1
|
Min WK, Jin S, Choi YJ, Won YJ, Lee K, Lim CH. Lung ultrasound score-based assessment of postoperative atelectasis in obese patients according to inspired oxygen concentration: A prospective, randomized-controlled study. Medicine (Baltimore) 2023; 102:e32990. [PMID: 36800571 PMCID: PMC9936007 DOI: 10.1097/md.0000000000032990] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND According to a recent meta-analysis, in patients with a body mass index (BMI) ≥ 30, a high fraction of inhaled oxygen (FiO2) did not increase postoperative atelectasis. However, a high FiO2 generally increases the risk of postoperative atelectasis. Therefore, this study aimed to evaluate the effect of FiO2 on the development of atelectasis in obese patients using the modified lung ultrasound score (LUSS). METHODS Patients were assigned to 4 groups: BMI ≥ 30: group A (n = 21) and group B (n = 20) and normal BMI: group C (n = 22) and group D (n = 21). Groups A and C were administered 100% O2 during preinduction and emergence and 50% O2 during anesthesia. Groups B and D received 40% O2 for anesthesia. The modified LUSS was assessed before and 20 min after arrival to the postanesthesia care unit (PACU). RESULTS The difference between the modified LUSS preinduction and PACU was significantly higher in group A with a BMI ≥ 30 (P = .006); however, there was an insignificant difference between groups C and D in the normal BMI group (P = .076). CONCLUSION High FiO2 had a greater effect on the development of atelectasis in obese patients than did low FiO2; however, in normal-weight individuals, FiO2 did not have a significant effect on postoperative atelectasis.
Collapse
Affiliation(s)
- Won Kee Min
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Gyeonggi- do, Republic of Korea
| | - Sejong Jin
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Gyeonggi- do, Republic of Korea
- Department of Neuroscience, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yoon Ji Choi
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Gyeonggi- do, Republic of Korea
- * Correspondence: Yoon Ji Choi, Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do 15355, Republic of Korea (e-mail: )
| | - Young Ju Won
- Department of Anesthesiology and Pain Medicine, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kaehong Lee
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Choon-Hak Lim
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
2
|
Figiel W, Niewiński G, Grąt M, Krawczyk M, Stypułkowski J, Lewandowski Z, Krasnodębski M, Patkowski W, Zieniewicz K. Postoperative Supplemental Oxygen in Liver Transplantation (PSOLT) does not reduce the rate of infections: results of a randomized controlled trial. BMC Med 2023; 21:51. [PMID: 36782227 PMCID: PMC9924861 DOI: 10.1186/s12916-023-02741-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 01/18/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Despite inconsistent evidence, international guidelines underline the importance of perioperative hyperoxygenation in prevention of postoperative infections. Further, data on safety and efficacy of this method in liver transplant setting are lacking. The aim was to evaluate efficacy and safety of postoperative hyperoxygenation in prophylaxis of infections after liver transplantation. METHODS In this randomized controlled trial, patients undergoing liver transplantation were randomly assigned to either 28% or 80% fraction of inspired oxygen (FiO2) for 6 postoperative hours. Infections occurring during 30-day post-transplant period were the primary outcome measure. Secondary outcome measures included 90-day mortality, 90-day severe morbidity, 30-day pulmonary complications, durations of hospital and intensive care unit stay, and 5-day postoperative bilirubin concentration, alanine and aspartate transaminase activity, and international normalized ratio (INR) (clinicatrials.gov NCT02857855). RESULTS A total of 193 patients were included and randomized to 28% (n = 99) and 80% (n = 94) FiO2. With similar patient, operative, and donor characteristics in both groups, infections occurred in 34.0% (32/94) of patients assigned to 80% FiO2 as compared to 23.2% (23/99) of patients assigned to 28% FiO2 (p = 0.112). Patients randomized to 80% FiO2 more frequently developed severe complications (p = 0.035), stayed longer in the intensive care unit (p = 0.033), and had higher bilirubin concentration over first 5 post-transplant days (p = 0.043). No significant differences were found regarding mortality, duration of hospital stay, pulmonary complications, and 5-day aspartate and alanine transaminase activity and INR. CONCLUSIONS Postoperative hyperoxygenation should not be used for prophylaxis of infections after liver transplantation due to the lack of efficacy. TRIAL REGISTRATION ClinicalTrials.gov NCT02857855. Registered 7 July 2016.
