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Gu WJ, Cen Y, Zhao FZ, Wang HJ, Yin HY, Zheng XF. Association between driving pressure-guided ventilation and postoperative pulmonary complications in surgical patients: a meta-analysis with trial sequential analysis. Br J Anaesth 2024; 133:647-657. [PMID: 38937217 DOI: 10.1016/j.bja.2024.04.060] [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: 01/22/2024] [Revised: 03/22/2024] [Accepted: 04/15/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Prior studies have reported inconsistent results regarding the association between driving pressure-guided ventilation and postoperative pulmonary complications (PPCs). We aimed to investigate whether driving pressure-guided ventilation is associated with a lower risk of PPCs. METHODS We systematically searched electronic databases for RCTs comparing driving pressure-guided ventilation with conventional protective ventilation in adult surgical patients. The primary outcome was a composite of PPCs. Secondary outcomes were pneumonia, atelectasis, and acute respiratory distress syndrome (ARDS). Meta-analysis and subgroup analysis were conducted to calculate risk ratios (RRs) with 95% confidence intervals (CI). Trial sequential analysis (TSA) was used to assess the conclusiveness of evidence. RESULTS Thirteen RCTs with 3401 subjects were included. Driving pressure-guided ventilation was associated with a lower risk of PPCs (RR 0.70, 95% CI 0.56-0.87, P=0.001), as indicated by TSA. Subgroup analysis (P for interaction=0.04) found that the association was observed in non-cardiothoracic surgery (nine RCTs, 1038 subjects, RR 0.61, 95% CI 0.48-0.77, P< 0.0001), with TSA suggesting sufficient evidence and conclusive result; however, it did not reach significance in cardiothoracic surgery (four RCTs, 2363 subjects, RR 0.86, 95% CI 0.67-1.10, P=0.23), with TSA indicating insufficient evidence and inconclusive result. Similarly, a lower risk of pneumonia was found in non-cardiothoracic surgery but not in cardiothoracic surgery (P for interaction=0.046). No significant differences were found in atelectasis and ARDS between the two ventilation strategies. CONCLUSIONS Driving pressure-guided ventilation was associated with a lower risk of postoperative pulmonary complications in non-cardiothoracic surgery but not in cardiothoracic surgery. SYSTEMATIC REVIEW PROTOCOL INPLASY 202410068.
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Affiliation(s)
- Wan-Jie Gu
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yun Cen
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Feng-Zhi Zhao
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Hua-Jun Wang
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Hai-Yan Yin
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China.
| | - Xiao-Fei Zheng
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital of Jinan University, Guangzhou, China.
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Cobert J, Frere Z, Wongsripuemtet P, Ohnuma T, Krishnamoorthy V, Fuller M, Chapman AC, Yaport M, Ghadimi K, Bartz R, Raghunathan K. Trends in the Utilization of Multiorgan Support Among Adults Undergoing High-risk Cardiac Surgery in the United States. J Cardiothorac Vasc Anesth 2024; 38:1987-1995. [PMID: 38926003 DOI: 10.1053/j.jvca.2024.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/03/2024] [Accepted: 04/22/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES To examine trends in the prevalence of multiorgan dysfunction (MODS), utilization of multi-organ support (MOS), and mortality among patients undergoing cardiac surgery with MODS who received MOS in the United States. DESIGN Retrospective cohort study. SETTING 183 hospitals in the Premier Healthcare Database. PARTICIPANTS Adults ≥18 years old undergoing high-risk elective or non-elective cardiac surgery. INTERVENTIONS none. MEASUREMENTS AND MAIN RESULTS The exposure was time (consecutive calendar quarters) January 2008 and June 2018. We analyzed hospital data using day-stamped hospital billing codes and diagnosis and procedure codes to assess MODS prevalence, MOS utilization, and mortality. Among 129,102 elective and 136,190 non-elective high-risk cardiac surgical cases across 183 hospitals, 10,001 (7.7%) and 21,556 (15.8%) of patients developed MODS, respectively. Among patients who experienced MODS, 2,181 (22%) of elective and 5,425 (25%) of non-elective cardiac surgical cases utilized MOS. From 2008-2018, MODS increased in both high-risk elective and non-elective cardiac surgical cases. Similarly, MOS increased in both high-risk elective and non-elective cardiac surgical cases. As a component of MOS, mechanical circulatory support (MCS) increased over time. Over the study period, risk-adjusted mortality, in patients who developed MODS receiving MOS, increased in high-risk non-elective cardiac surgery and decreased in high-risk elective cardiac surgery, despite increasing MODS prevalence and MOS utilization (p<0.001). CONCLUSIONS Among patients undergoing high-risk cardiac surgery in the United States, MODS prevalence and MOS utilization (including MCS) increased over time. Risk-adjusted mortality trends differed in elective and non-elective cardiac surgery. Further research is necessary to optimize outcomes among patients undergoing high-risk cardiac surgery.
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Affiliation(s)
- Julien Cobert
- Anesthesia Service, San Francisco VA Health Care System, San Francisco, CA; Department of Anesthesiology, University of California San Francisco, San Francisco, CA; Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University Medical Center, Durham, NC.
| | - Zachary Frere
- Yale University. Department of Statistics. New Haven, CT
| | - Pattrapun Wongsripuemtet
- Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University Medical Center, Durham, NC; Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tetsu Ohnuma
- Department of Anesthesiology, University of California San Francisco, San Francisco, CA; Department of Anesthesiology, Duke University, Durham, NC
| | - Vijay Krishnamoorthy
- Department of Anesthesiology, University of California San Francisco, San Francisco, CA; Department of Anesthesiology, Duke University, Durham, NC; Department of Population Health Sciences, Duke University, Durham, NC
| | - Matthew Fuller
- Department of Anesthesiology, University of California San Francisco, San Francisco, CA; Department of Anesthesiology, Duke University, Durham, NC
| | - Allyson C Chapman
- Palliative Medicine, Department of Internal Medicine, University of California San Francisco, San Francisco, CA; Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Miguel Yaport
- Department of Anesthesiology, University of California San Francisco, San Francisco, CA; Department of Anesthesiology, Duke University, Durham, NC
| | - Kamrouz Ghadimi
- Department of Anesthesiology, University of California San Francisco, San Francisco, CA; Department of Anesthesiology, Duke University, Durham, NC
| | - Raquel Bartz
- Department of Anesthesiology, Brigham and Women's Hospital, Harvard University. Boston, MA
| | - Karthik Raghunathan
- Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University Medical Center, Durham, NC; Department of Anesthesiology, Duke University, Durham, NC; Department of Population Health Sciences, Duke University, Durham, NC; Anesthesia Service, Durham VA Healthcare System. Durham, NC
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3
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Mittel A, Drubin C, Hua M, Nitta S, Wagener G, Vidal Melo MF. Association of Acute Systemic Inflammation with Patient-Centric Postoperative Pulmonary Complications After Elective Cardiac Surgery. Anesth Analg 2024:00000539-990000000-00897. [PMID: 39116015 DOI: 10.1213/ane.0000000000007122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
BACKGROUND Postoperative pulmonary complications (PPCs) occur frequently after cardiac surgery. Absolute postoperative values of biomarkers of inflammation (interleukin [IL]-6, IL-8, and tumor necrosis factor-alpha [TNF-α]) and alveolar epithelial injury (soluble receptor for advanced glycation end-products [sRAGE]) have been associated with hypoxia and prolonged ventilation. However, relationships between these biomarkers and PPCs, contextualized to preoperative inflammation and perioperative lung injury risk factors, are uncertain. We aimed to determine associations between perioperative increases in biomarkers of inflammation and alveolar epithelial injury with a patient-centric PPC definition in adult cardiac surgical patients, accounting for the influence of intraoperative risk factors for lung injury. METHODS Adults undergoing elective cardiac surgery were eligible for this observational cohort study. Blood concentrations of IL-6, IL-8, TNF-α, and sRAGE were collected after anesthesia induction (baseline) and on postoperative day 1 (POD 1). The primary outcome was the occurrence of moderate or severe PPCs, graded using a validated scale, in POD 0 to 7. We estimated the association between POD 1 IL-6, IL-8, TNF-α, and sRAGE concentrations and moderate/severe PPC presence using separate logistic regression models for each biomarker, adjusted for baseline biomarker values and risk factors for postoperative lung injury (age, baseline PaO2/FiO2, left ventricle ejection fraction [LVEF], procedural type, cardiopulmonary bypass duration, and transfusions). Covariables were chosen based on relevance to lung injury and unadjusted between-group differences among patients with versus without PPCs. The secondary outcome was postoperative ventilation duration, which was log-transformed and analyzed using linear regression, adjusted using the same variables as the primary outcome. RESULTS We enrolled 204 patients from 2016 to 2018. Biomarkers were analyzed in 2023 among 175 patients with complete data. In adjusted analyses, POD 1 IL-8 and IL-6 were significantly associated with moderate/severe PPCs. The odds ratio (OR) for developing a PPC for every 50 pg/mL increase in POD 1 IL-8 was 7.19 (95% confidence interval [CI], 2.13-28.53, P = .003) and 1.42 (95% CI, 1.13-1.93, P = .01) for every 50 pg/mL increase in POD 1 IL-6. In adjusted analyses, postoperative ventilation duration was significantly associated with POD 1 sRAGE; each 50 pg/mL increase in sRAGE was associated with a 25% (95% CI, 2%-52%, P = .03) multiplicative increase in hours of ventilation. TNF-α was not significantly associated with PPCs or ventilation duration. CONCLUSIONS Acute systemic inflammation is significantly associated with PPCs after elective cardiac surgery in adults when taking into consideration preoperative inflammatory burden and perioperative factors that may influence postoperative lung injury.
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Affiliation(s)
- Aaron Mittel
- From the Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York
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Oh AR, Park J, Lee JH, Ahn J, Lee D, Yoo SY. Effects of inhalation versus total intravenous anaesthesia on long-term mortality in older patients after noncardiac surgery: a retrospective observational study. Br J Anaesth 2024:S0007-0912(24)00417-3. [PMID: 39107164 DOI: 10.1016/j.bja.2024.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 06/30/2024] [Accepted: 07/08/2024] [Indexed: 08/09/2024] Open
Abstract
BACKGROUND Whether the anaesthetic agent used influences postoperative mortality in older patients remains unclear. We evaluated the effect of total intravenous anaesthesia (TIVA) vs inhalation anaesthesia on long-term mortality in older patients after noncardiac surgery. METHODS We retrospectively analysed 45,879 patients aged ≥60 yr who underwent noncardiac surgery under general anaesthesia (for ≥2 h) between January 2011 and June 2019. They were divided into two groups according to the type of maintenance anaesthetic. The primary outcome was all-cause mortality within 1 yr after surgery. Secondary outcomes included postoperative complications (postoperative pulmonary complications, perioperative adverse cardiovascular events, and acute kidney injury), and 3-yr and 5-yr mortality after surgery. The stabilised inverse probability of treatment weighting method was used to adjust for potential confounders. RESULTS Among 45,879 patients, 7273 (15.9%) patients received TIVA and 38,606 (84.1%) patients received inhalation anaesthesia. After adjustment with inverse probability of treatment weighting, there was no association between the type of anaesthetic agent and 1-yr mortality (hazard ratio=0.95; 95% confidence interval [CI] 0.84-1.08). Results for 3-yr and 5-yr mortality were similar. However, inhalation anaesthesia was associated with increased risk of postoperative complications (odds ratio [OR]=1.30; 95% CI 1.22-1.37 for postoperative pulmonary complications, OR=1.34; 95% CI 1.22-1.48 for perioperative adverse cardiovascular events, and OR=2.19; 95% CI 1.88-2.57 for acute kidney injury). In the subgroup analysis, the choice of anaesthetic agent showed differential effects on 1-yr mortality for female patients and emergency surgery. CONCLUSION The choice of anaesthetic agent during the intraoperative period was not associated with 1-yr mortality in older patients undergoing noncardiac surgery. CLINICAL TRIAL REGISTRATION Clinical Research Information Service of the Republic of Korea (KCT 0006363).
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Affiliation(s)
- Ah R Oh
- Department of Anaesthesiology and Pain Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Jungchan Park
- Department of Anaesthesiology and Pain Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong-Hwan Lee
- Department of Anaesthesiology and Pain Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joonghyun Ahn
- Biomedical Statistics Centre, Samsung Medical Centre, Data Science Research Institute, Seoul, Republic of Korea
| | - Dongjae Lee
- Department of Anaesthesiology and Pain Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung Y Yoo
- Department of Anaesthesiology and Pain Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Abbott M, Pereira SM, Sanders N, Girard M, Sankar A, Sklar MC. Weaning from mechanical ventilation in the operating room: a systematic review. Br J Anaesth 2024; 133:424-436. [PMID: 38816331 PMCID: PMC11282496 DOI: 10.1016/j.bja.2024.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/27/2024] [Accepted: 03/22/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Postoperative pulmonary complications (PPCs) are associated with postoperative mortality and prolonged hospital stay. Although intraoperative mechanical ventilation (MV) is a risk factor for PPCs, strategies addressing weaning from MV are understudied. In this systematic review, we evaluated weaning strategies and their effects on postoperative pulmonary outcomes. METHODS Our protocol was registered on PROSPERO (CRD42022379145). Eligible studies included randomised controlled trials and observational studies of adults weaned from MV in the operating room. Primary outcomes included atelectasis and oxygenation; secondary outcomes included lung volume changes and PPCs. Risk of bias was assessed using the Cochrane Risk of Bias (RoB2) tool, and quality of evidence with the GRADE framework. RESULTS Screening identified 14 randomised controlled trials including 1719 patients; seven studies were limited to the weaning phase and seven included interventions not restricted to the weaning phase. Strategies combining pressure support ventilation (PSV) with positive end-expiratory pressure (PEEP) and low fraction of inspired oxygen (FiO2) improved atelectasis, oxygenation, and lung volumes. Low FiO2 improved atelectasis and oxygenation but might not improve lung volumes. A fixed-PEEP strategy led to no improvement in oxygenation or atelectasis; however, individualised PEEP with low FiO2 improved oxygenation and might be associated with reduced PPCs. Half of included studies are of moderate or high risk of bias; the overall quality of evidence is low. CONCLUSIONS There is limited research evaluating weaning from intraoperative MV. Based on low-quality evidence, PSV, individualised PEEP, and low FiO2 may be associated with reduced postoperative pulmonary outcomes. SYSTEMATIC REVIEW PROTOCOL PROSPERO (CRD42022379145).
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Affiliation(s)
- Megan Abbott
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada
| | - Sergio M Pereira
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Noah Sanders
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada
| | - Martin Girard
- Department of Anesthesiology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Division of Critical Care, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Department of Anesthesiology, Centre Hospitalier de l'Université de Montréal Research Center, Montreal, QC, Canada
| | - Ashwin Sankar
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael C Sklar
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
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Hewson DW, Tedore TR, Hardman JG. Impact of spinal or epidural anaesthesia on perioperative outcomes in adult noncardiac surgery: a narrative review of recent evidence. Br J Anaesth 2024; 133:380-399. [PMID: 38811298 PMCID: PMC11282476 DOI: 10.1016/j.bja.2024.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/23/2024] [Accepted: 04/30/2024] [Indexed: 05/31/2024] Open
Abstract
Spinal and epidural anaesthesia and analgesia are important anaesthetic techniques, familiar to all anaesthetists and applied to patients undergoing a range of surgical procedures. Although the immediate effects of a well-conducted neuraxial technique on nociceptive and sympathetic pathways are readily observable in clinical practice, the impact of such techniques on patient-centred perioperative outcomes remains an area of uncertainty and active research. The aim of this review is to present a narrative synthesis of contemporary clinical science on this topic from the most recent 5-year period and summarise the foundational scholarship upon which this research was based. We searched electronic databases for primary research, secondary research, opinion pieces, and guidelines reporting the relationship between neuraxial procedures and standardised perioperative outcomes over the period 2018-2023. Returned citation lists were examined seeking additional studies to contextualise our narrative synthesis of results. Articles were retrieved encompassing the following outcome domains: patient comfort, renal, sepsis and infection, postoperative cancer, cardiovascular, and pulmonary and mortality outcomes. Convincing evidence of the beneficial effect of epidural analgesia on patient comfort after major open thoracoabdominal surgery outcomes was identified. Recent evidence of benefit in the prevention of pulmonary complications and mortality was identified. Despite mechanistic plausibility and supportive observational evidence, there is less certain experimental evidence to support a role for neuraxial techniques impacting on other outcome domains. Evidence of positive impact of neuraxial techniques is best established for the domains of patient comfort, pulmonary complications, and mortality, particularly in the setting of major open thoracoabdominal surgery. Recent evidence does not strongly support a significant impact of neuraxial techniques on cancer, renal, infection, or cardiovascular outcomes after noncardiac surgery in most patient groups.
