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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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2
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Yang C, Shi Y, Zhang M, Yang Y, Xie Y. Impact of staged goal-directed fluid therapy on postoperative pulmonary complications in patients undergoing McKeown esophagectomy: a randomized controlled trial. BMC Anesthesiol 2024; 24:330. [PMID: 39289608 PMCID: PMC11406780 DOI: 10.1186/s12871-024-02719-y] [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: 04/10/2024] [Accepted: 09/06/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND Our aim was to evaluate the influence of staged goal directed therapy (GDT) on postoperative pulmonary complications (PPCs), intraoperative hemodynamics and oxygenation in patients undergoing Mckeown esophagectomy. METHODS Patients were randomly divided into three groups, staged GDT group (group A, n = 56): stroke volume variation (SVV) was set at 8-10% during the one lung ventilation (OLV) stage and 8-12% during the two lung ventilation (TLV) stage, GDT group (group B, n = 56): received GDT with a target SVV of 8-12% During the entire surgical procedure, and control group (group C, n = 56): conventional fluid therapy was administered by mean arterial pressure (MAP), central venous pressure (CVP), and urine volume. The primary outcome was the incidence of postoperative pulmonary complications within Postoperative days (POD) 7. The secondary outcomes were postoperative lung ultrasound (LUS) B-lines artefacts (BLA) scoring, incidence of other complications, the length of hospital stay, intraoperative hemodynamic and oxygenation indicators included mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), cardiac output (CO), oxygenation index (OI), respiratory indices (RI), alveolar-arterial oxygen difference (Aa-DO2). RESULTS Patients in group A and group B had a lower incidence of PPCs (7/56 vs. 17/56 and 9/56 vs. 17/56, p < 0.05), and a fewer B-lines score on postoperative ultrasound (4.61 ± 0.51 vs. 6.15 ± 0.74 and 4.75 ± 0.62 vs. 6.15 ± 0.74, p < 0.05) compared to group C. The CI, CO, MAP, and OI were higher in group A compared to group B and group C in the stage of thoracic operation. During the abdominal operation stage, patients in group A and group B had a better hemodynamic and oxygenation indicators than group C. CONCLUSIONS In comparison to conventional fluid therapy, intraoperative staged GDT can significantly reduce the incidence of postoperative pulmonary complications in patients undergoing McKeown esophagectomy, facilitating patient recovery. Compared to GDT, it can improve intraoperative oxygenation and stabilize intraoperative hemodynamics in patients. TRIAL REGISTRATION This study was registered in the Chinese Clinical Trial Registry on 24/11/2021 (ChiCTR2100053598).
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Affiliation(s)
- Chao Yang
- Graduate School of Bengbu Medical College, Bengbu, Anhui, 233004, People's Republic of China
- Department of Anesthesiology, The First Affiliated Hospital of the University of Science and Technology of China, South District, No. 1 Tian'ehu Street, Hefei, 236001, China
| | - Yujie Shi
- Graduate School of Bengbu Medical College, Bengbu, Anhui, 233004, People's Republic of China
- Department of Anesthesiology, The First Affiliated Hospital of the University of Science and Technology of China, South District, No. 1 Tian'ehu Street, Hefei, 236001, China
| | - Min Zhang
- Department of Anesthesiology, The First Affiliated Hospital of the University of Science and Technology of China, South District, No. 1 Tian'ehu Street, Hefei, 236001, China
| | - Yang Yang
- Department of Anesthesiology, The First Affiliated Hospital of the University of Science and Technology of China, South District, No. 1 Tian'ehu Street, Hefei, 236001, China
| | - Yanhu Xie
- Graduate School of Bengbu Medical College, Bengbu, Anhui, 233004, People's Republic of China.
- Department of Anesthesiology, The First Affiliated Hospital of the University of Science and Technology of China, South District, No. 1 Tian'ehu Street, Hefei, 236001, China.
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3
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Fu M, Xu R, Chen G, Zheng X, Shu B, Huang H, Duan G, Chen Y. Postoperative esketamine improves ventilation after video-assisted thoracoscopic lung resection: A double-blinded randomized controlled trial. Heliyon 2024; 10:e25100. [PMID: 38322862 PMCID: PMC10844121 DOI: 10.1016/j.heliyon.2024.e25100] [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: 11/26/2023] [Revised: 01/19/2024] [Accepted: 01/19/2024] [Indexed: 02/08/2024] Open
Abstract
Background Pain management after lung resection plays a crucial role in reducing postoperative pulmonary complications (PPCs). This study aimed to examine the effect of postoperative esketamine infusion as an adjunct to opioid analgesia on ventilation and pulmonary complications in patients underwent lung resection. Methods Patients undergoing video-assisted thoracoscopic lung resection were randomly assigned to either the esketamine group or the control group. The esketamine group received a 24-h infusion of 1.5 mcg/ml sufentanil combined with 0.75 mcg/ml esketamine after surgery, while the control group received 1.5 mcg/ml sufentanil alone. The primary outcome measure was low minute ventilation, and the secondary outcome measures were hypoxemia, PaO2/FiO2 levels, postoperative pulmonary complications, hospital stay duration, ambulation time, Visual Analogue Scale (VAS) score, depression and anxiety levels, sleep quality, and analgesia satisfaction. Results 80 patients were randomly divided into two groups: the esketamine group (n = 40) and the control group (n = 40). The esketamine group exhibited notably reduced incidence of low minute ventilation (P = 0.014), lower occurrence of postoperative pulmonary complications (PPCs) compared to the control group (P = 0.039), and decreased incidence of hypoxemia (P = 0.003). Furthermore, the esketamine group showed improved outcomes with lower VAS scores on the second postoperative day and enhanced sleep quality (P < 0.001) after the surgery. Conclusions Postoperative esketamine infusion with opioids improved ventilation and reduced PPCs after lung resection, warranting further clinical studies. Trial registration This study was registered on ClinicalTrials.gov (Trial ID: NCT05458453, https://clinicaltrials.gov/ct2/show/NCT05458453).
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Affiliation(s)
| | | | - Guizhen Chen
- Department of Anaesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Xuemei Zheng
- Department of Anaesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Bin Shu
- Department of Anaesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - He Huang
- Department of Anaesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Guangyou Duan
- Department of Anaesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yuanjing Chen
- Department of Anaesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
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4
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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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5
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Sun Q, Zhang T, Liu J, Cui Y, Tan W. A 20-year bibliometric analysis of postoperative pulmonary complications: 2003-2022. Heliyon 2023; 9:e20580. [PMID: 37860522 PMCID: PMC10582290 DOI: 10.1016/j.heliyon.2023.e20580] [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: 07/24/2023] [Revised: 09/23/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023] Open
Abstract
Background Postoperative pulmonary complications (PPCs) are known to adversely affect surgical outcomes and patient prognoses, yet no published study provides a qualitative and quantitative analysis of the latest trends and developments in the field of PPCs. Therefore, we conducted a bibliometric analysis of 20 years of publications related to PPCs. Methods We examined publications on PPCs published between 2003 and 2022 in the Web of Science Core Collection database to assess trends in the field in four dimensions: trends in publications, major research power, keywords, and co-cited publications. Results A total of 1881 articles were analyzed using CiteSpace and VOSviewer. Overall, the number of publications on PPCs has increased in the last two decades, with 42.72% of the publications being produced in the last five years. The United States of America had the highest number of articles, accounting for 21.91% of the total. The institution with the highest number of publications was the University of Genoa, which published 54 articles and showed a general lack of inter-institutional collaboration. The most productive author was Paolo Pelosi, with no core group of authors identified in the field of PPCs. The keyword co-occurrence analysis indicated that the focus of research has shifted over the past 20 years in terms of risk factors, type of surgery, and so on, while "enhanced recovery", "prehabilitation", "driving pressure" and "sugammadex" have received the most recent attention. In the analysis of co-cited literature, the most recent clusters that received attention were driving pressure, lung cancer patient, enhanced recovery, and neuromuscular blockade. Conclusion This bibliometric study suggests that pulmonary protective ventilation strategies, neuromuscular blockade reversal, and pulmonary prehabilitation strategy will be the focus of attention in the coming period. More large-scale studies and strengthened institutional collaboration are necessary to generate robust evidence for guiding individualized prevention of PPCs.
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Affiliation(s)
- Qi Sun
- Department of Anesthesiology, The First Hospital of China Medical University, Shenyang, China
| | - Tianhao Zhang
- Department of Anesthesiology, The First Hospital of China Medical University, Shenyang, China
| | - Jiayun Liu
- Department of Anesthesiology, The First Hospital of China Medical University, Shenyang, China
| | - Yong Cui
- Department of Anesthesiology, The First Hospital of China Medical University, Shenyang, China
| | - Wenfei Tan
- Department of Anesthesiology, The First Hospital of China Medical University, Shenyang, China
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Lu X, Jiang Q, Qiu Y, Tang W, Sessler DI, Wu J. Aggressive intraoperative warming and postoperative pulmonary complications in elderly patients recovering from esophageal cancer surgery: sub-analysis of a randomized trial. Front Med (Lausanne) 2023; 10:1157392. [PMID: 37521353 PMCID: PMC10375046 DOI: 10.3389/fmed.2023.1157392] [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: 02/08/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023] Open
Abstract
Background Elderly patients having esophagectomies often become hypothermic which may promote complications. We tested the hypothesis that aggressive warming to a core temperature of 37°C reduces postoperative pulmonary complications (PPCs) in elderly patients having esophageal cancer resections. Methods This study was a pre-defined sub-study of a multi-center, parallel group, superiority trial (PROTECT). Patients aged >65 years and having elective radical resection of esophageal cancer in a single center were randomly allocated into either aggressive warming group (target intraoperative core temperatures of 37°C) or routine thermal management group (target intraoperative core temperatures of 35.5°C). The primary endpoint was the incidence of PPCs. Secondary endpoints included duration of chest tube drainage and other postoperative complications. Results A total of 300 patients were included in the primary analysis. PPCs occurred in 27 (18%) of 150 patients in the aggressive warming group and 31 (21%) of 150 patients in the routine thermal management group. The relative risk (RR) of aggressive versus routine thermal management was 0.9 (95% CI: 0.5, 1.4; p = 0.56). The duration of chest drainage in patients assigned to aggressive warming was shorter than that assigned to routine thermal management: 4 (3, 5) days vs. 5 (4, 7) days; hazard ratio (HR) 1.4 [95% CI: 1.1, 1.7]; p = 0.001. Fewer aggressively warmed patients needed chest drainage for more than 5 days: 30/150 (20%) vs. 51/150 (34%); RR:0.6 (95% CI: 0.4, 0.9; p = 0.03). The incidence of other postoperative complications were similar between the two groups. Conclusion Aggressive warming does not reduce the incidence of PPCs in elderly patients receiving esophagectomy. The duration of chest drainage was reduced by aggressive warming. But as a secondary analysis of a planned sub-group study, these results should be considered exploratory. Clinical trial registration https://www.chictr.org.cn/showproj.aspx?proj=37099, ChiCTR1900022257.
