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Westhoff M, Neumann P, Geiseler J, Bickenbach J, Arzt M, Bachmann M, Braune S, Delis S, Dellweg D, Dreher M, Dubb R, Fuchs H, Hämäläinen N, Heppner H, Kluge S, Kochanek M, Lepper PM, Meyer FJ, Neumann B, Putensen C, Schimandl D, Schönhofer B, Schreiter D, Walterspacher S, Windisch W. [Non-invasive Mechanical Ventilation in Acute Respiratory Failure. Clinical Practice Guidelines - on behalf of the German Society of Pneumology and Ventilatory Medicine]. Pneumologie 2024; 78:453-514. [PMID: 37832578 DOI: 10.1055/a-2148-3323] [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: 10/15/2023]
Abstract
The guideline update outlines the advantages as well as the limitations of NIV in the treatment of acute respiratory failure in daily clinical practice and in different indications.Non-invasive ventilation (NIV) has a high value in therapy of hypercapnic acute respiratory failure, as it significantly reduces the length of ICU stay and hospitalization as well as mortality.Patients with cardiopulmonary edema and acute respiratory failure should be treated with continuous positive airway pressure (CPAP) and oxygen in addition to necessary cardiological interventions. This should be done already prehospital and in the emergency department.In case of other forms of acute hypoxaemic respiratory failure with only mild or moderately disturbed gas exchange (PaO2/FiO2 > 150 mmHg) there is no significant advantage or disadvantage compared to high flow nasal oxygen (HFNO). In severe forms of ARDS NIV is associated with high rates of treatment failure and mortality, especially in cases with NIV-failure and delayed intubation.NIV should be used for preoxygenation before intubation. In patients at risk, NIV is recommended to reduce extubation failure. In the weaning process from invasive ventilation NIV essentially reduces the risk of reintubation in hypercapnic patients. NIV is regarded useful within palliative care for reduction of dyspnea and improving quality of life, but here in concurrence to HFNO, which is regarded as more comfortable. Meanwhile NIV is also recommended in prehospital setting, especially in hypercapnic respiratory failure and pulmonary edema.With appropriate monitoring in an intensive care unit NIV can also be successfully applied in pediatric patients with acute respiratory insufficiency.
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Affiliation(s)
- Michael Westhoff
- Klinik für Pneumologie, Lungenklinik Hemer - Zentrum für Pneumologie und Thoraxchirurgie, Hemer
| | - Peter Neumann
- Abteilung für Klinische Anästhesiologie und Operative Intensivmedizin, Evangelisches Krankenhaus Göttingen-Weende gGmbH
| | - Jens Geiseler
- Medizinische Klinik IV - Pneumologie, Beatmungs- und Schlafmedizin, Paracelsus-Klinik Marl, Marl
| | - Johannes Bickenbach
- Klinik für Operative Intensivmedizin und Intermediate Care, Uniklinik RWTH Aachen, Aachen
| | - Michael Arzt
- Schlafmedizinisches Zentrum der Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg
| | - Martin Bachmann
- Klinik für Atemwegs-, Lungen- und Thoraxmedizin, Beatmungszentrum Hamburg-Harburg, Asklepios Klinikum Harburg, Hamburg
| | - Stephan Braune
- IV. Medizinische Klinik: Akut-, Notfall- und Intensivmedizin, St. Franziskus-Hospital, Münster
| | - Sandra Delis
- Klinik für Pneumologie, Palliativmedizin und Geriatrie, Helios Klinikum Emil von Behring GmbH, Berlin
| | - Dominic Dellweg
- Klinik für Innere Medizin, Pneumologie und Gastroenterologie, Pius-Hospital Oldenburg, Universitätsmedizin Oldenburg
| | - Michael Dreher
- Klinik für Pneumologie und Internistische Intensivmedizin, Uniklinik RWTH Aachen
| | - Rolf Dubb
- Akademie der Kreiskliniken Reutlingen GmbH, Reutlingen
| | - Hans Fuchs
- Zentrum für Kinder- und Jugendmedizin, Neonatologie und pädiatrische Intensivmedizin, Universitätsklinikum Freiburg
| | | | - Hans Heppner
- Klinik für Geriatrie und Geriatrische Tagesklinik Klinikum Bayreuth, Medizincampus Oberfranken Friedrich-Alexander-Universität Erlangen-Nürnberg, Bayreuth
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Matthias Kochanek
- Klinik I für Innere Medizin, Hämatologie und Onkologie, Universitätsklinikum Köln, Köln
| | - Philipp M Lepper
- Klinik für Innere Medizin V - Pneumologie, Allergologie und Intensivmedizin, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg
| | - F Joachim Meyer
- Lungenzentrum München - Bogenhausen-Harlaching) München Klinik gGmbH, München
| | - Bernhard Neumann
- Klinik für Neurologie, Donauisar Klinikum Deggendorf, und Klinik für Neurologie der Universitätsklinik Regensburg am BKH Regensburg, Regensburg
| | - Christian Putensen
- Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn
| | - Dorit Schimandl
