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Czobor NR, Lehot JJ, Holndonner-Kirst E, Tully PJ, Gal J, Szekely A. Frailty In Patients Undergoing Vascular Surgery: A Narrative Review Of Current Evidence. Ther Clin Risk Manag 2019; 15:1217-1232. [PMID: 31802876 PMCID: PMC6802734 DOI: 10.2147/tcrm.s217717] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/01/2019] [Indexed: 12/13/2022] Open
Abstract
Frailty is presumably associated with an elevated risk of postoperative mortality and adverse outcome in vascular surgery patients. The aim of our review was to identify possible methods for risk assessment and prehabilitation in order to improve recovery and postoperative outcome. The literature search was performed via PubMed, Embase, OvidSP, and the Cochrane Library. We collected papers published in peer-reviewed journals between 2001 and 2018. The selection criterion was the relationship between vascular surgery, frailty and postoperative outcome or mortality. A total number of 52 publications were included. Frailty increases the risk of non-home discharge independently of presence or absence of postoperative complications and it is related to a higher 30-day mortality and major morbidity. The modified Frailty Index showed significant association with elevated risk for post-interventional stroke, myocardial infarction, prolonged in-hospital stays and higher readmission rates. When adjusted for comorbidity and surgery type, frailty seems to impact medium-term survival (within 2 years). Preoperative physical exercising, avoidance of hypalbuminemia, psychological and cognitive training, maintenance of muscle strength, adequate perioperative nutrition, and management of smoking behaviours are leading to a reduced length of stay and a decreased incidence of readmission rate, thus improving the effectiveness of early rehabilitation. Pre-frailty is a dynamically changing state of the patient, capable of deteriorating or improving over time. With goal-directed preoperative interventions, the decline can be prevented.
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Affiliation(s)
- Nikoletta Rahel Czobor
- Medical Centre of Hungarian Defense Forces, Department of Anesthesiology and Intensive Care, Budapest, Hungary.,Semmelweis University, School of Doctoral Studies, Budapest, Hungary
| | - Jean-Jacques Lehot
- Claude-Bernard University, Health Services and Performance Research Lab (EA 7425 HESPER), Lyon, France.,Hôpital Neurologique Pierre Wertheimer, Department of Neuroanesthesia and Intensive Care, Hospices Civils de Lyon, Lyon, France
| | - Eniko Holndonner-Kirst
- Medical Centre of Hungarian Defense Forces, Department of Anesthesiology and Intensive Care, Budapest, Hungary
| | - Phillip J Tully
- University of Adelaide, Freemasons Foundation Centre for Men's Health, Adelaide, Australia
| | - Janos Gal
- Semmelweis University, Department of Anesthesiology and Intensive Care, Budapest, Hungary
| | - Andrea Szekely
- Semmelweis University, Department of Anesthesiology and Intensive Care, Budapest, Hungary.,Semmelweis University, Heart and Vascular Center of Városmajor, Budapest, Hungary
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Stojanovic MD, Markovic DZ, Vukovic AZ, Dinic VD, Nikolic AN, Maricic TG, Janković RJ. Enhanced Recovery after Vascular Surgery. Front Med (Lausanne) 2018; 5:2. [PMID: 29404329 PMCID: PMC5785721 DOI: 10.3389/fmed.2018.00002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 01/03/2018] [Indexed: 12/22/2022] Open
Abstract
The beginnings of the enhanced recovery after surgery (ERAS) program were first developed for patients in colorectal surgery, and after it was established as the standard of care in this surgical field, it began to be applied in many others surgical areas. This is multimodal, evidence-based approach program and includes simultaneous optimization of preoperative status of patients, adequate selection of surgical procedure and postoperative management. The aim of this program is to reduce complications, the length of hospital stay and to improve the patients outcome. Over the past decades, special attention was directed to the postoperative management in vascular surgery, especially after major vascular surgery because of the great risk of multiorgan failure, such as: respiratory failure, myocardial infarction, hemodynamic instability, coagulopathy, renal failure, neurological disorders, and intra-abdominal complications. Although a lot of effort was put into it, there is no unique acceptable program for ERAS in this surgical field, and there is still a need to point out the factors responsible for postoperative outcomes of these patients. So far, it is known that special attention should be paid to already existing diseases, type and the duration of the surgical intervention, hemodynamic and fluid management, nutrition, pain management, and early mobilization of patients.