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Affiliation(s)
- Xiaofei Lu
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Qiliang Jiang
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
- Outcomes Research Consortium, Cleveland, OH, United States
| | - Yuwei Qiu
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
- Outcomes Research Consortium, Cleveland, OH, United States
| | - Wei Tang
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Daniel I. Sessler
- Outcomes Research Consortium, Cleveland, OH, United States
- Department of Outcomes Research, Anesthesiology Institute, Cleveland, OH, United States
| | - Jingxiang Wu
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
- Outcomes Research Consortium, Cleveland, OH, United States
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7
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Yu J, Wu Z, An R, Li H, Zhang T, Lin W, Tan H, Cao L. Association between driving pressure and postoperative pulmonary complications in patients undergoing lung resection surgery: A randomised clinical trial. Anaesth Crit Care Pain Med 2023; 42:101160. [PMID: 36349571 DOI: 10.1016/j.accpm.2022.101160] [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: 05/17/2022] [Revised: 08/16/2022] [Accepted: 08/21/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND It is uncertain whether an association exists for decreases in driving pressure and the occurrence of postoperative pulmonary complications (PPCs) in patients undergoing selective lung resection surgery. Thus, we designed this study to determine whether the positive end-expiratory pressure (PEEP) titration to the lowest driving pressure compared with conventional low PEEP level during one-lung ventilation (OLV) in patients undergoing selective lung resection surgery decreases PPCs. METHODS This single-centre, randomised trial approved by the Ethical Committee of the Sun Yat-Sen University Cancer Center involved patients who signed written consent. Patients were randomised to the PEEP titration to the lowest driving pressure group (n = 104), or to the conventional low level of PEEP group (n = 103), consisting a PEEP level of 4 cm H2O during OLV. All patients received volume-controlled ventilation with a tidal volume of 6 mL/kg of predicted body weight. The primary outcome was defined as positive if 4 or more of eight Melbourne Group Scale (MGS) variables developed within the first 3 days after surgery. The incidence of major PPCs occurring during postoperative 7 days was also recorded. RESULTS Among 222 patients who were randomised, 207 (93%) completed the trial (109 men [53%]; mean age, 56.9 years). The primary outcome occurred in 4 of 104 patients (4%) in the PEEP titration to the lowest driving pressure group compared with 13 of 103 patients (13%) in the conventional low level of PEEP group (risk ratio, 0.32 [95% CI, 0.10-0.90]; P = 0.021). CONCLUSIONS Among patients undergoing selective lung surgery, intraoperative OLV with PEEP titration to the lowest driving pressure compared with conventional low PEEP level (4 cm H2O) significantly reduced PPCs within the first 3 postoperative days, however, did not significantly reduce PPCs within the first 7 postoperative days.
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Affiliation(s)
- Junjie Yu
- Department of Anaesthesiology, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
| | - Zhijie Wu
- Department of Anaesthesiology, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China; Department of Anaesthesiology, Chaozhou Central Hospital Affiliated to Southern Medical University, Chaozhou, China
| | - Rui An
- Department of Anaesthesiology, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
| | - Huiting Li
- Department of Anaesthesiology, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
| | - Tianhua Zhang
- Department of Anaesthesiology, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
| | - Wenqian Lin
- Department of Anaesthesiology, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
| | - Hongying Tan
- Department of Anaesthesiology, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China.
| | - Longhui Cao
- Department of Anaesthesiology, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China.
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Eldaabossi S, Al-Ghoneimy Y, Ghoneim A, Awad A, Mahdi W, Farouk A, Soliman H, Kanany H, Antar A, Gaber Y, Shaarawy A, Nabawy O, Atef M, Nour SO, Kabil A. The ARISCAT Risk Index as a Predictor of Pulmonary Complications After Thoracic Surgeries, Almoosa Specialist Hospital, Saudi Arabia. J Multidiscip Healthc 2023; 16:625-634. [PMID: 36910018 PMCID: PMC9999721 DOI: 10.2147/jmdh.s404124] [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: 01/23/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
Background Pulmonary complications after thoracic surgery are common and are associated with prolonged hospital stay, higher costs, and increased mortality. This study aimed to evaluate the value of The Assess Respiratory risk in Surgical Patients in Catalonia (ARISCAT) risk index in predicting pulmonary complications after thoracic surgery. Methods This retrospective study was conducted at Almoosa Specialist Hospital, Saudi Arabia, from August 2016 to August 2019 and included 108 patients who underwent thoracic surgery during the study period. Demographic data, ARISCAT risk index score, length of hospital stay, time of chest tube removal, postoperative complications, and time of discharge were recorded. Results The study involved 108 patients who met the inclusion criteria. Their mean age was 42.5 ± 18.9 years, and most of them were men (67.6%). Comorbid diseases were present in 53.7%, including mainly type 2 diabetes mellitus and hypertension. FEV1% was measured in 58 patients, with a mean of 71.1 ± 7.3%. The mean ARISCAT score was 39.3 ± 12.4 and ranged from 24 to 76, with more than one-third (35.2%) having a high score grade. The most common surgical procedures were thoracotomy in 47.2%, video-assisted thoracoscopic surgery (VATS) in 28.7%, and mediastinoscopy in 17.6%. Postoperative pulmonary complications (PPCs) occurred in 22 patients (20.4%), mainly pneumonia and atelectasis (9.2%). PPCs occurred most frequently during thoracotomy (68.2%), followed by VATS (13.6%), and mediastinoscopy (9.1%). Multinomial logistic regression of significant risk factors showed that lower FEV1% (OR = 0.88 [0.79-0.98]; p=0.017), longer ICU length of stay (OR = 1.53 [1.04-2.25]; p=0.033), a higher ARISCAT score (OR = 1.22 [1.02-1.47]; p=0.040), and a high ARISCAT grade (OR = 2.77 [1.06-7.21]; p=0.037) were significant predictors of the occurrence of postoperative complications. Conclusion ARISCAT scoring system, lower FEV1% score, and longer ICU stay were significant predictors of postoperative complications. In addition, thoracotomy was also found to be associated with PPCs.
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Affiliation(s)
- Safwat Eldaabossi
- Department of Chest Diseases, Al-Azhar University, Cairo, Egypt.,Pulmonology Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Yasser Al-Ghoneimy
- Cardiothoracic Surgery Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Ayman Ghoneim
- Cardiothoracic Surgery Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia.,Department of Cardiothoracic Surgery, Al-Azhar University, Cairo, Egypt
| | - Amgad Awad
- Nephrology Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia.,Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Waheed Mahdi
- Pulmonology Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia.,Cardiothoracic Surgery Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia.,Department of Cardiothoracic Surgery, Al-Azhar University, Cairo, Egypt.,Nephrology Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia.,Department of Internal Medicine, Al-Azhar University, Cairo, Egypt.,Department of Chest Diseases, Banha Faculty of Medicine, Banha, Egypt
| | - Abdallah Farouk
- Critical Care Consultant, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia.,Department of Critical Care, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Hesham Soliman
- Consultant and Chief of Anesthesia, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Hatem Kanany
- Department of Critical Care and Anesthesia, Al-Azhar University, Cairo, Egypt
| | - Ahmad Antar
- Department of Internal Medicine, Hematology-Oncology Section, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Yasser Gaber
- Radiology Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia.,Department of Radiology, Al-Azhar University, Cairo, Egypt
| | - Ahmed Shaarawy
- Department of Chest Diseases, Al-Azhar University, Cairo, Egypt
| | - Osama Nabawy
- Department of Chest Diseases, Al-Azhar University, Cairo, Egypt
| | - Moaz Atef
- Department of Chest Diseases, Al-Azhar University, Cairo, Egypt
| | - Sameh O Nour
- Department of Chest Diseases, Al-Azhar University, Cairo, Egypt
| | - Ahmed Kabil
- Department of Chest Diseases, Al-Azhar University, Cairo, Egypt
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9
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Zheng Y, Mao M, Li F, Wang L, Zhang X, Zhang X, Wang H, Zhou H, Ji M, Wang Y, Liu L, Zhu Q, Reinhardt JD, Lu X. Effects of enhanced recovery after surgery plus pulmonary rehabilitation on complications after video-assisted lung cancer surgery: a multicentre randomised controlled trial. Thorax 2022; 78:574-586. [PMID: 35835552 DOI: 10.1136/thoraxjnl-2021-218183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 05/25/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lung cancer surgery is associated with a high incidence of postoperative pulmonary complications (PPCs). We evaluated whether enhanced recovery after surgery plus pulmonary rehabilitation was superior over enhanced recovery after surgery alone in reducing the incidence of postoperative PPCs and length of hospital stay. METHODS In this pragmatic multicentre, randomised controlled, parallel-group clinical trial, eligible patients scheduled for video-assisted lung cancer surgery were randomly assigned (1:1) to either a newly developed programme that integrated preoperative and postoperative pulmonary rehabilitation components into a generic thoracic enhanced recovery after surgery pathway, or routine thoracic enhanced recovery after surgery. Primary outcome was the overall occurrence of PPCs within 2 weeks after surgery. Secondary outcomes were the occurrence of specific complications, time to removal of chest drain, and length of hospital stay (LOS). RESULTS Of 428 patients scheduled for lung cancer surgery, 374 were randomised with 187 allocated to the experimental programme and 187 to control. Incidence of PPCs at 14 Days was 18.7% (35/187) in the experimental group and 33.2% (62/187) in the control group (intention-to-treat, unadjusted HR 0.524, 95% CI 0.347 to 0.792, p=0.002). Particularly, significant risk reduction was observed regarding pleural effusion, pneumonia and atelectasis. Time to removal of chest drain and LOS were not significantly reduced in the experimental group. CONCLUSIONS Adding pulmonary rehabilitation to enhanced recovery after surgery appears to be effective in reducing the incidence of PPCs, but not LOS. Standard integration of pulmonary rehabilitation into thoracic enhanced recovery after surgery is a promising approach to PPC prophylaxis. TRIAL REGISTRATION NUMBER ChiCTR1900024646.
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Affiliation(s)
- Yu Zheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Mao Mao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Fang Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lu Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.,Department of Rehabilitation Medicine, Qingdao Municipal Hospital Group, Qingdao, Shandong, China
| | - Xintong Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiu Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Haiming Wang
- Department of Rehabilitation Medicine, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Huiqing Zhou
- Department of Rehabilitation Therapy, Taizhou Enze Medical Center, Tai Zhou, Zhejiang, China
| | - Meifang Ji
- Department of Rehabilitation Therapy, the Second Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Yulong Wang
- Department of Rehabilitation Medicine, Shenzhen Dapeng New District Nan'ao People's Hospital, Shenzhen, China
| | - Liang Liu
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, Nanjing, Jiangsu, China
| | - Quan Zhu
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jan D Reinhardt
- Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, Sichuan, China .,Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.,Rehabilitation Research Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiao Lu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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10
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Kerr A, Lugg ST, Kadiri S, Swift A, Efstathiou N, Kholia K, Rogers V, Fallouh H, Steyn R, Bishay E, Kalkat M, Naidu B. Feasibility study of a randomised controlled trial of preoperative and postoperative nutritional supplementation in major lung surgery. BMJ Open 2022; 12:e057498. [PMID: 35768119 PMCID: PMC9240939 DOI: 10.1136/bmjopen-2021-057498] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Malnutrition and weight loss are important risk factors for complications after lung surgery. However, it is uncertain whether modifying or optimising perioperative nutritional state with oral supplements results in a reduction in malnutrition, complications or quality of life. DESIGN A randomised, open label, controlled feasibility study was conducted to assess the feasibility of carrying out a large multicentre randomised trial of nutritional intervention. The intervention involved preoperative carbohydrate-loading drinks (4×200 mL evening before surgery and 2×200 mL the morning of surgery) and early postoperative nutritional protein supplement drinks two times per day for 14 days compared with the control group receiving an equivalent volume of water. SETTING Single adult thoracic centre in the UK. PARTICIPANTS All adult patients admitted for major lung surgery. Patients were included if were able to take nutritional drinks prior to surgery and give written informed consent. Patients were excluded if they were likely unable to complete the study questionnaires, they had a body mass index <18.5 kg/m2, were receiving parenteral nutrition or known pregnancy. RESULTS All patients presenting for major lung surgery were screened over a 6-month period, with 163 patients screened, 99 excluded and 64 (41%) patients randomised. Feasibility criteria were met and the study completed recruitment 5 months ahead of target. The two groups were well balanced and tools used to measure outcomes were robust. Compliance with nutritional drinks was 97% preoperatively and 89% postoperatively; 89% of the questionnaires at 3 months were returned fully completed. The qualitative interviews demonstrated that the trial and the intervention were acceptable to patients. Patients felt the questionnaires captured their experience of recovery from surgery well. CONCLUSION A large multicentre randomised controlled trial of nutritional intervention in major lung surgery is feasible and required to test clinical efficacy in improving outcomes after surgery. TRIAL REGISTRATION NUMBER ISRCTN16535341.