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Affiliation(s)
- David W Hewson
- Department of Anaesthesia and Critical Care, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK; Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK.
| | - Tiffany R Tedore
- Department of Anesthesiology, Weill Cornell Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Jonathan G Hardman
- Department of Anaesthesia and Critical Care, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK; Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK
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Yamazaki Y, Matsuki Y, Hosokawa K, Tanaka K, Kawamura Y, Tanaka A, Shigemi K. Respiratory system compliance during anesthesia induction and postoperative mechanical ventilation needs: An observational study. Health Sci Rep 2024; 7:e2315. [PMID: 39139464 PMCID: PMC11319399 DOI: 10.1002/hsr2.2315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 05/13/2024] [Accepted: 08/01/2024] [Indexed: 08/15/2024] Open
Abstract
Background and Aims Respiratory system compliance (Crs) is a simple indicator of lung flexibility. However, it remains unclear whether a low Crs during anesthesia induction (iCrs) is associated with an increased risk of postoperative mechanical ventilation. Methods This retrospective observational study was conducted using a local database. All mechanically ventilated postoperative ICU patients were included in this study. The duration of postoperative mechanical ventilation, length of hospital stay, and in-hospital mortality were compared between the low iCrs group (<25% of distribution) and the normal iCrs group. Results A total of 315 patients were classified into the low iCrs (<39 mL/cmH2O) group (n = 78) or the normal iCrs group (n = 237). Low iCrs was associated with a higher chance of mechanical ventilation in 28 days (log-rank test, p < 0.001). The duration of hospital stay was similar. Multivariate analysis showed that in-hospital mortality was higher in the low iCrs group than in the normal iCrs group (adjusted odds ratio, 6.04 [1.13, 32.26]; p = 0.04). Conclusion Low iCrs was associated with an increased risk of requiring postoperative mechanical ventilation. An additional result of poor survival related to low iCrs may require further study.
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Affiliation(s)
- Yukiko Yamazaki
- Department of Intensive CareUniversity of Fukui HospitalFukuiJapan
- Department of Anesthesiology and Reanimatology, Faculty of Medical SciencesUniversity of FukuiFukuiJapan
| | - Yuka Matsuki
- Department of Anesthesiology and Reanimatology, Faculty of Medical SciencesUniversity of FukuiFukuiJapan
| | - Koji Hosokawa
- Department of Intensive CareUniversity of Fukui HospitalFukuiJapan
- Department of Anesthesiology and Reanimatology, Faculty of Medical SciencesUniversity of FukuiFukuiJapan
| | - Katsuya Tanaka
- Department of Anesthesiology and Reanimatology, Faculty of Medical SciencesUniversity of FukuiFukuiJapan
- Department of AnesthesiaFukui Prefectural HospitalFukuiJapan
| | - Yuko Kawamura
- Department of Intensive CareUniversity of Fukui HospitalFukuiJapan
| | - Aiko Tanaka
- Department of Intensive CareUniversity of Fukui HospitalFukuiJapan
- Department of Anesthesiology and Intensive Care MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Kenji Shigemi
- Department of Anesthesiology and Reanimatology, Faculty of Medical SciencesUniversity of FukuiFukuiJapan
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8
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Wang QY, Zhou Y, Wang MR, Jiao YY. Effects of starting one lung ventilation and applying individualized PEEP right after patients are placed in lateral decubitus position on intraoperative oxygenation for patients undergoing thoracoscopic pulmonary lobectomy: study protocol for a randomized controlled trial. Trials 2024; 25:500. [PMID: 39039591 DOI: 10.1186/s13063-024-08347-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 07/17/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND For patients receiving one lung ventilation in thoracic surgery, numerous studies have proved the superiority of lung protective ventilation of low tidal volume combined with recruitment maneuvers (RM) and individualized PEEP. However, RM may lead to overinflation which aggravates lung injury and intrapulmonary shunt. According to CT results, atelectasis usually forms in gravity dependent lung regions, regardless of body position. So, during anesthesia induction in supine position, atelectasis usually forms in the dorsal parts of lungs, however, when patients are turned into lateral decubitus position, collapsed lung tissue in the dorsal parts would reexpand, while atelectasis would slowly reappear in the lower flank of the lung. We hypothesize that applying sufficient PEEP without RM before the formation of atelectasis in the lower flank of the lung may beas effective to prevent atelectasis and thus improve oxygenation as applying PEEP with RM. METHODS A total of 84 patients scheduled for elective pulmonary lobe resection necessitating one lung ventilation will be recruited and randomized totwo parallel groups. For all patients, one lung ventilation is initiated the right after patients are turned into lateral decubitus position. For patients in the study group, individualized PEEP titration is started the moment one lung ventilation is started, while patients in the control group will receive a recruitment maneuver followed by individualized PEEP titration after initiation of one lung ventilation. The primary endpoint will be oxygenation index measured at T4. Secondary endpoints will include intrapulmonary shunt, respiratory mechanics, PPCs, and hemodynamic indicators. DISCUSSION Numerous previous studies compared the effects of individualized PEEP applied alone with that applied in combination with RM on oxygenation index, PPCs, intrapulmonary shunt and respiratory mechanics after atelectasis was formed in patients receiving one lung ventilation during thoracoscopic surgery. In this study, we will apply individualized PEEP before the formation of atelectasis while not performing RM in patients allocated to the study group, and then we're going to observe its effects on the aspects mentioned above. The results of this trial will provide a ventilation strategy that may be conductive to improving intraoperative oxygenation and avoiding the detrimental effects of RM for patients receiving one lung ventilation. TRIAL REGISTRATION www.Chictr.org.cn ChiCTR2400080682. Registered on February 5, 2024.
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Affiliation(s)
- Qing-Yuan Wang
- Department of Anesthesiology, Peking University Third Hospital, NO. 49, North Garden Road, Haidian District, Beijing, People's Republic of China.
| | - Yang Zhou
- Department of Anesthesiology, Peking University Third Hospital, NO. 49, North Garden Road, Haidian District, Beijing, People's Republic of China
| | - Meng-Rui Wang
- Department of Anesthesiology, Peking University Third Hospital, NO. 49, North Garden Road, Haidian District, Beijing, People's Republic of China
| | - You-You Jiao
- Department of Anesthesiology, Peking University Third Hospital, NO. 49, North Garden Road, Haidian District, Beijing, People's Republic of China
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Duan J, Li P, Shao A, Hao X, Zhou R, Bi C, Liu X, Li W, Zhu H, Chen G, Shen B, Zhu T. PPCRKB: a risk factor knowledge base of postoperative pulmonary complications. Database (Oxford) 2024; 2024:baae054. [PMID: 39028753 PMCID: PMC11259045 DOI: 10.1093/database/baae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 03/20/2024] [Accepted: 06/27/2024] [Indexed: 07/21/2024]
Abstract
Postoperative pulmonary complications (PPCs) are highly heterogeneous disorders with diverse risk factors frequently occurring after surgical interventions, resulting in significant financial burdens, prolonged hospitalization and elevated mortality rates. Despite the existence of multiple studies on PPCs, a comprehensive knowledge base that can effectively integrate and visualize the diverse risk factors associated with PPCs is currently lacking. This study aims to develop an online knowledge platform on risk factors for PPCs (Postoperative Pulmonary Complications Risk Factor Knowledge Base, PPCRKB) that categorizes and presents the risk and protective factors associated with PPCs, as well as to facilitate the development of individualized prevention and management strategies for PPCs based on the needs of each investigator. The PPCRKB is a novel knowledge base that encompasses all investigated potential risk factors linked to PPCs, offering users a web-based platform to access these risk factors. The PPCRKB contains 2673 entries, 915 risk factors that have been categorized into 11 distinct groups. These categories include habit and behavior, surgical factors, anesthetic factors, auxiliary examination, environmental factors, clinical status, medicines and treatment, demographic characteristics, psychosocial factors, genetic factors and miscellaneous factors. The PPCRKB holds significant value for PPC research. The inclusion of both quantitative and qualitative data in the PPCRKB enhances the ability to uncover new insights and solutions related to PPCs. It could provide clinicians with a more comprehensive perspective on research related to PPCs in future. Database URL: http://sysbio.org.cn/PPCs.
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Affiliation(s)
- Jianchao Duan
- Department of Anesthesiology, West China Hospital, Sichuan University, No. 37th, Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research, West China Hospital, Sichuan University, No. 37th, Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
- Research Unit for Perioperative Stress Assessment and Clinical Decision, Chinese Academy of Medical Sciences (2018RU012), West China Hospital, Sichuan University, No. 37th, Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 1 Shuai Fu Yuan, Beijing 100730, China
| | - Peiyi Li
- Department of Anesthesiology, West China Hospital, Sichuan University, No. 37th, Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research, West China Hospital, Sichuan University, No. 37th, Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
- Research Unit for Perioperative Stress Assessment and Clinical Decision, Chinese Academy of Medical Sciences (2018RU012), West China Hospital, Sichuan University, No. 37th, Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
| | - Aibin Shao
- Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Xinchuan Road 2222, Chengdu, Sichuan 610041, China
| | - Xuechao Hao
- Department of Anesthesiology, West China Hospital, Sichuan University, No. 37th, Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research, West China Hospital, Sichuan University, No. 37th, Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
| | - Ruihao Zhou
- Department of Anesthesiology, West China Hospital, Sichuan University, No. 37th, Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research, West China Hospital, Sichuan University, No. 37th, Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
| | - Cheng Bi
- Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Xinchuan Road 2222, Chengdu, Sichuan 610041, China
| | - Xingyun Liu
- Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Xinchuan Road 2222, Chengdu, Sichuan 610041, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37th, Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
- Institute of Respiratory Health, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, No. 37th, Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
| | - Huadong Zhu
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 1 Shuai Fu Yuan, Beijing 100730, China
| | - Guo Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, No. 37th, Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research, West China Hospital, Sichuan University, No. 37th, Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
| | - Bairong Shen
- Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Xinchuan Road 2222, Chengdu, Sichuan 610041, China
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital, Sichuan University, No. 37th, Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research, West China Hospital, Sichuan University, No. 37th, Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
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Siddiqui KM, Farooqui MH, Yousuf MS, Ali MA. ARISCAT and LAS VEGAS risk scores for predicting postoperative pulmonary complications after cardiac surgery: a cohort study. Ann Med Surg (Lond) 2024; 86:3873-3879. [PMID: 38989237 PMCID: PMC11230767 DOI: 10.1097/ms9.0000000000002191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/08/2024] [Indexed: 07/12/2024] Open
Abstract
Background Postoperative pulmonary complications (PPCs) could lead to morbidity, mortality, and prolonged hospital stay. Different risk-scoring systems are used to predict the identification of patients at risk of developing PPCs. The diagnostic accuracies of the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) and Local Assessment of Ventilatory Management During General Anaesthesia for Surgery (LAS VEGAS) risk scores are compared in prediction of PPCs taking pulmonary complication as the gold standard in cardiac surgery. Materials and methods A prospective cohort study with consecutive sampling technique. A total of 181 patients were included. Quantitative data is presented as simple descriptive statistics giving mean and standard deviation, and qualitative variables are presented as frequency and percentages. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracies are also calculated. Results Total 181 post-cardiac surgery patients were analyzed. The median [interquartile range] of age, height, weight, and BMI were 60.0 [52.0-67.0] years, 163.0 [156.0-168.0] cm, 71.0 [65.0-80.0] kg and 27.3 [24.2-30.4] kg/m2. 127 (70.2%) were male, and 54 (29.8%) were female. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of ARISCAT for the prediction of PPCs were (94.9%, 4.65%, 76.1%, 22.9% and 73.4%), whereas LAS VEGAS were (97.1%, 4.65%, 76.5%, 33.3% and 75.1%), respectively. Conclusion Both the ARISCAT and LAS VEGAS risk scores are of limited value in cardiac surgery patients for the prediction of postoperative pulmonary complications, based on the predicted scores in this study.
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Affiliation(s)
- Khalid M. Siddiqui
- Department of Anaesthesiology, Aga Khan University Hospital, Karachi, Pakistan
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Mares-Gutiérrez Y, Martínez-González A, Salinas-Escudero G, García-Minjares M, Liu S, Flores YN. Combining Spirometry and the ARISCAT Respiratory Risk Assessment Can Improve Postoperative Outcomes and Reduce Mortality Risk in Mexico. OPEN RESPIRATORY ARCHIVES 2024; 6:100325. [PMID: 38764716 PMCID: PMC11101723 DOI: 10.1016/j.opresp.2024.100325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/04/2024] [Indexed: 05/21/2024] Open
Abstract
Introduction Although a major goal of preoperative evaluation is to identify risk factors and improve postoperative outcomes, current clinical guidelines in Mexico indicate that preoperative spirometry should only be performed on patients with pulmonary disease. The aim of this study was to compare the incidence of postoperative complications (POC), mortality, and risk factors among adults who did or did not undergo preoperative spirometry, based on their Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) risk level. Material and methods An observational, retrospective and comparative study design was used to identify 2059 patients from the General Hospital of Mexico who had an ARISCAT assessment during 2013-2017. Patients were classified in two groups: ARISCAT with spirometry (n = 1306) and ARISCAT without spirometry (n = 753). Chi-square, Fisher's exact test and the Student's t-tests were used to compare groups. Logistic regression was used to identify factors associated with an increased risk of POC and mortality. Results In the ARISCAT with spirometry group, 11% of patients had POC, compared with 48% of patients in the ARISCAT without spirometry group. High-risk ARISCAT patients who did not receive spirometry had higher mortality (18%), than those who underwent spirometry (0.4%). Logistic regression results indicate that not performing preoperative spirometry increases the probability of POC and mortality. Conclusions Our findings suggest that the combined use of preoperative spirometry and ARISCAT is associated with reduced POC and mortality. Future clinical guidelines should recommend the use of preoperative spirometry for patients with a moderate or high ARISCAT level in Mexico.
