpose of this study was to investigate the risk factors associated with postoperative pulmonary complications(PPCs) in critically ill patients transferred to intensive care unit(ICU) after abdominal surgery and develop a predictive model for this disease. METHODS Data for 3716 patients who were admitted to ICU after abdominal surgery in Peking University People's Hospital between January 2015 and December 2020 were retrospectively collected and analyzed to identify the risk factors and develop a nomogram prediction model. Data for patients admitted to ICU following abdominal surgery at Peking University People's Hospital from March 2021 to December 2022 were prospectively collected as a validation set to validate and assess the model. RESULTS 10 independent risk factors for PPCs in critically ill patients transferred to ICU after abdominal surgery were identified. A nomogram prediction model was constructed for PPCs in this group patients, the area under ROC curve was 0.771[95%CI: 0.756,0.786] and 0.759[95%CI: 0.726,0.792] in the training set and validation set, respectively. CONCLUSIONS In this study, independent risk factors for PPCs in critically ill patients transferred to ICU after abdominal surgery were identified. A nomogram prediction model for PPCs in critically ill surgical population was constructed using these factors, demonstrating a good predictive value.
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Affiliation(s)
- Bin Wang
- Department of Anaesthesiology, Peking University People's Hospital, 100044, Beijing, China
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China
| | - Han Sheng Liang
- Department of Anaesthesiology, Peking University People's Hospital, 100044, Beijing, China
| | - Jia Wei Shen
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China
| | - You Zhong An
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China
| | - Yi Feng
- Department of Anaesthesiology, Peking University People's Hospital, 100044, Beijing, China
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Yu J, Park JY, Kim CS, Lee BJ, Seo H, Park JB, Seo YJ, Kim YK. Geriatric Nutritional Risk Index and 30-Day Postoperative Mortality in Geriatric Burn Patients. J Surg Res 2024; 301:610-617. [PMID: 39094519 DOI: 10.1016/j.jss.2024.07.031] [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: 12/28/2023] [Revised: 06/19/2024] [Accepted: 07/07/2024] [Indexed: 08/04/2024]
Abstract
INTRODUCTION The geriatric nutritional risk index (GNRI) can easily identify malnutrition-associated morbidity and mortality. We investigated the association between preoperative GNRI and 30-d mortality in geriatric burn patients who underwent surgery. METHODS The study involved geriatric burn patients (aged ≥ 65 y) who underwent burn surgery between 2012 and 2022. The GNRI was computed using the following formula: 1.489 × serum albumin concentration (mg/L) + 41.7 × patient body weight/ideal body weight. Patients were dichotomized into the high GNRI (≥ 82) and low GNRI (< 82) groups. GNRI was evaluated as an independent predictor of 30-d postoperative mortality. The study also evaluated the association between GNRI and sepsis, the need for continuous renal replacement therapy (CRRT), major adverse cardiac events (MACE), and pneumonia. RESULTS Out of 270 patients, 128 (47.4%) had low GNRI (< 82). Multivariate Cox regression analysis revealed that low GNRI was significantly associated with 30-d postoperative mortality (hazard ratio: 1.874, 95% confidence interval [CI]: 1.146-3.066, P = 0.001). Kaplan-Meier analysis revealed that the 30-day mortality rate differed significantly between the low and high GNRI groups (log-rank test, P < 0.001). The 30-d postoperative mortality (hazard ratio: 2.677, 95% CI: 1.536-4.667, P < 0.001) and the incidence of sepsis (odds ratio [OR]: 2.137, 95% CI: 1.307-3.494, P = 0.004), need for CRRT (OR: 1.919, 95% CI: 1.101-3.344, P = 0.025), MACE (OR: 1.680, 95% CI: 1.018-2.773, P = 0.043), and pneumonia (OR: 1.678, 95% CI: 1.019-2.764, P = 0.044), were significantly higher in the low GNRI group than in the high GNRI group. CONCLUSIONS Preoperative low GNRI was associated with increased 30-d postoperative mortality, sepsis, need for CRRT, MACE, and pneumonia in geriatric burn patients.
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Affiliation(s)
- Jihion Yu
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun-Young Park
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chan-Sik Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Bong Jae Lee
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hyungseok Seo
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jong Bum Park
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Young Joo Seo
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
| | - Young-Kug Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Bendel D, Wong T, Bedford J, Odor PM. Data Infrastructure for Improvement in Perioperative Medicine: Experience at a London Tertiary Hospital. Br J Hosp Med (Lond) 2024; 85:1-12. [PMID: 39212573 DOI: 10.12968/hmed.2024.0128] [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] [Indexed: 09/04/2024]
Abstract
Adoption of electronic health record systems offers an opportunity to collate massive volumes of complex information about patient care. Healthcare data can inform performance management, enable predictive analytics and enhance strategic decision making. A data-driven approach to improving patient care is vital to address the growing burden of morbidity and mortality associated with major surgery. We describe our methodology for transforming and utilising process of care data in an electronic health record system to develop a registry for quality improvement purposes in patients undergoing major surgery at a single UK hospital. We highlight development of our data-driven vision, technical aspects of processing raw data into metrics relevant to clinical decision making, alongside challenges encountered. Finally, we outline how our data infrastructure supports clinical governance, quality improvement and research. In sharing our experiences, we hope to enable others to embed and access the transformative clinical insights that healthcare data can yield.
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Affiliation(s)
- Daniel Bendel
- Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Trust, London, UK
| | - Teresa Wong
- Department of Anaesthesia, Woodlands Health, Singapore, Singapore
| | - James Bedford
- Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Trust, London, UK
| | - Peter M Odor
- Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Trust, London, UK
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Wang Y, Li W, Zhou CM, Zhao Z, Ma J, Jiang H, Wei M, Gao Y, Dai Y, Zhang X, Yang N, Feng F, Zhang J, Ji Y, Liu J, Zhang C, Li L, Jiang X, Li Z, Zhao Z. Mortality risk of patients with intestinal obstruction. BMC Cancer 2024; 24:1062. [PMID: 39198804 PMCID: PMC11351352 DOI: 10.1186/s12885-024-12834-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 08/20/2024] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND Intestinal obstruction represents a severe intestinal disease associated with higher mortality rates. However, the determinants of mortality in patients with intestinal obstruction remain inadequately understood. This study sought to elucidate the potential risk factors associated with mortality in the context of intestinal obstruction during the COVID-19 pandemic. METHODS A retrospective analysis was performed on a cohort of 227 patients diagnosed with intestinal obstruction at the First Hospital of Hebei Medical University, spanning the period from September 7, 2022, to January 7, 2023. The primary endpoint of the study was mortality within four weeks following discharge. Univariate and multivariable logistic regression models were utilized to evaluate the risk factors associated with mortality outcomes. RESULTS A cohort of 227 patients diagnosed with intestinal obstruction (median age, 59.02 years [IQR, 48.95-70.85 years]) was included in our study. Malignant bowel obstruction (MBO) and COVID-19 were identified as independent risk factors for mortality among these patients. Notably, the mortality rate increased significantly to 38.46% when MBO was concomitant with COVID-19. Furthermore, postoperative pulmonary complications (PPC) (OR, 54.21 [death]; 95% CI, 3.17-926.31), gastric cancer (OR, 9.71 [death]; 95% CI, 1.38-68.18), VTE (Caprini Score ≥ 5) (OR, 7.64 [death]; 95% CI, 1.37-42.51), and COVID-19 (OR, 5.72 [death]; 95% CI, 1.01-32.29) were all determined to be independent risk factors for postoperative mortality. Additionally, gastric cancer could have emerged as one of the most severe risk factors for mortality in individuals with intestinal obstruction within the cohort of cancer patients, of which gastric cancer exhibited higher mortality rates compared to individuals with other forms of cancer. CONCLUSION The study identifies MBO, gastric cancer, COVID-19, PPC, and VTE as potential risk factors for mortality in cases of intestinal obstruction. These findings highlight the necessity for continuous monitoring of indicators related to these mortality risk factors and their associated complications, thereby offering valuable insights for the management and treatment of intestinal obstruction.
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Affiliation(s)
- Yuanyuan Wang
- Gastrointestinal Disease Diagnosis and Treatment Center, The First Hospital of Hebei Medical University, Hebei, China
- Department of General Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, Hebei, China
| | - Wei Li
- Gastrointestinal Disease Diagnosis and Treatment Center, The First Hospital of Hebei Medical University, Hebei, China
- Department of General Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, Hebei, China
| | - Chuan-Min Zhou
- Gastrointestinal Disease Diagnosis and Treatment Center, The First Hospital of Hebei Medical University, Hebei, China
- Department of General Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, Hebei, China
| | - Zifeng Zhao
- Gastrointestinal Disease Diagnosis and Treatment Center, The First Hospital of Hebei Medical University, Hebei, China
- Department of General Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, Hebei, China
| | - Jianwei Ma
- Gastrointestinal Disease Diagnosis and Treatment Center, The First Hospital of Hebei Medical University, Hebei, China
- Department of General Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, Hebei, China
| | - Haibo Jiang
- Gastrointestinal Disease Diagnosis and Treatment Center, The First Hospital of Hebei Medical University, Hebei, China
- Department of General Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, Hebei, China
| | - Ming Wei
- Gastrointestinal Disease Diagnosis and Treatment Center, The First Hospital of Hebei Medical University, Hebei, China
- Department of General Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, Hebei, China
| | - Yingchao Gao
- Gastrointestinal Disease Diagnosis and Treatment Center, The First Hospital of Hebei Medical University, Hebei, China
- Department of General Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, Hebei, China
| | - Yongjun Dai
- Gastrointestinal Disease Diagnosis and Treatment Center, The First Hospital of Hebei Medical University, Hebei, China
- Department of General Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, Hebei, China
| | - Xing Zhang
- Gastrointestinal Disease Diagnosis and Treatment Center, The First Hospital of Hebei Medical University, Hebei, China
- Department of General Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, Hebei, China
| | - Ning Yang
- Gastrointestinal Disease Diagnosis and Treatment Center, The First Hospital of Hebei Medical University, Hebei, China
- Department of General Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, Hebei, China
| | - Feng Feng
- Gastrointestinal Disease Diagnosis and Treatment Center, The First Hospital of Hebei Medical University, Hebei, China
- Department of General Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, Hebei, China
| | - Jian Zhang
- Gastrointestinal Disease Diagnosis and Treatment Center, The First Hospital of Hebei Medical University, Hebei, China
- Department of General Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, Hebei, China
| | - Yiding Ji
- Gastrointestinal Disease Diagnosis and Treatment Center, The First Hospital of Hebei Medical University, Hebei, China
- Department of General Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, Hebei, China
| | - Jianjie Liu
- Gastrointestinal Disease Diagnosis and Treatment Center, The First Hospital of Hebei Medical University, Hebei, China
- Department of General Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, Hebei, China
| | - Chao Zhang
- Gastrointestinal Disease Diagnosis and Treatment Center, The First Hospital of Hebei Medical University, Hebei, China
- Department of General Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, Hebei, China
| | - Like Li
- Gastrointestinal Disease Diagnosis and Treatment Center, The First Hospital of Hebei Medical University, Hebei, China
- Department of General Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, Hebei, China
| | - Xia Jiang
- Gastrointestinal Disease Diagnosis and Treatment Center, The First Hospital of Hebei Medical University, Hebei, China
- Department of General Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, Hebei, China
| | - Zhongxin Li
- Gastrointestinal Disease Diagnosis and Treatment Center, The First Hospital of Hebei Medical University, Hebei, China.
- Department of General Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, Hebei, China.
| | - Zengren Zhao
- Gastrointestinal Disease Diagnosis and Treatment Center, The First Hospital of Hebei Medical University, Hebei, China.
- Department of General Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, Hebei, China.
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Liu Q, Wu X, Li Y, Ding J, Wang H, Dou D, An R, Bie D, Jia Y, Yuan S, Yan F. Predictors of length of hospital stay after pediatric Ebstein anomaly corrective surgery: a retrospective cohort study. BMC Pediatr 2024; 24:515. [PMID: 39127623 DOI: 10.1186/s12887-024-04936-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 07/08/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND The remarkable advancements in surgical techniques over recent years have shifted the clinical focus from merely reducing mortality to enhancing the quality of postoperative recovery. The duration of a patient's hospital stay serves as a crucial indicator in evaluating postoperative recovery and surgical outcomes. This study aims to identify predictors of the length of hospital stay for children who have undergone corrective surgery for Ebstein Anomaly (EA). METHODS We conducted a retrospective cohort study on children (under 18 years of age) diagnosed with EA who were admitted for corrective surgery between January 2009 and November 2021 at Fuwai Hospital. The primary outcome was the Time to Hospital Discharge (THD). Cox proportional hazard models were utilized to identify predictors of THD. In the context of time-to-event analysis, discharge was considered an event. In cases where death occurred before discharge, it was defined as an extended THD, input as 100 days (exceeding the longest observed THD), and considered as a non-event. RESULTS A total of 270 children were included in this study, out of which three died in the hospital. Following the Cox proportional hazard analysis, six predictors of THD were identified. The hazard ratios and corresponding 95% confidence intervals were as follows: age, 1.030(1.005,1.055); C/R > 0.65, 0.507(0.364,0.707); Carpentier type C or D, 0.578(0.429,0.779); CPB time, 0.995(0.991,0.998); dexamethasone, 1.373(1.051,1.795); and transfusion, 0.680(0.529,0.875). The children were categorized into three groups based on the quartile of THD. Compared to children in the ≤ 6 days group, those in the ≥ 11 days group were associated with a higher incidence of adverse outcomes. Additionally, the duration of mechanical ventilation and ICU stay, as well as hospital costs, were significantly higher in this group. CONCLUSION We identified six predictors of THD for children undergoing corrective surgery for EA. Clinicians can utilize these variables to optimize perioperative management strategies, reduce adverse complications, improve postoperative recovery, and reduce unnecessary medical expenses.
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Affiliation(s)
- Qiao Liu
- 1Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Xie Wu
- 1Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Yinan Li
- 1Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Jie Ding
- 1Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Hongbai Wang
- 1Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Dou Dou
- 1Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Ran An
- 1Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Dongyun Bie
- 1Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Yuan Jia
- 1Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Su Yuan
- 1Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Fuxia Yan
- 1Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China.
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9
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Rudolf D. [Neuromuscular Blockade in Geriatric Patients]. Anasthesiol Intensivmed Notfallmed Schmerzther 2024; 59:528-536. [PMID: 39197444 DOI: 10.1055/a-2195-8867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2024]
Abstract
The administration of neuromuscular blocking agents has been used in anesthesia for decades and continues to play an important role in modern anesthesia. Special patient populations, such as very young or very old patients, require adapted use. The following article discusses the specifics of neuromuscular blocking agents administration in geriatric patients.