- Klinik für Pneumologie, Beatmungszentrum, Zentralklinik Bad Berka GmbH, Bad Berka
| | - Bernd Schönhofer
- Klinik für Innere Medizin, Pneumologie und Intensivmedizin, Evangelisches Klinikum Bethel, Universitätsklinikum Ost Westphalen-Lippe, Bielefeld
| | | | - Stephan Walterspacher
- Medizinische Klinik - Sektion Pneumologie, Klinikum Konstanz und Lehrstuhl für Pneumologie, Universität Witten-Herdecke, Witten
| | - Wolfram Windisch
- Lungenklinik, Kliniken der Stadt Köln gGmbH, Lehrstuhl für Pneumologie Universität Witten/Herdecke, Köln
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Ferrando C, Carramiñana A, Piñeiro P, Mirabella L, Spadaro S, Librero J, Ramasco F, Scaramuzzo G, Cervantes O, Garutti I, Parera A, Argilaga M, Herranz G, Unzueta C, Vives M, Regi K, Costa-Reverte M, Sonsoles Leal M, Nieves-Alonso J, García E, Rodríguez-Pérez A, Fariña R, Cabrera S, Guerra E, Gallego-Ligorit L, Herrero-Izquierdo A, Vallés-Torres J, Ramos S, López-Herrera D, De La Matta M, Gokhan S, Kucur E, Mugarra A, Soro M, García L, Sastre JA, Aguirre P, Salazar CJ, Ramos MC, Morocho DR, Trespalacios R, Ezequiel-Fernández F, Lamanna A, Pia Cantatore L, Laforgia D, Bellas S, López C, Navarro-Ripoll R, Martínez S, Vallverdú J, Jacas A, Yepes-Temiño MJ, Belda FJ, Tusman G, Suárez-Sipmann F, Villar J. Individualised, perioperative open-lung ventilation strategy during one-lung ventilation (iPROVE-OLV): a multicentre, randomised, controlled clinical trial. THE LANCET. RESPIRATORY MEDICINE 2024; 12:195-206. [PMID: 38065200 DOI: 10.1016/s2213-2600(23)00346-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND It is uncertain whether individualisation of the perioperative open-lung approach (OLA) to ventilation reduces postoperative pulmonary complications in patients undergoing lung resection. We compared a perioperative individualised OLA (iOLA) ventilation strategy with standard lung-protective ventilation in patients undergoing thoracic surgery with one-lung ventilation. METHODS This multicentre, randomised controlled trial enrolled patients scheduled for open or video-assisted thoracic surgery using one-lung ventilation in 25 participating hospitals in Spain, Italy, Turkey, Egypt, and Ecuador. Eligible adult patients (age ≥18 years) were randomly assigned to receive iOLA or standard lung-protective ventilation. Eligible patients (stratified by centre) were randomly assigned online by local principal investigators, with an allocation ratio of 1:1. Treatment with iOLA included an alveolar recruitment manoeuvre to 40 cm H2O of end-inspiratory pressure followed by individualised positive end-expiratory pressure (PEEP) titrated to best respiratory system compliance, and individualised postoperative respiratory support with high-flow oxygen therapy. Participants allocated to standard lung-protective ventilation received combined intraoperative 4 cm H2O of PEEP and postoperative conventional oxygen therapy. The primary outcome was a composite of severe postoperative pulmonary complications within the first 7 postoperative days, including atelectasis requiring bronchoscopy, severe respiratory failure, contralateral pneumothorax, early extubation failure (rescue with continuous positive airway pressure, non-invasive ventilation, invasive mechanical ventilation, or reintubation), acute respiratory distress syndrome, pulmonary infection, bronchopleural fistula, and pleural empyema. Due to trial setting, data obtained in the operating and postoperative rooms for routine monitoring were not blinded. At 24 h, data were acquired by an investigator blinded to group allocation. All analyses were performed on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov, NCT03182062, and is complete. FINDINGS Between Sept 11, 2018, and June 14, 2022, we enrolled 1380 patients, of whom 1308 eligible patients (670 [434 male, 233 female, and three with missing data] assigned to iOLA and 638 [395 male, 237 female, and six with missing data] to standard lung-protective ventilation) were included in the final analysis. The proportion of patients with the composite outcome of severe postoperative pulmonary complications within the first 7 postoperative days was lower in the iOLA group compared with the standard lung-protective ventilation group (40 [6%] vs 97 [15%], relative risk 0·39 [95% CI 0·28 to 0·56]), with an absolute risk difference of -9·23 (95% CI -12·55 to -5·92). Recruitment manoeuvre-related adverse events were reported in five patients. INTERPRETATION Among patients subjected to lung resection under one-lung ventilation, iOLA was associated with a reduced risk of severe postoperative pulmonary complications when compared with conventional lung-protective ventilation. FUNDING Instituto de Salud Carlos III and the European Regional Development Funds.
