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Wang B, Liang H, Zhao H, Shen J, An Y, Feng Y. Risk factors and predictive model for pulmonary complications in patients transferred to ICU after hepatectomy. BMC Surg 2023; 23:150. [PMID: 37270566 DOI: 10.1186/s12893-023-02019-1] [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: 06/16/2022] [Accepted: 04/26/2023] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVE Postoperative pulmonary complications (PPCs) seriously harm the recovery and prognosis of patients undergoing surgery. However, its related risk factors in critical patients after hepatectomy have been rarely reported. This study aimed at analyzing the factors related to PPCs in critical adult patients after hepatectomy and create a nomogram for prediction of the PPCs. METHODS 503 patients' data were collected form the Peking University People's Hospital. Multivariate logistic regression analysis was used to identify independent risk factors to derive the nomogram. Nomogram's discriminatory ability was assessed using the area under the receiver operating characteristic curve (AUC), and calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test and calibration curve. RESULTS The independent risk factor for PPCs are advanced age (odds ratio [OR] = 1.026; P = 0.008), higher body mass index (OR = 1.139; P < 0.001), lower preoperative serum albumin level (OR = 0.961; P = 0.037), and intensive care unit first day infusion volume (OR = 1.152; P = 0.040). And based on this, we created a nomogram to predict the occurrence of PPCs. Upon assessing the nomogram's predictive ability, the AUC for the model was 0.713( 95% CI: 0.668-0.758, P<0.001). The Hosmer-Lemeshow test (P = 0.590) and calibration curve showed good calibration for the prediction of PPCs. CONCLUSIONS The prevalence and mortality of postoperative pulmonary complications in critical adult patients after hepatectomy are high. Advanced age, higher body mass index, lower preoperative serum albumin and intensive care unit first day infusion volume were found to be significantly associated with PPCs. And we created a nomogram model which can be used to predict the occurrence of PPCs.
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Affiliation(s)
- Bin Wang
- Department of Critical Care Medicine, Peking University People's Hospital, No.11 Xizhimen South Street, Beijing, 100044, China
| | - HanSheng Liang
- Department of Anaesthesiology and Pain Medicine, Peking University People's Hospital, No.11 Xizhimen South Street, Beijing, 100044, China
| | - HuiYing Zhao
- Department of Critical Care Medicine, Peking University People's Hospital, No.11 Xizhimen South Street, Beijing, 100044, China
| | - JiaWei Shen
- Department of Critical Care Medicine, Peking University People's Hospital, No.11 Xizhimen South Street, Beijing, 100044, China
| | - YouZhong An
- Department of Critical Care Medicine, Peking University People's Hospital, No.11 Xizhimen South Street, Beijing, 100044, China.
| | - Yi Feng
- Department of Anaesthesiology and Pain Medicine, Peking University People's Hospital, No.11 Xizhimen South Street, Beijing, 100044, China.
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Takemura N, Miyashita T, Baba Y. Anesthetic Management of a Patient Undergoing Cochlear Implantation With Superficial Cervical Plexus Block and Sedation: A Case Report. A A Pract 2022; 16:e01555. [PMID: 35020618 DOI: 10.1213/xaa.0000000000001555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Avoidance of general anesthesia and endotracheal intubation has been shown to reduce respiratory complications in patients with severe lung disease. We describe the case of a 75-year-old patient with chronic obstructive pulmonary disease (COPD) who underwent cochlear implantation managed with nerve block and sedation. A superficial cervical plexus block (SCPB) was performed with 1% mepivacaine before surgery. A small amount of intravenous analgesic and sedative was administered. The patient experienced only slight pain during surgery. A SCPB had a good analgesic effect on the posterior auricle. Cochlear implantation in patients with COPD can be performed using a SCPB and sedation.