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10
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Liang Y, Deng T, Long Y, Li J, Yang J, Hu Y, Lu T, Luo X, Ping Suen LK, Chen S. The effect of a hybrid structured pulmonary rehabilitation education program for patients with lung cancer with a high risk of postoperative pulmonary complications: A quasi-experimental study. Eur J Oncol Nurs 2024; 71:102655. [PMID: 38968668 DOI: 10.1016/j.ejon.2024.102655] [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: 04/10/2024] [Revised: 06/20/2024] [Accepted: 06/27/2024] [Indexed: 07/07/2024]
Abstract
PURPOSE The absence of standardized protocols and education are the main obstacles to perioperative pulmonary rehabilitation (PR), especially for patients with high-risk factors of postoperative pulmonary complications (PPCs). We aimed to explore the effect of a hybrid structured pulmonary rehabilitation education program (SPREP) on patients with lung cancer at high risk of PPCs. METHODS A quasi-experimental trial with a pre-post test design was conducted. The control group (n = 53) adopted routine perioperative pulmonary rehabilitation, while the intervention group (n = 53) received SPREP. Respiratory function, 6-min walk distance, Borg dyspnea scale, quality of life, anxiety-depression scores at admission, discharge, 2 weeks and 3 months post-discharge, and incidence of PPCs were compared between the two groups. RESULTS There were no significant differences on the 6-min walk distance and Borg Dyspnoea Scale at discharge between the two groups (P > 0.05), whereas the intervention group showed improved performance at the remaining time points (P < 0.05). In addition, the intervention group had improved exercise capacity, pulmonary function and quality of life, reduced levels of anxiety and depression at discharge, 2 weeks post-discharge and 3 months post-discharge (P < 0.05). In addition, incidence of PPCs was significantly reduced in the intervention group, especially postoperative pneumonia. CONCLUSIONS The SPREP could show significant benefits in enhancing exercise capacity, lung function, and quality of life, while diminishing the occurrence of PPCs and mitigating the levels of anxiety and depression, future large RCT need to further explore the efficacy. TRIAL REGISTRATION This study was registered with the China Clinical Trial Registration Center (ChiCTR) under the Clinical Trial Registration Number [ChiCTR2200066698].
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Affiliation(s)
- Yan Liang
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China; School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Ting Deng
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China; School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Yangyang Long
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Jin Li
- Thoracic Surgery Department, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Jinfen Yang
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Yufan Hu
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Taiping Lu
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Xu Luo
- School of Medical Informatics and Engineering, Zunyi Medical University, Zunyi, Guizhou, China
| | | | - Shaolin Chen
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China; School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China.
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11
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Abbott M, Pereira SM, Sanders N, Girard M, Sankar A, Sklar MC. Weaning from mechanical ventilation in the operating room: a systematic review. Br J Anaesth 2024; 133:424-436. [PMID: 38816331 PMCID: PMC11282496 DOI: 10.1016/j.bja.2024.03.043] [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: 11/09/2023] [Revised: 02/27/2024] [Accepted: 03/22/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Postoperative pulmonary complications (PPCs) are associated with postoperative mortality and prolonged hospital stay. Although intraoperative mechanical ventilation (MV) is a risk factor for PPCs, strategies addressing weaning from MV are understudied. In this systematic review, we evaluated weaning strategies and their effects on postoperative pulmonary outcomes. METHODS Our protocol was registered on PROSPERO (CRD42022379145). Eligible studies included randomised controlled trials and observational studies of adults weaned from MV in the operating room. Primary outcomes included atelectasis and oxygenation; secondary outcomes included lung volume changes and PPCs. Risk of bias was assessed using the Cochrane Risk of Bias (RoB2) tool, and quality of evidence with the GRADE framework. RESULTS Screening identified 14 randomised controlled trials including 1719 patients; seven studies were limited to the weaning phase and seven included interventions not restricted to the weaning phase. Strategies combining pressure support ventilation (PSV) with positive end-expiratory pressure (PEEP) and low fraction of inspired oxygen (FiO2) improved atelectasis, oxygenation, and lung volumes. Low FiO2 improved atelectasis and oxygenation but might not improve lung volumes. A fixed-PEEP strategy led to no improvement in oxygenation or atelectasis; however, individualised PEEP with low FiO2 improved oxygenation and might be associated with reduced PPCs. Half of included studies are of moderate or high risk of bias; the overall quality of evidence is low. CONCLUSIONS There is limited research evaluating weaning from intraoperative MV. Based on low-quality evidence, PSV, individualised PEEP, and low FiO2 may be associated with reduced postoperative pulmonary outcomes. SYSTEMATIC REVIEW PROTOCOL PROSPERO (CRD42022379145).
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Affiliation(s)
- Megan Abbott
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada
| | - Sergio M Pereira
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Noah Sanders
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada
| | - Martin Girard
- Department of Anesthesiology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Division of Critical Care, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Department of Anesthesiology, Centre Hospitalier de l'Université de Montréal Research Center, Montreal, QC, Canada
| | - Ashwin Sankar
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael C Sklar
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
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12
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Hewson DW, Tedore TR, Hardman JG. Impact of spinal or epidural anaesthesia on perioperative outcomes in adult noncardiac surgery: a narrative review of recent evidence. Br J Anaesth 2024; 133:380-399. [PMID: 38811298 PMCID: PMC11282476 DOI: 10.1016/j.bja.2024.04.044] [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: 02/20/2024] [Revised: 04/23/2024] [Accepted: 04/30/2024] [Indexed: 05/31/2024] Open
Abstract
Spinal and epidural anaesthesia and analgesia are important anaesthetic techniques, familiar to all anaesthetists and applied to patients undergoing a range of surgical procedures. Although the immediate effects of a well-conducted neuraxial technique on nociceptive and sympathetic pathways are readily observable in clinical practice, the impact of such techniques on patient-centred perioperative outcomes remains an area of uncertainty and active research. The aim of this review is to present a narrative synthesis of contemporary clinical science on this topic from the most recent 5-year period and summarise the foundational scholarship upon which this research was based. We searched electronic databases for primary research, secondary research, opinion pieces, and guidelines reporting the relationship between neuraxial procedures and standardised perioperative outcomes over the period 2018-2023. Returned citation lists were examined seeking additional studies to contextualise our narrative synthesis of results. Articles were retrieved encompassing the following outcome domains: patient comfort, renal, sepsis and infection, postoperative cancer, cardiovascular, and pulmonary and mortality outcomes. Convincing evidence of the beneficial effect of epidural analgesia on patient comfort after major open thoracoabdominal surgery outcomes was identified. Recent evidence of benefit in the prevention of pulmonary complications and mortality was identified. Despite mechanistic plausibility and supportive observational evidence, there is less certain experimental evidence to support a role for neuraxial techniques impacting on other outcome domains. Evidence of positive impact of neuraxial techniques is best established for the domains of patient comfort, pulmonary complications, and mortality, particularly in the setting of major open thoracoabdominal surgery. Recent evidence does not strongly support a significant impact of neuraxial techniques on cancer, renal, infection, or cardiovascular outcomes after noncardiac surgery in most patient groups.
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Affiliation(s)
- David W Hewson
- Department of Anaesthesia and Critical Care, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK; Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK.
| | - Tiffany R Tedore
- Department of Anesthesiology, Weill Cornell Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Jonathan G Hardman
- Department of Anaesthesia and Critical Care, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK; Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK
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13
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Bækgaard ES, Madsen BK, Crone V, El-Hallak H, Møller MH, Vester-Andersen M, Krag M. Perioperative hypotension and use of vasoactive agents in non-cardiac surgery: A scoping review. Acta Anaesthesiol Scand 2024. [PMID: 38965670 DOI: 10.1111/aas.14485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/03/2024] [Accepted: 06/13/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Perioperative hypotension is common and associated with adverse patient outcomes. Vasoactive agents are often used to manage hypotension, but the ideal drug, dose and duration of treatment has not been established. With this scoping review, we aim to provide an overview of the current body of evidence regarding the vasoactive agents used to treat perioperative hypotension in non-cardiac surgery. METHODS We included all studies describing the use of vasoactive agents for the treatment of perioperative hypotension in non-cardiac surgery. We excluded literature reviews, case studies, and studies on animals and healthy subjects. We posed the following research questions: (1) in which surgical populations have vasoactive agents been studied? (2) which agents have been studied? (3) what doses have been assessed? (4) what is the duration of treatment? and (5) which desirable and undesirable outcomes have been assessed? RESULTS We included 124 studies representing 10 surgical specialties. Eighteen different agents were evaluated, predominantly phenylephrine, ephedrine, and noradrenaline. The agents were administered through six different routes, and numerous comparisons between agents, dosages and routes were included. Then, 88 distinct outcome measures were assessed, of which 54 were judged to be non-patient-centred. CONCLUSIONS We found that studies concerning vasoactive agents for the treatment of perioperative hypotension varied considerably in all aspects. Populations were heterogeneous, interventions and exposures included multiple agents compared against themselves, each other, fluids or placebo, and studies reported primarily non-patient-centred outcomes.
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Affiliation(s)
| | - Bennedikte Kollerup Madsen
- Department of Anaesthesiology and Intensive Care, Holbæk Hospital, Holbæk, Denmark
- Department of Anaesthesiology and Intensive Care, Zealand University Hospital, Køge, Denmark
| | - Vera Crone
- Department of Anaesthesiology and Intensive Care, Holbæk Hospital, Holbæk, Denmark
| | - Hayan El-Hallak
- Department of Anaesthesiology and Intensive Care, Holbæk Hospital, Holbæk, Denmark
- Department of Anaesthesiology, Copenhagen University Hospital-Gentofte, Hellerup, Denmark
| | - Morten Hylander Møller
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten Vester-Andersen
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital-Herlev-Gentofte, Herlev, Denmark
| | - Mette Krag
- Department of Anaesthesiology and Intensive Care, Holbæk Hospital, Holbæk, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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14
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Boden I, Reeve J, Jernås A, Denehy L, Fagevik Olsén M. Preoperative physiotherapy prevents postoperative pulmonary complications after major abdominal surgery: a meta-analysis of individual patient data. J Physiother 2024; 70:216-223. [PMID: 38472053 DOI: 10.1016/j.jphys.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/06/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
QUESTIONS Among patients having elective abdominal surgery, how much does preoperative physiotherapy education with breathing exercise training reduce the incidence of postoperative pulmonary complications (PPCs), hospital length of stay and 12-month mortality? How stable are the treatment effects across different PPC definitions, including pneumonia? How much do the treatment effects on PPC, hospital length of stay and mortality vary within clinically relevant subgroups? DESIGN Individual participant-level meta-analysis (n = 800) from two randomised controlled trials analysed with multivariable regression. PARTICIPANTS Adults undergoing major elective abdominal surgery. INTERVENTIONS Experimental participants received a single preoperative session with a physiotherapist within 4 weeks of surgery and educated on PPC prevention with breathing exercises and early mobilisation. They were taught breathing exercises and instructed to start them immediately on waking from surgery. The control group received no preoperative or postoperative physiotherapy, or early ambulation alone. OUTCOME MEASURES PPC, hospital length of stay and 12-month mortality. RESULTS Participants who received preoperative physiotherapy had 47% lower odds of developing a PPC (adjusted OR 0.53, 95% CI 0.34 to 0.85). This effect was stable regardless of PPC definition. Effects were greatest in participants who smoked, were aged ≤ 45 years, had abnormal body weight, had multiple comorbidities, or were undergoing bariatric or upper gastrointestinal surgery. Participants having operations ≤ 3 hours in duration were least responsive to preoperative physiotherapy. Participants with multiple comorbidities were more likely to have a shorter hospital stay if provided with preoperative physiotherapy (adjusted MD -3.2 days, 95% CI -6.2 to -0.3). Effects on mortality were uncertain. CONCLUSION There is strong evidence to support preoperative physiotherapy in preventing PPCs after elective abdominal surgery.
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Affiliation(s)
- Ianthe Boden
- University of Tasmania, Launceston, Tasmania, Australia; Launceston General Hospital, Launceston, Australia.
| | - Julie Reeve
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand; Physiotherapy Department, North Shore Hospital, Auckland, New Zealand
| | - Anna Jernås
- Department of Physical Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Linda Denehy
- Physiotherapy Department, The University of Melbourne, Melbourne, Australia; Peter McCallum Cancer Centre, Melbourne, Australia
| | - Monika Fagevik Olsén
- Department of Physical Therapy, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
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15
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Boden I. Physiotherapy management of major abdominal surgery. J Physiother 2024; 70:170-180. [PMID: 38902197 DOI: 10.1016/j.jphys.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/22/2024] Open
Affiliation(s)
- Ianthe Boden
- Department of Physiotherapy, University of Tasmania, Launceston, Australia.
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16
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Ren A, Fan M, Gu Z, Liang X, Xu L, Liu C, Wang D, Chang H, Zhu M. Association between reversal agents (sugammadex vs. neostigmine) for neuromuscular block and postoperative pulmonary complications: A retrospective analysis. Br J Clin Pharmacol 2024; 90:1667-1676. [PMID: 38583490 DOI: 10.1111/bcp.16056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 04/09/2024] Open
Abstract
AIMS Residual neuromuscular blockade has been linked to pulmonary complications in the postoperative period. This study aimed to determine whether sugammadex was associated with a lower risk of postoperative pulmonary complications (PPCs) compared with neostigmine. METHODS This retrospective cohort study was conducted in a tertiary academic medical center. Patients ≥18 year of age undergoing noncardiac surgical procedures with general anesthesia and mechanical ventilation were enrolled between January 2019 and September 2021. We identified all patients receiving rocuronium and reversal with neostigmine or sugammadex via electronic medical record review. The primary endpoint was a composite of PPCs (including pneumonia, atelectasis, respiratory failure, pulmonary embolism, pleural effusion, or pneumothorax). The incidence of PPCs was compared using propensity score analysis. RESULTS A total of 1786 patients were included in this study. Among these patients, 976 (54.6%) received neostigmine, and 810 (45.4%) received sugammadex. In the whole sample, PPCs occurred in 81 (4.54%) subjects (7.04% sugammadex vs. 2.46% neostigmine). Baseline covariates were well balanced between groups after overlap weighting. Patients in the sugammadex group had similar risk (overlap weighting OR: 0.75; 95% CI: 0.40 to 1.41) compared to neostigmine. The sensitivity analysis showed consistent results. In subgroup analysis, the interaction P-value for the reversal agents stratified by surgery duration was 0.011. CONCLUSION There was no significant difference in the rate of PPCs when the neuromuscular blockade was reversed with sugammadex compared to neostigmine. Patients undergoing prolonged surgery may benefit from sugammadex, which needs to be further investigated.