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Affiliation(s)
- Amy Kerr
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sebastian T Lugg
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Salma Kadiri
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Amelia Swift
- Institute of Clinical Sciences and School of Nursing, University of Birmingham, Birmingham, UK
| | - Nikolaos Efstathiou
- Institute of Clinical Sciences and School of Nursing, University of Birmingham, Birmingham, UK
| | - Krishna Kholia
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Venessa Rogers
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Hazem Fallouh
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard Steyn
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ehab Bishay
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Maninder Kalkat
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Babu Naidu
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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11
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Tang W, Qiu Y, Lu H, Xu M, Wu J. Stroke Volume Variation-Guided Goal-Directed Fluid Therapy Did Not Significantly Reduce the Incidence of Early Postoperative Complications in Elderly Patients Undergoing Minimally Invasive Esophagectomy: A Randomized Controlled Trial. Front Surg 2021; 8:794272. [PMID: 34938769 PMCID: PMC8685214 DOI: 10.3389/fsurg.2021.794272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/12/2021] [Indexed: 01/29/2023] Open
Abstract
Study Objective: This study aimed to investigate whether stroke volume variation (SVV)-guided goal-directed therapy (GDT) can improve postoperative outcomes in elderly patients undergoing minimally invasive esophagectomy (MIE) compared with conventional care. Design: A prospective, randomized, controlled study. Setting: A single tertiary care center with a study period from November 2017 to December 2018. Patients: Patients over 65 years old who were scheduled for elective MIE. Interventions: The GDT protocol included a baseline fluid supplement of 7 ml/kg/h Ringer's lactate solution and SVV optimization using colloid boluses assessed by pulse-contour analysis (PiCCO™). When SVV exceeded 11%, colloid was infused at a rate of 50 ml per minute; if SVV returned below 9% for at least 2 minutes, then colloid was stopped. Measurements: The primary outcome was the incidence of postoperative complications before discharge, as assessed using a predefined list, including postoperative anastomotic leakage, postoperative hoarseness, postoperative pulmonary complications, chylothorax, myocardial injury, and all-cause mortality. Main Results: Sixty-five patients were included in the analysis. The incidence of postoperative complications between groups was similar (GDT 36.4% vs. control 37.5%, P = 0.92). The total fluid volume was not significantly different between the two groups (2,192 ± 469 vs. 2,201 ± 337 ml, P = 0.92). Compared with those in the control group (n = 32), patients in the GDT group (n = 33) received more colloids intraoperatively (874 ± 369 vs. 270 ± 67 ml, P <0.05) and less crystalloid fluid (1,318 ± 386 vs. 1,937 ± 334 ml, P <0.05). Conclusion: The colloid-based SVV optimization during GDT did not significantly reduce the incidence of early postoperative complications after minimally invasive esophagectomy in elderly patients. Clinical Trial Number and Registry URL: ChiCTR-INR-17013352; http://www.chictr.org.cn/showproj.aspx?proj=22883
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Affiliation(s)
- Wei Tang
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yuwei Qiu
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Outcomes Research Consortium, Cleveland, OH, United States
| | - Huijie Lu
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Meiying Xu
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jingxiang Wu
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Outcomes Research Consortium, Cleveland, OH, United States
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12
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He J, Ling Q, Chen Y. Construction and Application of a Model for Predicting the Risk of Delirium in Postoperative Patients With Type a Aortic Dissection. Front Surg 2021; 8:772675. [PMID: 34869569 PMCID: PMC8636852 DOI: 10.3389/fsurg.2021.772675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/11/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Postoperative delirium (POD), an alteration in a patient's consciousness pattern, can affect the treatment and prognosis of a disease. Objective: To construct a prediction model for delirium in patients with type A aortic dissection after surgery and to validate its effectiveness. Methods: A retrospective cohort design was used to study 438 patients undergoing surgical treatment for type A aortic dissection from April 2019 to June 2020 in tertiary care hospitals. POD (n = 78) and non-delirium groups (n = 360) were compared and analyzed for each index in the perioperative period. A prediction model was established using multifactorial logistic regression, and 30 patients' perioperative data were collected for model validation. Results: Eight predictors were included in this study: smoking, diabetes, previous cardiovascular surgery, ejection fraction (EF), time to aortic block, acute kidney injury, low cardiac output syndrome, and pulmonary complications. The area under the receiver operating characteristic (ROC) curve of the constructed prediction model was 0.98 ± 0.005, and the Youden index was 0.91. The validation results showed 97% sensitivity, 100% specificity, and 93% accuracy. The expression of the model was Z = Smoking assignment* – 2.807 – 6.009*Diabetes assignment – 2.994*Previous cardiovascular surgery assignment – 0.129*Ejection fraction assignment + 0.071*Brain perfusion time assignment – 2.583*Acute kidney injury assignment – 2.916*Low cardiac output syndrome assignment – 3.461*Pulmonary related complications assignment + 20.576. Conclusion: The construction of an effective prediction model for the risk of delirium in patients after type A aortic stratification can help identify patients at high risk of POD early. It also provides a reference for healthcare professionals in the prevention and care of these patients.
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Affiliation(s)
- Junfeng He
- Department of Nursing, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Qing Ling
- Department of Nursing, Nanjing First Hospital, Nanjing, China
| | - Yuhong Chen
- Department of Nursing, Nanjing First Hospital, Nanjing, China
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13
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D'Arx A, Freene N, Bowen S, Bissaker P, McKay G, Bissett B. What is the prevalence of inspiratory muscle weakness in preoperative cardiac surgery patients? An observational study. Heart Lung 2020; 49:909-914. [PMID: 32703620 DOI: 10.1016/j.hrtlng.2020.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/21/2020] [Accepted: 06/24/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND In patients undergoing elective cardiac surgery, the prevalence of inspiratory muscle weakness is not well-understood. This information could guide pre-operative therapy. OBJECTIVES To determine the prevalence of inspiratory muscle weakness in preoperative cardiac surgery patients, and describe relationships between pre-operative factors (including maximal inspiratory pressure, MIP) and post-operative pulmonary complications (PPCs). METHODS Prospective study of elective cardiac surgery patients. Pre-operative MIP was measured (cmH2O) and PPC data were extracted from medical records (Melbourne Group Score) while age, height, weight, frailty and physical activity levels were captured via questionnaire. Backwards-stepwise logistic regression was used to describe associations. RESULTS 24 participants were recruited (79% male, age 70 ± 10.7, BMI 26.8 ± 4.14). The prevalence of inspiratory muscle weakness (MIP < 60% predicted) was 25% (n = 6). PPCs were associated with body mass index (BMI) (r = 0.464, p = 0.022). CONCLUSION The prevalence of pre-operative inspiratory muscle weakness was 25%. BMI may be an important determinant of PPCs in elective cardiac surgery patients.
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Affiliation(s)
- Ashleigh D'Arx
- Discipline of Physiotherapy, University of Canberra, Faculty of Health, Bruce, ACT, Australia
| | - Nicole Freene
- Discipline of Physiotherapy, University of Canberra, Faculty of Health, Bruce, ACT, Australia
| | - Sarah Bowen
- National Capital Private Hospital, Garran, ACT, Australia
| | - Peter Bissaker
- National Capital Private Hospital, Garran, ACT, Australia; Canberra Hospital, Garran, ACT, Australia
| | - Glenn McKay
- National Capital Private Hospital, Garran, ACT, Australia; Canberra Hospital, Garran, ACT, Australia
| | - Bernie Bissett
- Discipline of Physiotherapy, University of Canberra, Faculty of Health, Bruce, ACT, Australia; Canberra Hospital, Garran, ACT, Australia.
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14
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Shaw LM, Iseli TA, Wiesenfeld D, Ramakrishnan A, Granger CL. Postoperative pulmonary complications following major head and neck cancer surgery. Int J Oral Maxillofac Surg 2020; 50:302-308. [PMID: 32682644 DOI: 10.1016/j.ijom.2020.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 04/16/2020] [Accepted: 06/22/2020] [Indexed: 11/19/2022]
Abstract
The primary aim of this observational study was to describe the incidence of postoperative pulmonary complications (PPCs) in 60 consecutive, surgically treated head and neck cancer patients requiring free flap reconstruction and tracheostomy, using both a prospective and a retrospective outcome measure. Secondary aims were to identify risk factors for PPC development, explore the effects of PPC on outcomes, and describe the provision of postoperative physiotherapy in this population. Postoperative pulmonary complications occurred in nine (15%) patients based on the Melbourne Group Scale and 27 (45%) patients based on Health Information Service coding data. The occurrence of a PPC was not statistically correlated with age, smoking history, comorbidities, operative time, or type of resection or free flap. Patients who developed a PPC, compared to those who did not, had a higher preoperative body mass index (P=0.022) and were more likely to be sat out of bed earlier post-surgery (P=0.038). Overall, patients required a median of 9.0 (interquartile range 7.0-11.0) physiotherapy sessions. Patients developing a PPC required significantly more physiotherapy sessions (P=0.007) and additional days of supplemental oxygen (P=0.022) as compared to those without a PPC, despite a similar hospital length of stay. In future, targeted physiotherapy interventions may reduce PPCs in this population.