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Affiliation(s)
- Natsuki Takemura
- From the Department of Anesthesiology, International University of Health and Welfare, Mita Hospital
| | - Tetsuya Miyashita
- From the Department of Anesthesiology, International University of Health and Welfare, Mita Hospital
| | - Yasuko Baba
- From the Department of Anesthesiology, International University of Health and Welfare, Mita Hospital
- Department of Anesthesiology and Intensive Care Medicine, School of Medicine, International University of Health and Welfare
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Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus. Aging Clin Exp Res 2020; 32:1647-1673. [PMID: 32651902 PMCID: PMC7508736 DOI: 10.1007/s40520-020-01624-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/03/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Surgical outcomes in geriatric patients may be complicated by factors such as multiple comorbidities, low functional performance, frailty, reduced homeostatic capacity, and cognitive impairment. An integrated multidisciplinary approach to management is, therefore, essential in this population, but at present, the use of such an approach is uncommon. The Perioperative Management of Elderly patients (PriME) project has been established to address this issue. AIMS To develop evidence-based recommendations for the integrated care of geriatric surgical patients. METHODS A 14-member Expert Task Force of surgeons, anesthetists, and geriatricians was established to develop evidence-based recommendations for the pre-, intra-, and postoperative care of hospitalized older patients (≥ 65 years) undergoing elective surgery. A modified Delphi approach was used to achieve consensus, and the strength of recommendations and quality of evidence was rated using the U.S. Preventative Services Task Force criteria. RESULTS A total of 81 recommendations were proposed, covering preoperative evaluation and care (30 items), intraoperative management (19 items), and postoperative care and discharge (32 items). CONCLUSIONS These recommendations should facilitate the multidisciplinary management of older surgical patients, integrating the expertise of the surgeon, the anesthetist, the geriatrician, and other specialists and health care professionals (where available) as needed. These roles may vary according to the phase and setting of care and the patient's conditions.
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Risk Factors for Pulmonary Complications After Laparoscopic Pylorus-preserving Pancreaticoduodenectomy: A Retrospective Observational Analysis. Surg Laparosc Endosc Percutan Tech 2018. [PMID: 29528947 DOI: 10.1097/sle.0000000000000521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Laparoscopic pylorus-preserving pancreaticoduodenectomy (LPPPD) is less invasive than open pylorus-preserving pancreaticoduodenectomy. However, LPPPD has a long operation time with pneumoperitoneum, which may affect the postoperative pulmonary complications (PPCs). We retrospectively evaluated the incidence of PPCs and their risk factors in LPPPD. In 191 patients who underwent LPPPD, the incidence of PPCs was 28.8% (n=55). Multivariate logistic regression analysis revealed that the risk factors for PPCs were male sex [odds ratio (OR), 2.518; P=0.008], high body mass index (OR, 1.172; P=0.024), and low preoperative serum albumin level (OR, 0.390; P=0.032). Length of hospital stay was significantly longer in the PPC group than in the no-PPC group [17 (14 to 26) vs. 14 (13 to 18) d, P<0.001]. There was no difference in the incidence of surgical complications between the PPC group and the no-PPC group (14.5% vs. 6.6%, P=0.096). These results provide useful information for perioperative pulmonary management in patients undergoing LPPPD.
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Thoracic Surgery in Older Patients. CURRENT GERIATRICS REPORTS 2017. [DOI: 10.1007/s13670-017-0207-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Evaristo-Méndez G, Rocha-Calderón CH. Risk factors for nosocomial pneumonia in patients with abdominal surgery. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.circen.2015.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Abstract
The chronic obstructive pulmonary disease has become a disease of public health importance. Among the various risk factors, smoking remains the main culprit. In addition to airway obstruction, the presence of intrinsic positive end expiratory pressure, respiratory muscle dysfunction contributes to the symptoms of the patient. Perioperative management of these patients includes identification of modifiable risk factors and their optimisation. Use of regional anaesthesia alone or in combination with general anaesthesia improves pulmonary functions and reduces the incidence of post-operative pulmonary complications.
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Affiliation(s)
- Devika Rani Duggappa
- Department of Anaesthesiology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - G Venkateswara Rao
- Department of Anaesthesiology, Vijayanagar Institute of Medical Sciences, Bellary, Karnataka, India
| | - Sudheesh Kannan
- Department of Anaesthesiology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
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[Risk factors for nosocomial pneumonia in patients with abdominal surgery]. CIR CIR 2015; 84:21-7. [PMID: 26259742 DOI: 10.1016/j.circir.2015.05.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/18/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND The risk of post-operative pneumonia is a latent complication. A study was conducted to determine its risk factors in abdominal surgery. MATERIAL AND METHODS A cross-sectional study was performed that included analysing the variables of age and gender, chronic obstructive pulmonary disease and smoking, serum albumin, type of surgery and anaesthesia, emergency or elective surgery, incision site, duration of surgery, length of hospital stay, length of stay in the intensive care unit, and time on mechanical ventilation. The adjusted odds ratio for risk factors was obtained using multivariate logistic regression. RESULTS The study included 91 (9.6%) patients with pneumonia and 851 (90.4%) without pneumonia. Age 60 years or over (OR=2.34), smoking (OR=9.48), chronic obstructive pulmonary disease (OR=3.52), emergency surgery (OR=2.48), general anaesthesia (OR=3.18), surgical time 120 minutes or over (OR=5.79), time in intensive care unit 7 days or over (OR=1.23), time on mechanical ventilation greater than or equal to 4 days (OR=5.93) and length of post-operative hospital stay of 15 days or over (OR=1.20), were observed as independent predictors for the development of postoperative pneumonia. CONCLUSIONS Identifying risk factors for post-operative pneumonia may prevent their occurrence. The length in the intensive care unit of greater than or equal to 7 days (OR=1.23; 95% CI 1.07 - 1.42) and a length postoperative hospital stay of 15 days or more (OR=1.20; 95% CI 1.07 - 1.34) were the predictive factors most strongly associated with lung infection in this study.