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Affiliation(s)
- Aolin Ren
- Department of Anesthesiology, Jiangnan University Medical Center (Wuxi No.2 People's Hospital of Nanjing Medical University), Wuxi, Jiangsu Province, China
| | - Meihan Fan
- Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Zhen Gu
- Department of Anesthesiology, Jiangnan University Medical Center (Wuxi No.2 People's Hospital of Nanjing Medical University), Wuxi, Jiangsu Province, China
| | - Xiao Liang
- Department of Anesthesiology, Jiangnan University Medical Center (Wuxi No.2 People's Hospital of Nanjing Medical University), Wuxi, Jiangsu Province, China
| | - Liuhang Xu
- Hubei University of Medicine, Shiyan, Hubei Province, China
| | - Chengjun Liu
- Department of Anesthesiology, Jiangnan University Medical Center (Wuxi No.2 People's Hospital of Nanjing Medical University), Wuxi, Jiangsu Province, China
| | - Dutian Wang
- Department of Anesthesiology, Jiangnan University Medical Center (Wuxi No.2 People's Hospital of Nanjing Medical University), Wuxi, Jiangsu Province, China
| | - Hanxuan Chang
- Department of Anesthesiology, Jiangnan University Medical Center (Wuxi No.2 People's Hospital of Nanjing Medical University), Wuxi, Jiangsu Province, China
| | - Minmin Zhu
- Department of Anesthesiology, Jiangnan University Medical Center (Wuxi No.2 People's Hospital of Nanjing Medical University), Wuxi, Jiangsu Province, China
- Nanjing Medical University, Nanjing, Jiangsu Province, China
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17
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Tsumura H, Brandon D, Vacchiano C, Krishnamoorthy V, Bartz R, Pan W. Exploring phenotype-based ventilator parameter optimization to mitigate postoperative pulmonary complications: a retrospective observational cohort study. Surg Today 2024; 54:722-733. [PMID: 38095709 PMCID: PMC11176264 DOI: 10.1007/s00595-023-02785-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 11/01/2023] [Indexed: 06/15/2024]
Abstract
PURPOSE To identify tidal volume (VT) and positive end-expiratory pressure (PEEP) associated with the lowest incidence and severity of postoperative pulmonary complications (PPCs) for each phenotype based on preoperative characteristics. METHODS The subjects of this retrospective observational cohort study were 34,910 adults who underwent surgery, using general anesthesia with mechanical ventilation. Initially, the least absolute shrinkage and selection operator regression was employed to select relevant preoperative characteristics. Then, the classification and regression tree (CART) was built to identify phenotypes. Finally, we computed the area under the receiver operating characteristic curves from logistic regressions to identify VT and PEEP associated with the lowest incidence and severity of PPCs for each phenotype. RESULTS CARTs classified seven phenotypes for each outcome. A probability of the development of PPCs ranged from the lowest (3.51%) to the highest (68.57%), whereas the probability of the development of the highest level of PPC severity ranged from 3.3% to 91.0%. Across all phenotypes, the VT and PEEP associated with the most desirable outcomes were within a small range of VT 7-8 ml/kg predicted body weight with PEEP of between 6 and 8 cmH2O. CONCLUSIONS The ranges of optimal VT and PEEP were small, regardless of the phenotypes, which had a wide range of risk profiles.
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Affiliation(s)
- Hideyo Tsumura
- Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, USA.
- Duke University Health System, 2301 Erwin Road, Durham, NC, 27710, USA.
| | - Debra Brandon
- Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, USA
- Department of Pediatrics, Duke University School of Medicine, DUMC 3352, Durham, NC, 27710, USA
| | - Charles Vacchiano
- Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, USA
| | - Vijay Krishnamoorthy
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, DUMC 309427710, USA
- Department of Population Health Sciences Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA
| | - Raquel Bartz
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Wei Pan
- Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, USA
- Department of Population Health Sciences Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA
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18
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Miao H, Ge D, Wang Q, Zhou L, Chen H, Qin Y, Zhang F. Predictive significance of systemic immune-inflammation index combined with prealbumin for postoperative pneumonia following lung resection surgery. BMC Pulm Med 2024; 24:277. [PMID: 38862955 PMCID: PMC11167804 DOI: 10.1186/s12890-024-03086-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/03/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND We aimed to determine whether systemic immune-inflammation index (SII) combined with prealbumin can provide better predictive power for postoperative pneumonia in patients undergoing lung resection surgery. METHODS We identified eligible patients undergoing lung resection surgery at the Affiliated Hospital of Nantong University from March 2021 to March 2022. Demographic characteristics, clinical data, and laboratory information were collected and reviewed from the electronic medical records of the patients. To test the effect of the combined detection of SII and prealbumin, we made an equation using logistic regression analysis. The receiver operating characteristic curve (ROC) was plotted to evaluate the predictive powers, sensitivity, and specificity of prealbumin, SII, and SII combined with prealbumin. Decision curve analysis (DCA) was used to determine the clinical validity and net benefit of different methods of detection. RESULTS Totally 386 eligible patients were included with a median age of 62.0 years (IQR: 55.0, 68.0), and 57 (14.8%) patients presented with postoperative pneumonia within 7 days after surgery. The multivariate regression analysis showed that preoperative SII as continuous variable was associated with an increased risk of postoperative pneumonia (OR: 1.38, 95% CI: 1.19-2.83, P = 0.011), whereas the prealbumin as continuous variable remained as an independent protective predictor of postoperative pneumonia in the adjusted analysis (OR: 0.80, 95% CI: 0.37-0.89, P = 0.023). Compared to SII or prealbumin, the combined detection of preoperative SII and prealbumin showed a higher predictive power with area under curve of 0.79 (95% CI: 0.71-0.86, P < 0.05 for all). Additionally, DCA indicated that the combined detection was superior over preoperative SII or prealbumin alone in clinical validity and net benefit. CONCLUSION Both preoperative SII and prealbumin are independent influencing factors for postoperative pneumonia after lung resection surgery. The combined detection of preoperative SII and prealbumin can significantly improve prediction capability to identify potential postoperative pneumonia-susceptible patients, facilitating early interventions to improve postoperative quality of life for surgical lung resection patients.
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Affiliation(s)
- Haihang Miao
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, China
| | - Dingying Ge
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, China
| | - Qianwen Wang
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, China
| | - Lulu Zhou
- Department of Oncology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Hongsheng Chen
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, China.
| | - Yibin Qin
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, China.
| | - Faqiang Zhang
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China.
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Dou D, Yuan S, Jia Y, Wang Y, Li Y, Wang H, Ding J, Wu X, Bie D, Liu Q, An R, Yan H, Yan F. The protocol of enhanced recovery after cardiac surgery in adult patients: A stepped wedge cluster randomized trial. Am Heart J 2024; 272:48-55. [PMID: 38437910 DOI: 10.1016/j.ahj.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/28/2024] [Accepted: 02/28/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND The enhanced recovery after cardiac surgery is a bundle of measurements from preoperative to postoperative phases to improve patients' recovery. METHODS This study is a multicenter, stepwise design, cluster randomized controlled trial. About 3,600 patients presenting during control and intervention periods are eligible if they are aged from 18 to 80 years old awaiting elective cardiac surgery with cardiopulmonary bypass (CPB). About 5 centers are randomly assigned to staggered start dates for one-way crossover from the control phase to the intervention phase. In the intervention periods, patients will receive ERAS strategy including preoperative, intraoperative, and postoperative approaches. During the control phase, patients receive usual care. The primary outcome consists of major adverse cardiac and cerebrovascular events (MACCEs), postoperative pulmonary complications (PPCs), and acute kidney injury (AKI). DISCUSSION This study aims to compare the application of ERAS management protocol and traditional management protocol in adult cardiac surgery under extracorporeal circulation.
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Affiliation(s)
- Dou Dou
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Su Yuan
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Yuan Jia
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Yang Wang
- Department of Medical Research & Biometrics Centre, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Yinan Li
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Hongbai Wang
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Jie Ding
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Xie Wu
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Dongyun Bie
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Qiao Liu
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Ran An
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Haoqi Yan
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Fuxia Yan
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China.
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20
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Li P, Gao S, Wang Y, Zhou R, Chen G, Li W, Hao X, Zhu T. Utilising intraoperative respiratory dynamic features for developing and validating an explainable machine learning model for postoperative pulmonary complications. Br J Anaesth 2024; 132:1315-1326. [PMID: 38637267 DOI: 10.1016/j.bja.2024.02.025] [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: 09/05/2023] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Timely detection of modifiable risk factors for postoperative pulmonary complications (PPCs) could inform ventilation strategies that attenuate lung injury. We sought to develop, validate, and internally test machine learning models that use intraoperative respiratory features to predict PPCs. METHODS We analysed perioperative data from a cohort comprising patients aged 65 yr and older at an academic medical centre from 2019 to 2023. Two linear and four nonlinear learning models were developed and compared with the current gold-standard risk assessment tool ARISCAT (Assess Respiratory Risk in Surgical Patients in Catalonia Tool). The Shapley additive explanation of artificial intelligence was utilised to interpret feature importance and interactions. RESULTS Perioperative data were obtained from 10 284 patients who underwent 10 484 operations (mean age [range] 71 [65-98] yr; 42% female). An optimised XGBoost model that used preoperative variables and intraoperative respiratory variables had area under the receiver operating characteristic curves (AUROCs) of 0.878 (0.866-0.891) and 0.881 (0.879-0.883) in the validation and prospective cohorts, respectively. These models outperformed ARISCAT (AUROC: 0.496-0.533). The intraoperative dynamic features of respiratory dynamic system compliance, mechanical power, and driving pressure were identified as key modifiable contributors to PPCs. A simplified model based on XGBoost including 20 variables generated an AUROC of 0.864 (0.852-0.875) in an internal testing cohort. This has been developed into a web-based tool for further external validation (https://aorm.wchscu.cn/). CONCLUSIONS These findings suggest that real-time identification of surgical patients' risk of postoperative pulmonary complications could help personalise intraoperative ventilatory strategies and reduce postoperative pulmonary complications.
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Affiliation(s)
- Peiyi Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shuanliang Gao
- College of Software Engineering, Chengdu University of Information Technology, Chengdu, Sichuan, China
| | - Yaqiang Wang
- College of Software Engineering, Chengdu University of Information Technology, Chengdu, Sichuan, China; Sichuan Key Laboratory of Software Automatic Generation and Intelligent Service, Chengdu, Sichuan, China
| | - RuiHao Zhou
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Guo Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Institute of Respiratory Health, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China; State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Xuechao Hao
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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21
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Tominaga T, Nonaka T, Takamura Y, Oishi K, Hashimoto S, Shiraishi T, Noda K, Ono R, Ishii M, Hisanaga M, Takeshita H, Fukuoka H, Oyama S, Ishimaru K, Kunizaki M, Sawai T, Matsumoto K. Risk factors for pulmonary complications after colorectal cancer surgery: a Japanese multicenter study. Int J Colorectal Dis 2024; 39:76. [PMID: 38780615 PMCID: PMC11116231 DOI: 10.1007/s00384-024-04652-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE Pulmonary complications (PC) are a serious condition with a 20% mortality rate. However, few reports have examined risk factors for PC after colorectal surgery. This study investigated the frequency, characteristics, and risk factors for PC after colorectal cancer surgery. METHODS Between January 2016 and December 2022, we retrospectively reviewed 3979 consecutive patients who underwent colorectal cancer surgery in seven participating hospitals. Patients were divided into patients who experienced PC (PC group, n = 54) and patients who did not (non-PC group, n = 3925). Clinical and pathological features were compared between groups. RESULTS Fifty-four patients (1.5%) developed PC, of whom 2 patients (3.7%) died due to PC. Age was greater (80 years vs 71 years; p < 0.001), frequency of chronic obstructive pulmonary distress was greater (9.3% vs 3.2%; p = 0.029), performance status was poorer (p < 0.001), the proportion of underweight was higher (42.6% vs 13.4%, p < 0.001), frequency of open surgery was greater (24.1% vs 9.3%; p < 0.001), and blood loss was greater (40 mL vs 22 mL; p < 0.001) in the PC group. Multivariate analysis revealed male sex (odds ratio (OR) 2.165, 95% confidence interval (CI) 1.176-3.986; p = 0.013), greater age (OR 3.180, 95%CI 1.798-5.624; p < 0.001), underweight (OR 3.961, 95%CI 2.210-7.100; p < 0.001), and poorer ASA-PS (OR 3.828, 95%CI 2.144-6.834; p < 0.001) as independent predictors of PC. CONCLUSION Our study revealed male sex, greater age, underweight, and poorer ASA-PS as factors associated with development of PC, and suggested that pre- and postoperative rehabilitation and pneumonia control measures should be implemented for patients at high risk of PC.
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Affiliation(s)
- Tetsuro Tominaga
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Takashi Nonaka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Yuma Takamura
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kaido Oishi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Shintaro Hashimoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Toshio Shiraishi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Keisuke Noda
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Rika Ono
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Mitsutoshi Ishii
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirasemachi, Nagasaki, 857-8511, Japan
| | - Makoto Hisanaga
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirasemachi, Nagasaki, 857-8511, Japan
| | - Hiroaki Takeshita
- Department of Surgery, National Hospital Organization Nagasaki Medical Center, 1-1001-1, Omura, Nagasaki, 856-8562, Japan
| | - Hidetoshi Fukuoka
- Department of Surgery, Isahaya General Hospital, 24-1, Isahaya, Nagasaki, 854-8501, Japan
| | - Shosaburo Oyama
- Department of Surgery, Ureshino Medical Center, 4279-3 Ko, Ureshinomachi, Oaza, Shimojuku, Ureshino, Saga, 843-0393, Japan
| | - Kazuhide Ishimaru
- Department of Surgery, Saiseikai Nagasaki Hospital, 2-5-1 Katafuchi, Nagasaki, 850-0003, Japan
| | - Masaki Kunizaki
- Department of Surgery, Saseno Chuo Hospital, 15 Yamatocho, Sasebo, 857-1195, Japan
| | - Terumitsu Sawai
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Keitaro Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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22
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Lee GR, Kim HS, Chung YJ, Kim EY. Venous-to-arterial carbon-dioxide tension difference as a useful predictor of patient prognosis after major surgery. Asian J Surg 2024; 47:2152-2160. [PMID: 38238140 DOI: 10.1016/j.asjsur.2024.01.001] [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: 10/13/2023] [Revised: 12/13/2023] [Accepted: 01/05/2024] [Indexed: 05/05/2024] Open
Abstract
PURPOSE Change in venous-to-arterial carbon dioxide partial pressure difference[P(v-a)CO2] could be a useful marker to assess tissue perfusion status. Herein, we assessed the predictive values of postoperative P(v-a)CO2 measurements for mortality in critically ill patients after major surgery. The correlation between P(v-a)CO2 values and other conventional parameters of patient prognosis was also evaluated. METHODS Patients admitted to the intensive care unit(ICU) after abdominal surgery were enrolled. Arterial and venous blood gas analyses were performed within 1 h(T0) and after 24 h(T1) of admission to the ICU, respectively. The relationship between P(v-a)CO2 levels at T1 and other conventional parameters were assessed using a Bland-Altman plot. Logistic regression analysis was performed to examine the predisposing factors of mortality after surgery. RESULTS A total of 231 patients were finally analyzed. We divided the participants into the high PvaCO2 group[P(v-a)CO2 ≥ 8.6] and the low PvaCO2 group[P(v-a)CO2 < 8.6]. Seven-day-, 28-day, and in-hospital mortality were significantly higher in the high PvaCO2 group than in the low PvaCO2 group. There was significant agreement between P(v-a)CO2 values at T1 and APACHE II scores, lactate levels at T1 and total SOFA scores at T1. In multivariate logistic analysis, an increased P(v-a)CO2 value at T1 was the only significant risk factor of 7-day mortality after surgery. [odds ratio:1.341, 95%confidence interval: 1.050-1.714, p=0.019]. CONCLUSION P(v-a)CO2 measurements could be not only a significant predictor of postoperative prognosis, but also a useful surveillance parameter to maintain tissue perfusion after abdominal surgery in patients with a potential risk of fatal complication-related tissue hypoperfusion.