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Affiliation(s)
- L M Shaw
- Department of Allied Health (Physiotherapy), The Royal Melbourne Hospital, Parkville, Victoria, Australia.
| | - T A Iseli
- Head and Neck Tumour Stream, Department of Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
| | - D Wiesenfeld
- Head and Neck Tumour Stream, Department of Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
| | - A Ramakrishnan
- Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia; Department of Plastic and Reconstructive Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - C L Granger
- Department of Allied Health (Physiotherapy), The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia
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15
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Boujibar F, Gillibert A, Gravier FE, Gillot T, Bonnevie T, Cuvelier A, Baste JM. Performance at stair-climbing test is associated with postoperative complications after lung resection: a systematic review and meta-analysis. Thorax 2020; 75:791-797. [PMID: 32651199 PMCID: PMC7476257 DOI: 10.1136/thoraxjnl-2019-214019] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 05/15/2020] [Accepted: 06/05/2020] [Indexed: 12/25/2022]
Abstract
Background Thoracic surgery is the optimal treatment for early-stage lung cancer, but there is a high risk of postoperative morbidity. Therefore, it is necessary to evaluate patients’ preoperative general condition and cardiorespiratory capacity to determine the risk of postoperative complications. The objective of this study was to assess whether the stair-climbing test could be used in the preoperative evaluation of lung resection patients to predict postoperative morbidity following thoracic surgery. Methods We performed a systematic review and a meta-analysis on the association between stair-climbing test result and morbidity/mortality after thoracic surgery. We analysed all articles published until May 2020 in the following databases: Pubmed/Medline, Pedro, The Cochrane library, Embase and CINAHL. The risk of bias was assessed using the Quality in Prognosis Studies tool. This meta-analysis is registered as PROSPERO CRD42019121348. Results 13 articles were included in the systematic review for a total of 2038 patients and 6 in the meta-analysis. There were multiple test evaluation criteria: rise time, height, desaturation and heart rate change. For the meta-analysis, we were able to pool data on the height of rise at a variable threshold: risk ratio 2.34 (95% CI 1.59 to 3.43) with I²=53% (p=0.06). The threshold for occurrence of complications was estimated at a 10 m climb. Conclusions Our results indicate that the stair-climbing test could be used as a first-line functional screening test to predict postoperative morbidity following thoracic surgery and that patients with a poor test result (<10 m) should be referred to formal cardiopulmonary exercise testing.
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Affiliation(s)
- Fairuz Boujibar
- Department of General and Thoracic Surgery, CHU Rouen, Rouen, France .,Normandie University UNIROUEN, INSERM U1096, Rouen, France
| | | | - Francis Edouard Gravier
- ADIR Association, Bois Guillaume, France.,Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France
| | - Timothée Gillot
- CETAPS EA 3832, Mont Saint Aignan, France.,ERFPS, CHU Rouen, Rouen, France
| | - Tristan Bonnevie
- ADIR Association, Bois Guillaume, France.,Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France
| | - Antoine Cuvelier
- Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France.,Pulmonary & Respiratory Intensive Care Department, CHU Rouen, Rouen, Normandie, France
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, CHU Rouen, Rouen, France.,Normandie University UNIROUEN, INSERM U1096, Rouen, France
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16
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Park M, Ahn HJ, Kim JA, Yang M, Heo BY, Choi JW, Kim YR, Lee SH, Jeong H, Choi SJ, Song IS. Driving Pressure during Thoracic Surgery: A Randomized Clinical Trial. Anesthesiology 2020; 130:385-393. [PMID: 30664548 DOI: 10.1097/aln.0000000000002600] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
WHAT WE ALREADY KNOW ABOUT THIS TOPIC Driving pressure (plateau minus end-expiratory airway pressure) is a target in patients with acute respiratory distress syndrome, and is proposed as a target during general anesthesia for patients with normal lungs. It has not been reported for thoracic anesthesia where isolated, inflated lungs may be especially at risk. WHAT THIS ARTICLE TELLS US THAT IS NEW In a double-blinded, randomized trial (292 patients), minimized driving pressure compared with standard protective ventilation was associated with less postoperative pneumonia or acute respiratory distress syndrome. BACKGROUND Recently, several retrospective studies have suggested that pulmonary complication is related with driving pressure more than any other ventilatory parameter. Thus, the authors compared driving pressure-guided ventilation with conventional protective ventilation in thoracic surgery, where lung protection is of the utmost importance. The authors hypothesized that driving pressure-guided ventilation decreases postoperative pulmonary complications more than conventional protective ventilation. METHODS In this double-blind, randomized, controlled study, 292 patients scheduled for elective thoracic surgery were included in the analysis. The protective ventilation group (n = 147) received conventional protective ventilation during one-lung ventilation: tidal volume 6 ml/kg of ideal body weight, positive end-expiratory pressure (PEEP) 5 cm H2O, and recruitment maneuver. The driving pressure group (n = 145) received the same tidal volume and recruitment, but with individualized PEEP which produces the lowest driving pressure (plateau pressure-PEEP) during one-lung ventilation. The primary outcome was postoperative pulmonary complications based on the Melbourne Group Scale (at least 4) until postoperative day 3. RESULTS Melbourne Group Scale of at least 4 occurred in 8 of 145 patients (5.5%) in the driving pressure group, as compared with 18 of 147 (12.2%) in the protective ventilation group (P = 0.047, odds ratio 0.42; 95% CI, 0.18 to 0.99). The number of patients who developed pneumonia or acute respiratory distress syndrome was less in the driving pressure group than in the protective ventilation group (10/145 [6.9%] vs. 22/147 [15.0%], P = 0.028, odds ratio 0.42; 95% CI, 0.19 to 0.92). CONCLUSIONS Application of driving pressure-guided ventilation during one-lung ventilation was associated with a lower incidence of postoperative pulmonary complications compared with conventional protective ventilation in thoracic surgery.
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Affiliation(s)
- MiHye Park
- From the Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine in Seoul, Korea (M.P., H.J.A., J.A.K., M.Y., B.Y.H., J.W.C., Y.R.K., S.H.L., H.J., S.J.C., I.S.S.) Kangwon National University School of Graduate Medicine in Chuncheon, Korea (M.P.)
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17
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Lockstone J, Parry SM, Denehy L, Robertson IK, Story D, Parkes S, Boden I. Physiotherapist administered, non-invasive ventilation to reduce postoperative pulmonary complications in high-risk patients following elective upper abdominal surgery; a before-and-after cohort implementation study. Physiotherapy 2020; 106:77-86. [DOI: 10.1016/j.physio.2018.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 12/01/2018] [Indexed: 11/29/2022]
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18
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Zheng Y, Mao M, Ji M, Zheng Q, Liu L, Zhao Z, Wang H, Wei X, Wang Y, Chen J, Zhou H, Liang Q, Chen Y, Zhang X, Wang L, Cheng Y, Zhang X, Teng M, Lu X. Does a pulmonary rehabilitation based ERAS program (PREP) affect pulmonary complication incidence, pulmonary function and quality of life after lung cancer surgery? Study protocol for a multicenter randomized controlled trial. BMC Pulm Med 2020; 20:44. [PMID: 32070326 PMCID: PMC7029521 DOI: 10.1186/s12890-020-1073-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 01/31/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Lung cancer surgery is associated with a high incidence of postoperative pulmonary complications (PPCs). Preliminary evidence suggests that ERAS processes can reduce overall incidence of PPCs as short- and long-term recovery improved by supporting units to adopt evidence-based care. However, the evidence is inconclusive due to insufficient high-level studies in this research field. No well-designed, adequately powered, randomized controlled trials (RCTs) have investigated the effects of pulmonary rehabilitation based ERAS program (PREP) on post-operative pulmonary complications, pulmonary function, and health related quality of life following lung cancer surgery. METHODS The PREP trial is a pragmatic, investigator-initiated, multi-center, randomized controlled, parallel group, clinical trial. Five hundred patients scheduled for minimally invasive pulmonary resection at six hospitals in China will be randomized with concealed allocation to receive either i) a pre-operative assessment and an information booklet or ii) a pre-operative assessment, an information booklet, plus an additional education, a 30-min pulmonary rehabilitation training session and the post-operative pulmonary rehabilitation program. The primary outcome is incidence of PPCs defined with the Melbourne Group Scale diagnostic scoring tool. Secondary outcomes include incidence of cardiopulmonary and other complications, pulmonary function, cardiopulmonary endurance, muscle strength, activity level, health-related quality of life (HRQoL), pre- and post-operative hospital length of stay (LOS), and total hospital LOS. DISCUSSION The PREP trial is designed to verify the hypothesis that pulmonary rehabilitation based ERAS program reduces incidence of PPCs and improves pulmonary function and HRQoL in patients following lung cancer surgery. This trial will furthermore contribute significantly to the limited knowledge about the pulmonary rehabilitation based ERAS program following lung cancer surgery, and may thereby form the basis of future recommendations in the surgical community. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR1900024646, 21 July 2019.
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Affiliation(s)
- Yu Zheng
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Mao Mao
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Meifang Ji
- Department of Rehabilitation Therapy, the Second Affiliated Hospital of Hainan Medical University, No. 368 Yehai Road, Haikou, 570100, China
| | - Qiugang Zheng
- Department of Rehabilitation Therapy, the Second Affiliated Hospital of Hainan Medical University, No. 368 Yehai Road, Haikou, 570100, China
| | - Liang Liu
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, China
| | - Zhigang Zhao
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, China
| | - Haiming Wang
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Zhengzhou University, No. 1 East of Jianshe Road, Zhengzhou, 450052, China
| | - Xiangyang Wei
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Zhengzhou University, No. 1 East of Jianshe Road, Zhengzhou, 450052, China
| | - Yulong Wang
- Department of Rehabilitation Medicine, Shenzhen Dapeng New District Nan'ao People's Hospital, No. 6 Renmin Road, Dapeng New District, Shenzhen, 518000, China
| | - Jiamin Chen
- Department of Rehabilitation Medicine, Shenzhen Dapeng New District Nan'ao People's Hospital, No. 6 Renmin Road, Dapeng New District, Shenzhen, 518000, China
| | - Huiqing Zhou
- Department of Rehabilitation Therapy, Taizhou Enze Medical Center, Enze Hospital, No. 1 East of Tongyang Road, Taizhou, 318050, China
| | - Qiaoqiao Liang
- Department of Rehabilitation Therapy, Taizhou Enze Medical Center, Enze Hospital, No. 1 East of Tongyang Road, Taizhou, 318050, China
| | - Ying Chen
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Xintong Zhang
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Lu Wang
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Yihui Cheng
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Xiu Zhang
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Meiling Teng
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Xiao Lu
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China.
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19
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Laurent H, Aubreton S, Galvaing G, Pereira B, Merle P, Richard R, Costes F, Filaire M. Preoperative respiratory muscle endurance training improves ventilatory capacity and prevents pulmonary postoperative complications after lung surgery. Eur J Phys Rehabil Med 2020; 56:73-81. [DOI: 10.23736/s1973-9087.19.05781-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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20
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Soares SMDTP, Nucci LB. Association between early pulmonary complications after abdominal surgery and preoperative physical capacity. Physiother Theory Pract 2019; 37:835-843. [PMID: 31402737 DOI: 10.1080/09593985.2019.1650404] [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: 10/26/2022]
Abstract
Objective: To investigate whether early postoperative pulmonary complications after abdominal surgery are associated with a lower performance in preoperative six-minute walk test.Methods: A cross-sectional cohort study of 50 participants who underwent elective abdominal surgery and performed the six-minute walk test within 48 hours prior to surgery were conducted. Postoperative pulmonary complications up to the seventh postoperative day were obtained from medical records.Results: Overall, 25 participants developed postoperative pulmonary complications. The mean (standard deviation) preoperative walked distances of the participants with and without postoperative pulmonary complications were, respectively, 444.8 (81.3) meters and 498.3 (63.7) meters (p = .013). The incidence of postoperative pulmonary complications was greater in the participants with walked distance < 400 meters. The multivariable logistic regression model revealed a significant association between postoperative pulmonary complications and preoperative walked distance (Odds ratio = 0.978, p = .010) in participants who underwent intestinal, stomach, or bile tract resection. Conclusions: This study found a high incidence of postoperative pulmonary complications in abdominal surgery participants and an association between lower preoperative physical capacity and the risk of postoperative pulmonary complications in participants who underwent intestinal, stomach, and biliary tract resection.
