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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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Carr ZJ, Siller S, McDowell BJ. Perioperative Pulmonary Complications in the Elderly: The Forgotten System. Anesthesiol Clin 2023; 41:531-548. [PMID: 37516493 DOI: 10.1016/j.anclin.2023.02.005] [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: 07/31/2023]
Abstract
With a rapidly aging population and increasing global surgical volumes, managing the elevated risk of perioperative pulmonary complications has become an expanding focus for quality improvement in health care. In this narrative review, we will analyze the evidence-based literature to provide high-quality and actionable management strategies to better detect, stratify risk, optimize, and manage perioperative pulmonary complications in geriatric populations.
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Affiliation(s)
- Zyad J Carr
- Department of Anesthesiology, Yale University School of Medicine, TMP-3, 333 Cedar Street, New Haven, CT 06520, USA.
| | - Saul Siller
- Department of Anesthesiology, Yale University School of Medicine, TMP-3, 333 Cedar Street, New Haven, CT 06520, USA
| | - Brittany J McDowell
- Department of Anesthesiology, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT 84107, USA
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Di Bella C, Araos J, Lacitignola L, Grasso S, De Marzo L, Crovace AM, Staffieri F. Effects of continuous positive airway pressure administered by a helmet in cats under general anaesthesia. J Feline Med Surg 2021; 23:337-343. [PMID: 32840420 PMCID: PMC10812219 DOI: 10.1177/1098612x20951279] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the respiratory effects of non-invasive continuous positive airway pressure (CPAP) administered by a helmet in healthy cats under anaesthesia. METHODS Fifteen healthy male cats scheduled for castration were anaesthetised with medetomidine (20 µg/kg), ketamine (10 mg/kg) and buprenorphine (20 µg/kg) intramuscularly. When an adequate level of anaesthesia was achieved, a paediatric helmet was placed on all subjects. The helmet was connected to a Venturi valve supplied with medical air and cats received the following phases of treatments: 0 cmH2O (pre-CPAP), 5 cmH2O (CPAP) and 0 cmH2O (post-CPAP). Each treatment lasted 10 mins. At the end of each phase an arterial blood sample was drawn. The following data were also collected: mean arterial pressure, respiratory rate, heart rate and the anaesthesia level score (0 = awake, 10 = deep anaesthesia). The alveolar to arterial oxygen gradient (P[A-a]O2) and the venous admixture (Fshunt) were also estimated. Data were analysed with two-way ANOVA (P <0.05). RESULTS The arterial partial pressure of oxygen was higher (P <0.001) at CPAP (103.2 ± 5.1 mmHg) vs pre-CPAP (77.5 ± 7.4 mmHg) and post-CPAP (84.6 ± 8.1 mmHg). The P(A-a)O2 and the Fshunt were lower (P <0.001) at CPAP (4.4 ± 2.3 mmHg; 7.4 ± 3.1%) vs pre-CPAP (18.9 ± 6.4 mmHg; 22.8 ± 4.6%) and post-CPAP (15.6 ± 7.3 mmHg; 20.9 ± 4.6 %). No other parameters differed between groups. CONCLUSIONS AND RELEVANCE Non-invasive CPAP applied by a helmet improves oxygenation in cats under injectable general anaesthesia.