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Affiliation(s)
- Carlos Ferrando
- Institut D'investigació August Pi I Sunyer, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
| | - Albert Carramiñana
- Department of Anesthesiology and Critical Care, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Patricia Piñeiro
- Department of Anesthesiology and Critical Care, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Lucia Mirabella
- Department of Medical and Surgical Sciences, Università Degli Studi di Foggia, Foggia, Italy
| | - Savino Spadaro
- Department of Anesthesiology and Critical Care, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Julián Librero
- UPNA, REDISSEC Red de Investigación en Servicios de Salud, Navarrabiomed, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Fernando Ramasco
- Department of Anesthesiology and Critical Care, Hospital Universitario de La Princesa, Madrid, Spain
| | - Gaetano Scaramuzzo
- Department of Anesthesiology and Critical Care, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Oriol Cervantes
- Department of Anesthesiology and Critical Care, Hospital Universitario Germans Trías i Pujol, Barcelona, Spain
| | - Ignacio Garutti
- Department of Anesthesiology and Critical Care, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Ana Parera
- Department of Anesthesiology and Critical Care, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - Marta Argilaga
- Department of Anesthesiology and Critical Care, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - Gracia Herranz
- Department of Anesthesiology and Critical Care, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - Carmen Unzueta
- Department of Anesthesiology and Critical Care, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - Marc Vives
- Department of Anesthesiology and Critical Care, Hospital Universitario Josep Trueta, Girona, Spain
| | - Kevin Regi
- Department of Anesthesiology and Critical Care, Hospital Universitario Josep Trueta, Girona, Spain
| | - Marta Costa-Reverte
- Department of Anesthesiology and Critical Care, Hospital Universitario de Bellvitge, Barcelona, Spain
| | | | - Jesús Nieves-Alonso
- Department of Anesthesiology and Critical Care, Hospital Universitario de La Princesa, Madrid, Spain
| | - Esther García
- Department of Anesthesiology and Critical Care, Hospital Universitario de La Princesa, Madrid, Spain
| | - Aurelio Rodríguez-Pérez
- Department of Anesthesiology and Critical Care, Hospital Universitario de Gran Canaria Dr Negrín, Gran Canarias, Spain
| | - Roberto Fariña
- Department of Anesthesiology and Critical Care, Hospital Universitario de Gran Canaria Dr Negrín, Gran Canarias, Spain
| | - Sergio Cabrera
- Department of Anesthesiology and Critical Care, Hospital Universitario de Gran Canaria Dr Negrín, Gran Canarias, Spain
| | - Elisabeth Guerra
- Department of Anesthesiology and Critical Care, Hospital Universitario de Gran Canaria Dr Negrín, Gran Canarias, Spain
| | - Lucia Gallego-Ligorit
- Department of Anesthesiology and Critical Care, Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón IIS Aragón, Zaragoza, Spain
| | - Alba Herrero-Izquierdo
- Department of Anesthesiology and Critical Care, Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón IIS Aragón, Zaragoza, Spain
| | - J Vallés-Torres
- Department of Anesthesiology and Critical Care, Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón IIS Aragón, Zaragoza, Spain
| | - Silvia Ramos
- Department of Anesthesiology and Critical Care, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Daniel López-Herrera
- Department of Anesthesiology and Critical Care, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Manuel De La Matta
- Department of Anesthesiology and Critical Care, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Sertcakacilar Gokhan
- Department of Anesthesiology and Critical Care, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey; Outcomes Research Consortium, Cleveland, OH, USA
| | - Evrim Kucur
- Department of Anesthesiology and Critical Care, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ana Mugarra
- Department of Anesthesiology and Critical Care, Hospital Universitario Clínico de Valencia, Valencia, Spain
| | - Marina Soro
- Department of Anesthesiology and Critical Care, Hospital Universitario Clínico de Valencia, Valencia, Spain
| | - Laura García
- Department of Anesthesiology and Critical Care, Hospital Universitario Clínico de Valencia, Valencia, Spain
| | - José Alfonso Sastre
- Department of Anesthesiology and Critical Care, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Pilar Aguirre
- Department of Anesthesiology and Critical Care, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Claudia Jimena Salazar
- Department of Anesthesiology and Critical Care, Hospital Universitario Ntra Sra de Candelaria, Santa Cruz de Tenerife, Spain
| | - María Carolina Ramos
- Department of Anesthesiology and Critical Care, Hospital Universitario Ntra Sra de Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Ramón Trespalacios
- Department of Anesthesiology and Critical Care, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Félix Ezequiel-Fernández
- Department of Anesthesiology and Critical Care, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Angella Lamanna
- Department of Medical and Surgical Sciences, Università Degli Studi di Foggia, Foggia, Italy
| | - Leonarda Pia Cantatore
- Department of Medical and Surgical Sciences, Università Degli Studi di Foggia, Foggia, Italy
| | - Donato Laforgia
- Department of Medical and Surgical Sciences, Università Degli Studi di Foggia, Foggia, Italy
| | - Soledad Bellas
- Department of Anesthesiology and Critical Care, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Carlos López
- Department of Anesthesiology and Critical Care, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Ricard Navarro-Ripoll
- Department of Anesthesiology and Critical Care, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Samira Martínez
- Department of Anesthesiology and Critical Care, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Jordi Vallverdú
- Department of Anesthesiology and Critical Care, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Adriana Jacas
- Department of Anesthesiology and Critical Care, Hospital Clinic de Barcelona, Barcelona, Spain