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Affiliation(s)
| | - Luciana Bertoldi Nucci
- Health Science Postgraduate Program, Life Sciences Centre, Pontifical Catholic University of Campinas, Campinas-São Paulo, Brazil
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Oswald N, Halle-Smith J, Kerr A, Webb J, Agostini P, Bishay E, Kalkat M, Steyn R, Naidu B. Perioperative immune function and pain control may underlie early hospital readmission and 90 day mortality following lung cancer resection: A prospective cohort study of 932 patients. Eur J Surg Oncol 2019; 45:863-869. [PMID: 30795954 DOI: 10.1016/j.ejso.2019.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 01/06/2019] [Accepted: 02/01/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Mortality following lung cancer resection has been shown to double between 30 and 90 days and readmission following surgery is associated with an increased risk of mortality. The aim of this study was to describe the causes of readmission and mortality and enable the identification of potentially modifiable factors associated with these events. METHODS Prospective cohort study at a United Kingdom tertiary referral centre conducted over 55 months. Binary logistic regression was used to identify factors associated with death within 90 days of surgery. RESULTS The 30 day and 90 day mortality rates were 1.4% and 3.3% respectively. The most common causes of death were pneumonia, lung cancer and Acute Respiratory Distress Syndrome/Multi Organ Failure. Potentially modifiable risk factors for death identified were: Postoperative pulmonary complications (Odds ratio 6.1), preoperative lymphocyte count (OR 0.25), readmission within 30 days (OR 4.2) and type of postoperative analgesia (OR for intrathecal morphine 4.8). The most common causes of readmission were pneumonia, shortness of breath and pain. CONCLUSIONS Postoperative mortality is not simply due to fixed factors; the impacts of age, gender and surgical procedure on postoperative survival are reduced when the postoperative course of recovery is examined. Perioperative immune function, as portrayed by the occurrence of infection and lower lymphocyte count in the immediate perioperative period, and pain control method are strongly associated with 90 day mortality; further studies in these fields are indicated as are studies of psychological factors in recovery. CLINICAL REGISTRATION NUMBER ISRCTN00061628.
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Affiliation(s)
- Nicola Oswald
- University of Birmingham, Birmingham, United Kingdom; Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Amy Kerr
- Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Joanne Webb
- Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Paula Agostini
- Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Ehab Bishay
- Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Maninder Kalkat
- Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Richard Steyn
- Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Babu Naidu
- University of Birmingham, Birmingham, United Kingdom; Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
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22
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Intraoperative use of dexmedetomidine for the prevention of emergence agitation and postoperative delirium in thoracic surgery: a randomized-controlled trial. Can J Anaesth 2019; 66:371-379. [DOI: 10.1007/s12630-019-01299-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/27/2018] [Accepted: 10/10/2018] [Indexed: 12/16/2022] Open
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Video-assisted thoracoscopic lobectomy: which patients require postoperative physiotherapy? Physiotherapy 2019; 106:87-93. [PMID: 31000366 DOI: 10.1016/j.physio.2019.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 01/04/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Following major thoracic surgery physiotherapy is recommended to improve reduced lung volume, aid secretion clearance, and improve mobility, however, in many centres physiotherapy provision is variable following minimally invasive video-assisted thoracoscopic surgery (VATS). The objective of this study was to observe frequency of problems potentially amenable to physiotherapy following VATS lobectomy, and to identify associated baseline factors of patients in whom physiotherapy may be beneficial. METHODS A prospective observational study was performed including all consecutive cancer patients undergoing VATS lobectomy in a regional centre over 4years (2012-2016). Standard postoperative care included early mobilisation by nursing staff from postoperative day one (POD1). Physiotherapy assessment of all patients on POD1 determined presence of issues potentially amenable to physiotherapy intervention, and treatment was commenced. Outcome measures included postoperative pulmonary complication (PPC) development, hospital and high dependency unit (HDU) length of stay (LOS). RESULTS Of 285 patients, 209 (73%) received physiotherapy to assist/improve reduced mobility, of these 23 (8%) also received sputum clearance therapies and 65 (23%) specific therapy for lung volume loss. The remaining 76 (27%) patients had significantly lower hospital/HDU LOS (P<0.001) reflecting uncomplicated recovery. Chronic obstructive pulmonary disease (COPD), body mass index (BMI), preoperative mobility and age were independently associated with issues potentially amenable to physiotherapy (P=0.013). CONCLUSION Following VATS lobectomy a large proportion of patients demonstrated issues potentially amenable to physiotherapy. The authors recommend that patients receive routine physiotherapy assessment following this type of surgery to ensure that all issues are identified early. Screening of COPD, BMI, preoperative mobility and age will allow early identification of patients who may benefit most from postoperative physiotherapy and preoperative optimisation, however, these factors cannot predict the need for physiotherapy.
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Lockstone J, Boden I, Robertson IK, Story D, Denehy L, Parry SM. Non-Invasive Positive airway Pressure thErapy to Reduce Postoperative Lung complications following Upper abdominal Surgery (NIPPER PLUS): protocol for a single-centre, pilot, randomised controlled trial. BMJ Open 2019; 9:e023139. [PMID: 30782696 PMCID: PMC6340066 DOI: 10.1136/bmjopen-2018-023139] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 08/18/2018] [Accepted: 11/23/2018] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Postoperative pulmonary complications (PPCs) are a common serious complication following upper abdominal surgery leading to significant consequences including increased mortality, hospital costs and prolonged hospitalisation. The primary objective of this study is to detect whether there is a possible signal towards PPC reduction with the use of additional intermittent non-invasive ventilation (NIV) compared with continuous high-flow nasal oxygen therapy alone following high-risk elective upper abdominal surgery. Secondary objectives are to measure feasibility of: (1) trial conduct and design and (2) physiotherapy-led NIV and a high-flow nasal oxygen therapy protocol, safety of NIV and to provide preliminary costs of care information of NIV and high-flow nasal oxygen therapy. METHODS AND ANALYSIS This is a single-centre, parallel group, assessor blinded, pilot, randomised trial, with 130 high-risk upper abdominal surgery patients randomly assigned via concealed allocation to either (1) usual care of continuous high-flow nasal oxygen therapy for 48 hours following extubation or (2) usual care plus five additional 30 min physiotherapy-led NIV sessions within the first two postoperative days. Both groups receive standardised preoperative physiotherapy and postoperative early ambulation. No additional respiratory physiotherapy is provided to either group. Outcome measures will assess incidence of PPC within the first 14 postoperative days, recruitment ability, physiotherapy-led NIV and high-flow nasal oxygen therapy protocol adherence, adverse events relating to NIV delivery and costs of providing a physiotherapy-led NIV and a high-flow nasal oxygen therapy service following upper abdominal surgery. ETHICS AND DISSEMINATION Ethics approval has been obtained from the relevant institution and results will be published to inform future multicentre trials. TRIAL REGISTRATION NUMBER ACTRN12617000269336; Pre-results.
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Affiliation(s)
- Jane Lockstone
- Department of Physiotherapy, Launceston General Hospital, Launceston, Tasmania, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ianthe Boden
- Department of Physiotherapy, Launceston General Hospital, Launceston, Tasmania, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Iain K Robertson
- School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - David Story
- Anaesthesia Perioperative and Pain Medicine Unit, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Selina M Parry
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
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Shyamsundar M, O'Kane C, Perkins GD, Kennedy G, Campbell C, Agus A, Phair G, McAuley D. Prevention of post-operative complications by using a HMG-CoA reductase inhibitor in patients undergoing one-lung ventilation for non-cardiac surgery: study protocol for a randomised controlled trial. Trials 2018; 19:690. [PMID: 30563555 PMCID: PMC6299644 DOI: 10.1186/s13063-018-3078-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 11/24/2018] [Indexed: 11/10/2022] Open
Abstract
Background Postoperative pulmonary complications (PPC) and peri-operative myocardial infarction (MI) have a significant impact on the long-term mortality of surgical patients. Patients undergoing one-lung ventilation (OLV) for surgery are at a high risk of developing these complications. These complications could be associated with intensive care unit (ICU) admissions and longer hospital stay with associated resource and economic burden. Simvastatin, a HMG-CoA reductase enzyme inhibitor has been shown to have pleiotropic anti-inflammatory effects as well as being endothelial protective. The benefits of statins have been shown in various observational studies and in small proof-of-concept studies. There is an urgent need for a well-designed, large clinical trial powered to detect clinical outcomes. The Prevention HARP 2 trial will test the hypothesis ‘simvastatin 80 mg when compared to placebo will reduce cardiac and pulmonary complications in patients undergoing elective oesophagectomy, lobectomy or pneumonectomy’. Methods/design The Prevention HARP 2 trial is a UK multi-centre, randomised, double-blind, placebo-controlled trial. Adult patients undergoing elective oesophagectomy, lobectomy or pneumonectomy will be eligible. Patients who are already on statins will be excluded from this trial. Patients will be randomised to receive simvastatin 80 mg or matched placebo for 4 days pre surgery and for up to 7 days post surgery. The primary outcome is a composite outcome of PPC and MI within 7 days post surgery. Various secondary outcome measures including clinical outcomes, safety outcomes and health economic outcomes will be collected. The study aims to recruit 452 patients in total across 12 UK sites. Discussion The results of the Prevention HARP 2 trial should add to our understanding of the benefits of peri-operative statins and influence clinical decision-making. Analysis of blood and urine samples from the patients will provide insight into the mechanism of simvastatin action. Trial registration International Standard Randomised Controlled Trials registry, ID: ISRCTN48095567. Registered on 11 November 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-3078-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Murali Shyamsundar
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, BT9 7BL, UK.
| | - Cecilia O'Kane
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, BT9 7BL, UK
| | - Gavin D Perkins
- Warwick Trials Unit, University of Warwick, Coventry, CV4 7AL, UK
| | - Gavin Kennedy
- Northern Ireland Clinical Trials Unit, 1st Floor Elliott Dynes Building, Royal Hospitals, Belfast, BT12 6BA, UK
| | - Christina Campbell
- Northern Ireland Clinical Trials Unit, 1st Floor Elliott Dynes Building, Royal Hospitals, Belfast, BT12 6BA, UK
| | - Ashley Agus
- Northern Ireland Clinical Trials Unit, 1st Floor Elliott Dynes Building, Royal Hospitals, Belfast, BT12 6BA, UK
| | - Glenn Phair
- Northern Ireland Clinical Trials Unit, 1st Floor Elliott Dynes Building, Royal Hospitals, Belfast, BT12 6BA, UK
| | - Danny McAuley
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, BT9 7BL, UK
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N-Acetylcysteine inhalation improves pulmonary function in patients received liver transplantation. Biosci Rep 2018; 38:BSR20180858. [PMID: 30217943 PMCID: PMC6165840 DOI: 10.1042/bsr20180858] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/02/2018] [Accepted: 09/12/2018] [Indexed: 02/08/2023] Open
Abstract
Postoperative pulmonary complications (PPCs) following orthotopic liver transplantation (OLT) are associated with high morbidity and mortality rates. The effect of N-acetylcysteine (NAC) inhalation on the incidence of PPCs and the outcomes of patients undergoing OLT is unknown. This prospective randomized controlled clinical trial was conducted to investigate the effect of NAC inhalation during OLT on PPCs. Sixty patients were randomly assigned to the NAC group (n = 30) or the control group (n = 30) to receive inhaled NAC or sterilized water, respectively, for 30 min before surgery and 3 h after reperfusion. The incidence of early PPCs and outcomes including survival rate were assessed. Biomarkers including tumor necrosis factor (TNF)-α, interleukin (IL)-8, Clara cell secretory protein (CC16), intercellular adhesion molecule (ICAM)-1, and superoxide dismutase (SOD) were measured in exhaled breath condensate (EBC) at T1 (before surgery) and T2 (at the end of operation) as well as in serum at T1, T2, T3 (12 h after operation), and T4 (24 h after operation). A total of 42 patients (20 in the NAC group and 22 in the control group) were enrolled in the final analysis. Atomization inhaled NAC significantly reduced the incidence of PPCs after OLT. The levels of TNF-α, IL-8, CC16, and ICAM-1 in EBC were significantly lower, and SOD activity was higher, at T2 in the NAC group; similar data were found in serum at T2, T3, and T4. In summary, perioperative NAC inhalation may reduce the incidence of PPCs and improve patient outcomes after OLT.