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Affiliation(s)
- Yolanda Mares-Gutiérrez
- Pulmonary Physiology Department, Hospital General de México Dr. Eduardo Liceaga, C.P. 06720 Mexico City, Mexico
- Departamento de Investigación, Subdirección de Regulación y de Atención Hospitalaria, Dirección Médica, ISSSTE, C.P. 14050 Mexico City, Mexico
| | - Adrián Martínez-González
- Departamento de Salud Pública, Facultad de Medicina, Universidad Nacional Autónoma de México, C.P. 04510 Mexico City, Mexico
| | - Guillermo Salinas-Escudero
- Centro de Estudios Económicos y Sociales en Salud, Hospital Infantil de México Federico Gómez, C.P. 06720 Mexico City, Mexico
| | - Manuel García-Minjares
- Coordinación de Universidad Abierta, Innovación Educativa y Educación a Distancia, CUAIEED, Universidad Nacional Autónoma de México, C.P. 04510 Mexico City, Mexico
| | - Stephanie Liu
- Rosemead School of Psychology, Biola University, La Mirada, CA 90639, United States
| | - Yvonne N. Flores
- UCLA Department of Health Policy and Management, Fielding School of Public Health, Los Angeles, CA 90095, United States
- UCLA Center for Cancer Prevention and Control Research and UCLA-Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA 90095, United States
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Morelos, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos C.P. 62000, Mexico
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Ren A, Fan M, Gu Z, Liang X, Xu L, Liu C, Wang D, Chang H, Zhu M. Association between reversal agents (sugammadex vs. neostigmine) for neuromuscular block and postoperative pulmonary complications: A retrospective analysis. Br J Clin Pharmacol 2024; 90:1667-1676. [PMID: 38583490 DOI: 10.1111/bcp.16056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 04/09/2024] Open
Abstract
AIMS Residual neuromuscular blockade has been linked to pulmonary complications in the postoperative period. This study aimed to determine whether sugammadex was associated with a lower risk of postoperative pulmonary complications (PPCs) compared with neostigmine. METHODS This retrospective cohort study was conducted in a tertiary academic medical center. Patients ≥18 year of age undergoing noncardiac surgical procedures with general anesthesia and mechanical ventilation were enrolled between January 2019 and September 2021. We identified all patients receiving rocuronium and reversal with neostigmine or sugammadex via electronic medical record review. The primary endpoint was a composite of PPCs (including pneumonia, atelectasis, respiratory failure, pulmonary embolism, pleural effusion, or pneumothorax). The incidence of PPCs was compared using propensity score analysis. RESULTS A total of 1786 patients were included in this study. Among these patients, 976 (54.6%) received neostigmine, and 810 (45.4%) received sugammadex. In the whole sample, PPCs occurred in 81 (4.54%) subjects (7.04% sugammadex vs. 2.46% neostigmine). Baseline covariates were well balanced between groups after overlap weighting. Patients in the sugammadex group had similar risk (overlap weighting OR: 0.75; 95% CI: 0.40 to 1.41) compared to neostigmine. The sensitivity analysis showed consistent results. In subgroup analysis, the interaction P-value for the reversal agents stratified by surgery duration was 0.011. CONCLUSION There was no significant difference in the rate of PPCs when the neuromuscular blockade was reversed with sugammadex compared to neostigmine. Patients undergoing prolonged surgery may benefit from sugammadex, which needs to be further investigated.
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Affiliation(s)
- Aolin Ren
- Department of Anesthesiology, Jiangnan University Medical Center (Wuxi No.2 People's Hospital of Nanjing Medical University), Wuxi, Jiangsu Province, China
| | - Meihan Fan
- Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Zhen Gu
- Department of Anesthesiology, Jiangnan University Medical Center (Wuxi No.2 People's Hospital of Nanjing Medical University), Wuxi, Jiangsu Province, China
| | - Xiao Liang
- Department of Anesthesiology, Jiangnan University Medical Center (Wuxi No.2 People's Hospital of Nanjing Medical University), Wuxi, Jiangsu Province, China
| | - Liuhang Xu
- Hubei University of Medicine, Shiyan, Hubei Province, China
| | - Chengjun Liu
- Department of Anesthesiology, Jiangnan University Medical Center (Wuxi No.2 People's Hospital of Nanjing Medical University), Wuxi, Jiangsu Province, China
| | - Dutian Wang
- Department of Anesthesiology, Jiangnan University Medical Center (Wuxi No.2 People's Hospital of Nanjing Medical University), Wuxi, Jiangsu Province, China
| | - Hanxuan Chang
- Department of Anesthesiology, Jiangnan University Medical Center (Wuxi No.2 People's Hospital of Nanjing Medical University), Wuxi, Jiangsu Province, China
| | - Minmin Zhu
- Department of Anesthesiology, Jiangnan University Medical Center (Wuxi No.2 People's Hospital of Nanjing Medical University), Wuxi, Jiangsu Province, China
- Nanjing Medical University, Nanjing, Jiangsu Province, China
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Tsumura H, Brandon D, Vacchiano C, Krishnamoorthy V, Bartz R, Pan W. Exploring phenotype-based ventilator parameter optimization to mitigate postoperative pulmonary complications: a retrospective observational cohort study. Surg Today 2024; 54:722-733. [PMID: 38095709 PMCID: PMC11176264 DOI: 10.1007/s00595-023-02785-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 11/01/2023] [Indexed: 06/15/2024]
Abstract
PURPOSE To identify tidal volume (VT) and positive end-expiratory pressure (PEEP) associated with the lowest incidence and severity of postoperative pulmonary complications (PPCs) for each phenotype based on preoperative characteristics. METHODS The subjects of this retrospective observational cohort study were 34,910 adults who underwent surgery, using general anesthesia with mechanical ventilation. Initially, the least absolute shrinkage and selection operator regression was employed to select relevant preoperative characteristics. Then, the classification and regression tree (CART) was built to identify phenotypes. Finally, we computed the area under the receiver operating characteristic curves from logistic regressions to identify VT and PEEP associated with the lowest incidence and severity of PPCs for each phenotype. RESULTS CARTs classified seven phenotypes for each outcome. A probability of the development of PPCs ranged from the lowest (3.51%) to the highest (68.57%), whereas the probability of the development of the highest level of PPC severity ranged from 3.3% to 91.0%. Across all phenotypes, the VT and PEEP associated with the most desirable outcomes were within a small range of VT 7-8 ml/kg predicted body weight with PEEP of between 6 and 8 cmH2O. CONCLUSIONS The ranges of optimal VT and PEEP were small, regardless of the phenotypes, which had a wide range of risk profiles.
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Affiliation(s)
- Hideyo Tsumura
- Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, USA.
- Duke University Health System, 2301 Erwin Road, Durham, NC, 27710, USA.
| | - Debra Brandon
- Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, USA
- Department of Pediatrics, Duke University School of Medicine, DUMC 3352, Durham, NC, 27710, USA
| | - Charles Vacchiano
- Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, USA
| | - Vijay Krishnamoorthy
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, DUMC 309427710, USA
- Department of Population Health Sciences Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA
| | - Raquel Bartz
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Wei Pan
- Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, USA
- Department of Population Health Sciences Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA
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Thakuria R, Ernest EE, Chowdhury AR, Pangasa N, Kayina CA, Bhattacharjee S, Khanna P, Baidya DK, Ravichandrane B, Maitra S. Oxygenation Index and Oxygen Saturation Index for Predicting Postoperative Outcome in Patients Undergoing Emergency Surgery: A Prospective Cohort Study. Indian J Crit Care Med 2024; 28:645-649. [PMID: 38994268 PMCID: PMC11234125 DOI: 10.5005/jp-journals-10071-24749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 05/30/2024] [Indexed: 07/13/2024] Open
Abstract
Background The OI was originally evaluated as a prognostic tool for acute hypoxemic respiratory failure in children and was an independent predictor for mortality in adult patients with acute respiratory distress syndrome (ARDS). Methods Oxygenation index and OSI of 201 adult patients undergoing emergency surgery were evaluated at different time points. The primary objective of this study was to find the correlation between OI and OSI. The secondary objectives were to find the prognostic utility of OI and OSI for postoperative mechanical ventilation and mortality. Results Significant statistical correlation was found between OI and OSI both at the beginning (r 2 = 0.61; p < 0.001) and immediately after surgery (r 2 = 0.47; p < 0.001). Oxygen saturation index at the beginning [area under the receiver operating characteristics curve (AUROC) (95% CI) 0.76 (0.62-0.89); best cutoff 3.9, sensitivity 64% and specificity 45%] and immediately after surgery [AUROC (95% CI) 0.82 (0.72-0.92); best cutoff 3.57, sensitivity 79%, and specificity 62%] were reasonable predictors of the requirement of invasive ventilatory support. Exploratory analysis reported that older age (p = 0.02), higher total leukocyte count (p = 0.002), higher arterial lactate (p = 0.02), and higher driving pressure (p < 0.001) were independently associated with hospital mortality. Conclusion In adult patients undergoing emergency laparotomy under general anesthesia, OI and OSI were found to be correlated. Both metrics demonstrated reasonable accuracy in predicting the need for invasive ventilatory support beyond 24 hours and hospital mortality. How to cite this article Thakuria R, Ernest EE, Chowdhury AR, Pangasa N, Kayina CA, Bhattacharjee S, et al. Oxygenation Index and Oxygen Saturation Index for Predicting Postoperative Outcome in Patients Undergoing Emergency Surgery: A Prospective Cohort Study. Indian J Crit Care Med 2024;28(7):645-649.
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Affiliation(s)
- Ruma Thakuria
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Emmanuel Easterson Ernest
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Apala Roy Chowdhury
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Neha Pangasa
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Choro Athiphro Kayina
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Sulagna Bhattacharjee
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Puneet Khanna
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Dalim K Baidya
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Banupriya Ravichandrane
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Souvik Maitra
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Deng T, Song J, Tuo J, Wang Y, Li J, Ping Suen LK, Liang Y, Ma J, Chen S. Incidence and risk factors of pulmonary complications after lung cancer surgery: A systematic review and meta-analysis. Heliyon 2024; 10:e32821. [PMID: 38975138 PMCID: PMC11226845 DOI: 10.1016/j.heliyon.2024.e32821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 05/28/2024] [Accepted: 06/10/2024] [Indexed: 07/09/2024] Open
Abstract
Postoperative pulmonary complications (PPCs) are associated with high mortality rates after lung cancer surgery. Although some studies have discussed the different risk factors for PPCs, the relationship between these factors and their impact on PPCs remains unclear. Hence, this study aimed to systematically summarize the incidence and determine the risk factors for PPCs. We conducted a systematic search of five English and four Chinese databases from their inception to April 1, 2023. A total of 34 articles (8 cohort studies and 26 case-control studies) (n = 31696, 5833 with PPCs) were included in the analysis. The primary outcome was the incidence of PPC. The secondary outcome was the odds ratio (OR) of PPCs based on the identified risk factors calculated by RevMan 5.4. A narrative descriptive summary of the study results was presented when pooling the results or conducting a meta-analysis was not possible. The pooled incidence of PPCs was 18.4 %. This meta-analysis demonstrated that TNM staging (OR 4.29, 95 % CI 2.59-7.13), chronic obstructive pulmonary disease (COPD) (OR 2.47, 95 % CI 1.80-3.40), smoking history (OR 2.37, 95 % CI 1.33-4.21), poor compliance with respiratory rehabilitation (OR 1.64, 95 % CI 1.17-2.30), male sex (OR 1.62, 95 % CI 1.28-2.04), diabetes (OR 1.56, 95 % CI 1.07-2.27), intraoperative bleeding volume (OR 1.44, 95 % CI 1.02-2.04), Eastern Cooperative Oncology Group score (ECOG) > 1 (OR 1.37, 95 % CI 1.04-1.80), history of chemotherapy and/or radiotherapy (OR 1.32, 95 % CI 1.03-1.70), older age (OR 1.18, 95 % CI 1.11-1.24), and duration of surgery (OR 1.07, 95 % CI 1.04-1.10) were significantly associated with a higher risk of PPCs. In contrast, the peak expiratory flow rate (PEF) (OR 0.99, 95 % CI 0.98-0.99) was a protective factor. Clinicians should implement targeted and effective interventions to prevent the occurrence of PPCs.
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Affiliation(s)
- Ting Deng
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Guizhou, China
- School of Nursing, Zunyi Medical University, Guizhou, China
- Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Jiamei Song
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Guizhou, China
- School of Nursing, Zunyi Medical University, Guizhou, China
| | - Jinmei Tuo
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Yu Wang
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Jin Li
- Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | | | - Yan Liang
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Guizhou, China
- School of Nursing, Zunyi Medical University, Guizhou, China
| | - Junliang Ma
- Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Shaolin Chen
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Guizhou, China
- School of Nursing, Zunyi Medical University, Guizhou, China
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Park HJ, Kim YH, Yoon YJ, Cho SY. Regional anesthesia in a patient with primary ciliary dyskinesia: A case report. World J Clin Cases 2024; 12:3183-3187. [PMID: 38898834 PMCID: PMC11185374 DOI: 10.12998/wjcc.v12.i17.3183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/09/2024] [Accepted: 04/22/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Primary ciliary dyskinesia (PCD) is an inherited autosomal-recessive disorder of impaired mucociliary clearance characterized by chronic respiratory diseases, otolaryngological diseases, central nervous system abnormalities, reproductive system abnormalities, and cardiac function abnormalities. General anesthesia in these patients is associated with a higher incidence of respiratory complications than in patients without the disease. CASE SUMMARY A 16-year-old male patient was referred to the emergency room complaining of right ankle pain due to distal tibiofibular fracture. Three years prior, he had been diagnosed with PCD. At that time, he had experienced several episodes of pneumonia, sinusitis, and chronic middle ear infections, for which he underwent surgical interventions. At the current admission, he presented with cough and sputum but no other respiratory symptoms. A chest computed tomography scan revealed centrilobular ground-glass opacities in both lower lobes and a calcified nodule in the left lower lobe. For the surgical procedure and postoperative pain management, combined spinal-epidural anesthesia was employed. The patient's postoperative pain score was measured by the numerical rating scale (NRS). On the day of surgery, his NRS was 5 points. By the second postoperative day, the NRS score had decreased to 2-3 points. The epidural catheter was removed on the fourth day following the operation. The patient was subsequently discharged no respiratory complications. CONCLUSION We performed combined spinal-epidural anesthesia in a patient with PCD. The patient experienced no additional respiratory complications and was discharged with a low NRS score for pain.
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Affiliation(s)
- Hyung Joon Park
- Department of Anesthe-siology and Pain Medicine, Hanyang University Guri Hospital, Guri-si 471-701, Gyeonggi-do, South Korea
| | - Ye Hwan Kim
- Department of Anesthe-siology and Pain Medicine, Hanyang University Guri Hospital, Guri-si 471-701, Gyeonggi-do, South Korea
| | - Young Joon Yoon
- Department of Anesthe-siology and Pain Medicine, Hanyang University Guri Hospital, Guri-si 471-701, Gyeonggi-do, South Korea
| | - Sang Yun Cho
- Department of Anesthe-siology and Pain Medicine, Hanyang University Guri Hospital, Guri-si 471-701, Gyeonggi-do, South Korea
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Smith-Voudouris J, Rubin LE, Grauer JN. Risk of Adverse Events Following Total Knee Arthroplasty in Asthma Patients. J Am Acad Orthop Surg 2024; 32:543-549. [PMID: 38657178 DOI: 10.5435/jaaos-d-23-01142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/08/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Total knee arthroplasty (TKA) is a common procedure for which patient factors are known to affect perioperative outcomes. Asthma has not been specifically considered in this regard, although it is the most common inflammatory airway disease and predisposes to osteoarthritis. METHODS Adult patients undergoing TKA were identified from 2015 to 2021-Q3 M157 PearlDiver data sets. Asthma patients were matched to those without 1:1 based on age, sex, and Elixhauser Comorbidity Index (ECI). The incidence of 90-day adverse events and 5-year revisions were compared using multivariable logistic regression ( P < 0.0023). The matched asthma group was then stratified based on disease severity for analysis of 90-day aggregated (any, severe, and minor) adverse events. RESULTS Among 721,686 TKA patients, asthma was noted for 76,125 (10.5%). Multivariable analysis revealed that patients with asthma were at increased odds of multiple 90-day pulmonary, non-pulmonary, and aggregated adverse events, as well as emergency department visits. Furthermore, patients with asthma had 1.17 times greater odds of 5-year revisions ( P < 0.0001). Upon secondary analysis stratifying asthma by severity, patients with all severity levels of asthma showed elevated odds of adverse events after TKA. These associations increased in odds with increasing severity of asthma. DISCUSSION Over one-tenth of patients undergoing TKA were identified as having asthma, and these patients were at greater odds of numerous pulmonary and non-pulmonary adverse events (a trend that increased with asthma severity), as well as 5-year revisions. Clearly, patients with asthma need specific risk mitigation strategies when considering TKA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Julian Smith-Voudouris
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
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Huang L, Huang X, Lin J, Yang Q, Zhu H. Incidence and risk factors of postoperative pulmonary complications following total hip arthroplasty revision: a retrospective Nationwide Inpatient Sample database study. J Orthop Surg Res 2024; 19:353. [PMID: 38877587 PMCID: PMC11177359 DOI: 10.1186/s13018-024-04836-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 06/05/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Postoperative pulmonary complications (PPCs) are among the most severe complications following total hip arthroplasty revision (THAR), imposing significant burdens on individuals and society. This study examined the prevalence and risk factors of PPCs following THAR using the NIS database, identifying specific pulmonary complications (SPCs) and their associated risks, including pneumonia, acute respiratory failure (ARF), and pulmonary embolism (PE). METHODS The National Inpatient Sample (NIS) database was used for this cross-sectional study. The analysis included patients undergoing THAR based on NIS from 2010 to 2019. Available data include demographic data, diagnostic and procedure codes, total charges, length of stay (LOS), hospital information, insurance information, and discharges. RESULTS From the NIS database, a total of 112,735 THAR patients in total were extracted. After THAR surgery, there was a 2.62% overall incidence of PPCs. Patients with PPCs after THAR demonstrated increased LOS, total charges, usage of Medicare, and in-hospital mortality. The following variables have been determined as potential risk factors for PPCs: advanced age, pulmonary circulation disorders, fluid and electrolyte disorders, weight loss, congestive heart failure, metastatic cancer, other neurological disorders (encephalopathy, cerebral edema, multiple sclerosis etc.), coagulopathy, paralysis, chronic pulmonary disease, renal failure, acute heart failure, deep vein thrombosis, acute myocardial infarction, peripheral vascular disease, stroke, continuous trauma ventilation, cardiac arrest, blood transfusion, dislocation of joint, and hemorrhage. CONCLUSIONS Our study revealed a 2.62% incidence of PPCs, with pneumonia, ARF, and PE accounting for 1.24%, 1.31%, and 0.41%, respectively. A multitude of risk factors for PPCs were identified, underscoring the importance of preoperative optimization to mitigate PPCs and enhance postoperative outcomes.