Collapse
Affiliation(s)
- Wojciech Figiel
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha 1A, 02-097, Warsaw, Poland
| | - Grzegorz Niewiński
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha 1A, 02-097, Warsaw, Poland
| | - Michał Grąt
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha 1A, 02-097, Warsaw, Poland.
| | - Marek Krawczyk
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha 1A, 02-097, Warsaw, Poland
| | - Jan Stypułkowski
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha 1A, 02-097, Warsaw, Poland
| | - Zbigniew Lewandowski
- Department of Epidemiology and Biostatistics, Medical University of Warsaw, Oczki 3, 02-007, Warsaw, Poland
| | - Maciej Krasnodębski
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha 1A, 02-097, Warsaw, Poland
| | - Waldemar Patkowski
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha 1A, 02-097, Warsaw, Poland
| | - Krzysztof Zieniewicz
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha 1A, 02-097, Warsaw, Poland
| |
Collapse
|
3
|
Gomes ET, Carbogim FDC, Lins RS, Lins-Filho RLDM, Poveda VDB, Püschel VADA. Effectiveness of supplemental oxygenation to prevent surgical site infections: A systematic review with meta-analysis. Rev Lat Am Enfermagem 2022; 30:e3648. [PMID: 36228236 PMCID: PMC9545934 DOI: 10.1590/1518-8345.6106.3648] [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: 02/21/2022] [Accepted: 05/06/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE to assess the effectiveness of supplemental oxygenation with high FiO2 when compared to conventional FiO2 in the prevention of surgical site infection. METHOD an effectiveness systematic review with meta-analysis conducted in five international databases and portals. The research was guided by the following question: Which is the effectiveness of supplemental oxygenation with high FiO2 (greater than 80%) when compared to conventional FiO2 (from 30% to 35%) in the prevention of surgical site infections in adults? RESULTS fifteen randomized clinical trials were included. Although all the subgroups presented a general effect in favor of the intervention, colorectal surgeries had this relationship evidenced with statistical significance (I2=10%;X2=4.42; p=0.352). CONCLUSION inspired oxygen fractions greater than 80% during the perioperative period in colorectal surgeries have proved to be effective to prevent surgical site infections, reducing their incidence by up to 27% (p=0.006). It is suggested to conduct new studies in groups of patients subjected to surgeries from other specialties, such as cardiac and vascular. PROSPERO registration No.: 178,453.
Collapse
Affiliation(s)
- Eduardo Tavares Gomes
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP,
Brazil., Universidade Federal de Pernambuco, Hospital das Clínicas, Recife,
PE, Brazil
| | | | | | | | | | | |
Collapse
|
4
|
Gomes ET, Carbogim FDC, Lins RS, Lins-Filho RLDM, Poveda VDB, Püschel VADA. Efectividad de la oxigenación suplementaria para prevenir la infección del sitio quirúrgico: revisión sistemática con metaanálisis. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.6106.3647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Resumen Objetivo: evaluar la efectividad de la oxigenación suplementaria con FiO2 elevada en comparación con la FiO2 convencional para prevenir la infección del sitio quirúrgico. Método: revisión sistemática de eficacia con metaanálisis en cinco bases de datos y portales internacionales. La investigación se guio por la pregunta: ¿Qué tan eficaz es la oxigenación suplementaria con FiO2 alta (más del 80%) en comparación con la FiO2 convencional (del 30 al 35%) para prevenir la infección del sitio quirúrgico en adultos? Resultados: se incluyeron quince ensayos clínicos aleatorizados. Aunque todos los subgrupos mostraron un efecto general a favor de la intervención, en las cirugías colorrectales esa relación tenía significancia estadística (I2=10%; X²=4,42; p=0,352). Conclusión: una fracción inspirada de oxígeno superior al 80% durante el perioperatorio en cirugías colorrectales ha demostrado ser eficaz en la prevención de la infección del sitio quirúrgico, reduciendo su incidencia hasta en un 27% (p=0,006). Se sugiere realizar más estudios en grupos de pacientes sometidos a cirugías en otras especialidades, como cardiaca y vascular. Registro PROSPERO: 178453.