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Affiliation(s)
- Gyeo Ra Lee
- Division of Trauma and Surgical Critical Care, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hye Sung Kim
- Division of Trauma and Surgical Critical Care, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yoon Ji Chung
- Division of Trauma and Surgical Critical Care, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Eun Young Kim
- Division of Trauma and Surgical Critical Care, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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23
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Guerra-Londono CE, Cata JP, Nowak K, Gottumukkala V. Prehabilitation in Adults Undergoing Cancer Surgery: A Comprehensive Review on Rationale, Methodology, and Measures of Effectiveness. Curr Oncol 2024; 31:2185-2200. [PMID: 38668065 PMCID: PMC11049527 DOI: 10.3390/curroncol31040162] [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: 03/21/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Cancer surgery places a significant burden on a patients' functional status and quality of life. In addition, cancer surgery is fraught with postoperative complications, themselves influenced by a patient's functional status. Prehabilitation is a unimodal or multimodal strategy that aims to increase a patient's functional capacity to reduce postoperative complications and improve postoperative recovery and quality of life. In most cases, it involves exercise, nutrition, and anxiety-reducing interventions. The impact of prehabilitation has been explored in several types of cancer surgery, most commonly colorectal and thoracic. Overall, the existing evidence suggests prehabilitation improves physiological outcomes (e.g., lean body mass, maximal oxygen consumption) as well as clinical outcomes (e.g., postoperative complications, quality of life). Notably, the benefit of prehabilitation is additional to that of enhanced recovery after surgery (ERAS) programs. While safe, prehabilitation programs require multidisciplinary coordination preoperatively. Despite the existence of numerous systematic reviews and meta-analyses, the certainty of evidence demonstrating the efficacy and safety of prehabilitation is low to moderate, principally due to significant methodological heterogeneity and small sample sizes. There is a need for more large-scale multicenter randomized controlled trials to draw strong clinical recommendations.
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Affiliation(s)
- Carlos E. Guerra-Londono
- Department of Anesthesiology, Pain Management & Perioperative Medicine, Henry Ford Health, Detroit, MI 48202, USA; (C.E.G.-L.); (K.N.)
| | - Juan P. Cata
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Katherine Nowak
- Department of Anesthesiology, Pain Management & Perioperative Medicine, Henry Ford Health, Detroit, MI 48202, USA; (C.E.G.-L.); (K.N.)
| | - Vijaya Gottumukkala
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
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24
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Carr SG, Clifton JC, Freundlich RE, Fowler LC, Sherwood ER, McEvoy MD, Robertson A, Dunworth B, McCarthy KY, Shotwell MS, Kertai MD. Improving Neuromuscular Monitoring Through Education-Based Interventions and Studying Its Association With Adverse Postoperative Outcomes: A Retrospective Observational Study. Anesth Analg 2024; 138:517-529. [PMID: 38364243 PMCID: PMC10878712 DOI: 10.1213/ane.0000000000006722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
BACKGROUND We assessed the association between education-based interventions, the frequency of train-of-four (TOF) monitoring, and postoperative outcomes. METHODS We studied adults undergoing noncardiac surgery from February 1, 2020 through October 31, 2021. Our education-based interventions consisted of 3 phases. An interrupted time-series analysis, adjusting for patient- and procedure-related characteristics and secular trends over time, was used to assess the associations between education-based interventions and the frequency of TOF monitoring, postoperative pulmonary complications (PPCs), 90-day mortality, and sugammadex dosage. For each outcome and intervention phase, we tested whether the intervention at that phase was associated with an immediate change in the outcome or its trend (weekly rate of change) over time. In a sensitivity analysis, the association between education-based interventions and postoperative outcomes was adjusted for TOF monitoring. RESULTS Of 19,422 cases, 11,636 (59.9%) had documented TOF monitoring. Monitoring frequency increased from 44.2% in the first week of preintervention stage to 83.4% in the final week of the postintervention phase. During the preintervention phase, the odds of TOF monitoring trended upward by 0.5% per week (odds ratio [OR], 1.005; 95% confidence interval [CI], 1.002-1.007). Phase 1 saw an immediate 54% increase (OR, 1.54; 95% CI, 1.33-1.79) in the odds, and the trend OR increased by 3% (OR, 1.03; 95% CI, 1.01-1.05) to 1.035, or 3.5% per week (joint Wald test, P < .001). Phase 2 was associated with a further immediate 29% increase (OR, 1.29; 95% CI, 1.02-1.64) but no significant association with trend (OR, 0.96; 95% CI, 0.93-1.01) of TOF monitoring (joint test, P = .04). Phase 3 and postintervention phase were not significantly associated with the frequency of TOF monitoring (joint test, P = .16 and P = .61). The study phases were not significantly associated with PPCs or sugammadex administration. The trend OR for 90-day mortality was larger by 24% (OR, 1.24; 95% CI, 1.06-1.45; joint test, P = .03) in phase 2 versus phase 1, from a weekly decrease of 8% to a weekly increase of 14%. However, this trend reversed again at the transition from phase 3 to the postintervention phase (OR, 0.82; 95% CI, 0.68-0.99; joint test, P = .05), from a 14% weekly increase to a 6.2% weekly decrease in the odds of 90-day mortality. In sensitivity analyses, adjusting for TOF monitoring, we found similar associations between study initiatives and postoperative outcomes. TOF monitoring was associated with lower odds of PPCs (OR, 0.69; 95% CI, 0.55-0.86) and 90-day mortality (OR, 0.79; 95% CI, 0.63-0.98), but not sugammadex dosing (mean difference, -0.02; 95% CI, -0.04 to 0.01). CONCLUSIONS Our education-based interventions were associated with both TOF utilization and 90-day mortality but were not associated with either the odds of PPCs or sugammadex dosing. TOF monitoring was associated with reduced odds of PPCs and 90-day mortality.
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Affiliation(s)
- Shane G. Carr
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Jacob C. Clifton
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert E. Freundlich
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Leslie C. Fowler
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Edward R. Sherwood
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew D. McEvoy
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amy Robertson
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brent Dunworth
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Karen Y. McCarthy
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew S. Shotwell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Miklos D. Kertai
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
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25
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Piriyapatsom A, Trisukhonth A, Chintabanyat O, Chaiwat O, Kongsayreepong S, Thanakiattiwibun C. Adherence to lung protective mechanical ventilation in patients admitted to a surgical intensive care unit and the associated increased mortality. Heliyon 2024; 10:e26220. [PMID: 38404779 PMCID: PMC10884462 DOI: 10.1016/j.heliyon.2024.e26220] [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] [Received: 08/08/2023] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/27/2024] Open
Abstract
Background The adherence rate to the lung protective ventilation (LPV) strategy, which is generally accepted as a standard practice in mechanically ventilated patients, reported in the literature is approximately 40%. This study aimed to determine the adherence rate to the LPV strategy, factors associated with this adherence, and related clinical outcomes in mechanically ventilated patients admitted to the surgical intensive care unit (SICU). Methods This prospective observational study was conducted in the SICU of a tertiary university-based hospital between April 2018 and February 2019. Three hundred and six adult patients admitted to the SICU who required mechanical ventilation support for more than 12 h were included. Ventilator parameters at the initiation of mechanical ventilation support in the SICU were recorded. The LPV strategy was defined as ventilation with a tidal volume of equal or less than 8 ml/kg of predicted body weight plus positive end-expiratory pressure of at least 5 cm H2O. Demographic and clinical data were recorded and analyzed. Results There were 306 patients included in this study. The adherence rate to the LPV strategy was 36.9%. Height was the only factor associated with adherence to the LPV strategy (odds ratio for each cm, 1.10; 95% confidence interval (CI), 1.06-1.15). Cox regression analysis showed that the LPV strategy was associated with increased 90-day mortality (hazard ratio, 1.73; 95% CI, 1.02-2.94). Conclusion The adherence rate to the LPV strategy among patients admitted to the SICU was modest. Further studies are warranted to explore whether the application of the LPV strategy is simply a marker of disease severity or a causative factor for increased mortality.
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Affiliation(s)
- Annop Piriyapatsom
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 10700, Thailand
| | - Ajana Trisukhonth
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 10700, Thailand
| | - Ornin Chintabanyat
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 10700, Thailand
| | - Onuma Chaiwat
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 10700, Thailand
| | - Suneerat Kongsayreepong
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 10700, Thailand
| | - Chayanan Thanakiattiwibun
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 10700, Thailand
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26
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Georges O, Abou Arab O, Ben Rahal M, de Dominicis F, Pfister AW, Merlusca G, Iquille J, Berna P. Diagnostic value of systematic bronchial aspirate on postoperative pneumonia after pulmonary resection surgery for lung cancer: a monocentre retrospective study. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivad212. [PMID: 38305501 PMCID: PMC10850844 DOI: 10.1093/icvts/ivad212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/01/2023] [Accepted: 01/31/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVES Intraoperative bacterial airway colonization seems to be associated with an increased risk of postoperative pneumonia (POP). It can be easily assessed by performing a bronchial aspirate (BA). The objective of this study is to assess the diagnostic performance of the BA to predict POP. METHODS We conducted a single-centre retrospective observational study over a period of 10 years, from 1 January 2011 to 30 December 2020. The population study included patients admitted for a scheduled pulmonary resection surgery for lung cancer. Patients were classified into 2 populations depending on whether or not they developed a POP. Uni- and multivariable analyses were performed to identify risk factors for developing POP. The diagnostic performance of BA was represented by its sensitivity, specificity and positive and negative predictive values. RESULTS A total of 1006 patients were included in the study. Uni- and multivariable analyses found that a positive BA was independently associated with a greater risk of developing POP with an odds ratio of 6.57 [4.165-10.865]; P < 0.001. Its specificity was 95%, sensitivity was 31%, positive predictive value was 66% and negative predictive value was 81%. CONCLUSIONS A positive intraoperative BA is an independent risk factor for POP after lung cancer surgery. Further trials are required to validate the systematic implementation of BA as an early diagnostic tool for POP.
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Affiliation(s)
- Olivier Georges
- Thoracic Surgery Department, Amiens University Hospital, Amiens, France
| | - Osama Abou Arab
- Anesthesiology and Critical Care Department, Amiens University Hospital, Amiens, France
| | - Malek Ben Rahal
- Thoracic Surgery Department, Amiens University Hospital, Amiens, France
| | | | | | - Geoni Merlusca
- Thoracic Surgery Department, Amiens University Hospital, Amiens, France
| | - Jules Iquille
- Thoracic and Vascular Surgery Department, Saint-Brieux Hospital, France
| | - Pascal Berna
- Thoracic Surgery Department, Clinique Victor Pauchet, Amiens, France
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Ryz S, Menger J, Veraar C, Datler P, Mouhieddine M, Zingher F, Geilen J, Skhirtladze-Dworschak K, Ankersmit HJ, Zuckermann A, Tschernko E, Dworschak M. Identifying High-Risk Patients for Severe Pulmonary Complications after Cardiosurgical Procedures as a Target Group for Further Assessment of Lung-Protective Strategies. J Cardiothorac Vasc Anesth 2024; 38:445-450. [PMID: 38129207 DOI: 10.1053/j.jvca.2023.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/31/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES It remains unclear whether intraoperative lung-protective strategies can reduce the rate of respiratory complications after cardiac surgery, partly because low-risk patients have been studied in the past. The authors established a screening model to easily identify a high-risk group for severe pulmonary complications (ie, pneumonia or acute respiratory distress syndrome) that may be the ideal target population for the assessment of the potential benefits of such measures. DESIGN Retrospective observational trial. SETTING Departments of cardiac surgery and cardiac anesthesia of a university hospital. PARTICIPANTS Consecutive patients undergoing cardiac surgery on cardiopulmonary bypass and subsequent treatment at a dedicated cardiosurgical intensive care unit between January 2019 and March 2021. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of the 2,572 patients undergoing surgery, 84 (3.3%) developed pneumonia/acute respiratory distress syndrome that significantly affected the outcome (ie, longer ventilatory support [66% vs 11%], higher reintubation rate [39% vs 3%]), prolonged length of intensive care unit [33 ± 36 vs 4 ± 10 days] and hospital stay [10 ± 15 vs 6 ± 7 days], and higher in-hospital [43% vs 9%] as well as 30-day [7% vs 3%] mortality). The screening model for severe pulmonary complications included left ventricular ejection fraction <52%, EuroSCORE II (European System for Cardiac Operative Risk Evaluation II) >5.9, cardiopulmonary bypass time >123 minutes, left ventricular assist device or aortic repair surgery, and bronchodilatory therapy. A cutoff for the predicted risk of 2.5% showed optimal sensitivity and specificity, with an area under the receiver operating characteristic curve of 0.82. CONCLUSIONS The authors suggest that future research on intraoperative lung-protective measures focuses on this high-risk population, primarily aiming to mitigate severe forms of postoperative pulmonary dysfunction associated with poor outcomes and increased resource consumption.
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Affiliation(s)
- Sylvia Ryz
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Johannes Menger
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Cecilia Veraar
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Philip Datler
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Mohamed Mouhieddine
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Florentina Zingher
- Division of General Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Johannes Geilen
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Keso Skhirtladze-Dworschak
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Edda Tschernko
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Martin Dworschak
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria.
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Li XF, Mao WJ, Jiang RJ, Yu H, Zhang MQ, Yu H. Effect of Mechanical Ventilation Mode Type on Postoperative Pulmonary Complications After Cardiac Surgery: A Randomized Controlled Trial. J Cardiothorac Vasc Anesth 2024; 38:437-444. [PMID: 38105126 DOI: 10.1053/j.jvca.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES It is unknown whether there is a difference in pulmonary outcome in different intraoperative ventilation modes for cardiac surgery with cardiopulmonary bypass (CPB). The aim of this trial was to determine whether patients undergoing cardiac surgery with CPB could benefit from intraoperative optimal ventilation mode. DESIGN This was a single-center, prospective, randomized controlled trial. SETTING The study was conducted at a single-center tertiary-care hospital. PARTICIPANTS A total of 1,364 adults undergoing cardiac surgery with CPB participated in this trial. INTERVENTIONS Patients were assigned randomly (1:1:1) to receive 1 of 3 ventilation modes: volume-controlled ventilation (VCV), pressure-controlled ventilation (PCV), and pressure-controlled ventilation-volume guaranteed (PCV-VG). All arms of the study received the lung-protective ventilation strategy. MEASUREMENTS AND MAIN RESULTS The primary outcome was a composite of postoperative pulmonary complications (PPCs) within the first 7 postoperative days. Pulmonary complications occurred in 168 of 455 patients (36.9%) in the PCV-VG group, 171 (37.6%) in the PCV group, and 182 (40.1%) in the VCV group, respectively. There was no statistical difference in the risk of overall pulmonary complications among groups (p = 0.585). There were no significant differences in the severity grade of PPCs within 7 days, postoperative ventilation duration, intensive care unit stay, postoperative hospital stay, or 30-day postoperative mortality. CONCLUSIONS Among patients scheduled for cardiac surgery with CPB, intraoperative ventilation mode type did not affect the risk of postoperative pulmonary complications.