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AlOtaibi KD, El-Sobkey SB. Spirometric values and chest pain intensity three days post-operative coronary artery bypass graft surgery. J Saudi Heart Assoc 2015; 27:137-43. [PMID: 26136627 PMCID: PMC4481464 DOI: 10.1016/j.jsha.2015.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 01/16/2015] [Accepted: 02/01/2015] [Indexed: 12/23/2022] Open
Abstract
Aim Coronary artery bypass graft surgery (CABG) is proved to have ventilatory complications and reduction in spirometric values. This study aimed to examine the hypothesis that reduction of post-operative chest pain intensity would be associated with improvement in the spirometric values for patient underwent CABG. Materials and method 26 cardiac patients recruited for this study. Their convenience to the study inclusion criteria decided their eligibility. Through 3 days after elective CABG their spirometric values were measured along with their perception to chest pain intensity using 0–10 numeric rating scale. Collected data were recorded and analyzed statistically. Results Chest pain intensity showed progressive significant (P = 0.0001) reduction through the 3 days post-operative. On the other hand spirometric values also showed progressive improvement through the 3 days post-operative. This improvement was significant for all measured spirometric values except for the ratio of forced expiratory volume in the 1st second to the forced vital capacity (P = 0.134). There was no significant relationship between the chest pain intensity and spirometric values. This was applied to all measured spirometric values and to the 3 days postoperative. Conclusion The current study findings rejected the examined hypothesis that reduction of post-operative chest pain intensity would be associated with improvement in the spirometric values for patient underwent coronary artery bypass graft surgery. There was no significant relationship between the chest pain intensity and any of the spirometric values at any of the 3 post-operative days.
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Affiliation(s)
- Kholoud D AlOtaibi
- College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Salwa B El-Sobkey
- College of Physical Therapy, Delta University For Science and Technology, Egypt
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Abstract
Hip fracture is one of the most common orthopedic conditions associated with significant morbidity and mortality. Patients with hip fracture are usually older, with significant comorbidities. Delayed surgical treatment beyond 48 hours after admission is associated with significantly higher mortality. Hereby clinicians are presented with the challenge to optimize the complex hip fracture within a short time period. This article reviews the evidence regarding preoperative, intraoperative, and postoperative considerations, and provides insights into the best strategies with which to optimize the patient's condition and improve perioperative outcomes.
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Affiliation(s)
- Jiabin Liu
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Jaimo Ahn
- Department of Orthopedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Nabil M Elkassabany
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Hulzebos EHJ, Smit Y, Helders PPJM, van Meeteren NLU. Preoperative physical therapy for elective cardiac surgery patients. Cochrane Database Syst Rev 2012; 11:CD010118. [PMID: 23152283 PMCID: PMC8101691 DOI: 10.1002/14651858.cd010118.pub2] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND After cardiac surgery, physical therapy is a routine procedure delivered with the aim of preventing postoperative pulmonary complications. OBJECTIVES To determine if preoperative physical therapy with an exercise component can prevent postoperative pulmonary complications in cardiac surgery patients, and to evaluate which type of patient benefits and which type of physical therapy is most effective. SEARCH METHODS Searches were run on the Cochrane Central Register of Controlled Trials (CENTRAL) on the Cochrane Library (2011, Issue 12 ); MEDLINE (1966 to 12 December 2011); EMBASE (1980 to week 49, 2011); the Physical Therapy Evidence Database (PEDro) (to 12 December 2011) and CINAHL (1982 to 12 December 2011). SELECTION CRITERIA Randomised controlled trials or quasi-randomised trials comparing preoperative physical therapy with no preoperative physical therapy or sham therapy in adult patients undergoing elective cardiac surgery. DATA COLLECTION AND ANALYSIS Data were collected on the type of study, participants, treatments used, primary outcomes (postoperative pulmonary complications grade 2 to 4: atelectasis, pneumonia, pneumothorax, mechanical ventilation > 48 hours, all-cause death, adverse events) and secondary outcomes (length of hospital stay, physical