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Boden I, Sullivan K, Hackett C, Winzer B, Lane R, McKinnon M, Robertson I. ICEAGE (Incidence of Complications following Emergency Abdominal surgery: Get Exercising): study protocol of a pragmatic, multicentre, randomised controlled trial testing physiotherapy for the prevention of complications and improved physical recovery after emergency abdominal surgery. World J Emerg Surg 2018; 13:29. [PMID: 29988707 PMCID: PMC6029354 DOI: 10.1186/s13017-018-0189-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 06/22/2018] [Indexed: 02/06/2023] Open
Abstract
Background Postoperative complications and delayed physical recovery are significant problems following emergency abdominal surgery. Physiotherapy aims to aid recovery and prevent complications in the acute phase after surgery and is commonplace in most first-world hospitals. Despite ubiquitous service provision, no well-designed, adequately powered, parallel-group, randomised controlled trial has investigated the effect of physiotherapy on the incidence of respiratory complications, paralytic ileus, rate of physical recovery, ongoing need for formal sub-acute rehabilitation, hospital length of stay, health-related quality of life, and mortality following emergency abdominal surgery. We hypothesise that an enhanced physiotherapy care package of additional education, breathing exercises, and early rehabilitation prevents postoperative complications and improves physical recovery following emergency abdominal surgery compared to standard care alone. Methods The Incidence of Complications following Emergency Abdominal surgery: Get Exercising (ICEAGE) trial is a pragmatic, investigator-initiated, multicentre, patient- and assessor-blinded, parallel-group, active-placebo controlled randomised trial, powered for superiority. ICEAGE will compare standard care physiotherapy to an enhanced physiotherapy care package in 288 participants admitted for emergency abdominal surgery at three Australian hospitals. Participants will be randomised using concealed allocation to receive either standard care physiotherapy (education, single session of coached breathing exercises, and daily early ambulation for 15 min) or an enhanced physiotherapy care package (education, twice daily coached breathing exercises for a minimum 2 days, and 30 min of daily supervised early rehabilitation for minimum five postoperative days). The primary outcome is a respiratory complication within the first 14 postoperative hospital days assessed daily with standardised diagnostic criteria. Secondary outcomes include referral for sub-acute rehabilitation services, discharge destination, paralytic ileus, hospital length of stay and costs, intensive care unit utilisation, 90-day patient-reported complications and health-related quality of life and physical capacity, and mortality at 30 days and at 1 year following surgery. Discussion The morbidity, mortality, and fiscal burdens following emergency abdominal surgery are some of the worst within surgery. Physiotherapy may be an effective, low-cost, minimal harm intervention to improve outcomes and reduce hospital utilisation following this surgery type. ICEAGE will test the benefits of this commonly provided intervention within a methodologically robust, multicentre, double-blinded, active-placebo controlled randomised trial. Trial registration ACTRN 12615000318583. Registered 8 April 2015 Electronic supplementary material The online version of this article (10.1186/s13017-018-0189-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ianthe Boden
- 1Physiotherapy Department, Launceston General Hospital, Charles St, Launceston, Tasmania 7250 Australia.,2Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria 3052 Australia
| | - Kate Sullivan
- 1Physiotherapy Department, Launceston General Hospital, Charles St, Launceston, Tasmania 7250 Australia.,3School of Primary Health Care, Faculty of Nursing, Medicine and Health Science, Monash University, Frankston, Victoria 3199 Australia
| | - Claire Hackett
- 4Department of Physiotherapy, Princess Alexandra Hospital, Woolloongabba, Queensland 4102 Australia
| | - Brooke Winzer
- Physiotherapy Department, Northeast Health Wangaratta, Green Street, Wangaratta, Victoria 3677 Australia
| | - Rebecca Lane
- 6School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Ballarat, Victoria 3350 Australia
| | - Melissa McKinnon
- 4Department of Physiotherapy, Princess Alexandra Hospital, Woolloongabba, Queensland 4102 Australia
| | - Iain Robertson
- 7Biostatistician, Clifford Craig Foundation, Launceston General Hospital, Charles Street, Launceston, Tasmania 7250 Australia.,8College of Health Sciences, University of Tasmania, Locked Bag 1320, Launceston, Tasmania 7250 Australia
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Li X, Chen C, Wei X, Zhu Q, Yao W, Yuan D, Luo G, Cai J, Hei Z. Retrospective Comparative Study on Postoperative Pulmonary Complications After Orthotopic Liver Transplantation Using the Melbourne Group Scale (MGS-2) Diagnostic Criteria. Ann Transplant 2018; 23:377-386. [PMID: 29853713 PMCID: PMC6248093 DOI: 10.12659/aot.907883] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Postoperative pulmonary complications (PPCs) after orthotopic liver transplantation (OLT) are associated with poor postoperative survival. However, there are no standard criteria for diagnosis of PPCs. This retrospective study aimed to explore the reliability of the Melbourne Group Scale version 2 (MGS-2) for determining PPCs after OLT. Material/Methods A total of 121 patients were divided into 3 groups. In the PPC and non-PPC groups, PPCs were determined to be present or absent in accordance with both the MGS-2 and the conventional broad criteria for diagnosis of PPCs; in the potential-PPC group, PPCs were determined to be present only in accordance with the conventional broad criteria. The perioperative risk factors for PPCs and prognosis of patients in potential-PPC group were all compared with non-PPC groups and PPC groups. Results The preoperative characteristics of patients in the potential-PPC group were similar to those in non-PPC group. The length of intensive care unit stay (2.26±0.22 vs. 4.75±0.47 days; P=0.017), duration of hospitalization (33.33±1.70 vs. 48.78±2.53 days; P<0.001), and treatment cost (28.01±1.78 vs. 38.35±1.85×10 000 yuan; P=0.018) were significantly less in the potential-PPC group than in the PPC group. Furthermore, in accordance with the MGS-2 criteria for diagnosis of PPCs, patients with PPCs showed poorer overall survival rates than those without (P=0.038). Conclusions The MGS-2 appears to be a more suitable and reliable tool for diagnosis of PPCs and to identify the post-OLT patients with poorer perioperative characteristics and prognosis.
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Affiliation(s)
- Xiaoyun Li
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Chaojin Chen
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Xiaoxia Wei
- Department of Anesthesiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China (mainland)
| | - Qianqian Zhu
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Nanning, Guangxi, China (mainland)
| | - Weifeng Yao
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Dongdong Yuan
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Gangjian Luo
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Jun Cai
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Ziqing Hei
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
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29
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Agostini PJ, Lugg ST, Adams K, Smith T, Kalkat MS, Rajesh PB, Steyn RS, Naidu B, Rushton A, Bishay E. Risk factors and short-term outcomes of postoperative pulmonary complications after VATS lobectomy. J Cardiothorac Surg 2018; 13:28. [PMID: 29673386 PMCID: PMC5909249 DOI: 10.1186/s13019-018-0717-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 04/05/2018] [Indexed: 11/25/2022] Open
Abstract
Background Postoperative pulmonary complications (PPCs) are associated with poor outcomes following thoracotomy and lung resection. Video-assisted thoracoscopic surgery (VATS) for lobectomy is now frequently utilised as an alternative to thoracotomy, however patients remain at risk for development of PPC. There is little known of the short-term outcome associated with PPC following VATS lobectomy and if there are any potential risk factors that could be modified to prevent PPC development; our study aimed to investigate this. Methods A prospective observational study of consecutive patients undergoing VATS lobectomy for lung cancer over a 4-year period in a regional centre was performed (2012–2016). Exclusion criteria included re-do VATS or surgery for pulmonary infection. All patients received physiotherapy as necessary from postoperative day 1 (POD1) and PPC was determined using the Melbourne Group Scale. Outcomes included hospital LOS, intensive therapy unit (ITU) admission and hospital mortality. Results Of the 285 patients included in the study, 137 were male (48.1%), the median (IQR) age was 69 (13) years and the mean (±SD) FEV1% predicted was 87% (±19). Patients that developed a PPC (n = 21; 7.4%) had a significantly longer hospital LOS (4 vs. 3 days), higher frequency of ITU admission (23.8% vs. 0.5%) and higher hospital mortality (14.3% vs. 0%) (p < 0.001). PPC patients also required more physiotherapy contacts/time, emergency call-outs and specific pulmonary therapy (p < 0.05). Current smoking and COPD diagnosis were significantly associated with development of PPC on univariate analysis (p < 0.05), however only current smoking was a significant independent risk factor on multivariate analysis (p = 0.015). Conclusions Patients undergoing VATS lobectomy remain at risk of developing a PPC, which is associated with an increase in physiotherapy requirements and a worse short-term morbidity and mortality. Current smoking is the only independent risk factor for PPC after VATS lobectomy, thus vigorous addressing of preoperative smoking cessation is urgently needed.
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Affiliation(s)
- Paula J Agostini
- Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK. .,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
| | - Sebastian T Lugg
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Kerry Adams
- Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK
| | - Tom Smith
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Maninder S Kalkat
- Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK
| | - Pala B Rajesh
- Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK
| | - Richard S Steyn
- Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK
| | - Babu Naidu
- Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Alison Rushton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Ehab Bishay
- Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK
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Laurent H, Galvaing G, Thivat E, Coudeyre E, Aubreton S, Richard R, Kwiatkowski F, Costes F, Filaire M. Effect of an intensive 3-week preoperative home rehabilitation programme in patients with chronic obstructive pulmonary disease eligible for lung cancer surgery: a multicentre randomised controlled trial. BMJ Open 2017; 7:e017307. [PMID: 29133320 PMCID: PMC5695321 DOI: 10.1136/bmjopen-2017-017307] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Surgery is the standard curative treatment for lung cancer but is only possible in patients with local tumour and preserved exercise capacity. Improving fitness before surgery can reduce postoperative complications and mortality. However, preoperative rehabilitation remains difficult to implement for several reasons. We aim to investigate the effectiveness of an intensive 3-week home-based preoperative exercise training programme on hospital discharge ability, postoperative complications and physical performance in patients with chronic obstructive pulmonary disease (COPD) who are eligible for lung cancer surgery. METHODS AND ANALYSIS We designed a multicentre randomised controlled trial. The randomisation sequence will be generated and managed electronically by a research manager independent of assessments or interventions. We will recruit 90 patients with COPD and a diagnosis of lung cancer from four university hospitals. The rehabilitation group (R group) will receive a standardised preoperative home exercise programme for 3 weeks, combining both high-intensity training and usual physical therapy. The R group will perform 15 training sessions over 3 weeks on a cycloergometer. A physical therapist experienced in pulmonary rehabilitation will visit the patient at home and supervise one session a week. The R group will be compared with a control group receiving preoperative usual physical therapy only. The primary outcome will be hospital discharge ability assessed with a 10-item list. Secondary outcomes will be postoperative course (complication rate and mortality) as well as pulmonary function, exercise capacity and quality of life assessed 1 month before and the day before surgery. ETHICS AND DISSEMINATION This protocol has been approved by the French health authority for research (2016-A00622-49) and the research ethics committee/institutional review board (AU1267). Adverse events that occur during the protocol will be reported to the principal investigator. The results will be published in an international peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT03020251.