Collapse
|
5
|
Demiselle J, Calzia E, Hartmann C, Messerer DAC, Asfar P, Radermacher P, Datzmann T. Target arterial PO 2 according to the underlying pathology: a mini-review of the available data in mechanically ventilated patients. Ann Intensive Care 2021; 11:88. [PMID: 34076802 PMCID: PMC8170650 DOI: 10.1186/s13613-021-00872-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/10/2021] [Indexed: 12/15/2022] Open
Abstract
There is an ongoing discussion whether hyperoxia, i.e. ventilation with high inspiratory O2 concentrations (FIO2), and the consecutive hyperoxaemia, i.e. supraphysiological arterial O2 tensions (PaO2), have a place during the acute management of circulatory shock. This concept is based on experimental evidence that hyperoxaemia may contribute to the compensation of the imbalance between O2 supply and requirements. However, despite still being common practice, its use is limited due to possible oxygen toxicity resulting from the increased formation of reactive oxygen species (ROS) limits, especially under conditions of ischaemia/reperfusion. Several studies have reported that there is a U-shaped relation between PaO2 and mortality/morbidity in ICU patients. Interestingly, these mostly retrospective studies found that the lowest mortality coincided with PaO2 ~ 150 mmHg during the first 24 h of ICU stay, i.e. supraphysiological PaO2 levels. Most of the recent large-scale retrospective analyses studied general ICU populations, but there are major differences according to the underlying pathology studied as well as whether medical or surgical patients are concerned. Therefore, as far as possible from the data reported, we focus on the need of mechanical ventilation as well as the distinction between the absence or presence of circulatory shock. There seems to be no ideal target PaO2 except for avoiding prolonged exposure (> 24 h) to either hypoxaemia (PaO2 < 55-60 mmHg) or supraphysiological (PaO2 > 100 mmHg). Moreover, the need for mechanical ventilation, absence or presence of circulatory shock and/or the aetiology of tissue dysoxia, i.e. whether it is mainly due to impaired macro- and/or microcirculatory O2 transport and/or disturbed cellular O2 utilization, may determine whether any degree of hyperoxaemia causes deleterious side effects.
Collapse
Affiliation(s)
- Julien Demiselle
- Service de Médecine Intensive - Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 1, place de l′Hôpital, F–67091, Strasbourg, Cedex, France
| | - Enrico Calzia
- Institut Für Anästhesiologische Pathophysiologie Und Verfahrensentwicklung, Universitätsklinikum, Helmholtzstrasse 8-1, 89081 Ulm, Germany
| | - Clair Hartmann
- Klinik Für Anästhesiologie Und Intensivmedizin, Universitätsklinikum, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - David Alexander Christian Messerer
- Institut Für Anästhesiologische Pathophysiologie Und Verfahrensentwicklung, Universitätsklinikum, Helmholtzstrasse 8-1, 89081 Ulm, Germany
- Klinik Für Anästhesiologie Und Intensivmedizin, Universitätsklinikum, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Pierre Asfar
- Service de Médecine Intensive - Réanimation Et Médecine Hyperbare, Centre Hospitalier Universitaire D’Angers, 4 rue Larrey - 49 933, Angers Cedex 9, France
| | - Peter Radermacher
- Institut Für Anästhesiologische Pathophysiologie Und Verfahrensentwicklung, Universitätsklinikum, Helmholtzstrasse 8-1, 89081 Ulm, Germany
| | - Thomas Datzmann
- Institut Für Anästhesiologische Pathophysiologie Und Verfahrensentwicklung, Universitätsklinikum, Helmholtzstrasse 8-1, 89081 Ulm, Germany
| |
Collapse
|
6
|
Myles P, Kasza J, Turner T. Credibility of subgroup findings in clinical trials and meta-analyses. Br J Anaesth 2021; 127:11-14. [PMID: 33992396 DOI: 10.1016/j.bja.2021.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/14/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Paul Myles
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Australia.