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Affiliation(s)
- Liping Huang
- School of Health, Dongguan Polytechnic, Dongguan, Guangdong, 523000, China
| | - Xinlin Huang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Junhao Lin
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Qinfeng Yang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China.
| | - Hailun Zhu
- Department of Orthopedics, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, 518100, China.
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Iwata H, Yoshida T, Hoshino T, Aiyama Y, Maezawa T, Hashimoto H, Koyama Y, Yamada T, Fujino Y. Electrical Impedance Tomography-based Ventilation Patterns in Patients after Major Surgery. Am J Respir Crit Care Med 2024; 209:1328-1337. [PMID: 38346178 DOI: 10.1164/rccm.202309-1658oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/12/2024] [Indexed: 06/01/2024] Open
Abstract
Rationale: General anesthesia and mechanical ventilation have negative impacts on the respiratory system, causing heterogeneous distribution of lung aeration, but little is known about the ventilation patterns of postoperative patients and their association with clinical outcomes. Objectives: To clarify the phenotypes of ventilation patterns along a gravitational direction after surgery by using electrical impedance tomography (EIT) and to evaluate their association with postoperative pulmonary complications (PPCs) and other relevant clinical outcomes. Methods: Adult postoperative patients at high risk for PPCs, receiving mechanical ventilation on ICU admission (N = 128), were prospectively enrolled between November 18, 2021 and July 18, 2022. PPCs were prospectively scored until hospital discharge, and their association with phenotypes of ventilation patterns was studied. The secondary outcomes were the times to wean from mechanical ventilation and oxygen use and the length of ICU stay. Measurements and Main Results: Three phenotypes of ventilation patterns were revealed by EIT: phenotype 1 (32% [n = 41], a predominance of ventral ventilation), phenotype 2 (41% [n = 52], homogeneous ventilation), and phenotype 3 (27% [n = 35], a predominance of dorsal ventilation). The median PPC score was higher in phenotype 1 and phenotype 3 than in phenotype 2. The median time to wean from mechanical ventilation was longer in phenotype 1 versus phenotype 2. The median duration of ICU stay was longer in phenotype 1 versus phenotype 2. The median time to wean from oxygen use was longer in phenotype 1 and phenotype 3 than in phenotype 2. Conclusions: Inhomogeneous ventilation patterns revealed by EIT on ICU admission were associated with PPCs, delayed weaning from mechanical ventilation and oxygen use, and a longer ICU stay.
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Affiliation(s)
- Hirofumi Iwata
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan; and
| | - Takeshi Yoshida
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan; and
| | - Taiki Hoshino
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan; and
| | - Yuki Aiyama
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan; and
| | - Takashi Maezawa
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan; and
| | - Haruka Hashimoto
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan; and
| | - Yukiko Koyama
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan; and
| | - Tomomi Yamada
- The Department of Medical Innovation Data Coordinating Center, Osaka University Hospital, Suita, Japan
| | - Yuji Fujino
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan; and
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20
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Li P, Gao S, Wang Y, Zhou R, Chen G, Li W, Hao X, Zhu T. Utilising intraoperative respiratory dynamic features for developing and validating an explainable machine learning model for postoperative pulmonary complications. Br J Anaesth 2024; 132:1315-1326. [PMID: 38637267 DOI: 10.1016/j.bja.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Timely detection of modifiable risk factors for postoperative pulmonary complications (PPCs) could inform ventilation strategies that attenuate lung injury. We sought to develop, validate, and internally test machine learning models that use intraoperative respiratory features to predict PPCs. METHODS We analysed perioperative data from a cohort comprising patients aged 65 yr and older at an academic medical centre from 2019 to 2023. Two linear and four nonlinear learning models were developed and compared with the current gold-standard risk assessment tool ARISCAT (Assess Respiratory Risk in Surgical Patients in Catalonia Tool). The Shapley additive explanation of artificial intelligence was utilised to interpret feature importance and interactions. RESULTS Perioperative data were obtained from 10 284 patients who underwent 10 484 operations (mean age [range] 71 [65-98] yr; 42% female). An optimised XGBoost model that used preoperative variables and intraoperative respiratory variables had area under the receiver operating characteristic curves (AUROCs) of 0.878 (0.866-0.891) and 0.881 (0.879-0.883) in the validation and prospective cohorts, respectively. These models outperformed ARISCAT (AUROC: 0.496-0.533). The intraoperative dynamic features of respiratory dynamic system compliance, mechanical power, and driving pressure were identified as key modifiable contributors to PPCs. A simplified model based on XGBoost including 20 variables generated an AUROC of 0.864 (0.852-0.875) in an internal testing cohort. This has been developed into a web-based tool for further external validation (https://aorm.wchscu.cn/). CONCLUSIONS These findings suggest that real-time identification of surgical patients' risk of postoperative pulmonary complications could help personalise intraoperative ventilatory strategies and reduce postoperative pulmonary complications.
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Affiliation(s)
- Peiyi Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shuanliang Gao
- College of Software Engineering, Chengdu University of Information Technology, Chengdu, Sichuan, China
| | - Yaqiang Wang
- College of Software Engineering, Chengdu University of Information Technology, Chengdu, Sichuan, China; Sichuan Key Laboratory of Software Automatic Generation and Intelligent Service, Chengdu, Sichuan, China
| | - RuiHao Zhou
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Guo Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Institute of Respiratory Health, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China; State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Xuechao Hao
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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21
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Sharma S, McKechnie T, Talwar G, Patel J, Heimann L, Doumouras A, Hong D, Eskicioglu C. Postoperative Gastrointestinal Dysfunction After Neuromuscular Blockade Reversal With Sugammadex Versus Cholinesterase Inhibitors in Patients Undergoing Gastrointestinal Surgery: A Systematic Review and Meta-Analysis. Am Surg 2024; 90:1618-1629. [PMID: 38199669 DOI: 10.1177/00031348241227200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
BACKGROUND Postoperative gastrointestinal dysfunction (POGD) commonly occurs following gastrointestinal (GI) surgery and is associated with specific anesthetic agents. Cholinesterase inhibitors employed for reversing neuromuscular blockade have been implicated in development of POGD. Sugammadex, a novel reversal agent, is linked with reduced POGD. However, there is a lack of comprehensive comparative review between these agents regarding their impact on POGD following GI surgery. This study aims to systematically review the effects of sugammadex on POGD compared to cholinesterase inhibitors following GI surgery. METHODS MEDLINE, EMBASE, and CENTRAL were searched as of July 2022 to identify articles comparing sugammadex with cholinesterase inhibitors in patients undergoing gastrointestinal surgery, specifically in relation to POGD. Secondary endpoints included length of hospital stay, readmission rates, pulmonary complications, and postoperative morbidity. RESULTS From 198 citations, 2 randomized controlled trials (RCTs) and 3 retrospective cohorts with 717 patients receiving sugammadex and 812 patients receiving cholinesterase inhibitors were included. Significantly lower rates of prolonged postoperative ileus (OR .44, 95% CI .25-.77, P < .05, I2 = 56%, low certainty evidence) was observed with sugammadex. No significant difference in any other outcome was observed. Narrative review of readmission data demonstrated no significant difference. CONCLUSION The use of sugammadex following gastrointestinal surgery is associated with significantly lower rates of prolonged postoperative ileus compared to cholinesterase inhibitors. However, these do not translate into a significant reduction in length of stay, morbidity, or postoperative nausea and vomiting. Results are limited by the numer of studies included and missing data, more robust RCTs are needed before recommendations can be made.
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Affiliation(s)
- Sahil Sharma
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Tyler McKechnie
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Gaurav Talwar
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Janhavi Patel
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Luke Heimann
- Division of General Surgery, Department of Surgery, Liberty University, Lynchburg, VA, USA
| | - Aristithes Doumouras
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Dennis Hong
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Cagla Eskicioglu
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
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22
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Gong J, Xu L, Yu H, Qiu F, Zhang Z, Yin Y, Ma H, Cai Z, Zhong J, Ding W, Cao C. Increased postoperative complications after laparoscopic gastrectomy in patients with preserved ratio impaired spirometry. J Gastrointest Surg 2024; 28:889-895. [PMID: 38513947 DOI: 10.1016/j.gassur.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/03/2024] [Accepted: 03/17/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Preserved ratio impaired spirometry (PRISm), defined as decreased forced expiratory volume in the first second in the setting of normal ratio, is associated with an increased risk of respiratory disease and systemic comorbidities. Unlike severe obstructive pulmonary disease, little is known about the impact of PRISm on short-term outcomes in patients undergoing laparoscopic gastrectomy (LG) and its association with small airway dysfunction (SAD). METHODS This study enrolled 830 patients who underwent preoperative spirometry and LG between January 2021 and August 2023. Of these, 228 patients were excluded. Participants were categorized into 3 groups based on their baseline lung function, and postoperative outcomes were subsequently analyzed. Potential associations between postoperative outcomes and various clinical variables were examined using univariate and multivariate analyses. RESULTS PRISm was identified in 16.6% of the patients, whereas SAD was present in 20.4%. The incidence of postoperative pulmonary complications (PPCs) was notably higher in the SAD group (20.3% vs 9.8%, P = .002) and the PRISm group (28.0% vs 9.8%, P < .001) than the normal group. Among the 3 groups, pneumonia was the most frequently observed PPC. Multivariate analysis revealed that both SAD (odds ratio [OR], 2.34; 95% CI, 1.30-4.22; P = .005) and PRISm (OR, 3.26; 95% CI, 1.80-5.90; P < .001) independently constituted significant risk factors associated with the occurrence of PPCs. Univariate analysis showed that female was a possible risk factor for PPCs in PRISm group. CONCLUSION Our study showed that PRISm and SAD were associated with the increased PPCs in patients undergoing LG for gastric cancer.
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Affiliation(s)
- Jun Gong
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, First Affiliated Hospital of Ningbo University, Ningbo, China; School of Medicine, Ningbo University, Ningbo, China
| | - Linbin Xu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, First Affiliated Hospital of Ningbo University, Ningbo, China; School of Medicine, Ningbo University, Ningbo, China
| | - Hang Yu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Feng Qiu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Zhiping Zhang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Yongfang Yin
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Hongying Ma
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Zejun Cai
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Jingjing Zhong
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Weiping Ding
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Chao Cao
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, First Affiliated Hospital of Ningbo University, Ningbo, China.
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23
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Piemontese C, Stabile M, Di Bella C, Scardia A, Vicenti C, Acquafredda C, Crovace A, Lacitignola L, Staffieri F. The incidence of hypoxemia in dogs recovering from general anesthesia detected with pulse-oximetry and related risk factors. Vet J 2024; 305:106135. [PMID: 38750813 DOI: 10.1016/j.tvjl.2024.106135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 04/12/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024]
Abstract
The postoperative period is critical for the development of complications, including hypoxemia. To detect hypoxemia early and provide appropriate care, continuous monitoring of saturation is necessary: pulse oximetry is an easily accessible and simple method for this purpose. However, a SpO2 cut-off value to detect hypoxemia in dogs recovering from general anesthesia is lacking in the veterinary literature. The objectives of this clinical study are to validate the room air SpO2 test (SpAT), to identify a cut-off value to discriminate hypoxemia (Phase 1), and to apply the SpAT to study the incidence of transient postoperative hypoxemia (TPH) (Phase 2) in dogs with healthy lungs recovering from general anesthesia. Phase 1: 87 dogs recovering from general anesthesia with an arterial line were included. After extubation, SpAT was performed simultaneously with arterial blood sampling. A PaO2 < 80 mmHg was considered hypoxemia. Phase 2: 654 dogs were enrolled. They underwent general anesthesia with different ventilation settings for different procedures. After extubation, dogs were classified as hypoxemic if the SpO2 was lower than the cut-off obtained in phase 1. Phase 1 showed that the SpO2 cut-off is < 95% (sensitivity 100%, specificity 97.4%; area under the curve, AUC = 0.996; 95% Confidence Interval = 0.944-1; P<0.0001). In Phase 2, 169 dogs were hypoxemic. Body Condition Score (BCS) > 3/5, dorsal recumbency, FiO2 1, absence of Positive End-Expiratory Pressure (PEEP) had a significant odds ratio to induce TPH (5.8, 1.9, 3.7, 1.7, respectively). These results showed that SpO2 < 95% indicates PaO2 < 80 mmHg in dogs and TPH occurs in up to 28% of cases. Identification of associated risks could be useful to prevent and to increase awareness for monitoring and treatment.
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Affiliation(s)
- C Piemontese
- Section of Veterinary Clinics and Animal Production, DiMePRe-J, University of Bari, Bari 70123, Italy; Ph.D. Course in "Tissues and Organs Transplantations and Cellular Therapies", DiMePRe-J, University of Bari, Bari 70121, Italy
| | - M Stabile
- Section of Veterinary Clinics and Animal Production, DiMePRe-J, University of Bari, Bari 70123, Italy
| | - C Di Bella
- School of Bioscience and Veterinary Medicine, University of Camerino, Matelica 62024, Italy
| | - A Scardia
- Section of Veterinary Clinics and Animal Production, DiMePRe-J, University of Bari, Bari 70123, Italy; Ph.D. Course in "Tissues and Organs Transplantations and Cellular Therapies", DiMePRe-J, University of Bari, Bari 70121, Italy
| | - C Vicenti
- Section of Veterinary Clinics and Animal Production, DiMePRe-J, University of Bari, Bari 70123, Italy; Ph.D. Course in "Tissues and Organs Transplantations and Cellular Therapies", DiMePRe-J, University of Bari, Bari 70121, Italy
| | - C Acquafredda
- Section of Veterinary Clinics and Animal Production, DiMePRe-J, University of Bari, Bari 70123, Italy; Ph.D. Course in "Tissues and Organs Transplantations and Cellular Therapies", DiMePRe-J, University of Bari, Bari 70121, Italy
| | - A Crovace
- Section of Veterinary Clinics and Animal Production, DiMePRe-J, University of Bari, Bari 70123, Italy
| | - L Lacitignola
- Section of Veterinary Clinics and Animal Production, DiMePRe-J, University of Bari, Bari 70123, Italy.
| | - F Staffieri
- Section of Veterinary Clinics and Animal Production, DiMePRe-J, University of Bari, Bari 70123, Italy.