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Affiliation(s)
- Xue-Fei Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Wen-Jie Mao
- Department of Anesthesiology, Jianyang People's Hospital, Jianyang, China
| | - Rong-Juan Jiang
- Department of Anesthesiology, Chengdu Second People's Hospital, Chengdu, China
| | - Hong Yu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Meng-Qiu Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hai Yu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.
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Yoo S, Yoon S, Kim BR, Yoo HK, Seo JH, Bahk JH. Positive end-expiratory pressure during one-lung ventilation for preventing atelectasis after video-assisted thoracoscopic surgery: a triple-arm, randomized controlled trial. Minerva Anestesiol 2024; 90:12-21. [PMID: 37987988 DOI: 10.23736/s0375-9393.23.17539-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
BACKGROUND There is little evidence regarding the benefits of lung-protective ventilation in patients undergoing one-lung ventilation for thoracic surgery. This study aimed to determine the optimal level of positive end-expiratory pressure (PEEP) during one-lung ventilation for minimizing postoperative atelectasis through lung ultrasonography. METHODS A total of 142 adult patients scheduled for video-assisted thoracoscopic surgery at Seoul National University Hospital between May 2019 and February 2020 were enrolled in this study. Patients were randomly assigned to different groups: 1) PEEP 3 cmH2O group; 2) PEEP 6 cmH2O group; and 3) PEEP 9 cmH2O group during one-lung ventilation. The lung ultrasound score was used to evaluate lung aeration using ultrasonography 1 hour after surgery. RESULTS The 1-hour post-surgery lung ultrasound scores were 8.1±2.5, 6.8±2.6, and 5.9±2.6 in the PEEP 3, 6, and 9 cmH2O groups, respectively (P<0.001). The PEEP 3 cmH2O group showed significantly higher lung ultrasound scores than the PEEP 6 (adjusted P=0.034) and 9 cmH2O groups (adjusted P<0.001). The PaO2/FiO2 ratio measured at 10 minutes after the end of one-lung ventilation was significantly lower in the PEEP 3 cmH2O group (392 [331 to 469]) than the PEEP 6 cmH2O (458 [384 to 530], adjusted P=0.018) or PEEP 9 cmH2O groups (454 [374 to 522], adjusted P=0.016). CONCLUSIONS Although the optimal level of PEEP during one-lung ventilation was not determined, the application of higher PEEP can prevent aeration loss in the ventilated lung after video-assisted thoracoscopic surgery under one-lung ventilation.
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Affiliation(s)
- Seokha Yoo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Susie Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Bo R Kim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Hae K Yoo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jeong-Hwa Seo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae-Hyon Bahk
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea -
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Yu J, Kong YG, Park JY, Kim HY, Kwon M, Han YJ, Lee N, Seo YJ, Kim YK. Chart-Derived Frailty Index and 90-Day Mortality After Burn Surgery. J Surg Res 2024; 293:291-299. [PMID: 37806214 DOI: 10.1016/j.jss.2023.08.041] [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: 02/21/2023] [Revised: 07/31/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Frailty is a reduced physiological reserve condition associated with postoperative morbidity and mortality. The chart-derived frailty index (CFI) can measure frailty using demographic and laboratory values. We evaluated the association of preoperative CFI with 90-d mortality after burn surgery. METHODS This large retrospective study included burn intensive care unit (ICU) patients between 2012 and 2021 and calculated CFI using the sum of the following five variables: age >70 y, body mass index <18.5 kg/m2, hematocrit <35%, albumin <3.4 g/dL, and creatinine >2.0 mg/dL; high CFI was a score of 3-5. Postoperative 90-d mortality rate, major adverse cardiac events (MACE), pneumonia, continuous renal replacement therapy (CRRT) requirement, and prolonged ICU stay (>60 d) were evaluated. RESULTS Of 1118 patients, 147 (13.1%) had high CFI. High CFI patients had a higher 90-d mortality rate than did low CFI patients (38.8% versus 22.6%, P < 0.001). A high CFI was significantly associated with postoperative 90-d mortality (hazard ratio = 4.124, 95% confidence interval = 2.980-5.707, P < 0.001) in multivariate Cox regression analysis. Kaplan-Meier analysis revealed significantly different postoperative 90-d mortality rates between patients with high and low CFIs (log-rank test, P < 0.001). Incidences of postoperative MACE, pneumonia, the need for CRRT, and prolonged ICU stay were significantly higher in patients with high CFIs than in those with low CFIs. CONCLUSIONS Preoperative high CFI was associated with increased 90-d mortality, MACE, pneumonia, CRRT requirement, and ICU stay following burn surgery.
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Affiliation(s)
- Jihion Yu
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yu-Gyeong Kong
- Department of Anesthesiology and Pain Medicine, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea
| | - Jun-Young Park
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hee Yeong Kim
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Republic of Korea
| | - Miyoung Kwon
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Republic of Korea
| | - Yun Jae Han
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Republic of Korea
| | - Narae Lee
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Young Joo Seo
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
| | - Young-Kug Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Yang Y, Niu L, Zhu Y, Wu Z, Xia L, Xiao C, Shen X, Xiao X, Tian C, Lin F. Optimum timing of lung resection surgery following SARS-CoV-2 infection for non-small cell lung cancer. Cancer Med 2024; 13:e6891. [PMID: 38169158 PMCID: PMC10807575 DOI: 10.1002/cam4.6891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/29/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on postoperative recovery of non-small cell lung cancer (NSCLC) is need to be understood, thereby informing the optimal timing of surgical decision-making during the COVID-19 pandemic for NSCLC patients. This study reports the postoperative outcomes of surgical NSCLC patients with preoperative SARS-CoV-2 infection. METHOD This single-center retrospective cohort study included 241 NSCLC patients who underwent lobectomy or sub-lobectomy between December 1, 2022 and February 14, 2023. Surgical outcomes of patients with preoperative SARS-CoV-2 infection (stratified by the time from diagnosis of SARS-CoV-2 infection to surgery) were compared with those without preoperative SARS-CoV-2 infection. The primary outcomes were total postoperative complications and postoperative pulmonary complications (PPCs), the secondary outcomes included operation time, total postoperative drainage and time, length of hospital stay (LOS), 30-day and 90-day postoperative symptoms. RESULTS This study included 153 (63.5%) patients with preoperative SARS-CoV-2 infection and 88 (36.5%) patients without previous SARS-CoV-2 infection. In patients with a preoperative SARS-CoV-2 diagnosis, the incidence of total postoperative complications (OR, 3.00; 95% CI, 1.12-8.01; p = 0.028) and PPCs (OR, 4.20; 95% CI, 1.11-15.91; p = 0.035) both increased in patients infected having surgery within 2 weeks compared with non-infection before surgery. However, patients who underwent lung resection more than 2 weeks after SARS-CoV-2 diagnosis had a similar risk of postoperative complications and surgical outcomes with those non-infection before surgery. CONCLUSION This is the first study to provide evidence regarding the optimum timing of lung resection surgery and assessing early outcomes after surgery in NSCLC patients with SARS-CoV-2 infection. Our study documents that the SARS-CoV-2 infection did not complicate surgical procedures for lung cancer, and suggest that lung surgery should be postponed at least 2 weeks after SARS-CoV-2 infection for NSCLC patients.
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Affiliation(s)
- Yanbo Yang
- Department of Thoracic Surgery, West China HospitalSichuan UniversityChengduChina
- Department of Thoracic Surgery, Shangjin Branch of Western China HospitalSichuan UniversityChengduChina
- Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung CancerSichuan UniversityChengduChina
| | - Lingli Niu
- Department of Thoracic Surgery, West China HospitalSichuan UniversityChengduChina
- Department of Thoracic Surgery, Shangjin Branch of Western China HospitalSichuan UniversityChengduChina
| | - Yunke Zhu
- Department of Thoracic Surgery, West China HospitalSichuan UniversityChengduChina
- Department of Thoracic Surgery, Shangjin Branch of Western China HospitalSichuan UniversityChengduChina
- Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung CancerSichuan UniversityChengduChina
| | - Zhu Wu
- Department of Thoracic Surgery, West China HospitalSichuan UniversityChengduChina
- Department of Thoracic Surgery, Shangjin Branch of Western China HospitalSichuan UniversityChengduChina
- Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung CancerSichuan UniversityChengduChina
| | - Liang Xia
- Department of Thoracic Surgery, West China HospitalSichuan UniversityChengduChina
- Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung CancerSichuan UniversityChengduChina
| | - Congjia Xiao
- Department of Thoracic Surgery, West China HospitalSichuan UniversityChengduChina
- Department of Thoracic Surgery, Shangjin Branch of Western China HospitalSichuan UniversityChengduChina
| | - Xu Shen
- Department of Thoracic Surgery, West China HospitalSichuan UniversityChengduChina
- Department of Thoracic Surgery, Shangjin Branch of Western China HospitalSichuan UniversityChengduChina
| | - Xin Xiao
- Department of Thoracic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Conglin Tian
- Department of Thoracic Surgery, Shangjin Branch of Western China HospitalSichuan UniversityChengduChina
| | - Feng Lin
- Department of Thoracic Surgery, West China HospitalSichuan UniversityChengduChina
- Department of Thoracic Surgery, Shangjin Branch of Western China HospitalSichuan UniversityChengduChina
- Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung CancerSichuan UniversityChengduChina
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Hackett C, Denehy L, Kruger P, Ripley N, Reid N, Smithers BM, Walker RM, Hope L, Boden I. PHYSIO+++: protocol for a pilot randomised controlled trial assessing the feasibility of physiotherapist-led non-invasive ventilation for patients with hypoxaemia following abdominal surgery. BMJ Open 2023; 13:e078175. [PMID: 38101825 PMCID: PMC11148710 DOI: 10.1136/bmjopen-2023-078175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Few clinical trials have investigated physiotherapy interventions to treat hypoxaemia following abdominal surgery. The objective of this study is to determine the feasibility and safety of conducting a clinical trial of physiotherapist-led non-invasive ventilation (NIV). METHODS AND ANALYSIS This single-centre, 50-patient, parallel-group, assessor blinded, pilot feasibility randomised controlled trial with concealed allocation will enrol spontaneously ventilating adults with hypoxaemia within 72 hours of major abdominal surgery. Participants will receive either (1) usual care physiotherapy of a single education session (talk), daily walking of 10-15 min (walk) and four sessions of coached deep breathing and coughing (breathe) or (2) usual care physiotherapy plus four 30 min sessions of physiotherapist-led NIV delivered over 2 postoperative days. Primary feasibility and safety outcome measures are; number of eligible patients recruited per week, total time of NIV treatment delivered, acceptability of treatments to patients and clinicians and incidence of adverse events. Secondary feasibility outcomes include measures of recruitment and treatment adherence. Exploratory outcome measures include change in respiratory parameters, postoperative pulmonary complications, length of hospital stay, health-related quality of life, postoperative activity levels and mortality. ETHICS AND DISSEMINATION Ethics approval has been obtained from the relevant institution. Results will be published to inform future research. TRIAL REGISTRATION NUMBER ACTRN12622000839707.
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Affiliation(s)
- Claire Hackett
- Department of Physiotherapy, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Linda Denehy
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Peter Kruger
- Department of Intensive Care, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia
| | - Nina Ripley
- Department of Physiotherapy, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Natasha Reid
- Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
| | - B Mark Smithers
- Upper Gastro-intestinal Unit, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Discipline of Surgery, The School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Rachel M Walker
- Division of Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Louise Hope
- Consumer representative, Brisbane, Queensland, Australia
| | - Ianthe Boden
- School of Health Science, University of Tasmania, Launceston, Tasmania, Australia
- Department of Physiotherapy, Launceston General Hospital, Launceston, Tasmania, Australia
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Alsubaiei ME, Althukair W, Almutairi H. Functional capacity in smoking patients after coronary artery bypass grafting surgery: a quasi-experimental study. J Med Life 2023; 16:1760-1768. [PMID: 38585530 PMCID: PMC10994605 DOI: 10.25122/jml-2023-0282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/20/2023] [Indexed: 04/09/2024] Open
Abstract
Coronary artery bypass grafting surgery (CABG) is an important approach to treating coronary heart disease. However, patients undergoing open heart surgery are at risk of postoperative complications. Cigarette smoking is one of the preoperative risk factors that may increase postoperative complications. Studies show that early mobilization intervention may reduce these complications and improve functional capacity, but the impact of smoking on early outcomes after CABG has been controversial for the past two decades. This quasi-experimental study explored the effects of early mobilization on functional capacity among patients with different smoking histories undergoing CABG. The study involved 51 participants who underwent CABG surgery, divided into three groups: current smokers, former smokers, and non-smokers (n=17 each). A day before surgery, all groups underwent a six-minute walking test (6MWT). Every participant received the same intervention after surgery, including deep breathing exercises, an upper limb range of motion assessment, an incentive spirometer, and walking with and without assistance. Five days postoperatively, all outcomes - including the 6MWT, length of stay (LOS) in the ICU, and postoperative pulmonary complications - were assessed, and the 6MWT was repeated. There was a reduced functional capacity after CABG in ex-smokers (215.8±102 m) and current smokers (272.7±97m) compared to non-smokers (298.5±97.1m) in terms of 6MWT (p<0.05). Current smokers were more likely to have atelectasis after CABG than ex-smokers (76.5% vs. 52.9%), with non-smokers being the least likely to have atelectasis among the three groups (29.4%, p<0.05). Additionally, current smokers required longer ventilator support post-CABG (11.9±7.3 hours) compared to ex-smokers (8.3±4.3 hours) and non-smokers (7±2.5 hours, p<0.01). Smoking status significantly impacts functional capacity reduction after CABG, with current smokers being more susceptible to prolonged ventilator use and atelectasis.
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Affiliation(s)
- Mohammed Essa Alsubaiei
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Imam Abdulrahman bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Wadha Althukair
- Department of Physical Therapy, Saud Al-Babtain Cardiac Center, Dammam, Kingdom of Saudi Arabia
| | - Hind Almutairi
- Department of Quality Improvement and Patient Safety, Dhahran General Hospital for Long Term Care, Dhahran, Kingdom of Saudi Arabia
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Wallace SK, Bucknall TK, Forbes A, Myles PS. A mixed methods study protocol to identify research priorities for perioperative medicine in Australia. BJA OPEN 2023; 8:100235. [PMID: 37927381 PMCID: PMC10624594 DOI: 10.1016/j.bjao.2023.100235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023]
Abstract
Background Clinical research in perioperative medicine requires the perspectives of patients and caregivers to increase its relevance and quality, benefiting both researchers and the community. Identifying these priorities will enable researchers, funders, and governing bodies to efficiently use scarce funding and resources. We aim to identify the top 10 research priorities in perioperative medical research in Australia. Methods A mixed-methods, exploratory-sequential design will be conducted. The study will include five phases. Initially, a published open-ended survey gathered responses from the population (researchers, healthcare workers, and consumers) regarding uncertainties/questions relevant to the population about perioperative medical research. We collected 544 questions and quantitatively analysed and grouped them according to the Standardised Endpoints in Perioperative Medicine-Core Outcomes Measures in Perioperative and Anaesthetic Care (StEP-COMPAC) endpoints. Using multicriteria decision-making software, workshops combining the population will be conducted to determine the top 10 priorities for perioperative medicine research for the Australian population. Ethics and dissemination Ethical approval to conduct the study was obtained from the Alfred Health (Australia) Human Research Ethics Committee (ID: 171/19). The findings will be disseminated in peer review publications, conferences, and dissemination across perioperative research networks. The top 10 priorities will be available to inform research funders, grant submissions, guidelines, and the population.