| | - Jessica Kasza
- Biostatics Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tari Turner
- Cochrane Australia, School of Population Health and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
7
|
Stryja J, Sandy-Hodgetts K, Collier M, Moser C, Ousey K, Probst S, Wilson J, Xuereb D. PREVENTION AND MANAGEMENT ACROSS HEALTH-CARE SECTORS. J Wound Care 2020; 29:S1-S72. [DOI: 10.12968/jowc.2020.29.sup2b.s1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Jan Stryja
- Vascular Surgeon, Centre of vascular and miniinvasive surgery, Hospital Podlesi, Trinec, The Czech Republic. Salvatella Ltd., Centre of non-healing wounds treatment, Podiatric outpatients’ department, Trinec, The Czech Republic
| | - Kylie Sandy-Hodgetts
- Senior Research Fellow – Senior Lecturer, Faculty of Medicine, School of Biomedical Sciences, University of Western Australia, Director, Skin Integrity Clinical Trials Unit, University of Western Australia
| | - Mark Collier
- Nurse Consultant and Associate Lecturer – Tissue Viability, Independent – formerly at the United Lincolnshire Hospitals NHS Trust, c/o Pilgrim Hospital, Sibsey Road, Boston, Lincolnshire, PE21 9Q
| | - Claus Moser
- Clinical microbiologist, Rigshospitalet, Department of Clinical Microbiology, Copenhagen, Denmark
| | - Karen Ousey
- Professor of Skin Integrity, University of Huddersfield. Institute of Skin Integrity and Infection Prevention, Huddersfield, UK
| | - Sebastian Probst
- Professor of wound care, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Jennie Wilson
- Professor of Healthcare Epidemiology, University of West London, College of Nursing, Midwifery and Healthcare, London, UK
| | - Deborah Xuereb
- Senior Infection Prevention & infection Control Nurse, Mater Dei Hospital, Msida, Malta
| |
Collapse
|
8
|
Ottolenghi S, Rubino FM, Sabbatini G, Coppola S, Veronese A, Chiumello D, Paroni R. Oxidative Stress Markers to Investigate the Effects of Hyperoxia in Anesthesia. Int J Mol Sci 2019; 20:ijms20215492. [PMID: 31690051 PMCID: PMC6862279 DOI: 10.3390/ijms20215492] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/24/2019] [Accepted: 10/29/2019] [Indexed: 12/15/2022] Open
Abstract
Oxygen (O2) is commonly used in clinical practice to prevent or treat hypoxia, but if used in excess (hyperoxia), it may act as toxic. O2 toxicity arises from the enhanced formation of Reactive Oxygen Species (ROS) that exceed the antioxidant defenses and generate oxidative stress. In this study, we aimed at assessing whether an elevated fraction of inspired oxygen (FiO2) during and after general anesthesia may contribute to the unbalancing of the pro-oxidant/antioxidant equilibrium. We measured five oxidative stress biomarkers in blood samples from patients undergoing elective abdominal surgery, randomly assigned to FiO2 = 0.40 vs. 0.80: hydroperoxides, antioxidants, nitrates and nitrites (NOx), malondialdehyde (MDA), and glutathionyl hemoglobin (HbSSG). The MDA concentration was significantly higher 24 h after surgery, and the body antioxidant defense lower, in the FiO2 = 0.80 group with respect to both the FiO2 = 0.40 group and the baseline values (p ≤ 0.05, Student’s t-test). HbSSG in red blood cells was also higher in the FiO2 = 0.80 group at the end of the surgery. NOx was higher in the FiO2 = 0.80 group than the FiO2 = 0.40 group at t = 2 h after surgery. MDA, the main end product of the peroxidation of polyunsaturated fatty acids directly influenced by FiO2, may represent the best marker to assess the pro-oxidant/antioxidant equilibrium after surgery.
Collapse
Affiliation(s)
- Sara Ottolenghi
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20142 Milan, Italy.
| | - Federico Maria Rubino
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20142 Milan, Italy.
| | - Giovanni Sabbatini
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, 20142 Milan, Italy.
| | - Silvia Coppola
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, 20142 Milan, Italy.
| | - Alice Veronese
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, 20142 Milan, Italy.
| | - Davide Chiumello
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20142 Milan, Italy.
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, 20142 Milan, Italy.
- Coordinated Research Center on Respiratory Failure, University of Milan, 20123 Milan, Italy.
| | - Rita Paroni
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20142 Milan, Italy.