| | - María José Yepes-Temiño
- Department of Anesthesiology and Critical Care, Clínica Universidad de Navarra, Pamplona, Spain
| | - Francisco Javier Belda
- Department of Anesthesiology and Critical Care, Hospital Universitario Clínico de Valencia, Valencia, Spain
| | - Gerardo Tusman
- Department of Anesthesiology, Hospital Privado de Comunidad, Mar de Plata, Buenos Aires, Argentina
| | - Fernando Suárez-Sipmann
- CIBER de Enfermedades Respiratorias CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Jesús Villar
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Hospital Universitario Dr Negrín, Las Palmas de Gran Canaria, Spain; Li Ka Shing Knowledge Institute for Medical Science, St Michael's Hospital, Toronto, ON, Canada
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Mutar MF, Ben Hamada H, Askar TRM, Hassini L, Naija W, Kahloul M. Intraoperative Use of High-Flow Nasal Cannula in Elderly Patients Undergoing Hip Fracture Repair Under Spinal Anesthesia: A Randomized Controlled Study. Cureus 2024; 16:e55846. [PMID: 38590487 PMCID: PMC11001159 DOI: 10.7759/cureus.55846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND The procedure of hip fracture repair poses a risk for postoperative pulmonary complications (PPCs) in elderly patients, accompanied by anesthesia and operations. Various noninvasive methods of respiratory support are used as prophylactic and therapeutic, mainly in the postoperative period. Objective: This study aims to determine whether intraoperative use of a high-flow nasal cannula (HFNC) impacts elderly patient outcomes after hip fracture surgery. METHOD Seventy patients aged 65 and older undergoing traumatic hip surgery under spinal anesthesia for isolated hip fractures were randomly assigned to either an interventional group (I) utilizing a high-flow nasal cannula or a control group (C) without respiratory intervention in a six-month single-blind controlled study at Sahloul Teaching Hospital. RESULTS The two groups had identical socio-demographic traits and baseline data. Respiratory postoperative complications occurred in two patients in group (I) and in nine patients in group (C), with a significant difference (p = 0.023). The main respiratory postoperative complications in group (I) were atelectasis (one case) and pulmonary edema (one case). The main respiratory postoperative complications in group (C) were atelectasis (four cases), pneumonia (two cases), COPD decompensation (two cases), and pulmonary edema (one case). No intensive care unit admissions or intraoperative complications were associated with using HFNC. The mean length of stay (LOS) in the hospital was 8.83 ± 2.91 for group I and 10.46 ± 3.4 for group (C), which differed significantly (p = 0.03) with no in-hospital mortality for the two groups. CONCLUSION The intraoperative administration of HFNC may lower the incidence of postoperative respiratory complications and the duration of hospital stays.
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Affiliation(s)
- Majid F Mutar
- Department of Anesthesia and Intensive Care/Faculty of Medicine of Sousse, Sahloul Hospital/University of Sousse, Sousse, TUN
- Anesthesia Department, College of Medical Technology, Al-Ayen Iraqi University, Thi-Qar, Thi-Qar, IRQ
| | - Habiba Ben Hamada
- Department of Anesthesia and Intensive Care/Faculty of Medicine of Souse, Sahloul Hospital/University of Sousse, Sousse, TUN
| | - Talib Razaq M Askar
- Anesthesia Department, Faculty of Medicine, University of Thi-Qar, Thi-Qar, IRQ
| | - Lassaad Hassini
- Department of Orthopedic Surgery, Faculty of Medicine of Sousse, Sahloul Hospital/University of Sousse, Sousse, TUN
| | - Walid Naija
- Department of Anesthesia and Intensive Care, Faculty of Medicine of Sousse, Sahloul Hospital/University of Sousse, Sousse, TUN
| | - Mohamed Kahloul
- Department of Anesthesia and Intensive Care/Faculty of Medicine of Souse, Sahloul Hospital/University of Sousse, Sousse, TUN
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Moury PH, Pasquier V, Greco F, Arvieux JL, Alves-Macedo S, Richard M, Casez-Brasseur M, Skaare K, Jacon P, Durand M, Bedague D, Jaber S, Bosson JL, Albaladejo P. A randomized controlled trial of the intraoperative use of noninvasive ventilation versus supplemental oxygen by face mask for procedural sedation in an electrophysiology laboratory. Can J Anaesth 2023; 70:1182-1193. [PMID: 37268802 DOI: 10.1007/s12630-023-02495-2] [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: 07/26/2022] [Revised: 11/21/2022] [Accepted: 11/26/2022] [Indexed: 06/04/2023] Open
Abstract
PURPOSE The efficacy of noninvasive ventilation (NIV) during procedures that require sedation and analgesia has not been established. We evaluated whether NIV reduces the incidence of respiratory events. METHODS In this randomized controlled trial, we included 195 patients with an American Society of Anesthesiologists Physical Status of III or IV during electrophysiology laboratory procedures. We compared NIV with face mask oxygen therapy for patients under sedation. The primary outcome was the incidence of respiratory events determined by a computer-driven blinded analysis and defined by hypoxemia (peripheral oxygen saturation < 90%) or apnea/hypopnea (absence of breathing for 20 sec on capnography). Secondary outcomes included hemodynamic variables, sedation, patient safety (composite scores of major or minor adverse events), and adverse outcomes at day 7. RESULTS A respiratory event occurred in 89/98 (95%) patients in the NIV group and in 69/97 (73%) patients with face masks (risk ratio [RR], 1.29; 95% confidence interval [CI], 1.13 to 1.47; P < 0.001). Hypoxemia occurred in 40 (42%) patients in the NIV group and in 33 (34%) patients with face masks (RR, 1.21; 95% CI, 0.84 to 1.74; P = 0.30). Apnea/hypopnea occurred in 83 patients (92%) in the NIV group vs 65 patients (70%) with face masks (RR, 1.32; 95% CI, 1.14 to 1.53; P < 0.001). Hemodynamic variables, sedation, major or minor safety events, and patient outcomes were not different between the groups. CONCLUSIONS Respiratory events were more frequent among patients receiving NIV without any safety or outcome impairment. These results do not support the routine use of NIV intraoperatively. STUDY REGISTRATION ClinicalTrials.gov (NCT02779998); registered 4 November 2015.