function measures, health-related quality of life, respiratory death, costs). Data were extracted by one review author and checked by a second review author. Review Manager 5.1 software was used for the analysis. MAIN RESULTS Eight randomised controlled trials with 856 patients were included. Three studies used a mixed intervention (including either aerobic exercises or breathing exercises); five studies used inspiratory muscle training. Only one study used sham training in the controls. Patients that received preoperative physical therapy had a reduced risk of postoperative atelectasis (four studies including 379 participants, relative risk (RR) 0.52; 95% CI 0.32 to 0.87; P = 0.01) and pneumonia (five studies including 448 participants, RR 0.45; 95% CI 0.24 to 0.83; P = 0.01) but not of pneumothorax (one study with 45 participants, RR 0.12; 95% CI 0.01 to 2.11; P = 0.15) or mechanical ventilation for > 48 hours after surgery (two studies with 306 participants, RR 0.55; 95% CI 0.03 to 9.20; P = 0.68). Postoperative death from all causes did not differ between groups (three studies with 552 participants, RR 0.66; 95% CI 0.02 to 18.48; P = 0.81). Adverse events were not detected in the three studies that reported on them. The length of postoperative hospital stay was significantly shorter in experimental patients versus controls (three studies with 347 participants, mean difference -3.21 days; 95% CI -5.73 to -0.69; P = 0.01). One study reported a reduced physical function measure on the six-minute walking test in experimental patients compared to controls. One other study reported a better health-related quality of life in experimental patients compared to controls. Postoperative death from respiratory causes did not differ between groups (one study with 276 participants, RR 0.14; 95% CI 0.01 to 2.70; P = 0.19). Cost data were not reported on. AUTHORS' CONCLUSIONS Evidence derived from small trials suggests that preoperative physical therapy reduces postoperative pulmonary complications (atelectasis and pneumonia) and length of hospital stay in patients undergoing elective cardiac surgery. There is a lack of evidence that preoperative physical therapy reduces postoperative pneumothorax, prolonged mechanical ventilation or all-cause deaths.
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Affiliation(s)
- Erik H J Hulzebos
- Department of Child Development and Exercise Center,University Children’s Hospital and Medical Center Utrecht, Utrecht, Netherlands. 2c/o Cochrane Heart Group, London, UK.
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Dewan SK, Zheng SB, Xia SJ. Preoperative geriatric assessment: comprehensive, multidisciplinary and proactive. Eur J Intern Med 2012; 23:487-94. [PMID: 22863423 DOI: 10.1016/j.ejim.2012.06.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 06/13/2012] [Accepted: 06/20/2012] [Indexed: 11/17/2022]
Abstract
With the changing global demographic pattern, our health care systems increasingly have to deal with a greater number of elderly patients, which consequently also takes its toll on our surgical services. The elderly are not simply older adults. They represent a heterogeneous branch of the population with specific physiological, psychological, functional and social issues that require individualised attention prior to surgery. Increased acknowledgement that chronological age alone is not an exclusion criterion, along with advances in surgical and anaesthetic techniques have today lead to decreased reluctance to deny the elderly surgical treatment. In order to ensure a safe perioperative period, we believe that a comprehensive, multidisciplinary and proactive preoperative assessment will be helpful to detect the multiple risk factors and comorbidities common in older patients, to assess functional status and simultaneously allow room for early preoperative interventions and planning of the intra- and postoperative period. In this review we outline the currently available preoperative geriatric risk assessment tools and provide an insight on how a comprehensive, multidisciplinary and proactive approach can help improve perioperative outcome.
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Affiliation(s)
- Sheilesh Kumar Dewan
- Department of Geriatric Medicine, Huadong Hospital affiliated to Fudan University, 221 West Yan'An Road, Shanghai 200040, China.
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Chow WB, Rosenthal RA, Merkow RP, Ko CY, Esnaola NF. Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg 2012; 215:453-66. [PMID: 22917646 DOI: 10.1016/j.jamcollsurg.2012.06.017] [Citation(s) in RCA: 513] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 05/29/2012] [Accepted: 06/11/2012] [Indexed: 01/10/2023]
Affiliation(s)
- Warren B Chow
- American College of Surgeons National Surgical Quality Improvement Program, Chicago, IL 60611-3211, USA.