| |
Collapse
|
9
|
Ban KA, Gibbons MM, Ko CY, Wick EC, Cannesson M, Scott MJ, Grant MC, Wu CL. Evidence Review Conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery. Anesth Analg 2019; 128:879-889. [DOI: 10.1213/ane.0000000000003366] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
10
|
Buhre W, Disma N, Hendrickx J, DeHert S, Hollmann MW, Huhn R, Jakobsson J, Nagele P, Peyton P, Vutskits L. European Society of Anaesthesiology Task Force on Nitrous Oxide: a narrative review of its role in clinical practice. Br J Anaesth 2019; 122:587-604. [PMID: 30916011 DOI: 10.1016/j.bja.2019.01.023] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 12/26/2018] [Accepted: 01/13/2019] [Indexed: 12/12/2022] Open
Abstract
Nitrous oxide (N2O) is one of the oldest drugs still in use in medicine. Despite its superior pharmacokinetic properties, controversy remains over its continued use in clinical practice, reflecting in part significant improvements in the pharmacology of other anaesthetic agents and developing awareness of its shortcomings. This narrative review describes current knowledge regarding the clinical use of N2O based on a systematic and critical analysis of the available scientific literature. The pharmacological properties of N2O are reviewed in detail along with current evidence for the indications and contraindications of this drug in specific settings, both in perioperative care and in procedural sedation. Novel potential applications for N2O for the prevention or treatment of chronic pain and depression are also discussed. In view of the available evidence, we recommend that the supply of N2O in hospitals be maintained while encouraging its economic delivery using modern low flow delivery systems. Future research into its potential novel applications in prevention or treatment of chronic conditions should be pursued to better identify its role place in the developing era of precision medicine.
Collapse
Affiliation(s)
- Wolfgang Buhre
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, University of Maastricht, Maastricht, the Netherlands
| | - Nicola Disma
- Department of Anesthesia, Istituto Giannina Gaslini, Genoa, Italy
| | - Jan Hendrickx
- Department of Anesthesiology, Onze-Lieve-Vrouwziekenhuis Hospital Aalst, Aalst, Belgium
| | - Stefan DeHert
- Department of Anesthesiology and Perioperative Medicine, University Hospital Ghent, Ghent, Belgium
| | - Markus W Hollmann
- Department of Anesthesiology, Amsterdam University Medical Center (AUMC), AMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Ragnar Huhn
- Department of Anesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Jan Jakobsson
- Department of Anesthesiology and Intensive Care, Institution for Clinical Science, Karolinska Institute, Danderyds University Hospital, Danderyd, Sweden
| | - Peter Nagele
- Department of Anesthesia and Critical Care, University of Chicago Medicine, Chicago, IL, USA
| | - Philip Peyton
- Department of Anaesthesia, Austin Health, and Anaesthesia Perioperative and Pain Medicine Unit, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Laszlo Vutskits
- Department of Anesthesiology, Pharmacology and Intensive Care, University Hospitals Geneva, Genève, Switzerland
| |
Collapse
|
11
|
Mayank M, Mohsina S, Sureshkumar S, Kundra P, Kate V. Effect of Perioperative High Oxygen Concentration on Postoperative SSI in Elective Colorectal Surgery-A Randomized Controlled Trial. J Gastrointest Surg 2019; 23:145-152. [PMID: 30298417 DOI: 10.1007/s11605-018-3996-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/23/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND This study was carried out to investigate the effect of perioperative high oxygen concentration on surgical site infection (SSI) in patients undergoing elective colorectal surgery. METHODS This was a single-center, prospective, parallel arm, double-blind, superiority randomized controlled trial. All patients more than 18 years of age undergoing elective colorectal surgery were included as per the inclusion criteria. Patients were randomized at the time of induction of anesthesia into high concentration and standard concentration oxygen group based on the concentration of oxygen. Incidence of SSI, day of the detection of SSI, grade of SSI, incidence of anastomotic leak, postoperative day of return of bowel functions, day of starting oral feeds, day of ambulation, and length of hospitalization were studied in both the groups. RESULTS A total of 94 patients were included in the study, 47 patients each in high concentration oxygen group and standard concentration oxygen group respectively. The SSI rates were comparable between the two groups [55.3% (95% CI-4.012-69.83) vs. 40.4% (95% CI-26.37-55.73); p = 0.215]. There was no significant difference found with respect to mean day of detection of SSI [4.5(IQR-3.0-7.5) vs. 6.0 (IQR-3.0-9.0; p = 0.602], postoperative day of return of bowel functions (2.20 ± 0.542 vs. 2.13 ± 0.582; p = 0.540), oral feeds (3.62 ± 0.945 vs. 3.46 ± 1.048; p = 0.544), ambulation (4.17 ± 0.868 vs. 4.17 ± 1.270; p = 0.987), and the length of hospitalization [15(IQR-10-19) vs. 15(IQR-10.75-18.25); p = 0.862] between the two groups. CONCLUSION There was no significant difference in the rate of SSI with the use of perioperative high oxygen concentration in patients undergoing elective colorectal surgery.