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Affiliation(s)
- Pierre-Henri Moury
- HP2 Laboratory, U1042, Grenoble Alpes University, Grenoble, France.
- Pôle Anesthésie-Réanimation, Réanimation Cardiovasculaire et Thoracique, CHU Grenoble Alpes, CS 10217, Grenoble Cedex 9, France.
| | | | - Flora Greco
- Pôle Anesthésie-Réanimation, CHU Grenoble Alpes, Grenoble, France
| | | | | | - Marion Richard
- Pôle Anesthésie-Réanimation, CHU Grenoble Alpes, Grenoble, France
| | | | - Kristina Skaare
- Department of Biostatistics, Public Health, ThEMAS, Université Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Peggy Jacon
- Department of Cardiology, CHU Grenoble Alpes, Grenoble, France
| | - Michel Durand
- Pôle Anesthésie-Réanimation, CHU Grenoble Alpes, Grenoble, France
| | - Damien Bedague
- Pôle Anesthésie-Réanimation, CHU Grenoble Alpes, Grenoble, France
| | - Samir Jaber
- Intensive Care Unit, Anesthesiology and Critical Care Department B, Saint Eloi Teaching Hospital, Université Montpellier 1, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - Jean-Luc Bosson
- Department of Biostatistics, Public Health, ThEMAS, Université Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
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Einav S, Lakbar I, Leone M. Non-Invasive Respiratory Support for Management of the Perioperative Patient: A Narrative Review. Adv Ther 2021; 38:1746-1756. [PMID: 33675524 DOI: 10.1007/s12325-021-01668-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/11/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Non-invasive respiratory support including high-flow nasal oxygen (HFNO), continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) is routinely used in the perioperative period. OBJECTIVES The aim of this narrative review was to discuss some of the existing literature on perioperative non-invasive respiratory support outlining its potential roles in each of the three perioperative periods (pre-, intra- and postoperatively) and to propose the way forward. RESULTS During induction of anesthesia, non-invasive ventilation (NIV) was associated with improved ventilatory variables and reduced risk of postoperative respiratory complications. HFNO did not seem to confer an advantage in terms of peri-intubation hypoxemia. Intraoperative data on NIV are scarce. Upper airway obstruction and worsening hypoventilation are two risks associated with its use. Compared with conventional oxygenation, HFNO is associated with a reduced risk of hypoxemia. Postoperative NIV has been associated with improved arterial blood gases and a reduced reintubation rate, but no difference was reported for mortality, hospital length of stay, rate of anastomotic leakage, pneumonia-related complications and sepsis or infections. Head-to-head comparison of HFNO versus BiPAP showed no advantage to either mode of support. CONCLUSION In the preoperative setting, NIV seems to be associated with improved clinical outcomes in specific patient subgroups (obesity, pregnancy). In the postoperative setting, both NIV and HFNO were associated with lower reintubation rates. The literature has provided little evidence regarding the use of non-invasive ventilatory support in other patient subgroups or intraoperatively. There is also little literature regarding the appropriateness of combining different modes of support. In the next years, the combination of several modes of respiratory support should be assessed in targeted populations.
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Landoni G, Likhvantsev V, Kuzovlev A, Cabrini L. Perioperative Noninvasive Ventilation After Adult or Pediatric Surgery: A Comprehensive Review. J Cardiothorac Vasc Anesth 2021; 36:785-793. [PMID: 33893015 DOI: 10.1053/j.jvca.2021.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/12/2021] [Accepted: 03/14/2021] [Indexed: 11/11/2022]
Abstract
Postoperative pulmonary complications and acute respiratory failure are among the leading causes of adverse postoperative outcomes. Noninvasive ventilation may safely and effectively prevent acute respiratory failure in high-risk patients after cardiothoracic surgery and after abdominal surgery. Moreover, noninvasive ventilation can be used to treat postoperative hypoxemia, particularly after abdominal surgery. Noninvasive ventilation also can be helpful to prevent or manage intraoperative acute respiratory failure during non-general anesthesia, primarily in patients with poor respiratory function. Finally, noninvasive ventilation is superior to standard preoxygenation in delaying desaturation during intubation in morbidly obese and in critically ill hypoxemic patients. The few available studies in children suggest that noninvasive ventilation could be safe and valuable in treating hypoxemic or hypercapnic acute respiratory failure after cardiac surgery; on the other hand, it could be dangerous after tracheoesophageal correction.
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Affiliation(s)
- Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Faculty of Medicine, Vita Salute San Raffaele University, Milan, Italy.
| | - Valery Likhvantsev
- Department of Anesthesiology and Intensive Care, First Moscow State Medical University, Moscow, Russia; V. Negovsky Reanimatology Research Institute, Moscow, Russia
| | - Artem Kuzovlev
- V. Negovsky Reanimatology Research Institute, Moscow, Russia
| | - Luca Cabrini
- Università degli Studi dell'Insubria, Varese, Italy; Ospedale di Circolo e Fondazione Macchi, Varese, ASST-Settelaghi, Varese, Italy
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7
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Perioperative Care and Medication-related Hypoventilation. Sleep Med Clin 2020; 15:471-483. [PMID: 33131658 DOI: 10.1016/j.jsmc.2020.08.008] [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: 11/20/2022]
Abstract
Cumulative evidence supports the association of adverse postoperative outcomes with obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS). Although current guidelines recommend preoperative screening for OSA and OHS, the best perioperative management pathways remain unknown. Interventions attempting to prevent complications in the postoperative period largely are consensus based and focused on enhanced monitoring, conservative measures, and specific OSA therapies, such as positive airway pressure. Until further research is available to improve the quality and strength of these recommendations, patients with known or suspected OSA and OHS should be considered at higher risk for perioperative cardiopulmonary complications.