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Affiliation(s)
- Hélène Laurent
- INRA, Unité de Nutrition Humaine (UNH), Université Clermont Auvergne, CRNH Auvergne, Clermont-Ferrand, France
- Service de Médecine Physique et Réadaptation, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Géraud Galvaing
- Service de Chirurgie Thoracique et Endocrinienne, Centre Jean Perrin, Clermont-Ferrand, France
| | - Emilie Thivat
- INSERM, U1240, Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, Clermont-Ferrand, France
- Direction de la Recherche Clinique, Centre Jean Perrin, Clermont-Ferrand, France
| | - Emmanuel Coudeyre
- INRA, Unité de Nutrition Humaine (UNH), Université Clermont Auvergne, CRNH Auvergne, Clermont-Ferrand, France
- Service de Médecine Physique et Réadaptation, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Sylvie Aubreton
- Service de Médecine Physique et Réadaptation, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Ruddy Richard
- INRA, Unité de Nutrition Humaine (UNH), Université Clermont Auvergne, CRNH Auvergne, Clermont-Ferrand, France
- Service de Médecine du Sport et des Explorations Fonctionnelles, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Fabrice Kwiatkowski
- INSERM, U1240, Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, Clermont-Ferrand, France
- Direction de la Recherche Clinique, Centre Jean Perrin, Clermont-Ferrand, France
| | - Frederic Costes
- INRA, Unité de Nutrition Humaine (UNH), Université Clermont Auvergne, CRNH Auvergne, Clermont-Ferrand, France
- Service de Médecine du Sport et des Explorations Fonctionnelles, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Marc Filaire
- INRA, Unité de Nutrition Humaine (UNH), Université Clermont Auvergne, CRNH Auvergne, Clermont-Ferrand, France
- Service de Chirurgie Thoracique et Endocrinienne, Centre Jean Perrin, Clermont-Ferrand, France
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Agostini P, Lugg ST, Adams K, Vartsaba N, Kalkat MS, Rajesh PB, Steyn RS, Naidu B, Rushton A, Bishay E. Postoperative pulmonary complications and rehabilitation requirements following lobectomy: a propensity score matched study of patients undergoing video-assisted thoracoscopic surgery versus thoracotomy†. Interact Cardiovasc Thorac Surg 2017; 24:931-937. [PMID: 28329213 DOI: 10.1093/icvts/ivx002] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/17/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES : Video-assisted thoracoscopic surgical (VATS) lobectomy is increasingly used for curative intent lung cancer surgery compared to open thoracotomy due to its minimally invasive approach and associated benefits. However, the effects of the VATS approach on postoperative pulmonary complications (PPC), rehabilitation and physiotherapy requirements are unclear; our study aimed to use propensity score matching to investigate this. METHODS Between January 2012 and January 2016 all consecutive patients undergoing lobectomy via thoracotomy or VATS were prospectively observed. Exclusion criteria included VATS converted to thoracotomy, re-do thoracotomy, sleeve/bilobectomy and tumour size >7 cm diameter (T3/T4). All patients received physiotherapy assessment on postoperative day 1 (POD1), and subsequent treatment as deemed appropriate. PPC frequency was measured daily using the Melbourne Group Scale. Postoperative length of stay (LOS), high dependency unit (HDU) LOS, intensive therapy unit (ITU) admission and in-hospital mortality were observed. Propensity score matching (PSM) was performed using previous PPC risk factors (age, ASA score, body mass index, chronic obstructive pulmonary disease, current smoking) and lung cancer staging. RESULTS Over 4 years 736 patients underwent lobectomy with 524 remaining after exclusions; 252 (48%) thoracotomy and 272 (52%) VATS cases. PSM produced 215 matched pairs. VATS approach was associated with less PPC (7.4% vs 18.6%; P < 0.001), shorter median LOS (4 days vs 6; P < 0.001), and a shorter median HDU LOS (1 day vs 2; P = 0.002). Patients undergoing VATS required less physiotherapy contacts (3 vs 6; P < 0.001) and reduced therapy time (80 min vs 140; P < 0.001). More patients mobilized on POD1 (84% vs 81%; P = 0.018), and significantly less physiotherapy to treat sputum retention and lung expansion was required ( P < 0.05). CONCLUSIONS This study demonstrates that patients undergoing VATS lobectomy developed less PPC and had improved associated outcomes compared to thoracotomy. Patients were more mobile earlier, and required half the physiotherapy resources having fewer pulmonary and mobility issues.
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Affiliation(s)
- Paula Agostini
- Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Sebastian T Lugg
- Institute of Inflammation and Ageing, Centre for Translational Inflammation Research, University of Birmingham, UK
| | - Kerry Adams
- Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK
| | - Nelia Vartsaba
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Maninder S Kalkat
- Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK
| | - Pala B Rajesh
- Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK
| | - Richard S Steyn
- Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK
| | - Babu Naidu
- Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK.,Institute of Inflammation and Ageing, Centre for Translational Inflammation Research, University of Birmingham, UK
| | - Alison Rushton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Ehab Bishay
- Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK
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Postoperative Respiratory Exercises Reduce the Risk of Developing Pulmonary Complications in Patients Undergoing Lobectomy. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.arbr.2016.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Rodriguez-Larrad A, Vellosillo-Ortega JM, Ruiz-Muneta C, Abecia-Inchaurregui LC, Seco J. Postoperative Respiratory Exercises Reduce the Risk of Developing Pulmonary Complications in Patients Undergoing Lobectomy. Arch Bronconeumol 2016; 52:347-53. [PMID: 26860844 DOI: 10.1016/j.arbres.2015.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 11/02/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the effects of an intensive postoperative physiotherapy program focused on respiratory exercises in patients undergoing lobectomy by open thoracotomy. DESIGN Quasi-experimental study. SETTING Tertiary referral academic hospital. PARTICIPANTS 208 patients undergoing lobectomy by open thoracotomy. INTERVENTIONS Control group patients (n=102) received standard medical/nursing care, and experimental group patients (n=106) added to the standard clinical pathway a daily physiotherapy program focused on respiratory exercises until discharge. OUTCOMES Analyzed outcomes were the frequency of postoperative pulmonary complications (PPCs) more amenable to physiotherapy (pneumonia, atelectasis and respiratory insufficiency) and length of hospital stay (LOS). RESULTS Both groups were comparable regarding preoperative and surgical characteristics. Incidence of PPCs was 20.6% in control and 6.6% in experimental group (P=.003). Median (IQR) LOS in control group was 14 (7) days (Huber M estimator 14.21) and 12 (6) days (Huber M estimator 12.81) in experimental. Logistic regression model identified the evaluated physiotherapy program (P=.017; EXP [B] 95% CI 0.081-0.780) and % FEV1 (P=.042; EXP [B] 95% CI 0.941-0.999) as protective factors for the development of PPCs in patients undergoing lobectomy. CONCLUSIONS Implementing a postoperative intensive physiotherapy program focused on respiratory exercises reduces the risk of PPCs and resultant LOS on patients undergoing lobectomy.
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Affiliation(s)
| | | | - Carlos Ruiz-Muneta
- Servicio de Medicina Física, Complejo Hospitalario de Navarra, Pamplona, España
| | - Luis Carlos Abecia-Inchaurregui
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Farmacia, Universidad del País Vasco, Vitoria-Gasteiz, España
| | - Jesús Seco
- Instituto de Biomedicina (IBIOMED), Universidad de León, León, España; Investigador y profesor visitante, Universidad del País Vasco, Leioa, Vizcaya, España.
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Lugg ST, Agostini PJ, Tikka T, Kerr A, Adams K, Bishay E, Kalkat MS, Steyn RS, Rajesh PB, Thickett DR, Naidu B. Long-term impact of developing a postoperative pulmonary complication after lung surgery. Thorax 2016; 71:171-6. [DOI: 10.1136/thoraxjnl-2015-207697] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Boden I, Browning L, Skinner EH, Reeve J, El-Ansary D, Robertson IK, Denehy L. The LIPPSMAck POP (Lung Infection Prevention Post Surgery - Major Abdominal - with Pre-Operative Physiotherapy) trial: study protocol for a multi-centre randomised controlled trial. Trials 2015; 16:573. [PMID: 26666321 PMCID: PMC4678689 DOI: 10.1186/s13063-015-1090-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 11/27/2015] [Indexed: 02/04/2023] Open
Abstract
Background Post-operative pulmonary complications are a significant problem following open upper abdominal surgery. Preliminary evidence suggests that a single pre-operative physiotherapy education and preparatory lung expansion training session alone may prevent respiratory complications more effectively than supervised post-operative breathing and coughing exercises. However, the evidence is inconclusive due to methodological limitations. No well-designed, adequately powered, randomised controlled trial has investigated the effect of pre-operative education and training on post-operative respiratory complications, hospital length of stay, and health-related quality of life following upper abdominal surgery. Methods/design The Lung Infection Prevention Post Surgery - Major Abdominal- with Pre-Operative Physiotherapy (LIPPSMAck POP) trial is a pragmatic, investigator-initiated, bi-national, multi-centre, patient- and assessor-blinded, parallel group, randomised controlled trial, powered for superiority. Four hundred and forty-one patients scheduled for elective open upper abdominal surgery at two Australian and one New Zealand hospital will be randomised using concealed allocation to receive either i) an information booklet or ii) an information booklet, plus one additional pre-operative physiotherapy education and training session. The primary outcome is respiratory complication incidence using standardised diagnostic criteria. Secondary outcomes include hospital length of stay and costs, pneumonia diagnosis, intensive care unit readmission and length of stay, days/h to mobilise >1 min and >10 min, and, at 6 weeks post-surgery, patient reported complications, health-related quality of life, and physical capacity. Discussion The LIPPSMAck POP trial is a multi-centre randomised controlled trial powered and designed to investigate whether a single pre-operative physiotherapy session prevents post-operative respiratory complications. This trial standardises post-operative assisted ambulation and physiotherapy, measures many known confounders, and includes a post-discharge follow-up of complication rates, functional capacity, and health-related quality of life. This trial is currently recruiting. Trial registration Australian New Zealand Clinical Trials Registry number: ACTRN12613000664741, 19 June 2013.