Collapse
Affiliation(s)
- Mangal Mayank
- Departments of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605006, India
| | - Subair Mohsina
- Departments of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605006, India
| | - Sathasivam Sureshkumar
- Departments of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605006, India
| | - Pankaj Kundra
- Department of Anaesthesiology & Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Vikram Kate
- Departments of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605006, India.
| |
Collapse
|
12
|
Griffiths SV, Conway DH, Sander M, Jammer I, Grocott MPW, Creagh-Brown BC. What are the optimum components in a care bundle aimed at reducing post-operative pulmonary complications in high-risk patients? Perioper Med (Lond) 2018; 7:7. [PMID: 29692886 PMCID: PMC5904979 DOI: 10.1186/s13741-018-0084-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 02/14/2018] [Indexed: 02/07/2023] Open
Abstract
Background Post-operative pulmonary complications (POPC) are common, predictable and associated with increased morbidity and mortality, independent of pre-operative risk. Interventions to reduce the incidence of POPC have been studied individually, but the use of a care bundle has not been widely investigated. The purpose of our work was to use Delphi consensus methodology and an independently chosen expert panel to formulate a care bundle for patients identified as being at high of POPC, as preparation towards an evaluation of its effectiveness at reducing POPC. Methods We performed a survey of members of the ESICM POIC section to inform a Delphi consensus and to share their opinions on a care bundle to reduce POPC, the POPC-CB. We formed a team of 36 experts to participate in and complete an email-based Delphi consensus over three rounds, leading to the formulation of the POPC-CB. Results The survey had 362 respondents and informed the design of the Delphi consensus. The Delphi consensus resulted in a proposed POPC-CB that incorporates components before surgery-supervised exercise programmes and inspiratory muscle training, during surgery, low tidal volume ventilation with individualised PEEP (positive end-expiratory pressure), use of routine monitoring to avoid hyperoxia and efforts made to limit neuromuscular blockade, and post-operatively, deep breathing exercises and elevation of the head of the bed. Conclusion A care bundle has been suggested for evaluation in surgical patients at high risk of POPC. Evaluation of feasibility of both implementation and effectiveness is now indicated.
Collapse
Affiliation(s)
- Sophie V Griffiths
- 1Faculty of Medicine, University of Southampton, Southampton, SO16 6YD UK
| | - Daniel H Conway
- Department of Anaesthesia and Critical Care, Central Manchester Foundation Trust, M13 9WL, Manchester, UK
| | | | - Michael Sander
- 3Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Gießen, Giessen, Germany
| | - Ib Jammer
- 4Department of Anaesthesiology and Intensive Care, Haukeland University Hospital, Bergen, Norway.,5Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Michael P W Grocott
- 6Critical Care Research Group, Southampton NIHR Biomedical Research Centre, Southampton University Hospitals NHS Trust/University of Southampton, Southampton, SO16 6YD UK
| | - Ben C Creagh-Brown
- 7Intensive Care Unit, Royal Surrey County Hospital, Guildford, GU2 7XX UK.,8Surrey Perioperative Anaesthetic Critical care collaborative group (SPACeR), FHMS, University of Surrey, Guildford, GU2 7XH UK
| |
Collapse
|
13
|
Robson JP, Kokhanenko P, Marshall JK, Phillips AR, van der Linden J. Increased visceral tissue perfusion with heated, humidified carbon dioxide insufflation during open abdominal surgery in a rodent model. PLoS One 2018; 13:e0195465. [PMID: 29617447 PMCID: PMC5884566 DOI: 10.1371/journal.pone.0195465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 03/22/2018] [Indexed: 01/07/2023] Open
Abstract
Tissue perfusion during surgery is important in reducing surgical site infections and promoting healing. This study aimed to determine if insufflation of the open abdomen with heated, humidified (HH) carbon dioxide (CO2) increased visceral tissue perfusion and core body temperature during open abdominal surgery in a rodent model. Using two different rodent models of open abdominal surgery, visceral perfusion and core temperature were measured. Visceral perfusion was investigated using a repeated measures crossover experiment with rodents receiving the same sequence of two alternating treatments: exposure to ambient air (no insufflation) and insufflation with HH CO2. Core body temperature was measured using an independent experimental design with three treatment groups: ambient air, HH CO2 and cold, dry (CD) CO2. Visceral perfusion was measured by laser speckle contrast analysis (LASCA) and core body temperature was measured with a rectal thermometer. Insufflation with HH CO2 into a rodent open abdominal cavity significantly increased visceral tissue perfusion (2.4 perfusion units (PU)/min (95% CI 1.23-3.58); p<0.0001) compared with ambient air, which significantly reduced visceral blood flow (-5.20 PU/min (95% CI -6.83- -3.58); p<0.0001). Insufflation of HH CO2 into the open abdominal cavity significantly increased core body temperature (+1.15 ± 0.14°C) compared with open cavities exposed to ambient air (-0.65 ± 0.52°C; p = 0.037), or cavities insufflated with CD CO2 (-0.73 ± 0.33°C; p = 0.006). Abdominal visceral temperatures also increased with HH CO2 insufflation compared with ambient air or CD CO2, as shown by infrared thermography. This study reports for the first time the use of LASCA to measure visceral perfusion in open abdominal surgery and shows that insufflation of open abdominal cavities with HH CO2 significantly increases visceral tissue perfusion and core body temperature.