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8
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Ahn HJ. Anesthetic management of patients with chronic obstructive pulmonary disease. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2020. [DOI: 10.5124/jkma.2020.63.9.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is the third most common cause of death worldwide. It has a prevalence of 14% among Koreans aged above 40 years and a prevalence of 31% among those aged above 65 years. However, only 6% of the COPD patients receive treatment. Most of the patients do not seek medical attention, as they think that dyspnea, cough, and productive sputum, which are the common symptoms of COPD, are normal aging phenomena. Smoking is a major risk factor for COPD, but environmental hazards and genetic susceptibility are also involved. With aging, lung injuries due to these risk factors accumulate, leading to increased prevalence of COPD. The major concerns regarding perioperative management of COPD patients include preoperative evaluation of cardiopulmonary risks, optimization of lung function, and evaluation of COPD-related physiological functions that are easily aggravated during anesthesia. These include respiratory muscle dysfunction, dynamic hyperinflation and auto-positive end-expiratory pressure, hypoxia-hypercarbia, and pulmonary hypertension-associated heart failure. Therefore, anesthesia for COPD patients should focus on preoperative evaluation, risk reduction measures, and prevention of postoperative pulmonary complications.
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9
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Lim H, Oh M, Chung YH, Ki H, Lee JJ. Effects of continuous positive airway pressure in patients at high risk of obstructive sleep apnea during propofol sedation after spinal anesthesia. J Clin Monit Comput 2018; 33:657-663. [PMID: 30284097 DOI: 10.1007/s10877-018-0202-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 09/21/2018] [Indexed: 01/13/2023]
Abstract
In patients with obstructive sleep apnea, short-term use of a continuous positive airway pressure mask improves oxygenation, decreases the apnea-hypopnea index, and reduces hemodynamic instability. In this study, we investigated the effects of use of a continuous positive airway pressure mask in patients at high risk of obstructive sleep apnea during propofol sedation after spinal anesthesia. Forty patients who underwent propofol sedation after spinal anesthesia for transurethral bladder or prostate resection with a STOP-Bang score of 3 or more were enrolled in this study. Patients were randomly divided into two groups: a simple oxygen mask group (n = 20) and a continuous positive airway pressure mask group (n = 20). After spinal anesthesia, propofol was injected at a target concentration of 1.3 mcg/ml via a target concentration control injector. ApneaLink™ was applied to all patients. Patients in the simple oxygen mask group were administered oxygen at a rate of 6 L/min through a simple facial mask. Patients in the CPAP mask group were connected to a pressurizer, and oxygen (6 L/min, 5-15 cm H2O) was administered. Blood pressure, heart rate, respiratory rate, and oxygen saturation were recorded preoperatively, after spinal anesthesia, and every 5 min after the injection of propofol to observe hemodynamic changes. Apnea-hypopnea index was estimated using ApneaLink™. There were no significant differences in hemodynamic changes between the two groups. Apnea-hypopnea index was significantly reduced in the continuous positive airway pressure mask group compared to the simple facial mask group. Application of a continuous positive airway pressure mask in a patient at high risk of obstructive sleep apnea can lower the incidence of obstructive sleep apnea during sedation without a significant effect on hemodynamic stability.
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Affiliation(s)
- Hyunyoung Lim
- Department of Anesthesiology and Pain Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Minseok Oh
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yang Hoon Chung
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital, Bucheon, Republic of Korea
| | - Hyunseo Ki
- Department of Anesthesiology and Pain Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Jeong Jin Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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10
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de Araújo-Filho AA, de Cerqueira-Neto ML, de Assis Pereira Cacau L, Oliveira GU, Cerqueira TCF, de Santana-Filho VJ. Effect of prophylactic non-invasive mechanical ventilation on functional capacity after heart valve replacement: a clinical trial. Clinics (Sao Paulo) 2017; 72:618-623. [PMID: 29160424 PMCID: PMC5666445 DOI: 10.6061/clinics/2017(10)05] [Citation(s) in RCA: 7] [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: 04/04/2017] [Revised: 05/07/2017] [Accepted: 08/02/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE During cardiac surgery, several factors contribute to the development of postoperative pulmonary complications. Non-invasive ventilation is a promising therapeutic tool for improving the functionality of this type of patient. The aim of this study is to evaluate the functional capacity and length of stay of patients in a nosocomial intensive care unit who underwent prophylactic non-invasive ventilation after heart valve replacement. METHOD The study was a controlled clinical trial, comprising 50 individuals of both sexes who were allocated by randomization into two groups with 25 patients in each group: the control group and experimental group. After surgery, the patients were transferred to the intensive care unit and then participated in standard physical therapy, which was provided to the experimental group after 3 applications of non-invasive ventilation within the first 26 hours after extubation. For non-invasive ventilation, the positive pressure was 10 cm H2O, with a duration of 1 hour. The evaluation was performed on the 7th postoperative day/discharge and included a 6-minute walk test. The intensive care unit and hospitalization times were monitored in both groups. Brazilian Registry of Clinical Trials (REBeC): RBR number 8bxdd3. RESULTS Analysis of the 6-minute walk test showed that the control group walked an average distance of 264.34±76 meters and the experimental group walked an average distance of 334.07±71 meters (p=0.002). The intensive care unit and hospitalization times did not differ between the groups. CONCLUSION Non-invasive ventilation as a therapeutic resource was effective toward improving functionality; however, non-invasive ventilation did not influence the intensive care unit or hospitalization times of the studied cardiac patients.