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24
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Karthik AR, Gupta N, Garg R, Bharati SJ, Ray MD, Hadda V, Pahuja S, Mishra S, Bhatnagar S, Kumar V. Comparison of lung aeration loss in open abdominal oncologic surgeries after ventilation with electrical impedance tomography-guided PEEP versus conventional PEEP: a pilot feasibility study. Korean J Anesthesiol 2024; 77:353-363. [PMID: 38438222 PMCID: PMC11150122 DOI: 10.4097/kja.23858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Existing literature lacks high-quality evidence regarding the ideal intraoperative positive end-expiratory pressure (PEEP) to minimize postoperative pulmonary complications (PPCs). We hypothesized that applying individualized PEEP derived from electrical impedance tomography would reduce the severity of postoperative lung aeration loss, deterioration in oxygenation, and PPC incidence. METHODS A pilot feasibility study was conducted on 36 patients who underwent open abdominal oncologic surgery. The patients were randomized to receive individualized PEEP or conventional PEEP at 4 cmH2O. The primary outcome was the impact of individualized PEEP on changes in the modified lung ultrasound score (MLUS) derived from preoperative and postoperative lung ultrasonography. A higher MLUS indicated greater lung aeration loss. The secondary outcomes were the PaO2/FiO2 ratio and PPC incidence. RESULTS A significant increase in the postoperative MLUS (12.0 ± 3.6 vs 7.9 ± 2.1, P < 0.001) and a significant difference between the postoperative and preoperative MLUS values (7.0 ± 3.3 vs 3.0 ± 1.6, P < 0.001) were found in the conventional PEEP group, indicating increased lung aeration loss. In the conventional PEEP group, the intraoperative PaO2/FiO2 ratios were significantly lower but not the postoperative ratios. The PPC incidence was not significantly different between the groups. Post-hoc analysis showed the increase in lung aeration loss and deterioration of intraoperative oxygenation correlated with the deviation from the individualized PEEP. CONCLUSIONS Individualized PEEP appears to protect against lung aeration loss and intraoperative oxygenation deterioration. The advantage was greater in patients whose individualized PEEP deviated more from the conventional PEEP.
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Affiliation(s)
- A. R. Karthik
- Department of Anesthesiology, Cancer Institute (WIA), Adyar, Chennai, India
| | - Nishkarsh Gupta
- Department of Onco-Anesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, AIIMS, Ansari Nagar, New Delhi, India
| | - Rakesh Garg
- Department of Onco-Anesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, AIIMS, Ansari Nagar, New Delhi, India
| | - Sachidanand Jee Bharati
- Department of Onco-Anesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, AIIMS, Ansari Nagar, New Delhi, India
| | - M. D. Ray
- Department of Surgical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, AIIMS, Ansari Nagar, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, Ansari Nagar, New Delhi, India
| | - Sourabh Pahuja
- Department of Pulmonary Medicine, Amrita Hospital, Faridabad, India
| | - Seema Mishra
- Department of Onco-Anesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, AIIMS, Ansari Nagar, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, AIIMS, Ansari Nagar, New Delhi, India
| | - Vinod Kumar
- Department of Anesthesiology, University of Minnesota Medical School, Minneapolis, MN, USA
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25
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Savino S, Gaetano S. Functional Phenotyping: A New Role for Electrical Impedance Tomography. Am J Respir Crit Care Med 2024; 209:1291-1292. [PMID: 38457807 PMCID: PMC11146560 DOI: 10.1164/rccm.202402-0328ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/06/2024] [Indexed: 03/10/2024] Open
Affiliation(s)
- Spadaro Savino
- Department of Translational Medicine University of Ferrara Ferrara, Italy
| | - Scaramuzzo Gaetano
- Department of Translational Medicine University of Ferrara Ferrara, Italy
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26
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Fan G, Zhang F, Shan T, Jiang Y, Zheng M, Zang B, Zhao W. Association of point-of-care lung ultrasound findings with 30-day pulmonary complications after cardiac surgery: A prospective cohort study. Heliyon 2024; 10:e31293. [PMID: 38813155 PMCID: PMC11133817 DOI: 10.1016/j.heliyon.2024.e31293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 05/31/2024] Open
Abstract
Background Several studies have shown that bedside lung ultrasound findings in postanaesthesia care units (PACUs) and intensive care units (ICUs) correlate with postoperative pulmonary complications(PPCs) after noncardiac major surgery. However, it remains unclear whether lung ultrasound findings can be used as early predictors of PPCs in patients undergoing cardiac surgery. The main aim of our study was to evaluate the relationship between early postoperative point-of-care lung ultrasound findings and PPCs after cardiac surgery. Methods Two board-certified physicians performed a point-of-care pulmonary ultrasound on cardiac surgery patients approximately 2 h after the patient was admitted to the ICU. Pulmonary complications occurring within 30 days postoperatively were recorded. Logistic regression modeling was used to analyze the relationship between lung ultrasound findings and PPCs. Results PPCs occurred in 61 (30.9 %) of the 197 patients. Lung ultrasound scores(LUS), number of lung consolidation(NLC), and depth of pleural effusion(DPE) were more significant in patients who developed PPCs (P < 0.001). According to the multivariate analysis, NLC≥3(aOR 2.71,95%CI 1.14-6.44; p = 0.024)and DPE >0.95(aOR 3.79,95%CI 1.60-8.99; p = 0.002) were found to be independently associated with PPCs during this study. Conclusions Our study demonstrated that DPE >0.95 and NLC ≥3 were associated with PPCs after cardiac surgery based on bedside lung ultrasound findings in the ICU. When these signs manifest perioperatively, the surgeon should be alerted and the necessary steps should be taken, especially if they present simultaneously.
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Affiliation(s)
- Guanglei Fan
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Fengran Zhang
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Tianchi Shan
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yaning Jiang
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Mingzhu Zheng
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Baohe Zang
- Department of Critical Care Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Wenjing Zhao
- Department of Critical Care Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
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Chen X, Chen Q, Qin Z, Alam A, Zhao H, West R, Liu X, Li J, Li X, Yi B, Ma D, Gu J. Dexmedetomidine Attenuates Inflammation in Elderly Patients Following Major Hepatobiliary and Pancreatic Surgery: A Randomized Clinical Trial. Clin Interv Aging 2024; 19:981-991. [PMID: 38827237 PMCID: PMC11144432 DOI: 10.2147/cia.s455987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/15/2024] [Indexed: 06/04/2024] Open
Abstract
Background Dexmedetomidine (Dex) may have anti-inflammatory properties and potentially reduce the incidence of postoperative organ injury. Objective To investigate whether Dex protects pulmonary and renal function via its anti-inflammatory effects in elderly patients undergoing prolonged major hepatobiliary and pancreatic surgery. Design and Setting Between October 2019 and December 2020, this randomized controlled trial was carried out at a tertiary hospital in Chongqing, China. Patients 86 patients aged 60-75 who underwent long-duration (> 4 hrs) hepatobiliary and pancreatic surgery without significant comorbidities were enrolled and randomly assigned into two groups at a 1:1 ratio. Interventions Patients were given either Dex or an equivalent volume of 0.9% saline (Placebo) with a loading dose of 1 μg kg-1 for 10 min, followed by 0.5 μg kg-1 hr-1 for maintenance until the end of surgery. Main Outcome Measures The changes in serum concentrations of interleukin-6 (IL-6) and tumour necrosis factor-α (TNF-α) were primary outcomes. Results At one hour postoperatively, serum IL-6 displayed a nine-fold increase (P<0.05) in the Placebo group. Administration of Dex decreased IL-6 to 278.09 ± 45.43 pg/mL (95% CI: 187.75 to 368.43) compared to the Placebo group (P=0.019; 432.16 ± 45.43 pg/mL, 95% CI: 341.82 to 522.50). However, no significant differences in TNF-α were observed between the two groups. The incidence of postoperative acute kidney injury was twice as high in the Placebo group (9.30%) compared to the Dex group (4.65%), and the incidence of postoperative acute lung injury was 23.26% in the Dex group, lower than that in the Placebo group (30.23%), although there was no statistical significance between the two groups. Conclusion Dex administration in elderly patients undergoing major hepatobiliary and pancreatic surgery reduces inflammation and potentially protects kidneys and lungs. Registration Chinese Clinical Trials Registry, identifier: ChiCTR1900024162, on 28 June 2019.
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Affiliation(s)
- Xingtong Chen
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Qian Chen
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
- Perioperative and Systems Medicine Laboratory, National Clinical Research Center for Child Health, Children’s Hospital, Zhejiang University School of Medicine, Zhejiang, People’s Republic of China
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London, UK
| | - Zhigang Qin
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Azeem Alam
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London, UK
| | - Hailin Zhao
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London, UK
| | - Raha West
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London, UK
| | - Xianzhe Liu
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Jieyu Li
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Xin Li
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Bin Yi
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Daqing Ma
- Perioperative and Systems Medicine Laboratory, National Clinical Research Center for Child Health, Children’s Hospital, Zhejiang University School of Medicine, Zhejiang, People’s Republic of China
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London, UK
| | - Jianteng Gu
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
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Tominaga T, Nonaka T, Takamura Y, Oishi K, Hashimoto S, Shiraishi T, Noda K, Ono R, Ishii M, Hisanaga M, Takeshita H, Fukuoka H, Oyama S, Ishimaru K, Kunizaki M, Sawai T, Matsumoto K. Risk factors for pulmonary complications after colorectal cancer surgery: a Japanese multicenter study. Int J Colorectal Dis 2024; 39:76. [PMID: 38780615 PMCID: PMC11116231 DOI: 10.1007/s00384-024-04652-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE Pulmonary complications (PC) are a serious condition with a 20% mortality rate. However, few reports have examined risk factors for PC after colorectal surgery. This study investigated the frequency, characteristics, and risk factors for PC after colorectal cancer surgery. METHODS Between January 2016 and December 2022, we retrospectively reviewed 3979 consecutive patients who underwent colorectal cancer surgery in seven participating hospitals. Patients were divided into patients who experienced PC (PC group, n = 54) and patients who did not (non-PC group, n = 3925). Clinical and pathological features were compared between groups. RESULTS Fifty-four patients (1.5%) developed PC, of whom 2 patients (3.7%) died due to PC. Age was greater (80 years vs 71 years; p < 0.001), frequency of chronic obstructive pulmonary distress was greater (9.3% vs 3.2%; p = 0.029), performance status was poorer (p < 0.001), the proportion of underweight was higher (42.6% vs 13.4%, p < 0.001), frequency of open surgery was greater (24.1% vs 9.3%; p < 0.001), and blood loss was greater (40 mL vs 22 mL; p < 0.001) in the PC group. Multivariate analysis revealed male sex (odds ratio (OR) 2.165, 95% confidence interval (CI) 1.176-3.986; p = 0.013), greater age (OR 3.180, 95%CI 1.798-5.624; p < 0.001), underweight (OR 3.961, 95%CI 2.210-7.100; p < 0.001), and poorer ASA-PS (OR 3.828, 95%CI 2.144-6.834; p < 0.001) as independent predictors of PC. CONCLUSION Our study revealed male sex, greater age, underweight, and poorer ASA-PS as factors associated with development of PC, and suggested that pre- and postoperative rehabilitation and pneumonia control measures should be implemented for patients at high risk of PC.
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Affiliation(s)
- Tetsuro Tominaga
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Takashi Nonaka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Yuma Takamura
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kaido Oishi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Shintaro Hashimoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Toshio Shiraishi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Keisuke Noda
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Rika Ono
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Mitsutoshi Ishii
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirasemachi, Nagasaki, 857-8511, Japan
| | - Makoto Hisanaga
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirasemachi, Nagasaki, 857-8511, Japan
| | - Hiroaki Takeshita
- Department of Surgery, National Hospital Organization Nagasaki Medical Center, 1-1001-1, Omura, Nagasaki, 856-8562, Japan
| | - Hidetoshi Fukuoka
- Department of Surgery, Isahaya General Hospital, 24-1, Isahaya, Nagasaki, 854-8501, Japan
| | - Shosaburo Oyama
- Department of Surgery, Ureshino Medical Center, 4279-3 Ko, Ureshinomachi, Oaza, Shimojuku, Ureshino, Saga, 843-0393, Japan
| | - Kazuhide Ishimaru
- Department of Surgery, Saiseikai Nagasaki Hospital, 2-5-1 Katafuchi, Nagasaki, 850-0003, Japan
| | - Masaki Kunizaki
- Department of Surgery, Saseno Chuo Hospital, 15 Yamatocho, Sasebo, 857-1195, Japan
| | - Terumitsu Sawai
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Keitaro Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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Oh AR, Kang ES, Park J, Lee SM, Jeong M, Lee JH. Does coronavirus disease 2019 history alone increase the risk of postoperative pulmonary complications after surgery? Prospective observational study using serology assessment. PLoS One 2024; 19:e0300782. [PMID: 38771760 PMCID: PMC11108156 DOI: 10.1371/journal.pone.0300782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/05/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Concern exists about the increasing risk of postoperative pulmonary complications in patients with a history of coronavirus disease 2019 (COVID-19). OBJECTIVE We conducted a prospective observational study that compared the incidence of postoperative pulmonary complications in patients with and without a history of COVID-19. METHODS From August 2022 to November 2022, 244 adult patients undergoing major non-cardiac surgery were enrolled and allocated either to history or no history of COVID-19 groups. For patients without a history of confirming COVID-19 diagnosis, we tested immunoglobulin G to nucleocapsid antigen of SARS-CoV-2 for serology assessment to identify undetected infection. We compared the incidence of postoperative pulmonary complications, defined as a composite of atelectasis, pleural effusion, pulmonary edema, pneumonia, aspiration pneumonitis, and the need for additional oxygen therapy according to a COVID-19 history. RESULTS After excluding 44 patients without a COVID-19 history who were detected as seropositive, 200 patients were finally enrolled in this study, 100 in each group. All subjects with a COVID-19 history experienced no or mild symptoms during infection. The risk of postoperative pulmonary complications was not significantly different between the groups according to the history of COVID-19 (24.0% vs. 26.0%; odds ratio, 0.99; 95% confidence interval, 0.71-1.37; P-value, 0.92). The incidence of postoperative pulmonary complications was also similar (27.3%) in excluded patients owing to being seropositive. CONCLUSION Our study showed patients with a history of no or mild symptomatic COVID-19 did not show an increased risk of PPCs compared to those without a COVID-19 history. Additional precautions may not be needed to prevent PPCs in those patients.
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Affiliation(s)
- Ah Ran Oh
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Suk Kang
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jungchan Park
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sangmin Maria Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mijeong Jeong
- Research Institute for Future Medicine, R&D Management & Supporting Team, Republic of Korea
| | - Jong-Hwan Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Feng G, Jia Y, Zhao G, Meng F, Wang T. Risk factors for postoperative pulmonary complications in elderly patients undergoing video-assisted thoracoscopic surgery lobectomy under general anesthesia: a retrospective study. BMC Surg 2024; 24:153. [PMID: 38745149 PMCID: PMC11091990 DOI: 10.1186/s12893-024-02444-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The objective of this study is to identify and evaluate the risk factors associated with the development of postoperative pulmonary complications (PPCs) in elderly patients undergoing video-assisted thoracoscopic surgery lobectomy under general anesthesia. METHODS The retrospective study consecutively included elderly patients (≥ 70 years old) who underwent thoracoscopic lobectomy at Xuanwu Hospital of Capital Medical University from January 1, 2018 to August 31, 2023. The demographic characteristics, the preoperative, intraoperative and postoperative parameters were collected and analyzed using multivariate logistic regression to identify the prediction of risk factors for PPCs. RESULTS 322 patients were included for analysis, and 115 patients (35.7%) developed PPCs. Multifactorial regression analysis showed that ASA ≥ III (P = 0.006, 95% CI: 1.230 ∼ 3.532), duration of one-lung ventilation (P = 0.033, 95% CI: 1.069 ∼ 4.867), smoking (P = 0.027, 95% CI: 1.072 ∼ 3.194) and COPD (P = 0.015, 95% CI: 1.332 ∼ 13.716) are independent risk factors for PPCs after thoracoscopic lobectomy in elderly patients. CONCLUSION Risk factors for PPCs are ASA ≥ III, duration of one-lung ventilation, smoking and COPD in elderly patients over 70 years old undergoing thoracoscopic lobectomy. It is necessary to pay special attention to these patients to help optimize the allocation of resources and enhance preventive efforts.