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Affiliation(s)
- Sophie K.A. Wallace
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Anaesthesiology and Perioperative Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Tracey K. Bucknall
- Centre for Quality and Patient Safety- Alfred Health Partnership, Institute for Health Transformation, Deakin University, Geelong, Australia
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | - Andrew Forbes
- Biostatistics Unit, Department of Epidemiology and Perioperative Medicine, Monash University, Melbourne, Australia
| | - Paul S. Myles
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Anaesthesiology and Perioperative Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Shelley B, Goebel A, Grant S, Jackson L, Jarrett H, Jepson M, Kerr A, Marczin N, Mehta R, Melody T, Middleton L, Naidu B, Szentgyorgyi L, Tearne S, Watkins B, Wilson M, Worrall A, Yeung J, Smith FG. Study protocol for a randomised controlled trial to investigate the effectiveness of thoracic epidural and paravertebral blockade in reducing chronic post-thoracotomy pain: 2 (TOPIC 2). Trials 2023; 24:748. [PMID: 37996898 PMCID: PMC10666334 DOI: 10.1186/s13063-023-07463-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/15/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Thoracotomy is considered one of the most painful surgical procedures and can cause debilitating chronic post-surgical pain lasting months or years postoperatively. Aggressive management of acute pain resulting from thoracotomy may reduce the likelihood of developing chronic pain. This trial compares the two most commonly used modes of acute analgesia provision at the time of thoracotomy (thoracic epidural blockade (TEB) and paravertebral blockade (PVB)) in terms of their clinical and cost-effectiveness in preventing chronic post-thoracotomy pain. METHODS TOPIC 2 is a multi-centre, open-label, parallel group, superiority, randomised controlled trial, with an internal pilot investigating the use of TEB and PVB in 1026 adult (≥ 18 years old) patients undergoing thoracotomy in up to 20 thoracic centres throughout the UK. Patients (N = 1026) will be randomised in a 1:1 ratio to receive either TEB or PVB. During the first year, the trial will include an integrated QuinteT (Qualitative Research Integrated into Trials) Recruitment Intervention (QRI) with the aim of optimising recruitment and informed consent. The primary outcome is the incidence of chronic post-surgical pain at 6 months post-randomisation defined as 'worst chest pain over the last week' equating to a visual analogue score greater than or equal to 40 mm indicating at least a moderate level of pain. Secondary outcomes include acute pain, complications of regional analgesia and surgery, health-related quality of life, mortality and a health economic analysis. DISCUSSION Both TEB and PVB have been demonstrated to be effective in the prevention of acute pain following thoracotomy and nationally practice is divided. Identification of which mode of analgesia is both clinically and cost-effective in preventing chronic post-thoracotomy pain could ameliorate the debilitating effects of chronic pain, improving health-related quality of life, facilitating return to work and caring responsibilities and resulting in a cost saving to the NHS. TRIAL REGISTRATION NCT03677856 [ClinicalTrials.gov] registered September 19, 2018. https://clinicaltrials.gov/ct2/show/NCT03677856 . First patient recruited 8 January 2019.
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Affiliation(s)
- Ben Shelley
- School of Medicine, University of Glasgow, Glasgow, UK
| | - Andreas Goebel
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Stephen Grant
- School of Medicine, University of Glasgow, Glasgow, UK
| | - Louise Jackson
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | | | - Marcus Jepson
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Amy Kerr
- University Hospitals Birmingham Thoracic Surgical Research Centre, Bristol, UK
| | - Nandor Marczin
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | | | | | - Babu Naidu
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | | | | | - Ben Watkins
- Birmingham Clinical Trial Unit, Birmingham, UK
| | - Matthew Wilson
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | | | - Joyce Yeung
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Fang Gao Smith
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
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Cai BB, Wang DP. Risk factors for postoperative pulmonary complications in neonates: a retrospective cohort study. WORLD JOURNAL OF PEDIATRIC SURGERY 2023; 6:e000657. [PMID: 38025904 PMCID: PMC10668248 DOI: 10.1136/wjps-2023-000657] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Postoperative pulmonary complications (PPCs) are an important quality indicator and are associated with significantly increased mortality in infants. The objective of this study was to identify risk factors for PPCs in neonates undergoing non-cardiothoracic surgery. Methods In this retrospective study, all neonates who underwent non-cardiothoracic surgery in a children's hospital from October 2020 to September 2022 were included for analysis. Demographic data and perioperative variables were obtained. The primary outcome was the occurrence of PPCs. Univariate analysis and multivariable logistic regression analysis were used to investigate the effect of patient-related factors on the occurrence of PPCs. Results Totally, 867 neonatal surgery patients met the inclusion criteria in this study, among which 35.3% (306/867) patients experienced pulmonary complications within 1 week postoperatively. The PPCs observed in this study were 51 exacerbations of pre-existing pneumonia, 198 new patchy shadows, 123 new pulmonary atelectasis, 10 new pneumothorax, and 6 new pleural effusion. Patients were divided into two groups: PPCs (n=306) and non-PPCs (n=561). The multivariate stepwise logistic regression analysis revealed five independent risk factors for PPCs: corrected gestational age (OR=0.938; 95% CI 0.890 to 0.988), preoperative pneumonia (OR=2.139; 95% CI 1.033 to 4.426), length of surgery (> 60 min) (OR=1.699; 95% CI 1.134 to 2.548), preoperative mechanical ventilation (OR=1.857; 95% CI 1.169 to 2.951), and intraoperative albumin infusion (OR=1.456; 95% CI 1.041 to 2.036) in neonates undergoing non-cardiothoracic surgery. Conclusion Identifying risk factors for neonatal PPCs will allow for the identification of patients who are at higher risk and intervention for any modifiable risk factors identified.
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Affiliation(s)
- Bin Bin Cai
- Department of Anesthesiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hang Zhou, China
| | - Dong Pi Wang
- Department of Anesthesiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hang Zhou, China
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Piccioni F, Spagnesi L, Pelosi P, Bignami E, Guarnieri M, Fumagalli L, Polati E, Schweiger V, Comi D, D'Andrea R, DI Marco P, Spadaro S, Antonelli S, Sollazzi L, Mirabella L, Schiavoni M, Laici C, Marelli JA, Fabiani F, Ball L, Roasio A, Servillo G, Franchi M, Murino P, Irone M, Parrini V, DE Cosmo G, Cornara G, Ruberto F, Pasta G, Ferrari L, Greco M, Cecconi M, Della Rocca G. Postoperative pulmonary complications and mortality after major abdominal surgery. An observational multicenter prospective study. Minerva Anestesiol 2023; 89:964-976. [PMID: 37671537 DOI: 10.23736/s0375-9393.23.17382-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
BACKGROUND Postoperative pulmonary complications (PPCs) significantly contribute to postoperative morbidity and mortality. We conducted a study to determine the incidence of PPCs after major elective abdominal surgery and their association with early and 1-year mortality in patient without pre-existing respiratory disease. METHODS We conducted a multicenter observational prospective clinical study in 40 Italian centers. 1542 patients undergoing elective major abdominal surgery were recruited in a time period of 14 days and clinically managed according to local protocol. The primary outcome was to determine the incidence of PPCs. Further, we aimed to identify independent predictors for PPCs and examine the association between PPCs and mortality. RESULTS PPCs occurred in 12.6% (95% CI 11.1-14.4%) of patients with significant differences among general (18.3%, 95% CI 15.7-21.0%), gynecological (3.7%, 95% CI 2.1-6.0%) and urological surgery (9.0%, 95% CI 6.0-12.8%). PPCs development was associated with known pre- and intraoperative risk factors. Patients who developed PPCs had longer length of hospital stay, higher risk of 30-days hospital readmission, and increased in-hospital and one-year mortality (OR 3.078, 95% CI 1.825-5.191; P<0.001). CONCLUSIONS The incidence of PPCs in patients without pre-existing respiratory disease undergoing elective abdominal surgery is high and associated with worse clinical outcome at one year after surgery. General surgery is associated with higher incidence of PPCs and mortality compared to gynecological and urological surgery.
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Affiliation(s)
- Federico Piccioni
- Anesthesia Unit1, Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy -
| | - Lorenzo Spagnesi
- Section of Anesthesia and Intensive Care Medicine Clinic, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
- Anesthesia and Critical Care, IRCCS San Martino University Hospital, Genoa, Italy
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marcello Guarnieri
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Fumagalli
- Department of Critical and Supportive Therapy, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Enrico Polati
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Anesthesia, Intensive Care and Pain Therapy, University of Verona, Verona, Italy
| | - Vittorio Schweiger
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Anesthesia, Intensive Care and Pain Therapy, University of Verona, Verona, Italy
| | - Daniela Comi
- Anesthesia and Intensive Care Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Rocco D'Andrea
- Department of Anesthesia, Intensive Care and Emergency, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pierangelo DI Marco
- Department of Clinical, Anesthesiological, and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Savino Spadaro
- Anesthesia and Intensive Care Unit, Department of Translational Medicine, Ferrara University Hospital, University of Ferrara, Ferrara, Italy
| | - Serena Antonelli
- Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico Foundation of Rome, Rome, Italy
| | - Liliana Sollazzi
- Department of Emergency Medicine, Anesthesiology, and Resuscitation, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- IRCCS Roma, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lucia Mirabella
- Intensive Care Unit, Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Marina Schiavoni
- Anesthesia and Intensive Care Unit1, Giovanni XXIII Polyclinic Hospital, Bari, Italy
| | - Cristiana Laici
- Postoperative and Abdominal Organ Transplant Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Jlenia A Marelli
- Unit of Anesthesia and Resuscitation2, Department of Emergency Medicine, Anesthesia, and Resuscitation, Azienda Socio Sanitaria Territoriale Lariana, Como, Italy
| | - Fabio Fabiani
- Anesthesia and Intensive Care Medicine, Centro di Riferimento Oncologico di Aviano IRCCS, Aviano, Pordenone, Italy
| | - Lorenzo Ball
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
- Anesthesia and Critical Care, IRCCS San Martino University Hospital, Genoa, Italy
| | - Agostino Roasio
- Anesthesia and Intensive Care Unit, Cardinal Massaia Hospital, Asti, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Matteo Franchi
- Anesthesia and Intensive Care Unit, Azienda Usl Toscana Nordovest, Versilia Hospital, Camaiore, Lucca, Italy
| | - Patrizia Murino
- Anesthesia Unit, Critical Area Department, Azienda Ospedaliera Specialistica dei Colli, Monaldi Hospital, Naples, Italy
| | - Marco Irone
- Unit of Anesthesia and Resuscitation, San Bortolo Hospital, Vicenza, Italy
| | - Vieri Parrini
- Anesthesia and Intensive Care Unit, del Mugello Hospital, USL Toscana Centro, Florence, Italy
| | - Germano DE Cosmo
- Anesthesia and Intensive Care Institute, Sacred Heart Catholic University, Rome, Italy
| | - Giuseppe Cornara
- Anesthesia and Intensive Care Unit, ASO S. Croce e Carle, Cuneo, Italy
| | - Franco Ruberto
- "Paride Stefanini" Department of General and Specialist Surgery, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Gilda Pasta
- Division of Anesthesia, Pain Medicine and Supportive Care, Istituto Nazionale dei Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Lorenzo Ferrari
- Anesthesia and Intensive Care Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimiliano Greco
- Anesthesia Unit1, Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Maurizio Cecconi
- Anesthesia Unit1, Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Tsumura H, McConnell ES, Xue T(M, Wei S, Lee C, Pan W. Impact of Dementia on Incidence and Severity of Postoperative Pulmonary Complications Following Hip Fracture Surgery Among Older Patients. Clin Nurs Res 2023; 32:1145-1156. [PMID: 37592720 PMCID: PMC10811580 DOI: 10.1177/10547738231194098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Postoperative pulmonary complications (PPCs) are the leading cause of death following hip fracture surgery. Dementia has been identified as a PPC risk factor that complicates the clinical course. By leveraging electronic health records, this retrospective observational study evaluated the impact of dementia on the incidence and severity of PPCs, hospital length of stay, and postoperative 30-day mortality among 875 older patients (≥65 years) who underwent hip fracture surgery between October 1, 2015 and December 31, 2018 at a health system in the southeastern United States. Inverse probability of treatment weighting using propensity scores was utilized to balance confounders between patients with and without dementia to isolate the impact of dementia on PPCs. Regression analyses revealed that dementia did not have a statistically significant impact on the incidence and severity of PPCs or postoperative 30-day mortality. However, dementia significantly extended the hospital length of stay by an average of 1.37 days.
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Affiliation(s)
| | - Eleanor S. McConnell
- Duke University School of Nursing Durham, NC, USA
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System Durham, NC, USA
| | - Tingzhong (Michelle) Xue
- Duke University School of Nursing Durham, NC, USA
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System Durham, NC, USA
| | - Sijia Wei
- Center for Education in Health Sciences, Institute for Public Health and Medicine Northwestern University Feinberg School of Medicine Chicago, IL, USA
| | - Chiyoung Lee
- University of Washington Bothell School of Nursing & Health Studies Bothell, WA, USA
| | - Wei Pan
- Duke University School of Nursing Durham, NC, USA
- Department of Population Health Sciences Duke University School of Medicine Durham, NC, USA
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Kiyatkin ME, Aasman B, Fazzari MJ, Rudolph MI, Vidal Melo MF, Eikermann M, Gong MN. Development of an automated, general-purpose prediction tool for postoperative respiratory failure using machine learning: A retrospective cohort study. J Clin Anesth 2023; 90:111194. [PMID: 37422982 PMCID: PMC10529165 DOI: 10.1016/j.jclinane.2023.111194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 06/13/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
STUDY OBJECTIVE Postoperative respiratory failure is a major surgical complication and key quality metric. Existing prediction tools underperform, are limited to specific populations, and necessitate manual calculation. This limits their implementation. We aimed to create an improved, machine learning powered prediction tool with ideal characteristics for automated calculation. DESIGN, SETTING, AND PATIENTS We retrospectively reviewed 101,455 anesthetic procedures from 1/2018 to 6/2021. The primary outcome was the Standardized Endpoints in Perioperative Medicine consensus definition for postoperative respiratory failure. Secondary outcomes were respiratory quality metrics from the National Surgery Quality Improvement Sample, Society of Thoracic Surgeons, and CMS. We abstracted from the electronic health record 26 procedural and physiologic variables previously identified as respiratory failure risk factors. We randomly split the cohort and used the Random Forest method to predict the composite outcome in the training cohort. We coined this the RESPIRE model and measured its accuracy in the validation cohort using area under the receiver operating curve (AUROC) analysis, among other measures, and compared this with ARISCAT and SPORC-1, two leading prediction tools. We compared performance in a validation cohort using score cut-offs determined in a separate test cohort. MAIN RESULTS The RESPIRE model exhibited superior accuracy with an AUROC of 0.93 (95% CI, 0.92-0.95) compared to 0.82 for both ARISCAT and SPORC-1 (P-for-difference < 0.0001 for both). At comparable 80-90% sensitivities, RESPIRE had higher positive predictive value (11%, 95% CI: 10-12%) and lower false positive rate (12%, 95% CI: 12-13%) compared to 4% and 37% for both ARISCAT and SPORC-1. The RESPIRE model also better predicted the established quality metrics for postoperative respiratory failure. CONCLUSIONS We developed a general-purpose, machine learning powered prediction tool with superior performance for research and quality-based definitions of postoperative respiratory failure.