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Lo IL, Siu CW, Tse HF, Lau TW, Leung F, Wong M. Pre-operative pulmonary assessment for patients with hip fracture. Osteoporos Int 2010; 21:S579-86. [PMID: 21057997 PMCID: PMC2924432 DOI: 10.1007/s00198-010-1427-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 09/04/2010] [Indexed: 12/13/2022]
Abstract
Hip fracture is a common injury among the elderly. Although patients who receive hip fracture surgery carry the best functional recovery compared to other treatment modalities, the presence of postoperative pulmonary complications, such as atelectasis, pneumonia, and pulmonary thromboembolism, may contribute to increased length of hospital stay, perioperative morbidity, and mortality. This review aims to provide evidence-based recommendations for preoperative assessment and perioperative strategies to reduce the risk of pulmonary complications after hip fracture surgery. Clinical assessment and basic laboratory results are sufficient to stratify the risk of postoperative pulmonary complications. Well-documented risk factors for pulmonary complications include advanced age, poor general health status, current infections, pre-existing cardiopulmonary diseases, hypoalbuminemia, and impaired renal function. Apart from optimizing the patient's medical conditions, interventions such as lung expansion maneuvers and thromboprophylaxis have been proven to be effective in reducing the risk of pulmonary complications after hip fracture surgery.
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Affiliation(s)
- I.-L. Lo
- Department of Respiratory Medicine, Centro Hospital Conde de Sao Januario, Macau, China
| | - C.-W. Siu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong China
- Research Center of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, Pokfulam, Hong Kong China
| | - H.-F. Tse
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong China
- Research Center of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, Pokfulam, Hong Kong China
| | - T.-W. Lau
- Department of Orthopaedics & Traumatology, The University of Hong Kong, Pokfulam, Hong Kong China
| | - F. Leung
- Department of Orthopaedics & Traumatology, The University of Hong Kong, Pokfulam, Hong Kong China
| | - M. Wong
- Division of Respiratory Medicine, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong China
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Yu J, Kim B, Chung S, Park CW, Chang YS. Ischaemic enteritis in a patient with chronic renal failure: diagnosis and management decisions. BMJ Case Rep 2010; 2010:2010/oct27_1/bcr0920092249. [PMID: 22791732 DOI: 10.1136/bcr.09.2009.2249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Ischaemic enteritis is rare in patients with chronic renal failure not on dialysis. Here we report a case of ischaemic enteritis in an 81-year-old woman with chronic renal failure secondary to hypertension (not dialysis dependent) who presented with acute onset of abdominal pain, non-bloody diarrhoea and subsequent oliguria. The abdominal CT with angiography showed diffuse segmental wall thickening and decreased perfusion of the long segment of the ileum, with decreased enhancement of the vessels that supply the distal ileum. The clinical diagnosis of ischaemic enteritis was made. The patient responded initially to total parenteral nutrition and intravenous antibiotics. After the initiation of haemodialysis, because of the oliguria, the ischaemic enteritis progressed to bowel infarction, and an open laparotomy was performed. This report illustrates some of the difficult therapeutic decisions in a patient with ischaemic enteritis and chronic renal failure.
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Affiliation(s)
- Jihan Yu
- Division of Nephrology, St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
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Cascade iatrogenesis: factors leading to the development of adverse events in hospitalized older adults. Int J Nurs Stud 2009; 46:1528-35. [PMID: 19643409 DOI: 10.1016/j.ijnurstu.2009.06.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 06/23/2009] [Accepted: 06/26/2009] [Indexed: 01/23/2023]
Abstract
Older adults are at particular risk for injuries associated with hospitalization and the rate of adverse events increases significantly with age. The purpose of this paper is to review factors associated with the development of adverse events in hospitalized older adults, especially those factors that contribute to cascade iatrogenesis. Cascade iatrogenesis is the serial development of multiple medical complications that can be set in motion by a seemingly innocuous first event [Rothschild, J.M., Bates, D.W., Leape, L.L., 2000. Preventable medical injuries in older patients. Archieves of Internal Medicine 160 (October), 2717-2728]. Research has examined how patient characteristics may lead to cascade iatrogenesis, but existing conceptual models and research have not considered the role of nursing care. Using the outcome postoperative respiratory failure as an example, we expand on existing knowledge about factors associated with older adults' risk for developing this complication by presenting a conceptual model of events that may trigger the initial cascade and the nursing care variables that may prevent or mitigate these risks. We believe that this model will help guide research in this area and enable clinicians to identify systemic failures and develop targeted interventions to prevent their occurrence.