Collapse
Affiliation(s)
| | | | | | - Anthony R. Phillips
- School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - Jan van der Linden
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
14
|
|
15
|
Akca O, Ball L, Belda FJ, Biro P, Cortegiani A, Eden A, Ferrando C, Gattinoni L, Goldik Z, Gregoretti C, Hachenberg T, Hedenstierna G, Hopf HW, Hunt TK, Pelosi P, Qadan M, Sessler DI, Soro M, Şentürk M. WHO Needs High FIO 2? Turk J Anaesthesiol Reanim 2017; 45:181-192. [PMID: 28868164 DOI: 10.5152/tjar.2017.250701] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
World Health Organization and the United States Center for Disease Control have recently recommended the use of 0.8 FIO2 in all adult surgical patients undergoing general anaesthesia, to prevent surgical site infections. This recommendation has arisen several discussions: As a matter of fact, there are numerous studies with different results about the effect of FIO2 on surgical site infection. Moreover, the clinical effects of FIO2 are not limited to infection control. We asked some prominent authors about their comments regarding the recent recommendations.
Collapse
Affiliation(s)
- Ozan Akca
- Department of Anesthesiology and Perioperative Medicine, Neuroscience ICU, University of Louisville, Kentucky, USA
| | - Lorenzo Ball
- IRCCS AOU San Martino-IST, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - F Javier Belda
- Department of Anesthesiology and Critical Care, Hospital Clinico Universitario, University of Valencia, Valencia, Spain
| | - Peter Biro
- Institute of Anesthesiology, University Hospital Zurich, Switzerland
| | - Andrea Cortegiani
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency. Policlinico Paolo Giaccone. University of Palermo, Italy
| | - Arieh Eden
- Department of Anesthesiology, Critical Care and Pain Medicine, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Carlos Ferrando
- Department of Anesthesiology and Critical Care, Hospital Clinico Universitario, University of Valencia, Valencia, Spain
| | - Luciano Gattinoni
- Department of Anesthesiology Emergency & Intensive Care Medicine, Gottingen University, Gottingen, Germany
| | - Zeev Goldik
- Department of Anesthesiology, Critical Care and Pain Medicine, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Cesare Gregoretti
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency. Policlinico Paolo Giaccone. University of Palermo, Italy
| | - Thomas Hachenberg
- Department of Anaesthesiology and Intensive Care Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | | | - Harriet W Hopf
- Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
| | - Thomas K Hunt
- Division of General Surgery, University of California, San Francisco, USA
| | - Paolo Pelosi
- IRCCS AOU San Martino-IST, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Motaz Qadan
- Massachusetts General Hospital, Department of Surgery, Harvard University, Massachusetts, USA
| | - Daniel I Sessler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marina Soro
- Department of Anesthesiology and Critical Care, Hospital Clinico Universitario, University of Valencia, Valencia, Spain
| | - Mert Şentürk
- Department of Anaesthesiology and Reanimation, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| |
Collapse
|
16
|
Asfar P, Schortgen F, Boisramé-Helms J, Charpentier J, Guérot E, Megarbane B, Grimaldi D, Grelon F, Anguel N, Lasocki S, Henry-Lagarrigue M, Gonzalez F, Legay F, Guitton C, Schenck M, Doise JM, Devaquet J, Van Der Linden T, Chatellier D, Rigaud JP, Dellamonica J, Tamion F, Meziani F, Mercat A, Dreyfuss D, Seegers V, Radermacher P. Hyperoxia and hypertonic saline in patients with septic shock (HYPERS2S): a two-by-two factorial, multicentre, randomised, clinical trial. THE LANCET RESPIRATORY MEDICINE 2017; 5:180-190. [DOI: 10.1016/s2213-2600(17)30046-2] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/10/2016] [Accepted: 12/21/2016] [Indexed: 01/01/2023]