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Affiliation(s)
- Michael E Kiyatkin
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Boudewijn Aasman
- Center for Health Data Innovations, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Melissa J Fazzari
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Maíra I Rudolph
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA; Department for Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Marcos F Vidal Melo
- Department of Anesthesiology, NewYork-Presbyterian, Columbia University Irving Medical Center, New York, NY, USA
| | - Matthias Eikermann
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA; Department of Anesthesiology, NewYork-Presbyterian, Columbia University Irving Medical Center, New York, NY, USA; Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen, Essen, Germany
| | - Michelle N Gong
- Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
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Girard J, Zaouter C, Moore A, Carrier FM, Girard M. Effects of an open lung extubation strategy compared with a conventional extubation strategy on postoperative pulmonary complications after general anesthesia: a single-centre pilot randomized controlled trial. Can J Anaesth 2023; 70:1648-1659. [PMID: 37498442 DOI: 10.1007/s12630-023-02533-z] [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: 11/28/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 07/28/2023] Open
Abstract
PURPOSE Postoperative pulmonary complications (PPCs) are a common cause of morbidity. Postoperative atelectasis is thought to be a significant risk factor in their development. Recent imaging studies suggest that patients' extubation may result in similar postoperative atelectasis regardless of the intraoperative mechanical ventilation strategy used. In this pilot trial, we hypothesized that a study investigating the effects of an open lung extubation strategy compared with a conventional one on PPCs would be feasible. METHODS We conducted a pilot, single-centre, double-blinded randomized controlled trial. Adult patients at moderate to high risk of PPCs and scheduled for elective surgery were eligible. Patients were randomized to an open lung extubation strategy (semirecumbent position, fraction of inspired oxygen [FIO2] 50%, pressure support ventilation, unchanged positive end-expiratory pressure) or to a conventional extubation strategy (dorsal decubitus position, FIO2 100%, manual bag ventilation). The primary feasibility outcome was global protocol adherence while the primary exploratory efficacy outcome was PPCs. RESULTS We randomized 35 patients to the conventional extubation group and 34 to the open lung extubation group. We observed a global protocol adherence of 96% (95% confidence interval, 88 to 99), which was not different between groups. Eight PPCs occurred (two in the conventional extubation group vs six in the open lung extubation group). Less postoperative supplemental oxygen and better lung aeration were observed in the open lung extubation group. CONCLUSIONS In this single-centre pilot trial, we observed excellent feasibility. A multicentre pilot trial comparing the effect of an open lung extubation strategy with that of a conventional extubation strategy on the occurrence of PPCs is feasible. STUDY REGISTRATION DATE ClinicalTrials.gov (NCT04993001); registered 6 August 2021.
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Affiliation(s)
- Julie Girard
- Department of Anesthesiology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, QC, Canada
| | - Cédrick Zaouter
- Department of Anesthesiology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, QC, Canada
| | - Alex Moore
- Department of Anesthesiology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, QC, Canada
| | - François M Carrier
- Department of Anesthesiology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, QC, Canada
- Centre de Recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Martin Girard
- Department of Anesthesiology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada.
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, QC, Canada.
- Centre de Recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada.
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Li XF, Jiang RJ, Mao WJ, Yu H, Xin J, Yu H. The effect of driving pressure-guided versus conventional mechanical ventilation strategy on pulmonary complications following on-pump cardiac surgery: A randomized clinical trial. J Clin Anesth 2023; 89:111150. [PMID: 37307653 DOI: 10.1016/j.jclinane.2023.111150] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/28/2023] [Accepted: 05/14/2023] [Indexed: 06/14/2023]
Abstract
STUDY OBJECTIVE Postoperative pulmonary complications occur frequently and are associated with worse postoperative outcomes in cardiac surgical patients. The advantage of driving pressure-guided ventilation strategy in decreasing pulmonary complications remains to be definitively established. We aimed to investigate the effect of intraoperative driving pressure-guided ventilation strategy compared with conventional lung-protective ventilation on pulmonary complications following on-pump cardiac surgery. DESIGN Prospective, two-arm, randomized controlled trial. SETTING The West China university hospital in Sichuan, China. PATIENTS Adult patients who were scheduled for elective on-pump cardiac surgery were enrolled in the study. INTERVENTIONS Patients undergoing on-pump cardiac surgery were randomized to receive driving pressure-guided ventilation strategy based on positive end-expiratory pressure (PEEP) titration or conventional lung-protective ventilation strategy with fixed 5 cmH2O of PEEP. MEASUREMENTS The primary outcome of pulmonary complications (including acute respiratory distress syndrome, atelectasis, pneumonia, pleural effusion, and pneumothorax) within the first 7 postoperative days were prospectively identified. Secondary outcomes included pulmonary complication severity, ICU length of stay, and in-hospital and 30-day mortality. MAIN RESULTS Between August 2020 and July 2021, we enrolled 694 eligible patients who were included in the final analysis. Postoperative pulmonary complications occurred in 140 (40.3%) patients in the driving pressure group and 142 (40.9%) in the conventional group (relative risk, 0.99; 95% confidence interval, 0.82-1.18; P = 0.877). Intention-to-treat analysis showed no significant difference between study groups regarding the incidence of primary outcome. The driving pressure group had less atelectasis than the conventional group (11.5% vs 17.0%; relative risk, 0.68; 95% confidence interval, 0.47-0.98; P = 0.039). Secondary outcomes did not differ between groups. CONCLUSION Among patients who underwent on-pump cardiac surgery, the use of driving pressure-guided ventilation strategy did not reduce the risk of postoperative pulmonary complications when compared with conventional lung-protective ventilation strategy.
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Affiliation(s)
- Xue-Fei Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Rong-Juan Jiang
- Department of Anesthesiology, Chengdu Second People's Hospital, Chengdu 610041, China
| | - Wen-Jie Mao
- Department of Anesthesiology, Jianyang People's Hospital, Jianyang 641400, China
| | - Hong Yu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Juan Xin
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Hai Yu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China.
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Keast T, McErlane J, Kearns R, McKinlay S, Raju I, Watson M, Robertson KE, Berry C, Greenlaw N, Ackland G, McCall P, Shelley B. Study protocol for IMPRoVE: a multicentre prospective observational cohort study of the incidence, impact and mechanisms of perioperative right ventricular dysfunction in non-cardiac surgery. BMJ Open 2023; 13:e074687. [PMID: 37673452 PMCID: PMC10496661 DOI: 10.1136/bmjopen-2023-074687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/21/2023] [Indexed: 09/08/2023] Open
Abstract
INTRODUCTION Perioperative myocardial injury evidenced by elevated cardiac biomarkers (both natriuretic peptides and troponin) is common after major non-cardiac surgery. However, it is unclear if the rise in cardiac biomarkers represents global or more localised cardiac injury. We have previously shown isolated right ventricular (RV) dysfunction in patients following lung resection surgery, with no change in left ventricular (LV) function. Given that perioperative RV dysfunction (RVD) can manifest insidiously, we hypothesise there may be a substantial burden of covert yet clinically important perioperative RVD in other major non-cardiac surgical groups. The Incidence, impact and Mechanisms of Perioperative Right VEntricular dysfunction (IMPRoVE) study has been designed to address this knowledge gap. METHODS AND ANALYSIS A multicentre prospective observational cohort study across four centres in the West of Scotland and London. One hundred and seventy-five patients will be recruited from five surgical specialties: thoracic, upper gastrointestinal, vascular, colorectal and orthopaedic surgery (35 patients from each group). All patients will undergo preoperative and postoperative (day 2-4) echocardiography, with contemporaneous cardiac biomarker testing. Ten patients from each surgical specialty (50 patients in total) will undergo T1-cardiovascular magnetic resonance (CMR) imaging preoperatively and postoperatively. The coprimary outcomes are the incidence of perioperative RVD (diagnosed by RV speckle tracking echocardiography) and the effect that RVD has on days alive and at home at 30 days postoperatively. Secondary outcomes include LV dysfunction and clinical outcomes informed by Standardised Endpoints in Perioperative Medicine consensus definitions. T1 CMR will be used to investigate for imaging correlates of myocardial inflammation as a possible mechanism driving perioperative RVD. ETHICS AND DISSEMINATION Approval was gained from Oxford C Research Ethics Committee (REC reference 22/SC/0442). Findings will be disseminated by various methods including social media, international presentations and publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05827315.
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Affiliation(s)
- Thomas Keast
- Anaesthesia, Critical Care & Peri-operative Medicine Research Group, University of Glasgow, Glasgow, UK
- Department of Anaesthesia, Golden National Jubilee Hospital, Clydebank, UK
| | - James McErlane
- Anaesthesia, Critical Care & Peri-operative Medicine Research Group, University of Glasgow, Glasgow, UK
- Department of Anaesthesia, Golden National Jubilee Hospital, Clydebank, UK
| | - Rachel Kearns
- Anaesthesia, Critical Care & Peri-operative Medicine Research Group, University of Glasgow, Glasgow, UK
- Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK
| | - Sonya McKinlay
- Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK
| | - Indran Raju
- Department of Anaesthesia and Critical Care, Queen Elizabeth University Hospital, Glasgow, UK
| | - Malcolm Watson
- Department of Anaesthesia and Critical Care, Queen Elizabeth University Hospital, Glasgow, UK
| | - Keith E Robertson
- Golden Jubilee National Hospital West of Scotland Regional Heart and Lung Centre, Clydebank, UK
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Nicola Greenlaw
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Gareth Ackland
- Department of Anaesthesia and Perioperative Medicine, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - Philip McCall
- Anaesthesia, Critical Care & Peri-operative Medicine Research Group, University of Glasgow, Glasgow, UK
- Department of Anaesthesia, Golden National Jubilee Hospital, Clydebank, UK
| | - Benjamin Shelley
- Anaesthesia, Critical Care & Peri-operative Medicine Research Group, University of Glasgow, Glasgow, UK
- Department of Anaesthesia, Golden National Jubilee Hospital, Clydebank, UK
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Xiao L, Yu K, Yang JJ, Liu WT, Liu L, Miao HH, Li TZ. Effect of individualized positive end-expiratory pressure based on electrical impedance tomography guidance on pulmonary ventilation distribution in patients who receive abdominal thermal perfusion chemotherapy. Front Med (Lausanne) 2023; 10:1198720. [PMID: 37731718 PMCID: PMC10507689 DOI: 10.3389/fmed.2023.1198720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 08/15/2023] [Indexed: 09/22/2023] Open
Abstract
Background Electrical impedance tomography (EIT) has been shown to be useful in guiding individual positive end-expiratory pressure titration for patients with mechanical ventilation. However, the appropriate positive end-expiratory pressure (PEEP) level and whether the individualized PEEP needs to be adjusted during long-term surgery (>6 h) were unknown. Meanwhile, the effect of individualized PEEP on the distribution of pulmonary ventilation in patients who receive abdominal thermoperfusion chemotherapy is unknown. The primary aim of this study was to observe the effect of EIT-guided PEEP on the distribution of pulmonary ventilation in patients undergoing cytoreductive surgery (CRS) combined with hot intraperitoneal chemotherapy (HIPEC). The secondary aim was to analyze their effect on postoperative pulmonary complications. Methods A total of 48 patients were recruited and randomly divided into two groups, with 24 patients in each group. For the control group (group A), PEEP was set at 5 cm H2O, while in the EIT group (group B), individual PEEP was titrated and adjusted every 2 h with EIT guidance. Ventilation distribution, respiratory/circulation parameters, and PPC incidence were compared between the two groups. Results The average individualized PEEP was 10.3 ± 1.5 cm H2O, 10.2 ± 1.6 cm H2O, 10.1 ± 1.8 cm H2O, and 9.7 ± 2.1 cm H2O at 5 min, 2 h, 4 h, and 6 h after tracheal intubation during CRS + HIPEC. Individualized PEEP was correlated with ventilation distribution in the regions of interest (ROI) 1 and ROI 3 at 4 h mechanical ventilation and ROI 1 at 6 h mechanical ventilation. The ventilation distribution under individualized PEEP was back-shifted for 6 h but moved to the control group's ventral side under PEEP 5 cm H2O. The respiratory and circulatory function indicators were both acceptable either under individualized PEEP or PEEP 5 cm H2O. The incidence of total PPCs was significantly lower under individualized PEEP (66.7%) than PEEP 5 cm H2O (37.5%) for patients with CRS + HIPEC. Conclusion The appropriate individualized PEEP was stable at approximately 10 cm H2O during 6 h for patients with CRS + HIPEC, along with better ventilation distribution and a lower total PPC incidence than the fixed PEEP of 5 cm H2O.Clinical trial registration: identifier ChiCTR1900023897.
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Affiliation(s)
- Li Xiao
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Kang Yu
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Jiao-Jiao Yang
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Wen-Tao Liu
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Lei Liu
- Department of Science and Technology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Hui-Hui Miao
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Tian-Zuo Li
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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Fuchs-Buder T, Brull SJ, Fagerlund MJ, Renew JR, Cammu G, Murphy GS, Warlé M, Vested M, Fülesdi B, Nemes R, Columb MO, Damian D, Davis PJ, Iwasaki H, Eriksson LI. Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents III: The 2023 Geneva revision. Acta Anaesthesiol Scand 2023; 67:994-1017. [PMID: 37345870 DOI: 10.1111/aas.14279] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/01/2023] [Indexed: 06/23/2023]
Abstract
The set of guidelines for good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents was developed following an international consensus conference in Copenhagen in 1996 (Viby-Mogensen et al., Acta Anaesthesiol Scand 1996, 40, 59-74); the guidelines were later revised and updated following the second consensus conference in Stockholm in 2005 (Fuchs-Buder et al., Acta Anaesthesiol Scand 2007, 51, 789-808). In view of new devices and further development of monitoring technologies that emerged since then, (e.g., electromyography, three-dimensional acceleromyography, kinemyography) as well as novel compounds (e.g., sugammadex) a review and update of these recommendations became necessary. The intent of these revised guidelines is to continue to help clinical researchers to conduct high-quality work and advance the field by enhancing the standards, consistency, and comparability of clinical studies. There is growing awareness of the importance of consensus-based reporting standards in clinical trials and observational studies. Such global initiatives are necessary in order to minimize heterogeneous and inadequate data reporting and to improve clarity and comparability between different studies and study cohorts. Variations in definitions of endpoints or outcome variables can introduce confusion and difficulties in interpretation of data, but more importantly, it may preclude building of an adequate body of evidence to achieve reliable conclusions and recommendations. Clinical research in neuromuscular pharmacology and physiology is no exception.