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Affiliation(s)
- Guang Feng
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Yitong Jia
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Guanxu Zhao
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Fanqi Meng
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Tianlong Wang
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
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31
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Pettenuzzo T, Boscolo A, Pistollato E, Pretto C, Giacon TA, Frasson S, Carbotti FM, Medici F, Pettenon G, Carofiglio G, Nardelli M, Cucci N, Tuccio CL, Gagliardi V, Schiavolin C, Simoni C, Congedi S, Monteleone F, Zarantonello F, Sella N, De Cassai A, Navalesi P. Effects of non-invasive respiratory support in post-operative patients: a systematic review and network meta-analysis. Crit Care 2024; 28:152. [PMID: 38720332 PMCID: PMC11077852 DOI: 10.1186/s13054-024-04924-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/21/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Re-intubation secondary to post-extubation respiratory failure in post-operative patients is associated with increased patient morbidity and mortality. Non-invasive respiratory support (NRS) alternative to conventional oxygen therapy (COT), i.e., high-flow nasal oxygen, continuous positive airway pressure, and non-invasive ventilation (NIV), has been proposed to prevent or treat post-extubation respiratory failure. Aim of the present study is assessing the effects of NRS application, compared to COT, on the re-intubation rate (primary outcome), and time to re-intubation, incidence of nosocomial pneumonia, patient discomfort, intensive care unit (ICU) and hospital length of stay, and mortality (secondary outcomes) in adult patients extubated after surgery. METHODS A systematic review and network meta-analysis of randomized and non-randomized controlled trials. A search from Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, and Web of Science from inception until February 2, 2024 was performed. RESULTS Thirty-three studies (11,292 patients) were included. Among all NRS modalities, only NIV reduced the re-intubation rate, compared to COT (odds ratio 0.49, 95% confidence interval 0.28; 0.87, p = 0.015, I2 = 60.5%, low certainty of evidence). In particular, this effect was observed in patients receiving NIV for treatment, while not for prevention, of post-extubation respiratory failure, and in patients at high, while not low, risk of post-extubation respiratory failure. NIV reduced the rate of nosocomial pneumonia, ICU length of stay, and ICU, hospital, and long-term mortality, while not worsening patient discomfort. CONCLUSIONS In post-operative patients receiving NRS after extubation, NIV reduced the rate of re-intubation, compared to COT, when used for treatment of post-extubation respiratory failure and in patients at high risk of post-extubation respiratory failure.
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Affiliation(s)
- Tommaso Pettenuzzo
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy
| | - Annalisa Boscolo
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Elisa Pistollato
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Chiara Pretto
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | | | - Sara Frasson
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | | | - Francesca Medici
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Giovanni Pettenon
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Giuliana Carofiglio
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Marco Nardelli
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Nicolas Cucci
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Clara Letizia Tuccio
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Veronica Gagliardi
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Chiara Schiavolin
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Caterina Simoni
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Sabrina Congedi
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Francesco Monteleone
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Francesco Zarantonello
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy
| | - Nicolò Sella
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy
| | - Alessandro De Cassai
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy
| | - Paolo Navalesi
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy.
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy.
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Montero-Cámara J, Ferrer-Sargues FJ, Rovira MJS, Cabello AS, Peredo DC, Calabuig JAM, Valtueña-Gimeno N, Sánchez-Sánchez ML. Can resistance prehabilitation training bring additional benefits in valvular cardiac surgery? protocol for a randomized controlled trial. PLoS One 2024; 19:e0303163. [PMID: 38713654 DOI: 10.1371/journal.pone.0303163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 04/15/2024] [Indexed: 05/09/2024] Open
Abstract
INTRODUCTION Cardiovascular diseases (CVD) are a group of illnesses that include coronary heart disease, cerebrovascular disease, congenital heart disease and deep vein thrombosis. Major surgery is often chosen as the treatment of choice for CVD. The concept of fast-track rehabilitation after surgery appeared in the 1970s. Participation in these exercise-based prehabilitation programmes may decrease postoperative complications and length of hospital stay. The primary aim of the present study is to evaluate whether the implementation of an additional resistance training (RT) prehabilitation protocol within cardiac exercises based prehabilitation can reduce intensive care unit (ICU) length of stay, postoperative complications and hospital length of stay (LOS). METHODS A protocol of a prospective, parallel, randomised clinical trial includes 96 adult patients diagnosed with valvular pathology and who have been scheduled for surgery. The participants will be randomly assigned to two groups of 48. Control group will be treated with ventilatory and strengthening of respiratory muscles, and aerobic exercise. Experimental group, in addition, will be treated with RT of peripheral muscles. Both hospital stay and ICU stay will be assessed as main variables. Other secondary variables such as exercise capacity, quality of life and respiratory values will also be assessed. Quantitative variables will be analysed with a T-Test or ANOVA, or Mann Witney if the distribution is non-parametric. RESULTS AND CONCLUSION This will be the first controlled clinical study focused on adding strength exercise as an additional treatment during prehabilitation. The results of this study will focus on helping to improve rehabilitation and prehabilitation protocols, considering that it is essential to maintain pulmonary training, as well as the inclusion of peripheral exercises that help people with heart disease to be in a better physical condition in order to increase their participation and sense of quality of life.
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Affiliation(s)
- Jorge Montero-Cámara
- Deparment of Nursing and Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, Alfara del Patriarca, Valencia, Spain
| | - Francisco José Ferrer-Sargues
- Deparment of Nursing and Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, Alfara del Patriarca, Valencia, Spain
| | - María José Segrera Rovira
- Deparment of Nursing and Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, Alfara del Patriarca, Valencia, Spain
- Hospital Universitario de la Ribera, Alzira, Valencia, Spain
| | | | | | | | - Noemí Valtueña-Gimeno
- Deparment of Nursing and Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, Alfara del Patriarca, Valencia, Spain
| | - María Luz Sánchez-Sánchez
- Department of Physiotherapy, Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain
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Yoon S, Nam JS, Blank RS, Ahn HJ, Park M, Kim H, Kim HJ, Choi H, Kang HU, Lee DK, Ahn J. Association of Mechanical Energy and Power with Postoperative Pulmonary Complications in Lung Resection Surgery: A Post Hoc Analysis of Randomized Clinical Trial Data. Anesthesiology 2024; 140:920-934. [PMID: 38109657 DOI: 10.1097/aln.0000000000004879] [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: 12/20/2023]
Abstract
BACKGROUND Mechanical power (MP), the rate of mechanical energy (ME) delivery, is a recently introduced unifying ventilator parameter consisting of tidal volume, airway pressures, and respiratory rates, which predicts pulmonary complications in several clinical contexts. However, ME has not been previously studied in the perioperative context, and neither parameter has been studied in the context of thoracic surgery utilizing one-lung ventilation. METHODS The relationships between ME variables and postoperative pulmonary complications were evaluated in this post hoc analysis of data from a multicenter randomized clinical trial of lung resection surgery conducted between 2020 and 2021 (n = 1,170). Time-weighted average MP and ME (the area under the MP time curve) were obtained for individual patients. The primary analysis was the association of time-weighted average MP and ME with pulmonary complications within 7 postoperative days. Multivariable logistic regression was performed to examine the relationships between energy variables and the primary outcome. RESULTS In 1,055 patients analyzed, pulmonary complications occurred in 41% (431 of 1,055). The median (interquartile ranges) ME and time-weighted average MP in patients who developed postoperative pulmonary complications versus those who did not were 1,146 (811 to 1,530) J versus 924 (730 to 1,240) J (P < 0.001), and 6.9 (5.5 to 8.7) J/min versus 6.7 (5.2 to 8.5) J/min (P = 0.091), respectively. ME was independently associated with postoperative pulmonary complications (ORadjusted, 1.44 [95% CI, 1.16 to 1.80]; P = 0.001). However, the association between time-weighted average MP and postoperative pulmonary complications was time-dependent, and time-weighted average MP was significantly associated with postoperative pulmonary complications in cases utilizing longer periods of mechanical ventilation (210 min or greater; ORadjusted, 1.46 [95% CI, 1.11 to 1.93]; P = 0.007). Normalization of ME and time-weighted average MP either to predicted body weight or to respiratory system compliance did not alter these associations. CONCLUSIONS ME and, in cases requiring longer periods of mechanical ventilation, MP were independently associated with postoperative pulmonary complications in thoracic surgery. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Susie Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, University of Seoul National College of Medicine, Seoul, South Korea
| | - Jae-Sik Nam
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Randal S Blank
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia
| | - Hyun Joo Ahn
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - MiHye Park
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Heezoo Kim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Hye Jin Kim
- Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Hoon Choi
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyun-Uk Kang
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Do-Kyeong Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joonghyun Ahn
- Biomedical Statistics Center, Data Science Research Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea
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Akhtar AB, Ur Rehman S, Ur Rehman S, Bari H. Retrospective Analysis of Postoperative Nonhepatic Outcomes Following Major Liver Resection. Cureus 2024; 16:e60311. [PMID: 38883004 PMCID: PMC11176564 DOI: 10.7759/cureus.60311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/18/2024] Open
Abstract
Background Liver surgery is a major and challenging procedure for the surgeon, the anesthetist, and the patient. The objective of this study was to evaluate the postoperative nonhepatic complications of patients undergoing liver resection surgery with perioperative factors. Methods We retrospectively analyzed 79 patients who underwent liver resection surgeries at the Shaukat Khanum Memorial Cancer Hospital and Research Centre in Lahore, Pakistan, from July 2015 to December 2022. Results The mean age at the time of surgery was 53 years (range: 3-77 years), and the mean BMI was 26.43 (range: 15.72-38.0 kg/m2). Of the total patients, 44.3 % (n = 35) had no comorbidities, 26.6% (n=21) had one comorbidity, and 29.1% (n=23) had two or more comorbidities. Patients in whom the blood loss was more than 375 ml required postoperative oxygen inhalation with a significant relative risk of 2.6 (p=0.0392) and an odds ratio of 3.5 (p=0.0327). Similarly, patients who had a surgery time of more than five hours stayed in the hospital for more than seven days, with a statistically significant relative risk of 2.7 (p=0.0003) and odds ratio of 7.64 (p=0.0001). The duration of surgery was also linked with the possibility of requiring respiratory support, with a relative risk of 5.0 (p=0.0134) and odds ratio of 5.73 (p=0.1190). Conclusion Patients in our cohort who had a prolonged duration of surgery received an increased amount of fluids, and a large volume of blood loss was associated with prolonged stay in the ICU (>2 days), hospital admission (>7 days), ICU readmission, and increased incidence of cardiorespiratory, neurological, and renal disturbances postoperatively.
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Affiliation(s)
- Ahmed Bilal Akhtar
- Anesthesia and Critical Care, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Saad Ur Rehman
- Anesthesiology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | | | - Hassaan Bari
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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Terano K, Motoi T, Nagata E, Oho T. Association of remaining tooth number with postoperative respiratory complications in heart valve surgery patients. Int J Dent Hyg 2024; 22:394-400. [PMID: 36760162 DOI: 10.1111/idh.12673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/23/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVES This study examined the association between the number of remaining teeth and the incidence of postoperative respiratory complications in patients undergoing heart valve surgery. METHODS We retrospectively enrolled 157 patients who underwent heart valve surgery between April 2010 and March 2019. Data on patient characteristics including systemic and oral conditions were extracted and postoperative respiratory complications were set as outcomes. Patients were divided into two groups according to the number of remaining teeth (≥20, <20). After adjusting for confounding factors with propensity scoring, logistic regression analysis was performed to examine the association of remaining teeth number with the incidence of postoperative respiratory complications. In addition, subgroup analysis was performed by stratifying the data into quintiles based on the propensity score. RESULTS Univariate analysis showed significant differences between the two groups in factors, including age, past cardiac surgery experience, New York Heart Association functional classification class IV, denture use, tooth extraction before surgery, occlusal support, and periodontitis. Logistic regression analysis showed that patients with <20 remaining teeth had a significantly higher incidence of postoperative respiratory complications than those with ≥20 remaining teeth, with an odds ratio of 29.800 (p = 0.004). Subgroup analysis showed that the odds ratio for the patients with <20 remaining teeth was 9.000 (p = 0.038). CONCLUSIONS The results suggest that heart valve surgery patients shall get attention on oral disease prevention by dental care practitioners to maintain a sufficient number of teeth for the prevention of postoperative respiratory complications.
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Affiliation(s)
- Kurara Terano
- Division of Clinical Technology, Kagoshima University Hospital, Kagoshima, Japan
| | - Toshihiro Motoi
- Department of Preventive Dentistry, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Emi Nagata
- Division of Preventive Dentistry, Kagoshima University Hospital, Kagoshima, Japan
| | - Takahiko Oho
- Department of Preventive Dentistry, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Blike GT, McGrath SP, Ochs Kinney MA, Gali B. Pro-Con Debate: Universal Versus Selective Continuous Monitoring of Postoperative Patients. Anesth Analg 2024; 138:955-966. [PMID: 38621283 DOI: 10.1213/ane.0000000000006840] [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: 04/17/2024]
Abstract
In this Pro-Con commentary article, we discuss use of continuous physiologic monitoring for clinical deterioration, specifically respiratory depression in the postoperative population. The Pro position advocates for 24/7 continuous surveillance monitoring of all patients starting in the postanesthesia care unit until discharge from the hospital. The strongest arguments for universal monitoring relate to inadequate assessment and algorithms for patient risk. We argue that the need for hospitalization in and of itself is a sufficient predictor of an individual's risk for unexpected respiratory deterioration. In addition, general care units carry the added risk that even the most severe respiratory events will not be recognized in a timely fashion, largely due to higher patient to nurse staffing ratios and limited intermittent vital signs assessments (e.g., every 4 hours). Continuous monitoring configured properly using a "surveillance model" can adequately detect patients' respiratory deterioration while minimizing alarm fatigue and the costs of the surveillance systems. The Con position advocates for a mixed approach of time-limited continuous pulse oximetry monitoring for all patients receiving opioids, with additional remote pulse oximetry monitoring for patients identified as having a high risk of respiratory depression. Alarm fatigue, clinical resource limitations, and cost are the strongest arguments for selective monitoring, which is a more targeted approach. The proponents of the con position acknowledge that postoperative respiratory monitoring is certainly indicated for all patients, but not all patients need the same level of monitoring. The analysis and discussion of each point of view describes who, when, where, and how continuous monitoring should be implemented. Consideration of various system-level factors are addressed, including clinical resource availability, alarm design, system costs, patient and staff acceptance, risk-assessment algorithms, and respiratory event detection. Literature is reviewed, findings are described, and recommendations for design of monitoring systems and implementation of monitoring are described for the pro and con positions.