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Affiliation(s)
- Caterina Di Bella
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organs Transplantation, University of Bari ‘Aldo Moro’, Valenzano, Bari, Italy
| | - Joaquin Araos
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, USA
| | - Luca Lacitignola
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organs Transplantation, University of Bari ‘Aldo Moro’, Valenzano, Bari, Italy
| | - Salvatore Grasso
- Section of Anaesthesia and Intensive Care, Department of Emergency and Organs Transplantation, University of Bari ‘Aldo Moro’, Bari, Italy
| | - Linda De Marzo
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organs Transplantation, University of Bari ‘Aldo Moro’, Valenzano, Bari, Italy
| | - Alberto Maria Crovace
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organs Transplantation, University of Bari ‘Aldo Moro’, Valenzano, Bari, Italy
| | - Francesco Staffieri
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organs Transplantation, University of Bari ‘Aldo Moro’, Valenzano, Bari, Italy
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Brainard J, Scott BK, Sullivan BL, Fernandez-Bustamante A, Piccoli JR, Gebbink MG, Bartels K. Heated humidified high-flow nasal cannula oxygen after thoracic surgery - A randomized prospective clinical pilot trial. J Crit Care 2017; 40:225-228. [PMID: 28454060 DOI: 10.1016/j.jcrc.2017.04.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/11/2017] [Accepted: 04/14/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Thoracic surgery patients are at high-risk for adverse pulmonary outcomes. Heated humidified high-flow nasal cannula oxygen (HHFNC O2) may decrease such events. We hypothesized that patients randomized to prophylactic HHFNC O2 would develop fewer pulmonary complications compared to conventional O2 therapy. METHODS AND PATIENTS Fifty-one patients were randomized to HHFNC O2 vs. conventional O2. The primary outcome was a composite of postoperative pulmonary complications. Secondary outcomes included oxygenation and length of stay. Continuous variables were compared with t-test or Mann-Whitney-U test, categorical variables with Fisher's Exact test. RESULTS There were no differences in postoperative pulmonary complications based on intention to treat [two in HHFNC O2 (n=25), two in control (n=26), p=0.680], and after exclusion of patients who discontinued HHFNC O2 early [one in HHFNC O2 (n=18), two in control (n=26), p=0.638]. Discomfort from HHFNC O2 occurred in 11/25 (44%); 7/25 (28%) discontinued treatment. CONCLUSIONS Pulmonary complications were rare after thoracic surgery. Although HHFNC O2 did not convey significant benefits, these results need to be interpreted with caution, as our study was likely underpowered to detect a reduction in pulmonary complications. High rates of patient-reported discomfort with HHFNC O2 need to be considered in clinical practice and future trials.
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Affiliation(s)
- Jason Brainard
- Department of Anesthesiology, University of Colorado School of Medicine, 12401 E. 17th Avenue, Leprino Office Building, 7th Floor, MS B-113, Aurora, CO 80045, USA
| | - Benjamin K Scott
- Department of Anesthesiology, University of Colorado School of Medicine, 12401 E. 17th Avenue, Leprino Office Building, 7th Floor, MS B-113, Aurora, CO 80045, USA
| | - Breandan L Sullivan
- Department of Anesthesiology, University of Colorado School of Medicine, 12401 E. 17th Avenue, Leprino Office Building, 7th Floor, MS B-113, Aurora, CO 80045, USA
| | - Ana Fernandez-Bustamante
- Department of Anesthesiology, University of Colorado School of Medicine, 12401 E. 17th Avenue, Leprino Office Building, 7th Floor, MS B-113, Aurora, CO 80045, USA
| | - Jerome R Piccoli
- Department of Respiratory Care, University of Colorado Hospital, 12605 East 16th Avenue, MS F-764, Aurora, CO 80045, USA
| | - Morris G Gebbink
- Department of Respiratory Care, University of Colorado Hospital, 12605 East 16th Avenue, MS F-764, Aurora, CO 80045, USA
| | - Karsten Bartels
- Department of Anesthesiology, University of Colorado School of Medicine, 12401 E. 17th Avenue, Leprino Office Building, 7th Floor, MS B-113, Aurora, CO 80045, USA.
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[Non-invasive mechanical ventilation in postoperative patients. A clinical review]. ACTA ACUST UNITED AC 2015; 62:512-22. [PMID: 25892605 DOI: 10.1016/j.redar.2015.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/03/2015] [Accepted: 03/05/2015] [Indexed: 11/20/2022]
Abstract
Non-invasive ventilation (NIV) is a method of ventilatory support that is increasing in importance day by day in the management of postoperative respiratory failure. Its role in the prevention and treatment of atelectasis is particularly important in the in the period after thoracic and abdominal surgeries. Similarly, in the transplanted patient, NIV can shorten the time of invasive mechanical ventilation, reducing the risk of infectious complications in these high-risk patients. It has been performed A systematic review of the literature has been performed, including examining the technical, clinical experiences and recommendations concerning the application of NIV in the postoperative period.
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Preventive and therapeutic noninvasive ventilation in cardiovascular surgery. Curr Opin Anaesthesiol 2015; 28:67-72. [DOI: 10.1097/aco.0000000000000148] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Ball J, McAnulty G. Ignoring our evolution: the 'pandemic' of over-nutrition and under-activity. Not simply a metabolic syndrome? Anaesthesia 2014; 69:203-7. [PMID: 24548351 DOI: 10.1111/anae.12599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- J Ball
- Adult Critical Care Directorate, St George's Hospital, London, UK.
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