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Affiliation(s)
- Amaro Afrânio de Araújo-Filho
- Nucleo de Pos Graduacao em Ciencias da Saude, Universidade Federal de Sergipe, Aracaju, SE, BR
- Departamento de Fisioterapia, Universidade Tiradentes - UNIT, Aracaju, SE, BR
| | - Manoel Luiz de Cerqueira-Neto
- Departamento de Fisioterapia, Universidade Federal de Sergipe - UFS, Aracaju, SE, BR
- Departamento de Fisioterapia, Universidade Federal de Sergipe - UFS, Lagarto, SE, BR
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11
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Kondo Y, Kumasawa J, Kawaguchi A, Seo R, Nango E, Hashimoto S. Effects of non-invasive ventilation in patients with acute respiratory failure excluding post-extubation respiratory failure, cardiogenic pulmonary edema and exacerbation of COPD: a systematic review and meta-analysis. J Anesth 2017; 31:714-725. [PMID: 28741217 DOI: 10.1007/s00540-017-2389-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 07/10/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND This meta-analysis compared the effects of non-invasive ventilation (NIV) with invasive mechanical ventilation (InMV) and standard oxygen (O2) therapy on mortality and rate of tracheal intubation in patients presenting acute respiratory failure (ARF). METHODS We searched the MEDLINE, EMBASE and Cochrane Central Register of clinical trials databases between 1949 and May 2015 to identify randomized trials of NIV for ARF. We excluded the ARF caused by extubation, cardiogenic pulmonary edema, and COPD. RESULTS The meta-analysis included 21 studies and 1691 patients, of whom 846 were assigned to NIV and 845 to control (InMV or standard O2 therapy). One hundred ninety-one patients (22.6%) in the NIV group and 261 patients (30.9%) in the control group died before discharge from hospital. The pooled odds ratio (OR) for short-term mortality (in-hospital mortality) was 0.56 (95% CI 0.40-0.78). When comparing NIV with standard O2 therapy, the short-term mortality was 155 (27.4%) versus 204 (36.0%), respectively. For this comparison, the pooled OR of short-term mortality was 0.56 (95% CI 0.36-0.85). When comparing NIV with InMV, the short-term mortality was 36 (12.9%) versus 57 (20.5%) patients, respectively. For this comparison, the pooled OR of short-term mortality was 0.56 (95% CI 0.34-0.90). Tracheal intubation was performed in 106 patients (22.7%) in the NIV and in 183 patients (39.4%) in the standard O2 group, representing a pooled OR of 0.37 (95% CI 0.25-0.55). There were publication biases and the quality of the evidence was graded as low. CONCLUSION Compared with standard O2 therapy or InMV, NIV lowered both the short-term mortality and the rate of tracheal intubation in patients presenting with ARF.
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Affiliation(s)
- Yutaka Kondo
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan.
| | - Junji Kumasawa
- Department of Critical Care Medicine, Sakai City Medical Center, Osaka, Japan.,Department of Healthcare Epidemiology, School of Public Health, Kyoto University, Kyoto, Japan
| | - Atsushi Kawaguchi
- University of Alberta, Department of Pediatrics, Pediatric Critical Care Medicine, Edmonton, Canada.,University of Alberta, School of Public Health, Edmonton, Canada
| | - Ryutaro Seo
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Eishu Nango
- Department of General Medicine, Tokyo Kita Medical Center, Tokyo, Japan
| | - Satoru Hashimoto
- Department of Anesthesiology and Intensive Care, Kyoto Prefectural University of Medicine, Kyoto, Japan
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12
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Bordes J, Goutorbe P, Cungi PJ, Boghossian MC, Kaiser E. Noninvasive ventilation during spontaneous breathing anesthesia: an observational study using electrical impedance tomography. J Clin Anesth 2016; 34:420-6. [DOI: 10.1016/j.jclinane.2016.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 03/21/2016] [Accepted: 04/07/2016] [Indexed: 10/21/2022]
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13
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Yurtlu BS, Köksal B, Hancı V, Turan IÖ. Non-invasive mechanical ventilation and epidural anesthesia for an emergency open cholecystectomy. Braz J Anesthesiol 2016; 66:546-8. [PMID: 27591472 DOI: 10.1016/j.bjane.2014.05.007] [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: 03/20/2014] [Accepted: 05/06/2014] [Indexed: 11/28/2022] Open
Abstract
Non-invasive ventilation is an accepted treatment modality in both acute exacerbations of respiratory diseases and chronic obstructive lung disease. It is commonly utilized in the intensive care units, or for postoperative respiratory support in post-anesthesia care units. This report describes intraoperative support in non-invasive ventilation to neuroaxial anesthesia for an emergency upper abdominal surgery.