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Affiliation(s)
- George T Blike
- From the Departments of Anesthesiology
- Community and Family Medicine, Geisel School of Medicine, Hanover, New Hampshire
- The Dartmouth Institute, Dartmouth College, Hanover, New Hampshire
- Surveillance Analytics Core, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Susan P McGrath
- From the Departments of Anesthesiology
- Surveillance Analytics Core, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Michelle A Ochs Kinney
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Bhargavi Gali
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
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Griva P, Talliou C, Rougeris L, Samara D, Panagouli K, Varvarousi G, Papa M, Kathopoulis N, Chantziara V, Rovina N. Restoration of Pulmonary Compliance after Laparoscopic Gynecologic Surgery Using a Recruitment Maneuver. J Pers Med 2024; 14:451. [PMID: 38793032 PMCID: PMC11122417 DOI: 10.3390/jpm14050451] [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: 03/13/2024] [Revised: 04/12/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND/OBJECTIVES This study aimed to investigate the hypothesis that an alveolar recruitment maneuver can restore lung compliance to initial values after laparoscopic gynecological surgery. METHODS A total of 31 patients who underwent laparoscopic gynecological surgery were enrolled. Protective mechanical ventilation was applied, and the radial artery was catheterized in all patients. An alveolar recruitment maneuver (incremental and decremental positive end-expiratory pressure) was applied ten minutes after the release of pneumoperitoneum. The respiratory mechanics and blood gas results were recorded at eight different time points: after induction of anesthesia (T1), in the lithotomy position (T2), in the Trendelenburg position (T3), 10 and 90 min after insufflation of carbon dioxide (T4 and T5), in the supine position (T6), after desufflation (T7), and 10 min after an alveolar recruitment maneuver at the end of surgery (T8). RESULTS Pneumoperitoneum and the Trendelenburg position caused a decline of 15 units in compliance (T7 vs. T1; p < 0.05) compared to baseline. After the alveolar recruitment maneuver, compliance increased by 17.5% compared with the mean value of compliance at time T1 (T8 vs. T1; p < 0.05). The recruitment maneuver had favorable results in patients with low initial compliance (41.5 mL/cmH2O, IQR: 9.75 mL/cmH2O), high Body Mass Index 30.32 kg/m2 (IQR: 1.05 kg/m2), and high initial plateau airway pressure (16.5 cmH2O, IQR: 0.75 cmH2O). CONCLUSIONS Lung compliance does not return to initial values after performing laparoscopic gynecological procedures. However, after the release of pneumoperitoneum, an alveolar recruitment maneuver is beneficial as it improves compliance and gas exchange.
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Affiliation(s)
- Panagiota Griva
- Department of Anesthesiology, University General Hospital Attikon,12462 Athens, Greece
| | - Christina Talliou
- Department of Anesthesiology, University General Hospital Attikon,12462 Athens, Greece
| | - Loizos Rougeris
- Department of Anaesthesiology, Rea Maternity Hospital, 17564 Athens, Greece
| | - Dimitra Samara
- Department of Anesthesiology, University General Hospital Attikon,12462 Athens, Greece
| | - Konstantina Panagouli
- Department of Anesthesiology, University General Hospital Attikon,12462 Athens, Greece
| | - Giolanda Varvarousi
- Department of Anaesthesiology, General Hospital of Athens Alexandra, 11528 Athens, Greece
| | - Maria Papa
- Department of Anaesthesiology, General Hospital of Athens Alexandra, 11528 Athens, Greece
| | - Nikolaos Kathopoulis
- Department of Obstetrics and Gynaecology, General Hospital of Athens Alexandra, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Vasiliki Chantziara
- 1st Department of Respiratory Medicine, Sotiria Thoracic Diseases Hospital of Athens, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Nikoletta Rovina
- 1st Department of Respiratory Medicine, Sotiria Thoracic Diseases Hospital of Athens, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Jain A, Goldberg ZN, Briggs E, Amin DR, Urdang ZD, Goldman RA, Cognetti DM, Curry JM. Modified Frailty Index Associates With Transoral Robotic Surgery Complications and Survival: A National Database Study. Laryngoscope 2024. [PMID: 38651382 DOI: 10.1002/lary.31458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE The modified frailty index (mFI-5) is a National Surgical Quality Improvement Program-derived 5-factor index that has been proven to reflect frailty and predict morbidity and mortality. We hypothesize that mFI-5 is a valid predictive measure in the transoral robotic surgery (TORS) population. METHODS Retrospective study utilizing the TriNetX US-collaborative health records network querying for TORS patients. Cohorts were stratified by mFI-5 score which uses five ICD-10 codes: nonindependent functional status, hypertension, obstructive respiratory disease, heart failure, and diabetes mellitus. Cohorts were matched by age using propensity score matching. Outcome measures included survival, infection, pneumonia, tracheostomy dependence, and percutaneous endoscopic gastrostomy dependence. Reported odds ratios were normalized to mFI-5 = 0. RESULTS A total of 9,081 patients were included in the final analysis. Greater mFI-5 scores predicted decreased survival and increased incidence of postoperative infection and pneumonia. Odds of 5-year mortality were 1.93 (p = 0.0003) for mFI-5 = 2 and 1.90 (p = 0.0002) for mFI-5 = 3. Odds of 2-year mortality were 1.25 (p = 0.0125) for mFI-5 = 1, 1.58 (p = 0.0002) for mFI-5 = 2, and 1.87 (p = 0.003) for mFI-5 = 3. Odds of postoperative infection were 1.51 (p = 0.02) for mFI-5 = 2 and 1.78 (p = 0.05) for mFI-5 = 3. Two-year odds of developing pneumonia were 1.69 (p = 0.0001) for mFI-5 = 2 and 2.84 (p < 0.0001) for mFI-5 = 3. Two-month odds of pneumonia were 1.50 (p = 0.0259) for mFI-5 = 2 and 2.55 (p = 0.0037) for mFI-5 = 3. mFI-5 = 4 or 5 had too few patients to analyze. Using polynomial regression to model age versus incident 5-year post-TORS death (R2 = 0.99), mFI-5 scores better predicted survival than age alone. CONCLUSION This study demonstrates that mFI-5 predicts mortality, pneumonia, and postoperative infection independently of age. LEVEL OF EVIDENCE 4 Laryngoscope, 2024.
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Affiliation(s)
- Amiti Jain
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Zachary N Goldberg
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Erin Briggs
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Dev R Amin
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Zachary D Urdang
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Richard A Goldman
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - David M Cognetti
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Joseph M Curry
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Lee S, Seo J, Kim DY, Lee Y, Kang HY, Choi JH, Kim Y, Kim MK, You AH. Comparison of Hemodynamic Parameters Based on the Administration of Remimazolam or Sevoflurane in Patients under General Anesthesia in the Beach Chair Position: A Single-Blinded Randomized Controlled Trial. J Clin Med 2024; 13:2364. [PMID: 38673637 PMCID: PMC11051199 DOI: 10.3390/jcm13082364] [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: 03/24/2024] [Revised: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Background: We aimed to evaluate whether the administration of remimazolam as a maintenance agent for general anesthesia affects the occurrence of hypotension compared with sevoflurane when switching to the beach chair position (BCP). Methods: We conducted a prospective randomized controlled trial from June 2023 to October 2023 in adult patients undergoing orthopedic surgery under general anesthesia in the BCP. A total of 78 participants were randomly allocated to the remimazolam (R) or sevoflurane (S) groups. The primary outcome was the incidence of hypotension that occurred immediately after switching to a BCP. The secondary outcomes included differences between the study groups in perioperative blood pressure (BP), heart rate (HR), endotracheal tube extubation time, postoperative complications, and hospital length of stay (LOS). Results: The incidence of hypotension immediately after switching to a BCP was significantly higher in the S group. The risk factors associated with hypotension included sevoflurane administration and a high baseline systolic BP. In the receiver operating characteristic curve analysis for the occurrence of hypotension after the transition to a BCP, the cutoff value for systolic BP was 142 mmHg. The perioperative BP and HR were higher in the R group at several timepoints. Postoperative endotracheal tube extubation time was shorter in the R group. There were no significant differences in the postoperative complications or hospital LOS between the two groups. Conclusions: Remimazolam should be considered as an anesthetic agent to prevent hypotension when switching to BCP, and hypotension may occur frequently in patients with high baseline BP.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ann Hee You
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul 02447, Republic of Korea; (S.L.); (J.S.); (D.Y.K.); (Y.L.); (H.Y.K.); (J.-H.C.); (Y.K.); (M.K.K.)
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Vetrugno L, Deana C, Colaianni-Alfonso N, Tritapepe F, Fierro C, Maggiore SM. Noninvasive respiratory support in the perioperative setting: a narrative review. Front Med (Lausanne) 2024; 11:1364475. [PMID: 38695030 PMCID: PMC11061466 DOI: 10.3389/fmed.2024.1364475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/08/2024] [Indexed: 05/04/2024] Open
Abstract
The application of preoperative noninvasive respiratory support (NRS) has been expanding with increasing recognition of its potential role in this setting as a physiological optimization for patients with a high risk of developing atelectasis and postoperative pulmonary complications (PPC). The increased availability of high-performance anesthesia ventilator machines providing an easy way for NRS support in patients with reduced lung function should not be under-evaluated. This support can reduce hypoxia, restore lung volumes and theoretically reduce atelectasis formation after general anesthesia. Therapeutic purposes should also be considered in the perioperative setting, such as preoperative NRS to optimize treatment of patients' pre-existing diseases, e.g., sleep-disordered breathing. Finally, the recent guidelines for airway management suggest preoperative NRS application before anesthesia induction in difficult airway management to prolong the time needed to secure the airway with an orotracheal tube. This narrative review aims to revise all these aspects and to provide some practical notes to maximize the efficacy of perioperative noninvasive respiratory support.
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Affiliation(s)
- Luigi Vetrugno
- Department of Medical, Oral and Biotecnological Science, “G. D’Annunzio” Chieti-Pescara University, Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | | | - Fabrizio Tritapepe
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
| | - Carmen Fierro
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
| | - Salvatore Maurizio Maggiore
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
- Department of Innovative Technologies in Medicine & Dentistry, Section of Anesthesia and Intensive Care, SS. Annunziata Hospital, G. D’Annunzio University, Chieti, Italy
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Yu LS, Zhou SJ, Chen XH, Wang J, Wang ZC. Single-Lung Ventilation in Infants for Surgical Repair of Coarctation of The Aorta Without Cardiopulmonary Bypass. Braz J Cardiovasc Surg 2024; 39:e20220424. [PMID: 38629954 PMCID: PMC11020275 DOI: 10.21470/1678-9741-2022-0424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 09/08/2023] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE To investigate the effect of improving the operative field and postoperative atelectasis of single-lung ventilation (SLV) in the surgical repair of coarctation of the aorta (CoA) in infants without the use of cardiopulmonary bypass (CPB). METHODS This was a retrospective cohort study. The clinical data of 28 infants (aged 1 to 4 months, weighing between 4.2 and 6 kg) who underwent surgical repair of CoA without CPB from January 2019 to May 2022 were analyzed. Fourteen infants received SLV with a bronchial blocker (Group S), and the other 14 infants received routine endotracheal intubation and bilateral lung ventilation (Group R). RESULTS In comparison to Group R, Group S exhibited improved exposure of the operative field, a lower postoperative atelectasis score (P<0.001), reduced prevalence of hypoxemia (P=0.01), and shorter durations of operation, mechanical ventilation, and ICU stay (P=0.01, P<0.001, P=0.03). There was no difference in preoperative information or perioperative respiratory and circulatory indicators before SLV, 10 minutes after SLV, and 10 minutes after the end of SLV between the two groups (P>0.05). Intraoperative bleeding, intraoperative positive end-expiratory pressure (PEEP), and systolic pressure gradient across the coarctation after operation were also not different between the two groups (P>0.05). CONCLUSION This study demonstrates that employing SLV with a bronchial blocker is consistent with enhanced operative field, reduced operation duration, lower prevalence of intraoperative hypoxemia, and fewer postoperative complications during the surgical repair of CoA in infants without the use of CPB.
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Affiliation(s)
- Ling-Shan Yu
- Department of Cardiac Surgery, Fujian Children’s Hospital (Fujian
Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for
Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Si-Jia Zhou
- Department of Cardiac Surgery, Fujian Children’s Hospital (Fujian
Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for
Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiu-Hua Chen
- Department of Cardiac Surgery, Fujian Children’s Hospital (Fujian
Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for
Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Jing Wang
- Department of Cardiac Surgery, Fujian Children’s Hospital (Fujian
Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for
Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Zeng-Chun Wang
- Department of Cardiac Surgery, Fujian Children’s Hospital (Fujian
Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for
Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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Lilaj K, Shpata V, Bollano E, Kuçi S. Positive end-expiratory pressure and the incidence of postoperative pulmonary complications in patients undergoing general anaesthesia. J Perioper Pract 2024:17504589241234191. [PMID: 38595040 DOI: 10.1177/17504589241234191] [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: 04/11/2024]
Abstract
AIM OF THE STUDY To evaluate the effect of intraoperative positive end-expiratory pressure and driving pressure on the development of postoperative pulmonary complications. METHOD The prospective study included 83 patients undergoing abdominal surgery and receiving general anaesthesia. Patients were divided into two groups: with low intraoperative positive end-expiratory pressure (0-2cm H2O) and with high intraoperative positive end-expiratory pressure (8-10cm H2O). The primary endpoint is the development of postoperative pulmonary complications during follow-up. RESULTS The incidence of postoperative pulmonary complications in the group of low intraoperative positive end-expiratory pressure was 9.8%, while in the group of high positive end-expiratory pressure was 7.1% (p = 0.6), demonstrating that high positive end-expiratory pressure used during general anaesthesia does not affect the frequency of complications (odds ratio = 0.71, p = 0.6). In the multivariate analysis that controls for all confounders, driving pressure resulted in a significant and independent risk factor for complications. CONCLUSION High intraoperative positive end-expiratory pressure does not affect the frequency of postoperative pulmonary complications. The increase in driving pressure is a risk factor for complications. Positive end-expiratory pressure is easily implemented, and its use does not result in significant economic costs.
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Affiliation(s)
- Krenar Lilaj
- General Surgery Department, University Hospital Center 'Mother Teresa', Tirana, Albania
| | - Vjollca Shpata
- Faculty of Rehabilitation Sciences, University of Sports of Tirana, Albania
| | - Enton Bollano
- General Surgery Department, University Hospital Center 'Mother Teresa', Tirana, Albania
| | - Saimir Kuçi
- General Surgery Department, University Hospital Center 'Mother Teresa', Tirana, Albania
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Salloum E, Lotte Seibold E, Azimaraghi O, Rudolph MI, Beier J, Schaefer MS, Sauer WJ, Tam C, Fassbender P, Kiyatkin M, Eikermann M, Wongtangman K. Association of ketamine use during procedural sedation with oxygen desaturation and healthcare utilisation: a multicentre retrospective hospital registry study. Br J Anaesth 2024; 132:779-788. [PMID: 38087741 DOI: 10.1016/j.bja.2023.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND We investigated the effects of ketamine on desaturation and the risk of nursing home discharge in patients undergoing procedural sedation by anaesthetists. METHODS We included adult patients who underwent procedures under monitored anaesthetic care between 2005 and 2021 at two academic healthcare networks in the USA. The primary outcome was intraprocedural oxygen desaturation, defined as oxygen saturation <90% for ≥2 consecutive minutes. The co-primary outcome was a nursing home discharge. RESULTS Among 234,170 included patients undergoing procedural sedation, intraprocedural desaturation occurred in 5.6% of patients who received ketamine vs 5.2% of patients who did not receive ketamine (adjusted odds ratio [ORadj] 1.22, 95% confidence interval [CI] 1.15-1.29, P<0.001; adjusted absolute risk difference [ARDadj] 1%, 95% CI 0.7-1.3%, P<0.001). The effect was magnified by age >65 yr, smoking, or preprocedural ICU admission (P-for-interaction <0.001, ORadj 1.35, 95% CI 1.25-1.45, P<0.001; ARDadj 2%, 95% CI 1.56-2.49%, P<0.001), procedural risk factors (upper endoscopy of longer than 2 h; P-for-interaction <0.001, ORadj 2.91, 95% CI 1.85-4.58, P<0.001; ARDadj 16.2%, 95% CI 9.8-22.5%, P<0.001), and high ketamine dose (P-for-trend <0.001, ORadj 1.61, 95% CI, 1.43-1.81 for ketamine >0.5 mg kg-1). Concomitant opioid administration mitigated the risk (P-for-interaction <0.001). Ketamine was associated with higher odds of nursing home discharge (ORadj 1.11, 95% CI 1.02-1.21, P=0.012; ARDadj 0.25%, 95% CI 0.05-0.46%, P=0.014). CONCLUSIONS Ketamine use for procedural sedation was associated with an increased risk of oxygen desaturation and discharge to a nursing home. The effect was dose-dependent and magnified in subgroups of vulnerable patients.