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Weber LM, Ghafoor VL, Phelps P. Implementation of standard order sets for patient-controlled analgesia. Am J Health Syst Pharm 2008; 65:1184-91. [DOI: 10.2146/ajhp060416] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Silvay G, Castillo JG, Chikwe J, Flynn B, Filsoufi F. Cardiac anesthesia and surgery in geriatric patients. Semin Cardiothorac Vasc Anesth 2008; 12:18-28. [PMID: 18397906 DOI: 10.1177/1089253208316446] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The average age of US population is steadily increasing, with more than 15 million people aged 80 and older. Coronary artery disease and degenerative cardiovascular diseases are particularly prevalent in this population. Consequently, an increasing number of elderly patients are referred for surgical intervention. Advanced age is associated with decreased physiologic reserve and significant comorbidity. Thorough preoperative assessment, identification of the risk factors for perioperative morbidity and mortality, and optimal preparation are critical in these patients. Age-related changes in comorbidities and altered pharmacokinetics and pharmacodynamics impacts anesthetic management, perioperative monitoring, postoperative care, and outcome. This article updates the age-related changes in organ subsystems relevant to cardiac anesthesia, perioperative issues, and intraoperative management. Early and late operative outcome in octogenarians undergoing cardiac surgery are reviewed. The data clearly indicate that no patient group is "too old" for cardiac surgery and that excellent outcomes can be achieved in selected group of elderly patients.
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Affiliation(s)
- George Silvay
- Department of Anesthesiology, Mount Sinai Medical Center, New York, NY 10029-6574, USA.
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Dronkers J, Veldman A, Hoberg E, van der Waal C, van Meeteren N. Prevention of pulmonary complications after upper abdominal surgery by preoperative intensive inspiratory muscle training: a randomized controlled pilot study. Clin Rehabil 2008; 22:134-42. [DOI: 10.1177/0269215507081574] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To investigate the feasibility and effects of preoperative inspiratory muscle training on the incidence of atelectasis in patients at high risk of postoperative pulmonary complications scheduled for elective abdominal aortic aneurysm surgery.Design: Single-blind randomized controlled pilot study.Setting: Gelderse Vallei Hospital Ede, the Netherlands.Subjects: Twenty high-risk patients undergoing elective abdominal aortic aneurysm surgery were randomly assigned to receive preoperative inspiratory muscle training or usual care.Main measures: Effectiveness outcome variables were atelectasis, inspiratory muscle strength and vital capacity, and feasibility outcome variables were adverse effects and patient satisfaction with inspiratory muscle training.Results: Despite randomization, patients in the intervention group were significantly older than the patients in the control group (70 ± 6 years versus 59 ± 6 years, respectively; P = 0.001). Eight patients in the control group and three in the intervention group developed atelectasis (P = 0.07). The median duration of atelectasis was 0 days in the intervention group and 1.5 days in the control group (P = 0.07). No adverse effects of preoperative inspiratory muscle training were observed and patients considered that inspiratory muscle training was a good preparation for surgery. Mean postoperative inspiratory pressure was 10% higher in the intervention group.Conclusion: Preoperative inspiratory muscle training is well tolerated and appreciated and seems to reduce the incidence of atelectasis in patients scheduled for elective abdominal aortic aneurysm surgery.
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Affiliation(s)
- Jaap Dronkers
- Department of Physiotherapy, Gelderse Vallei Hospital, Ede,
| | - André Veldman
- Department of Physiotherapy, Gelderse Vallei Hospital, Ede
| | - Ellen Hoberg
- Department of Physiotherapy, Gelderse Vallei Hospital, Ede
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Lee P, Colt HG. A spray catheter technique for pleural anesthesia: a novel method for pain control before talc poudrage. Anesth Analg 2007; 104:198-200. [PMID: 17179270 DOI: 10.1213/01.ane.0000249046.02025.ef] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Chemical pleurodesis causes severe pain, prompting physicians to perform thoracoscopic talc poudrage under general or neuroleptanalgesia. We describe a novel method for pain control in five patients with pneumothoraces and severe chronic obstructive pulmonary disease. METHODS Patients were premedicated with IM pethidine and IV midazolam. The pleural space was examined with the flex-rigid pleuroscope. Before talc poudrage, 250 mg lidocaine was administered via spray catheter, and pain scores measured immediately after the procedure and on postoperative days 1 and 2 were 3, 2, and 2, respectively. RESULTS No complications were noted, and 30-day mortality was 0%. CONCLUSION Lidocaine via spray catheter is effective for pain control before pleurodesis.
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Affiliation(s)
- Pyng Lee
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.