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Affiliation(s)
- Bülent Serhan Yurtlu
- Dokuz Eylül University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Izmir, Turkey.
| | - Bengü Köksal
- Bülent Ecevit University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Zonguldak, Turkey
| | - Volkan Hancı
- Dokuz Eylül University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Izmir, Turkey
| | - Işıl Özkoçak Turan
- Anesthesiology and Reanimation Clinic, Intensive Care Unit, Ankara Numune Education and Research Hospital, Ankara, Turkey
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14
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Farzanegan R, Farzanegan B, Zangi M, Golestani Eraghi M, Noorbakhsh S, Doozandeh Tabarestani N, Shadmehr MB. Incidence Rate of Post-Intubation Tracheal Stenosis in Patients Admitted to Five Intensive Care Units in Iran. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e37574. [PMID: 28144465 PMCID: PMC5253460 DOI: 10.5812/ircmj.37574] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 03/29/2016] [Accepted: 04/09/2016] [Indexed: 11/30/2022]
Abstract
Background Tracheal stenosis is one of the worst complications associated with endotracheal intubation and it is the most common reason for reconstructive airway surgeries. Due to various local risk factors, the incidence rate of tracheal stenosis may vary in different countries. In order to estimate the incidence rate of post-intubation tracheal stenosis (PITS) in patients admitted to an intensive care unit (ICU), a follow-up study was planned. As there was no similar methodological model in the literature, a feasibility step was also designed to examine the whole project and to enhance the follow-up rate. Objectives To estimate the PITS incidence rate in patients admitted to ICUs, as well as to evaluate the feasibility of the study. Methods This prospective cohort study was conducted in five hospitals in two provinces (Tehran and Arak) of Iran from November 2011 to March 2013. All patients admitted to ICUs who underwent more than 24 hours of endotracheal intubation were included. Upon their discharge from the ICUs, the patients received oral and written educational materials intended to ensure a more successful follow-up. The patients were asked to come back for follow-up three months after their extubation, or sooner in case of any symptoms developing. Those with dyspnea or stridor underwent a bronchoscopy. The asymptomatic patients were given a spirometry and then they underwent a bronchoscopy if the flow-volume loop suggested airway stenosis. Results Some seventy-three patients (70% men) were included in the study. Multiple trauma secondary to motor vehicle accidents (52%) was the most common cause of intubation. Follow-ups were completed in only 14 (19.2%, CI = 0.109 - 0.300) patients. One patient (7%, CI = 0.007 - 0.288) developed symptomatic tracheal stenosis that was confirmed by bronchoscopy. The barriers to a successful follow-up were assessed on three levels: ineffective oral education upon discharge, improper usage of educational materials, and difficulties to attending follow-up visits. There were also some important obstacles in terms of human, time, material, and cost resources, as well as data management. Conclusions To enhance the follow-up rate, three strategies were proposed: patient-focused strategies such as emphasizing patient education upon discharge and providing rewards; structural-focused strategies such as scheduling home visits and uploading questionnaires onto the research center’s website; and provider-focused strategies such as selecting coordinators with good communication skills. All necessary resources should also be re-arranged for a multicenter national study.
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Affiliation(s)
- Roya Farzanegan
- Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Behrooz Farzanegan
- Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Mahdi Zangi
- Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Majid Golestani Eraghi
- Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | | | - Neda Doozandeh Tabarestani
- Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Behgam Shadmehr
- Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Mohammad Behgam Shadmehr, Tracheal Diseases Research Center, Shahid Beheshti University of Medical Sciences, Massih Daneshvari Hospital, Tehran, IR Iran. Tel: +98-2127122163, Fax: +98-212610538, E-mail:
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15
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Cabrini L, Pasin L. Non invasive ventilation in surgical patients: Definitely yes, but wisely please. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2015; 62:485-486. [PMID: 25899826 DOI: 10.1016/j.redar.2015.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 02/23/2015] [Indexed: 06/04/2023]
Affiliation(s)
- L Cabrini
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy.
| | - L Pasin
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
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16
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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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17
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Cabrini L, Landoni G, Oriani A, Plumari VP, Nobile L, Greco M, Pasin L, Beretta L, Zangrillo A. Noninvasive Ventilation and Survival in Acute Care Settings. Crit Care Med 2015; 43:880-8. [DOI: 10.1097/ccm.0000000000000819] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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18
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Preventive and therapeutic noninvasive ventilation in cardiovascular surgery. Curr Opin Anaesthesiol 2015; 28:67-72. [DOI: 10.1097/aco.0000000000000148] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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19
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Yurtlu BS, Köksal B, Hancı V, Turan IÖ. [Non-invasive mechanical ventilation and epidural anesthesia for an emergency open cholecystectomy]. Rev Bras Anestesiol 2014; 66:546-8. [PMID: 25435418 DOI: 10.1016/j.bjan.2014.05.009] [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: 03/20/2014] [Accepted: 05/06/2014] [Indexed: 11/26/2022] Open
Abstract
Non-invasive ventilation is an accepted treatment modality in both acute exacerbations of respiratory diseases and chronic obstructive lung disease. It is commonly utilized in the intensive care units, or for postoperative respiratory support in post-anesthesia care units. This report describes intraoperative support in non-invasive ventilation to neuroaxial anesthesia for an emergency upper abdominal surgery.
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Affiliation(s)
- Bülent Serhan Yurtlu
- Dokuz Eylül University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Esmirna, Turquia.
| | - Bengü Köksal
- Bülent Ecevit University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Zonguldak, Turquia
| | - Volkan Hancı
- Dokuz Eylül University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Esmirna, Turquia
| | - Işıl Özkoçak Turan
- Anesthesiology and Reanimation Clinic, Intensive Care Unit, Ankara Numune Education and Research Hospital, Ancara, Turquia
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