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Affiliation(s)
- Ianthe Boden
- Physiotherapy Department, Launceston General Hospital, Charles St, Launceston, Tasmania, 7250, Australia. .,Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Parkville, Victoria, 3010, Australia.
| | - Laura Browning
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Parkville, Victoria, 3010, Australia. .,Division of Allied Health, Western Health, Furlong Road, St Albans, Victoria, 3021, Australia.
| | - Elizabeth H Skinner
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Parkville, Victoria, 3010, Australia. .,Department of Physiotherapy, Western Health, 160 Gordon St, Footscray, Victoria, 3011, Australia.
| | - Julie Reeve
- Department of Physiotherapy, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand. .,Physiotherapy Department, North Shore Hospital, Waitemata District Health Board, North Shore City, Auckland, 0622, New Zealand.
| | - Doa El-Ansary
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Parkville, Victoria, 3010, Australia.
| | - Iain K Robertson
- School of Health Sciences, University of Tasmania, Locked Bag 1320, Launceston, Tasmania, 7250, Australia. .,Clifford Craig Medical Research Trust, Launceston General Hospital, Charles Street, Launceston, Tasmania, 7250, Australia.
| | - Linda Denehy
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Parkville, Victoria, 3010, Australia.
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Brocki BC, Andreasen JJ, Langer D, Souza DSR, Westerdahl E. Postoperative inspiratory muscle training in addition to breathing exercises and early mobilization improves oxygenation in high-risk patients after lung cancer surgery: a randomized controlled trial. Eur J Cardiothorac Surg 2015; 49:1483-91. [PMID: 26489835 DOI: 10.1093/ejcts/ezv359] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 09/10/2015] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The aim was to investigate whether 2 weeks of inspiratory muscle training (IMT) could preserve respiratory muscle strength in high-risk patients referred for pulmonary resection on the suspicion of or confirmed lung cancer. Secondarily, we investigated the effect of the intervention on the incidence of postoperative pulmonary complications. METHODS The study was a single-centre, parallel-group, randomized trial with assessor blinding and intention-to-treat analysis. The intervention group (IG, n = 34) underwent 2 weeks of postoperative IMT twice daily with 2 × 30 breaths on a target intensity of 30% of maximal inspiratory pressure, in addition to standard postoperative physiotherapy. Standard physiotherapy in the control group (CG, n = 34) consisted of breathing exercises, coughing techniques and early mobilization. We measured respiratory muscle strength (maximal inspiratory/expiratory pressure, MIP/MEP), functional performance (6-min walk test), spirometry and peripheral oxygen saturation (SpO2), assessed the day before surgery and again 3-5 days and 2 weeks postoperatively. Postoperative pulmonary complications were evaluated 2 weeks after surgery. RESULTS The mean age was 70 ± 8 years and 57.5% were males. Thoracotomy was performed in 48.5% (n = 33) of cases. No effect of the intervention was found regarding MIP, MEP, lung volumes or functional performance at any time point. The overall incidence of pneumonia was 13% (n = 9), with no significant difference between groups [IG 6% (n = 2), CG 21% (n = 7), P = 0.14]. An improved SpO2 was found in the IG on the third and fourth postoperative days (Day 3: IG 93.8 ± 3.4 vs CG 91.9 ± 4.1%, P = 0.058; Day 4: IG 93.5 ± 3.5 vs CG 91 ± 3.9%, P = 0.02). We found no association between surgical procedure (thoracotomy versus thoracoscopy) and respiratory muscle strength, which was recovered in both groups 2 weeks after surgery. CONCLUSIONS Two weeks of additional postoperative IMT, compared with standard physiotherapy alone, did not preserve respiratory muscle strength but improved oxygenation in high-risk patients after lung cancer surgery. Respiratory muscle strength recovered in both groups 2 weeks after surgery. CLINICAL TRIALSGOV ID NCT01793155.
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Affiliation(s)
- Barbara Cristina Brocki
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark Faculty of Medicine and Health, Surgery, Örebro University, Örebro, Sweden
| | - Jan Jesper Andreasen
- Department of Cardiothoracic Surgery, Aalborg University, Aalborg, Denmark Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Daniel Langer
- KU Leuven Faculty of Kinesiology and Rehabilitation Sciences, Leuven, Belgium Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium
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Retrospective investigation of postoperative outcome after reversal of residual neuromuscular blockade: sugammadex, neostigmine or no reversal. Eur J Anaesthesiol 2015; 31:423-9. [PMID: 24296853 DOI: 10.1097/eja.0000000000000010] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Postoperative residual neuromuscular blockade (RNMB) is associated with significant morbidity. OBJECTIVE The aim of this retrospective data analysis was to investigate the influence of the method of RNMB reversal on postoperative outcome. SETTING Tertiary teaching hospital in Western Australia. PATIENTS With Ethics Committee approval, data from 1444 patients who received at least one dose of a non-depolarising muscle relaxant intraoperatively during 2011 were analysed. MAIN OUTCOME MEASURES Endpoints included unwanted events in the postanaesthesia care unit (PACU); symptoms of pulmonary complications within 7 postoperative days (0 to 100 outcome score based on 'temperature >38°C', 'leucocyte count >11 × 10 l', 'physical examination consistent with pneumonia' and 'shortness of breath'); PACU turnover time; and length of hospital stay. RESULTS Data from 1444 patients (722 sugammadex, 212 neostigmine and 510 no-reversal) were analysed. The incidence of postoperative nausea and vomiting (PONV) in PACU was higher in neostigmine-reversed than sugammadex-reversed patients (21.5 vs. 13.6%; P <0.05). No differences were found regarding other PACU incidents, length of PACU stay or hospital stay. Pulmonary outcome deteriorated significantly (outcome score increased) with age and American Society of Anesthesiologists (ASA) physical status. This was observed particularly in ASA 3/4 patients more than 60 years of age in neostigmine-reversed or non-reversed patients, but almost no detrimental effect of age on pulmonary outcome was found in the sugammadex group (P <0.05). CONCLUSION RNMB reversal with sugammadex was associated with the lowest rate of PONV and may reduce the risk of pulmonary complications in elderly ASA 3/4 patients. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12612000087853.
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Impact of Preoperative Counselling on Early Postoperative Mobilization and Its Role in Smooth Recovery. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:250536. [PMID: 27351013 PMCID: PMC4897513 DOI: 10.1155/2014/250536] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 08/08/2014] [Indexed: 11/17/2022]
Abstract
Background and Objectives. Preoperative counseling is effective to foster early postoperative mobilization that reduces pulmonary complications following abdominal surgery. This study aims at evaluating the effect of preoperative counseling regarding postoperative mobilization and its impact on reducing pulmonary complications. Design and Setting. Randomized control trial was conducted at the Department of Surgery of a tertiary care hospital, Karachi. Patients and Materials. Patients who underwent abdominal surgery and met inclusion criteria were recruited. All participants were randomly divided into two groups. Both groups received information about the surgery and Group I received additional counseling for postoperative mobilization. All patients were encouraged for postoperative mobilization. Scholes et al. criteria were used to evaluate postoperative pulmonary complications. Results. In total 232 participants were recruited and divided into two groups. There was no significant difference in participants' age (P = 0.79), duration of surgery (P = 0.5), and pain score (P = 0.1) of both groups. However, significant difference was identified in mobilization from bed to chair and mobilization for >10 minutes. Patients in Group I experienced less pulmonary complications in comparison with Group II.
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Mans CM, Reeve JC, Elkins MR. Postoperative outcomes following preoperative inspiratory muscle training in patients undergoing cardiothoracic or upper abdominal surgery: a systematic review and meta analysis. Clin Rehabil 2014; 29:426-38. [DOI: 10.1177/0269215514545350] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 07/06/2014] [Indexed: 01/15/2023]
Abstract
Objective: To evaluate whether preoperative inspiratory muscle training is effective in preventing postoperative pulmonary complications and reducing length of hospital stay in people undergoing cardiothoracic or upper abdominal surgery. Data sources: Medline, CINAHL, AMED, PsychINFO, Scopus, PEDro, and the Cochrane Library. Review methods: A systematic review and meta analysis of randomized controlled trials (or quasi-randomized controlled trials) investigating a form of preoperative inspiratory muscle training, compared with sham or no inspiratory muscle training. Participants were adults (16 years and over) awaiting elective open cardiac, thoracic, or upper abdominal surgery. Methodological quality was assessed using the PEDro scale. Results: Eight studies involving 295 participants were eligible for inclusion. The trained group had significantly higher maximal inspiratory pressure at the end of the preoperative training period (mean difference: 15 cm H2O, 95% confidence interval (CI): 9 to 21). This benefit was maintained through the early postoperative period, when lung function also recovered significantly more quickly in the trained group. Inspiratory muscle training also substantially reduced postoperative pulmonary complications (relative risk 0.48, 95% CI 0.26 to 0.89). Although not statistically significant, length of hospital stay also tended to favour the trained group. There were no statistically significant differences between the groups for the remaining outcomes. Participant satisfaction with inspiratory muscle training was high. Conclusion: Preoperative inspiratory muscle training significantly improves respiratory (muscle) function in the early postoperative period, halving the risk of pulmonary complications. The training does not increase length of stay, but more data are required to confirm whether it reduces length of stay.
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Affiliation(s)
- Christina M Mans
- Physiotherapy Department, Waikato Hospital, Hamilton, New Zealand
| | - Julie C Reeve
- Division of Rehabilitation and Occupation Studies, AUT University, Auckland, New Zealand
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Reference chart of inspiratory muscle strength: a new tool to monitor the effect of pre-operative training. Physiotherapy 2013; 100:128-33. [PMID: 24216046 DOI: 10.1016/j.physio.2013.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 08/20/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To develop a reference chart to monitor inspiratory muscle strength during pre-operative inspiratory muscle training for patients at high risk of developing postoperative pulmonary complications awaiting coronary artery bypass graft (CABG) surgery. DESIGN Secondary data analysis using patients from the intervention arm of a randomised clinical trial. SETTING University medical centre. PARTICIPANTS Patients at high risk of developing postoperative pulmonary complications awaiting CABG surgery. INTERVENTIONS Patients performed inspiratory muscle training seven times per week for at least 2 weeks before surgery. MAIN OUTCOME MEASURES Maximal inspiratory muscle strength. RESULTS A new reference chart was produced using a non-linear time trend model with a normal error structure. CONCLUSIONS The chart is a novel tool for monitoring the progress of inspiratory muscle training for physiotherapy practice. Wider use of this chart is recommended.
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Haines K, Skinner E, Berney S. Association of postoperative pulmonary complications with delayed mobilisation following major abdominal surgery: an observational cohort study. Physiotherapy 2013; 99:119-25. [DOI: 10.1016/j.physio.2012.05.013] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Accepted: 05/25/2012] [Indexed: 01/12/2023]
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Agostini P, Naidu B, Cieslik H, Steyn R, Rajesh PB, Bishay E, Kalkat MS, Singh S. Effectiveness of incentive spirometry in patients following thoracotomy and lung resection including those at high risk for developing pulmonary complications. Thorax 2013; 68:580-5. [DOI: 10.1136/thoraxjnl-2012-202785] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Varela G, Novoa NM, Agostini P, Ballesteros E. Chest Physiotherapy in Lung Resection Patients: State of the Art. Semin Thorac Cardiovasc Surg 2011; 23:297-306. [DOI: 10.1053/j.semtcvs.2011.11.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2011] [Indexed: 11/11/2022]
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