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24
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Serejo LGG, da Silva-Júnior FP, Bastos JPC, de Bruin GS, Mota RMS, de Bruin PFC. Risk factors for pulmonary complications after emergency abdominal surgery. Respir Med 2006; 101:808-13. [PMID: 16963245 DOI: 10.1016/j.rmed.2006.07.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2006] [Revised: 07/18/2006] [Accepted: 07/27/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Pulmonary complications are common after abdominal surgery. Although a variety of risk factors have been described for these complications, studies so far have focused on elective interventions. The aim of this study was to determine the incidence and predictors of pulmonary complications following emergency abdominal surgery. METHODS This was a prospective cohort study. Pre and intra-operative data were collected through interview and chart review and their association with the occurrence of postoperative pulmonary complications (PPC) were analyzed. RESULTS Two hundred and sixty-six consecutive adult patients were included and seventy-five (28.2%) developed PPC. Age >50 years (adjusted OR=3.86; P<0.001), body mass index (BMI) <21 kg/m(2) or 30 kg/m(2) (adjusted OR=2.43; P=0.007) and upper or upper/lower abdominal incision (adjusted OR=2.57; P=0.027) were independently associated with PPC. Patients submitted to multiple procedures tended to be at a higher risk for PPC (adjusted OR=1.73; P=0.079). The development of PPC was associated with prolonged hospital stay (P<0.001) and increased death rate (P<0.001). CONCLUSIONS Pulmonary complications are frequent among patients undergoing abdominal emergency surgery and lead to increased length of hospital stay and death rate. Older age, abnormal BMI, upper or upper/lower abdominal incision and multiple procedures are predictors of PPC in this setting.
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Affiliation(s)
- Livia Goreth Galvão Serejo
- Department of Medicine, Faculdade de Medicina, Universidade Federal do Ceará, rua Prof. Costa Mendes 1608, 60430-040 Fortaleza, Ceará, Brazil
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25
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Bergman SA, Coletti D. Perioperative management of the geriatric patient. Part I: respiratory system. ACTA ACUST UNITED AC 2006; 102:e1-6. [PMID: 16920526 DOI: 10.1016/j.tripleo.2005.03.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2004] [Revised: 03/02/2005] [Accepted: 03/17/2005] [Indexed: 11/16/2022]
Abstract
The population of the United States is aging. It is expected that the population age 65 and older will increase to nearly 60 million by the year 2030 and those age 85 and over to nearly 11 million. Patients over age 65 are more than twice as likely to undergo surgical procedures than patients 40 to 65. Structural and physiologic changes associated with advancing age, combined with the increased likelihood of major disability or disease, significantly increase the risk of perioperative complications. These articles review the major age-related changes and the effect they have on the perioperative management of these patients.
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Affiliation(s)
- Stewart A Bergman
- Department of Oral and Maxillofacial Surgery, Baltimore College of Dental Surgery, University of Maryland Dental School, Baltimore, MD 21201, USA.
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26
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Friedman WH, Gallup DG, Burke JJ, Meister EA, Hoskins WJ. Outcomes of octogenarians and nonagenarians in elective major gynecologic surgery. Am J Obstet Gynecol 2006; 195:547-52; discussion 552-3. [PMID: 16890555 DOI: 10.1016/j.ajog.2006.03.085] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Revised: 03/13/2006] [Accepted: 03/21/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether age is a risk factor for perioperative and postoperative complications. STUDY DESIGN This was a retrospective case-control study of 120 women over age 79 (group 1) compared with 1,497 younger patients 50-79 (group 2) undergoing major elective gynecologic surgery. RESULTS Mean length of stay was 4.8 days for group 1, compared with 3.8 for group 2 (P = .018). Patients hospitalized longer than 1 week was higher (P < .01) among group 1. There were statistically significant increases in UTI, psychiatric events, pulmonary edema, respiratory failure, sepsis, and hypovolemic shock. No significant difference in mortality rate was noted (group 1: 0.83%, n = 1 vs group 2: 0.47%, n = 7). CONCLUSION Although length of stay for the elderly is slightly increased, mortality and complication rates are comparable to younger patients with few exceptions. We conclude that age need not be the sole determinant in the decision to undergo major elective gynecologic surgery.
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Affiliation(s)
- Wayne H Friedman
- Department of Obstetrics and Gynecology, Memorial Health University Medical Center, Savannah, GA, USA.
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27
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Abstract
Over 20 million Americans are affected with asthma. Many will require some type of surgical procedure during which their asthma management should be optimized. Preoperative assessment of asthma should include a specialized history and physical as well as pulmonary function testing. In many asthmatic patients, treatment with systemic corticosteroids and bronchodilators is indicated to prevent the inflammation and bronchoconstriction associated with endotracheal intubation. The use of corticosteroids has not been shown to adversely affect wound healing or increase the rate of infections postoperatively. Preoperative systemic corticosteroids may be used safely in the majority of patients to decrease asthma-related morbidity.