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Affiliation(s)
- Thomas Fuchs-Buder
- Department of Anaesthesia, Critical Care & Perioperative Medicine, University Hospital Nancy, Nancy, France
| | - Sorin J Brull
- Mayo Clinic College of Medicine and Science, Jacksonville, Florida, USA
| | - Malin Jonsson Fagerlund
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - J Ross Renew
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Guy Cammu
- Department of Anesthesiology, Critical Care and Emergency Medicine, Aalst, Belgium
| | - Glenn S Murphy
- Department of Anesthesiology, NorthShore University HealthSystem, Chicago, Illinois, USA
| | - Michiel Warlé
- Department of Surgery, Radbound University Medical Center, Nijmegen, The Netherlands
| | - Matias Vested
- Department of Anesthesia Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Béla Fülesdi
- Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary
| | - Reka Nemes
- Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary
| | - Malachy O Columb
- Anaesthesia & Intensive Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Daniela Damian
- Anesthesiology and Perioperative Medicine, UPMC Children's Hospital, Pittsburgh, Pennsylvania, USA
| | - Peter J Davis
- Anesthesia and Pediatrics, UPMC Children's Hospital, Pittsburgh, Pennsylvania, USA
| | - Hajime Iwasaki
- Department of Anesthesiology and Crtical Care Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Lars I Eriksson
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
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45
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Carr ZJ, Siller S, McDowell BJ. Perioperative Pulmonary Complications in the Elderly: The Forgotten System. Anesthesiol Clin 2023; 41:531-548. [PMID: 37516493 DOI: 10.1016/j.anclin.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Abstract
With a rapidly aging population and increasing global surgical volumes, managing the elevated risk of perioperative pulmonary complications has become an expanding focus for quality improvement in health care. In this narrative review, we will analyze the evidence-based literature to provide high-quality and actionable management strategies to better detect, stratify risk, optimize, and manage perioperative pulmonary complications in geriatric populations.
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Affiliation(s)
- Zyad J Carr
- Department of Anesthesiology, Yale University School of Medicine, TMP-3, 333 Cedar Street, New Haven, CT 06520, USA.
| | - Saul Siller
- Department of Anesthesiology, Yale University School of Medicine, TMP-3, 333 Cedar Street, New Haven, CT 06520, USA
| | - Brittany J McDowell
- Department of Anesthesiology, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT 84107, USA
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Cho SA, Kim JH, Cho CK, Sung TY. The Effect of Neuromuscular Blockade Reversal Agents on Postoperative Pulmonary Complications in Patients undergoing Femur Fracture Repair Surgery: A Retrospective Observational Study. Ann Geriatr Med Res 2023; 27:212-219. [PMID: 37401010 PMCID: PMC10556711 DOI: 10.4235/agmr.23.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/19/2023] [Accepted: 06/28/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Femoral fracture repair surgery under general anesthesia is associated with postoperative pulmonary complications (PPCs). However, information on PPCs caused by residual neuromuscular blockade following perioperative use of neuromuscular blockers is limited. This study aimed to identify the differences in the incidence of PPCs according to the type of neuromuscular blockade reversal agent used in femoral fracture repair surgery, as well as the risk factors for PPCs. METHODS We retrospectively analyzed the electronic medical records of 604 patients aged >18 years who underwent general anesthesia for femoral fracture repair surgery at a single university hospital between March 2017 and March 2022. Patients in whom sugammadex or anticholinesterase was used to reverse the neuromuscular block were subjected to propensity score matching. Multivariate logistic regression analysis was performed to identify risk factors for PPCs. RESULTS Among the 604 patients, 108 were matched in each group. The incidence rates of PPCs overall and in the anticholinesterase and sugammadex groups were 7.0%, 8.3%, and 5.6%, respectively, with no significant differences between the groups. Older age, higher ASA (American Society of Anesthesiologists) physical status, and lower preoperative oxygen saturation were risk factors, whereas emergency surgery was a preventive factor. CONCLUSIONS Our results demonstrated that the incidence of PPC did not differ significantly between sugammadex and anticholinesterase in patients undergoing femur fracture repair under general anesthesia. Identifying the risk factors and confirming complete recovery from neuromuscular blockade might be more important.
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Affiliation(s)
- Sung-Ae Cho
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
- Myunggok Medical Research Center, Konyang University Hospital, Daejeon, Korea
| | - Jun-ho Kim
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Choon-Kyu Cho
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
- Myunggok Medical Research Center, Konyang University Hospital, Daejeon, Korea
| | - Tae-Yun Sung
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
- Myunggok Medical Research Center, Konyang University Hospital, Daejeon, Korea
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Guo J, He Q, Peng C, Dai R, Li W, Su Z, Li Y. Machine learning algorithms to predict risk of postoperative pneumonia in elderly with hip fracture. J Orthop Surg Res 2023; 18:571. [PMID: 37543618 PMCID: PMC10403839 DOI: 10.1186/s13018-023-04049-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/25/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Hip fracture (HF) is one of the most common fractures in the elderly and is significantly associated with high mortality and unfavorable prognosis. Postoperative pneumonia (POP), the most common postoperative complication of HF, can seriously affect patient prognosis and increase the burden on the healthcare system. The aim of this study was to develop machine learning models for identifying elderly patients at high risk of pneumonia after hip fracture surgery. METHODS From May 2016 to November 2022, patients admitted to a single central hospital for HF served as the study population. We extracted data that could be collected within 24 h of patient admission. The dataset was divided into training and validation sets according to 70:30. Based on the screened risk factors, prediction models were developed using seven machine learning algorithms, namely CART, GBM, KNN, LR, NNet, RF, and XGBoost, and their performance was evaluated. RESULTS Eight hundred five patients were finally included in the analysis and 75 (9.3%) patients suffered from POP. Age, CI, COPD, WBC, HB, GLU, STB, GLOB, Ka+ which are used as features to build machine learning models. By evaluating the model's AUC value, accuracy, sensitivity, specificity, Kappa value, MCC value, Brier score value, calibration curve, and DCA curve, the model constructed by XGBoost algorithm has the best and near-perfect performance. CONCLUSION The machine learning model we created is ideal for detecting elderly patients at high risk of POP after HF at an early stage.
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Affiliation(s)
- Jiale Guo
- Department of Orthopedics, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Qionghan He
- Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Caiju Peng
- Department of Orthopedics, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Ru Dai
- Department of Orthopedics, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Wei Li
- Department of Orthopedics, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Zhichao Su
- Department of Orthopedics, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Yehai Li
- Department of Orthopedics, Chaohu Hospital of Anhui Medical University, Hefei, China.
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Yee MS, Tarshis J. Anesthesia quality indicators to measure and improve your practice: a modified delphi study. BMC Anesthesiol 2023; 23:256. [PMID: 37525089 PMCID: PMC10388503 DOI: 10.1186/s12871-023-02195-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 07/02/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Implementation of the new competency-based post-graduate medical education curriculum has renewed the push by medical regulatory bodies in Canada to strongly advocate and/or mandate continuous quality improvement (cQI) for all physicians. Electronic anesthesia information management systems contain vast amounts of information yet it is unclear how this information could be used to promote cQI for practicing anesthesiologists. The aim of this study was to create a refined list of meaningful anesthesia quality indicators to assist anesthesiologists in the process of continuous self-assessment and feedback of their practice. METHODS An initial list of quality indicators was created though a literature search. A modified-Delphi (mDelphi) method was used to rank these indicators and achieve consensus on those indicators considered to be most relevant. Fourteen anesthesiologists representing different regions across Canada participated in the panel. RESULTS The initial list contained 132 items and through 3 rounds of mDelphi the panelists selected 56 items from the list that they believed to be top priority. In the fourth round, a subset of 20 of these indicators were ranked as highest priority. The list included items related to process, structure and outcome. CONCLUSION This ranked list of anesthesia quality indicators from this modified Delphi study could aid clinicians in their individual practice assessments for continuous quality improvement mandated by Canadian medical regulatory bodies. Feasibility and usability of these quality indicators, and the significance of process versus outcome measures in assessment, are areas of future research.
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Affiliation(s)
- May-Sann Yee
- Southlake Regional Health Centre, Newmarket, ON, L3Y 2P9, Canada.
| | - Jordan Tarshis
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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49
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Bignami E, Guarnieri M, Giambuzzi I, Trumello C, Saglietti F, Gianni S, Belluschi I, Di Tomasso N, Corti D, Alfieri O, Gemma M. Three Logistic Predictive Models for the Prediction of Mortality and Major Pulmonary Complications after Cardiac Surgery. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1368. [PMID: 37629658 PMCID: PMC10456464 DOI: 10.3390/medicina59081368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 07/15/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Pulmonary complications are a leading cause of morbidity after cardiac surgery. The aim of this study was to develop models to predict postoperative lung dysfunction and mortality. Materials and Methods: This was a single-center, observational, retrospective study. We retrospectively analyzed the data of 11,285 adult patients who underwent all types of cardiac surgery from 2003 to 2015. We developed logistic predictive models for in-hospital mortality, postoperative pulmonary complications occurring in the intensive care unit, and postoperative non-invasive mechanical ventilation when clinically indicated. Results: In the "preoperative model" predictors for mortality were advanced age (p < 0.001), New York Heart Association (NYHA) class (p < 0.001) and emergent surgery (p = 0.036); predictors for non-invasive mechanical ventilation were advanced age (p < 0.001), low ejection fraction (p = 0.023), higher body mass index (p < 0.001) and preoperative renal failure (p = 0.043); predictors for postoperative pulmonary complications were preoperative chronic obstructive pulmonary disease (p = 0.007), preoperative kidney injury (p < 0.001) and NYHA class (p = 0.033). In the "surgery model" predictors for mortality were intraoperative inotropes (p = 0.003) and intraoperative intra-aortic balloon pump (p < 0.001), which also predicted the incidence of postoperative pulmonary complications. There were no specific variables in the surgery model predicting the use of non-invasive mechanical ventilation. In the "intensive care unit model", predictors for mortality were postoperative kidney injury (p < 0.001), tracheostomy (p < 0.001), inotropes (p = 0.029) and PaO2/FiO2 ratio at discharge (p = 0.028); predictors for non-invasive mechanical ventilation were kidney injury (p < 0.001), inotropes (p < 0.001), blood transfusions (p < 0.001) and PaO2/FiO2 ratio at the discharge (p < 0.001). Conclusions: In this retrospective study, we identified the preoperative, intraoperative and postoperative characteristics associated with mortality and complications following cardiac surgery.
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Affiliation(s)
- Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy;
| | - Marcello Guarnieri
- Department of Anesthesia and Intensive Care, Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy;
| | - Ilaria Giambuzzi
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino-IRCCS, 20122 Milan, Italy;
- Department of Clinical and Community Sciences, DISCCO University of Milan, 20126 Milan, Italy
| | - Cinzia Trumello
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (C.T.); (I.B.); (O.A.)
| | - Francesco Saglietti
- Department of Anesthesia and Intensive Care, Azienda Ospedaliera Santa Croce e Carle, 12100 Cuneo, Italy;
| | - Stefano Gianni
- Department of Anesthesia and Intensive Care, Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy;
| | - Igor Belluschi
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (C.T.); (I.B.); (O.A.)
| | - Nora Di Tomasso
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (N.D.T.); (D.C.)
| | - Daniele Corti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (N.D.T.); (D.C.)
| | - Ottavio Alfieri
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (C.T.); (I.B.); (O.A.)
| | - Marco Gemma
- Intensive Care Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
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50
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Zhou X, Pan J, Wang H, Xu Z, Zhao L, Chen B. Prophylactic noninvasive respiratory support in the immediate postoperative period after cardiac surgery - a systematic review and network meta-analysis. BMC Pulm Med 2023; 23:233. [PMID: 37380968 DOI: 10.1186/s12890-023-02525-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/17/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Noninvasive respiratory support has been increasingly applied in the immediate postoperative period to prevent postoperative pulmonary complications (PPCs). However, the optimal approach remains uncertain. We sought to evaluate the comparative effectiveness of various noninvasive respiratory strategies used in the immediate postoperative period after cardiac surgery. METHODS We conducted a frequentist random-effect network meta-analysis (NMA) of randomized controlled trials (RCTs) comparing the prophylactic use of noninvasive ventilation (NIV), continuous positive airway pressure (CPAP), high flow nasal cannula (HFNC), or postoperative usual care (PUC) in the immediate postoperative period after cardiac surgery. Databases were systematically searched through September 28, 2022. Study selection, data extraction, and quality assessment were performed in duplicate. The primary outcome was the incidence of PPCs. RESULTS Sixteen RCTs enrolling 3011 patients were included. Compared with PUC, NIV significantly reduced the incidence of PPCs [relative risk (RR) 0.67, 95% confidence interval (CI): 0.49 to 0.93; absolute risk reduction (ARR) 7.6%, 95% CI: 1.6-11.8%; low certainty] and the incidence of atelectasis (RR 0.65, 95% CI: 0.45 to 0.93; ARR 19.3%, 95% CI: 3.9-30.4%; moderate certainty); however, prophylactic NIV was not associated with a decreased reintubation rate (RR 0.82, 95% CI: 0.29 to 2.34; low certainty) or reduced short-term mortality (RR 0.64, 95% CI: 0.16 to 2.52; very low certainty). As compared to PUC, the preventive use of CPAP (RR 0.85, 95% CI: 0.60 to 1.20; very low certainty) or HFNC (RR 0.74, 95% CI: 0.46 to 1.20; low certainty) had no significant beneficial effect on the incidence of PPCs, despite exhibiting a downward trend. Based on the surface under the cumulative ranking curve, the highest-ranked treatment for reducing the incidence of PPCs was NIV (83.0%), followed by HFNC (62.5%), CPAP (44.3%), and PUC (10.2%). CONCLUSIONS Current evidence suggest that the prophylactic use of NIV in the immediate postoperative period is probably the most effective noninvasive respiratory approach to prevent PPCs in patients undergoing cardiac surgery. Given the overall low certainty of the evidence, further high-quality research is warranted to better understand the relative benefits of each noninvasive ventilatory support. CLINICAL TRIAL REGISTRATION PROSPERO, https://www.crd.york.ac.uk/prospero/ , registry number: CRD42022303904.
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Affiliation(s)
- Xiaoyang Zhou
- Department of Intensive Care Medicine, Ningbo No.2 Hospital, Ningbo, 315000, Zhejiang, China
| | - Jianneng Pan
- Department of Intensive Care Medicine, Ningbo No.2 Hospital, Ningbo, 315000, Zhejiang, China
| | - Hua Wang
- Department of Intensive Care Medicine, Ningbo No.2 Hospital, Ningbo, 315000, Zhejiang, China
| | - Zhaojun Xu
- Department of Intensive Care Medicine, Ningbo No.2 Hospital, Ningbo, 315000, Zhejiang, China
| | - Long Zhao
- Department of Cardiovascular Surgery, Ningbo No.2 Hospital, Ningbo, Ningbo, 315000, Zhejiang, China
| | - Bixin Chen
- Department of Intensive Care Medicine, Ningbo No.2 Hospital, Ningbo, 315000, Zhejiang, China.
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