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Affiliation(s)
- Elie Salloum
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Eva Lotte Seibold
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Omid Azimaraghi
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Maíra I Rudolph
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Department for Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Juliane Beier
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Maximilian S Schaefer
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany
| | - William J Sauer
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Christopher Tam
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Philipp Fassbender
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Klinik für Anästhesiologie, Operative Intensivmedizin, Schmerz- und Palliativmedizin, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Herne, Germany
| | - Michael Kiyatkin
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Matthias Eikermann
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Klinik für Anä¨sthesiologie and Intensivmedizin, Universität Duisburg-Essen, Essen, Germany.
| | - Karuna Wongtangman
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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44
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Bignami E, Andrei G. Pro: Mechanical Ventilation During Cardiopulmonary Bypass in Adult Cardiac Surgery. J Cardiothorac Vasc Anesth 2024; 38:1041-1044. [PMID: 38290867 DOI: 10.1053/j.jvca.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 12/27/2023] [Accepted: 01/05/2024] [Indexed: 02/01/2024]
Affiliation(s)
- Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Giulia Andrei
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
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45
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Ernest EE, Bhattacharjee S, Baidya DK, Anand RK, Ray BR, Bansal VK, Subramaniam R, Maitra S. Effect of incremental PEEP titration on postoperative pulmonary complications in patients undergoing emergency laparotomy: a randomized controlled trial. J Clin Monit Comput 2024; 38:445-454. [PMID: 37968546 DOI: 10.1007/s10877-023-01091-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 10/08/2023] [Indexed: 11/17/2023]
Abstract
Postoperative pulmonary complications (PPC) has a significant negative impact and are associated with increased length of hospital stay and cost of care. Emergency surgery is a well-established risk factor for PPC. Previous studies reported that personalized positive end-expiratory pressure (PEEP) might reduce postoperative atelectasis and postoperative pulmonary complications. N = 168 adult patients undergoing major emergency laparotomy under general anesthesia were recruited in this study. A minimum driving pressure based incremental PEEP titration was compared to a fixed PEEP of 5 cmH2O. The primary outcome was PPC up to postoperative day 7. The mean (standard deviation) of the recruited patients was 41.7(16.1)y, and 48.8% (82 of 168 patients) were female. The risk of PPC at postoperative day 7 was similar in both the study groups [Relative risk (RR) (95% Confidence interval, CI) 0.81 (0.58, 1.13); p = 0.25]. In addition, the incidence of intraoperative hypotension [p = 0.75], oxygen-free days at day 28 [p = 0.27], duration of postoperative hospital stay [p = 0.50], length of postoperative intensive care unit stay [p = 0.28], and in-hospital mortality [p = 0.38] were similar in two groups. Incidence of PPC was not reduced with the use of an individualized PEEP strategy based on lowest driving pressure. However, the incidence of hypotension and bradycardia was also not increased with titrated PEEP.Trial Registration: www.ctri.nic.in ; CTRI/2020/12/029765.
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Affiliation(s)
- Emmanuel Easterson Ernest
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, Room No: 5013, Teaching Block, Ansari Nagar, New Delhi, 110019, India
| | - Sulagna Bhattacharjee
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, Room No: 5013, Teaching Block, Ansari Nagar, New Delhi, 110019, India
| | - Dalim K Baidya
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, Room No: 5013, Teaching Block, Ansari Nagar, New Delhi, 110019, India
| | - Rahul K Anand
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, Room No: 5013, Teaching Block, Ansari Nagar, New Delhi, 110019, India
| | - Bikash R Ray
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, Room No: 5013, Teaching Block, Ansari Nagar, New Delhi, 110019, India
| | - Virinder K Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeshwari Subramaniam
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, Room No: 5013, Teaching Block, Ansari Nagar, New Delhi, 110019, India
| | - Souvik Maitra
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, Room No: 5013, Teaching Block, Ansari Nagar, New Delhi, 110019, India.
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46
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Zhou CM, Xue Q, Li H, Yang JJ, Zhu Y. A predictive model for post-thoracoscopic surgery pulmonary complications based on the PBNN algorithm. Sci Rep 2024; 14:7035. [PMID: 38528066 DOI: 10.1038/s41598-024-57700-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 03/20/2024] [Indexed: 03/27/2024] Open
Abstract
We constructed an early prediction model for postoperative pulmonary complications after thoracoscopic surgery using machine learning and deep learning algorithms. The artificial intelligence prediction models were built in Python, primarily using artificial intelligencealgorithms including both machine learning and deep learning algorithms. Correlation analysis showed that postoperative pulmonary complications were positively correlated with age and surgery duration, and negatively correlated with serum albumin. Using the light gradient boosting machine(LGBM) algorithm, weighted feature engineering revealed that single lung ventilation duration, history of smoking, surgery duration, ASA score, and blood glucose were the main factors associated with postoperative pulmonary complications. Results of artificial intelligence algorithms for predicting pulmonary complications after thoracoscopy in the test group: In terms of accuracy, the two best algorithms were Logistic Regression (0.831) and light gradient boosting machine(0.827); in terms of precision, the two best algorithms were Gradient Boosting (0.75) and light gradient boosting machine (0.742); in terms of recall, the three best algorithms were gaussian naive bayes (0.581), Logistic Regression (0.532), and pruning Bayesian neural network (0.516); in terms of F1 score, the two best algorithms were LogisticRegression (0.589) and pruning Bayesian neural network (0.566); and in terms of Area Under Curve(AUC), the two best algorithms were light gradient boosting machine(0.873) and pruning Bayesian neural network (0.869). The results of this study suggest that pruning Bayesian neural network (PBNN) can be used to assess the possibility of pulmonary complications after thoracoscopy, and to identify high-risk groups prior to surgery.
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Affiliation(s)
- Cheng-Mao Zhou
- Big Data and Artificial Intelligence Research Group, Department of Anaesthesiology, Central People's Hospital of Zhanjiang, Zhanjiang, Guangdong, China.
- Big Data and Artificial Intelligence Research Group, Department of Anesthesiology, Pain and Perioperative Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
| | - Qiong Xue
- Big Data and Artificial Intelligence Research Group, Department of Anesthesiology, Pain and Perioperative Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - HuiJuan Li
- Big Data and Artificial Intelligence Research Group, Department of Anesthesiology, Pain and Perioperative Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jian-Jun Yang
- Big Data and Artificial Intelligence Research Group, Department of Anesthesiology, Pain and Perioperative Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
| | - Yu Zhu
- Big Data and Artificial Intelligence Research Group, Department of Anaesthesiology, Central People's Hospital of Zhanjiang, Zhanjiang, Guangdong, China.
- Big Data and Artificial Intelligence Research Group, Department of Anesthesiology, Pain and Perioperative Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
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47
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Garg S, Govindaraj V, Dwivedi DP, Raja K, Theerthar EP. Postoperative pulmonary complications in patients undergoing upper abdominal surgery: risk factors and predictive models. Monaldi Arch Chest Dis 2024. [PMID: 38526466 DOI: 10.4081/monaldi.2024.2915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/13/2024] [Indexed: 03/26/2024] Open
Abstract
Postoperative pulmonary complications (PPCs) are unexpected disorders that occur up to 30 days after surgery, affecting the patient's clinical status and requiring therapeutic intervention. Therefore, it becomes important to assess the patient preoperatively, as many of these complications can be minimized with proper perioperative strategies following a thorough preoperative checkup. Herein, we describe the PPCs and risk factors associated with developing PPCs in patients undergoing upper abdominal surgery. Additionally, we compared the accuracy of the American Society of Anaesthesiologists (ASA) score, the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score, the 6-Minute Walk Test (6MWT), and spirometry in predicting PPCs. Consenting patients (>18 years) undergoing elective upper abdominal surgery were recruited from November 2021 to April 2023. Clinical history was noted. Spirometry and 6MWT were both performed. Pre-operative ASA and ARISCAT scores were recorded. Postoperative follow-up was conducted to assess respiratory symptoms and the occurrence of PPC. PPC was defined as per EPCO guidelines. A total of 133 patients were recruited, predominantly male. A total of 27 (20.3%) patients developed PPCs. A total of 14 (10.5%) patients had more than one PPC. The most common PPCs developed were pleural effusion (11.3%), respiratory failure (7.5%), and pneumonia (4.5%). We obtained ten statistically significant associated variables on univariable analysis, viz obstructive airway disease (p=0.002), airflow limitation (p=0.043), chest radiography (p<0.001), albumin (p=0.30), blood urea nitrogen (BUN) (p=0.029), aspartate aminotransferase (p=0.019), alanine aminotransferase (p=0.009), forced expiratory volume in one second/forced vital capacity ratio (p=0.006), duration of surgery (p<0.001), and ASA score (p=0.012). On multivariable regression analysis, abnormal chest radiograph [odds ratio: 8.26; (95% confidence interval: 2.58-25.43), p<0.001], BUN [1.05; (1.00-1.09), p=0.033], and duration of surgery [1.44; (1.18-1.76), p<0.001] were found to be independently associated with PPC. The ASA score was found to have better predictive power for the development of PPCs compared to the ARISCAT score but is of poor clinical significance. Additionally, 6MWD and spirometry results were found to lack any meaningful predictive power for PPC. To conclude, preoperative evaluation of the chest radiograph, BUN, and duration of surgery are independently associated with developing PPCs. The ASA score performs better than the ARISCAT score in identifying patients at a higher risk of developing PPCs and implementing preventive measures.
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Affiliation(s)
- Shivam Garg
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry.
| | - Vishnukanth Govindaraj
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry.
| | - Dharm Prakash Dwivedi
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry.
| | - Kalayarasan Raja
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry.
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Ranjeva S, Nagebretsky A, Odozynski G, Fernandez-Bustamante A, Frendl G, Gupta RA, Sprung J, Subramaniam B, Ruiz RM, Bartels K, Giquel J, Lee JW, Houle T, Melo MFV. Effects of Intra-operative Cardiopulmonary Variability On Post-operative Pulmonary Complications in Major Non-cardiac Surgery: A Retrospective Cohort Study. J Med Syst 2024; 48:31. [PMID: 38488884 DOI: 10.1007/s10916-024-02050-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/27/2024] [Indexed: 03/17/2024]
Abstract
Intraoperative cardiopulmonary variables are well-known predictors of postoperative pulmonary complications (PPC), traditionally quantified by median values over the duration of surgery. However, it is unknown whether cardiopulmonary instability, or wider intra-operative variability of the same metrics, is distinctly associated with PPC risk and severity. We leveraged a retrospective cohort of adults (n = 1202) undergoing major non-cardiothoracic surgery. We used multivariable logistic regression to evaluate the association of two outcomes (1)moderate-or-severe PPC and (2)any PPC with two sets of exposure variables- (a)variability of cardiopulmonary metrics (inter-quartile range, IQR) and (b)median intraoperative cardiopulmonary metrics. We compared predictive ability (receiver operating curve analysis, ROC) and parsimony (information criteria) of three models evaluating different aspects of the intra-operative cardiopulmonary metrics: Median-based: Median cardiopulmonary metrics alone, Variability-based: IQR of cardiopulmonary metrics alone, and Combined: Medians and IQR. Models controlled for peri-operative/surgical factors, demographics, and comorbidities. PPC occurred in 400(33%) of patients, and 91(8%) experienced moderate-or-severe PPC. Variability in multiple intra-operative cardiopulmonary metrics was independently associated with risk of moderate-or-severe, but not any, PPC. For moderate-or-severe PPC, the best-fit predictive model was the Variability-based model by both information criteria and ROC analysis (area under the curve, AUCVariability-based = 0.74 vs AUCMedian-based = 0.65, p = 0.0015; AUCVariability-based = 0.74 vs AUCCombined = 0.68, p = 0.012). For any PPC, the Median-based model yielded the best fit by information criteria. Predictive accuracy was marginally but not significantly higher for the Combined model (AUCCombined = 0.661) than for the Median-based (AUCMedian-based = 0.657, p = 0.60) or Variability-based (AUCVariability-based = 0.649, p = 0.29) models. Variability of cardiopulmonary metrics, distinct from median intra-operative values, is an important predictor of moderate-or-severe PPC.
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Affiliation(s)
- Sylvia Ranjeva
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, USA.
| | - Alexander Nagebretsky
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, USA
| | | | | | - Gyorgy Frendl
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - R Alok Gupta
- Department of Anesthesiology, Northwestern Medicine, Chicago, USA
| | - Juraj Sprung
- Department of Anesthesiology, Mayo Clinic, Rochester, USA
| | - Bala Subramaniam
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Boston, USA
| | | | - Karsten Bartels
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, USA
| | - Jadelis Giquel
- Department of Anesthesiology, University of Miami Hospital and Clinics, Miami, USA
| | - Jae-Woo Lee
- Department of Anesthesiology, University of California San Francisco, San Francisco, USA
| | - Timothy Houle
- Department of Anesthesiology, Anesthesia Research Center, Massachusetts General Hospital, Boston, USA
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49
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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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50
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Mato-Búa R, Prado-Rodríguez A, López-López D, Rama-Maceiras P, Molins-Gauna N, Álvarez-Refojo F. Intraoperative effects of an alveolar recruitment manoeuvre in patients undergoing laparoscopic colon surgery. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:151-159. [PMID: 38452926 DOI: 10.1016/j.redare.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Pulmonary atelectasis is common in patients undergoing laparoscopic abdominal surgery under general anaesthesia, which increases the risk of perioperative respiratory complications. Alveolar recruitment manoeuvres (ARM) are used to open up the lung parenchyma with atelectasis, although the duration of their benefit has not been clearly established. The aim of this study was to determine the effectiveness of an ARM in laparoscopic colon surgery, the duration of response over time, and its haemodynamic impact. METHODS Twenty-five patients undergoing laparoscopic colon surgery were included. After anaesthetic induction and initiation of surgery with pneumoperitoneum, an ARM was performed, and then optimal PEEP determined. Respiratory mechanics and gas exchange variables, and haemodynamic parameters, were analysed before the manoeuvre and periodically over the following 90 min. RESULTS Three patients were excluded for surgical reasons. The alveolar arterial oxygen gradient went from 94.3 (62.3-117.8) mmHg before to 60.7 (29.6-91.0) mmHg after the manoeuvre (P < .05). This difference was maintained during the 90 min of the study. Dynamic compliance of the respiratory system went from 31.3 ml/cmH2O (26.1-39.2) before the manoeuvre to 46.1 ml/cmH2O (37.5-53.5) after the manoeuvre (P < .05). This difference was maintained for 60 min. No significant changes were identified in any of the haemodynamic variables studied. CONCLUSION In patients undergoing laparoscopic colon surgery, performing an intraoperative ARM improves the mechanics of the respiratory system and oxygenation, without associated haemodynamic compromise. The benefit of these manoeuvres lasts for at least one hour.
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Affiliation(s)
- R Mato-Búa
- Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain.
| | - A Prado-Rodríguez
- Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
| | - D López-López
- Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
| | - P Rama-Maceiras
- Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
| | - N Molins-Gauna
- Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
| | - F Álvarez-Refojo
- Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
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