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Affiliation(s)
- Milena D Stojanovic
- Center for Anesthesiology, Reanimatology and Intensive Care, Clinical Center Nis, Nis, Serbia
| | - Danica Z Markovic
- Center for Anesthesiology, Reanimatology and Intensive Care, Clinical Center Nis, Nis, Serbia
| | - Anita Z Vukovic
- Center for Anesthesiology, Reanimatology and Intensive Care, Clinical Center Nis, Nis, Serbia
| | - Vesna D Dinic
- Center for Anesthesiology, Reanimatology and Intensive Care, Clinical Center Nis, Nis, Serbia
| | - Aleksandar N Nikolic
- Center for Anesthesiology, Reanimatology and Intensive Care, Clinical Center Nis, Nis, Serbia
| | - Tijana G Maricic
- Center for Anesthesiology, Reanimatology and Intensive Care, Clinical Center Nis, Nis, Serbia
| | - Radmilo J Janković
- Center for Anesthesiology, Reanimatology and Intensive Care, Clinical Center Nis, Nis, Serbia.,School of Medicine, University of Nis, Nis, Serbia
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Reintam Blaser A, Starkopf J, Alhazzani W, Berger MM, Casaer MP, Deane AM, Fruhwald S, Hiesmayr M, Ichai C, Jakob SM, Loudet CI, Malbrain MLNG, Montejo González JC, Paugam-Burtz C, Poeze M, Preiser JC, Singer P, van Zanten ARH, De Waele J, Wendon J, Wernerman J, Whitehouse T, Wilmer A, Oudemans-van Straaten HM. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med 2017; 43:380-398. [PMID: 28168570 PMCID: PMC5323492 DOI: 10.1007/s00134-016-4665-0] [Citation(s) in RCA: 414] [Impact Index Per Article: 59.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 12/27/2016] [Indexed: 12/11/2022]
Abstract
Purpose To provide evidence-based guidelines for early enteral nutrition (EEN) during critical illness. Methods We aimed to compare EEN vs. early parenteral nutrition (PN) and vs. delayed EN. We defined “early” EN as EN started within 48 h independent of type or amount. We listed, a priori, conditions in which EN is often delayed, and performed systematic reviews in 24 such subtopics. If sufficient evidence was available, we performed meta-analyses; if not, we qualitatively summarized the evidence and based our recommendations on expert opinion. We used the GRADE approach for guideline development. The final recommendations were compiled via Delphi rounds. Results We formulated 17 recommendations favouring initiation of EEN and seven recommendations favouring delaying EN. We performed five meta-analyses: in unselected critically ill patients, and specifically in traumatic brain injury, severe acute pancreatitis, gastrointestinal (GI) surgery and abdominal trauma. EEN reduced infectious complications in unselected critically ill patients, in patients with severe acute pancreatitis, and after GI surgery. We did not detect any evidence of superiority for early PN or delayed EN over EEN. All recommendations are weak because of the low quality of evidence, with several based only on expert opinion. Conclusions We suggest using EEN in the majority of critically ill under certain precautions. In the absence of evidence, we suggest delaying EN in critically ill patients with uncontrolled shock, uncontrolled hypoxaemia and acidosis, uncontrolled upper GI bleeding, gastric aspirate >500 ml/6 h, bowel ischaemia, bowel obstruction, abdominal compartment syndrome, and high-output fistula without distal feeding access. Electronic supplementary material The online version of this article (doi:10.1007/s00134-016-4665-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annika Reintam Blaser
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia.
- Center of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland.
| | - Joel Starkopf
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia
- Department of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia
| | - Waleed Alhazzani
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Mette M Berger
- Services of Adult Intensive Care Medicine and Burns, Lausanne University Hospital, Lausanne, Switzerland
| | - Michael P Casaer
- Department of Intensive Care Medicine, University Hospital Leuven, Louvain, Belgium
| | - Adam M Deane
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
| | - Sonja Fruhwald
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Michael Hiesmayr
- Klinische Abteilung für Herz-Thorax-Gefäßchirurgische Anästhesie & Intensivmedizin, Medizinische Universität Wien, Vienna, Austria
| | - Carole Ichai
- Intensive Care Unit, Hôpital Pasteur 2, University of Nice, Nice, France
| | - Stephan M Jakob
- Department of Intensive Care Medicine, University Hospital, University of Bern, Bern, Switzerland
| | - Cecilia I Loudet
- Intensive Care Unit, Hospital Interzonal General de Agudos General San Martín de La Plata, Buenos Aires, Argentina
| | - Manu L N G Malbrain
- Intensive Care Unit, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg, Antwerp, Belgium
| | | | - Catherine Paugam-Burtz
- Anesthesiology and Perioperative Care Medicine Department, Hôpital Beaujon APHP, Clichy, France
| | - Martijn Poeze
- Department of Surgery/IntensiveCare Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jean-Charles Preiser
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Singer
- Intensive Care Department, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
- Anesthesia and Intensive Care Division, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arthur R H van Zanten
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Jan De Waele
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Julia Wendon
- Department of Intensive Care Medicine, Division of Immunobiology and Transplantation, King's College London, King's College Hospital, London, UK
| | - Jan Wernerman
- Department of Anaesthesiology and Intensive Care Medicine, Karolinska University Hospital Huddinge and Karolinska Institutet, Stockholm, Sweden
| | - Tony Whitehouse
- Department of Critical Care and Anaesthesia, Queen Elizabeth Hospital, Birmingham, UK
| | - Alexander Wilmer
- Medical Intensive Care Unit, University Hospital Leuven, Leuven, Belgium
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