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Affiliation(s)
- Jyothi Tirumalasetty
- Division of Allergy-Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
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28
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Marley RA, Hoyle B, Ries C. Perianesthesia respiratory care of the bariatric patient. J Perianesth Nurs 2006; 20:404-31; quiz 432-4. [PMID: 16387272 DOI: 10.1016/j.jopan.2005.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Our nation's obesity problem has reached epidemic proportions and is only projected to worsen. The morbidly obese patient is at risk for experiencing a multitude of health-related conditions. Morbidly obese patients are presenting for surgery at an increasing rate, especially with the growing popularity of weight-loss surgery. Therefore the perianesthesia nurse has to remain informed of optimal care strategies for this sometimes challenging population. The obese patient presents with distinct respiratory care considerations of which the perianesthesia nurse must be knowledgeable. This review article will specifically focus on the respiratory care of the bariatric patient presenting for surgery.
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Affiliation(s)
- Rex A Marley
- Northwestern Colorado Anesthesia Professional Consultants, Fort Collins, CO 80524, USA.
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30
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Bellinetti LM, Thomson JC. Avaliação muscular respiratória nas toracotomias e laparotomias superiores eletivas. J Bras Pneumol 2006; 32:99-105. [PMID: 17273578 DOI: 10.1590/s1806-37132006000200004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2004] [Accepted: 07/29/2005] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Verificar se existe associação entre a função muscular respiratória pré-operatória abaixo dos valores previstos e a incidência de complicações pós-operatórias e o óbito, nas laparotomias superiores e toracotomias eletivas. MÉTODOS: Estudo de coorte prospectivo, no qual 70 pacientes acima de dezoito anos foram acompanhados, em dois hospitais similares. A avaliação durante a internação pré-operatória classificou-os em não expostos (50) ou expostos (20), estes quando os valores das pressões respiratórias máximas foram abaixo de 75% dos valores previstos. O acompanhamento foi feito até a alta hospitalar, verificando-se a incidência de pneumonia, insuficiência respiratória aguda, broncoespasmo, ventilação mecânica prolongada, atelectasia, derrame pleural, pneumotórax e óbito nos dois grupos. Realizou-se análise comparativa entre os grupos e cálculo do risco relativo. RESULTADOS: A incidência total de complicações pós-operatórias da amostra foi de 22,86% (16/70); no grupo exposto foi de 55% (11/20) e no grupo não exposto de 10% (5/50). Os pacientes expostos apresentaram risco relativo de 5,5 (intervalo de confiança de 95% entre 2,19 e 13,82). CONCLUSÃO: Os resultados indicaram que a função muscular respiratória pré-operatória abaixo do valor previsto esteve associada a um risco relativo maior de complicações pós-operatórias nas cirurgias pesquisadas.
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Jiang SP, Li ZY, Huang LW, Zhang W, Lu ZQ, Zheng ZY. Multivariate analysis of the risk for pulmonary complication after gastrointestinal surgery. World J Gastroenterol 2005; 11:3735-41. [PMID: 15968730 PMCID: PMC4316026 DOI: 10.3748/wjg.v11.i24.3735] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To identify the risk factors for postoperative pulmonary complications (PPC) after gastrointestinal surgery.
METHODS: A total of 1002 patients undergoing gastrointestinal surgery in the Second Affiliated Hospital, Sun Yat-Sen University, during December 1999 and December 2003, were retrospectively studied.
RESULTS: The overall incidence of PPC was 22.8% (228/1002). Multivariate logistic analysis identified nine risk factors associated with PPC, including age odds ratio (OR = 1.040) history of respiratory diseases (OR = 2.976), serum albumin (OR = 0.954), chemotherapy 2 wk before operation (OR = 3.214), volume of preoperative erythrocyte transfusion (OR = 1.002), length of preoperative antibiotic therapy (OR = 1.072), intraoperative intratracheal intubation (OR = 1.002), nasogastric intubation (OR = 1.050) and postoperative mechanical ventilation (OR = 1.878). Logistic regression equation for predicting the risk of PPC was P(1) = 1/[1+e-(-3.488+ 0.039×Y+1.090×Rd+0.001×Rbc-0.047×Alb+0.002×Lii+ 0.049×Lni+0.630×Lmv+0.070×Dat+ 1.168×Ct)].
CONCLUSION: Old patients are easier to develop PPC.
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Affiliation(s)
- Shan-Ping Jiang
- Department of Respiratory Medicine, the Second Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510120, Guangdong Province, China.
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