|
17
|
Love KL. Patient Care Interventions to Reduce the Risk of Surgical Site Infections. AORN J 2016; 104:506-515. [DOI: 10.1016/j.aorn.2016.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 10/04/2016] [Indexed: 01/28/2023]
|
18
|
Nußbaum B, Radermacher P, Asfar P, Hartmann C. Does hyperoxia enhance susceptibility to secondary pulmonary infection in the ICU? Crit Care 2016; 20:239. [PMID: 27526848 PMCID: PMC4986255 DOI: 10.1186/s13054-016-1427-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Hyperoxia is common practice in the acute management of circulatory shock, and observational studies report that it is present in more than 50 % of mechanically ventilated patients during the first 24 h after intensive care unit (ICU) admission. On the other hand, "oxygen toxicity" due to the increased formation of reactive oxygen species limits its use due to serious deleterious side effects. However, formation of reactive oxygen species to boost bacterial killing is one of the body's anti-microbial auto-defense mechanisms and, hence, O2 has been referred to as an antibiotic. Consequently, hyperoxia during the peri-operative period has been advocated for surgical patients in order to reduce surgical site infection. However, there is ample evidence that long-term exposure to hyperoxia impaired bacterial phagocytosis and thereby aggravated both bacterial burden and dissemination. Moreover, a recent retrospective study identified the number of days with hyperoxia, defined as a PaO2 > 120 mmHg only, as an independent risk factor of ventilator-associated pneumonia in patients needing mechanical ventilation for more than 48 h. Since so far the optimal oxygenation target is unknown for ICU patients, "conservative" O2 therapy represents the treatment of choice to avoid exposure to both hypoxemia and excess hyperoxemia.
Collapse
Affiliation(s)
- Benedikt Nußbaum
- Institut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinikum, Helmholtzstrasse 8/1, Ulm, Germany.,Klinik für Anästhesiologie, Abteilung Klinische Anästhesiologie, Universitätsklinikum, Albert-Einstein-Allee 23, Ulm, Germany
| | - Peter Radermacher
- Klinik für Anästhesiologie, Abteilung Klinische Anästhesiologie, Universitätsklinikum, Albert-Einstein-Allee 23, Ulm, Germany.
| | - Pierre Asfar
- Département de Réanimation Médicale et de Médecine Hyperbare, Centre Hospitalier Universitaire, 4 rue Larrey, Angers, France.,Laboratoire de Biologie Neurovasculaire et Mitochondriale Intégrée, CNRS UMR 6214 - INSERM U1083, Université Angers, PRES L'UNAM, Angers, 49933, Cedex 9, France
| | - Clair Hartmann
- Institut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinikum, Helmholtzstrasse 8/1, Ulm, Germany.,Klinik für Anästhesiologie, Abteilung Klinische Anästhesiologie, Universitätsklinikum, Albert-Einstein-Allee 23, Ulm, Germany
| |
Collapse
|
19
|
Abbas M, Pittet D. Surgical site infection prevention: a global priority. J Hosp Infect 2016; 93:319-22. [DOI: 10.1016/j.jhin.2016.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 06/03/2016] [Indexed: 12/21/2022]
|
20
|
Rasmussen LS, Meyhoff CS, Jørgensen LN, Wetterslev J. Effect of intraoperative high oxygen fraction on surgical site infection: a meta-analysis of randomized controlled trials. J Hosp Infect 2016; 94:207-8. [PMID: 27480018 DOI: 10.1016/j.jhin.2016.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
Affiliation(s)
- L S Rasmussen
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - C S Meyhoff
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - L N Jørgensen
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J Wetterslev
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
21
|
Effect of intraoperative high oxygen concentrations on surgical site infection. J Hosp Infect 2016; 94:206-7. [PMID: 27480017 DOI: 10.1016/j.jhin.2016.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 06/17/2016] [Indexed: 11/23/2022]
|