PROtective Ventilation with a low versus high Inspiratory Oxygen fraction (PROVIO) and its effects on postoperative pulmonary complications: protocol for a randomized controlled trial

The Effect of Anaesthesia Management with Different Fresh Gas Flows on Cognitive Functions of Geriatric Patients: A Randomized Double-blind Study

Objective

The present study aimed to compare the effects of two different fresh gas flows (FGFs) (0.5 L min^-1 and 2 L min^-1) applied during maintenance of anaesthesia on recovery from anaesthesia and early cognitive functions in geriatric patients.

Methods

In this prospective, randomised, double-blind study, sixty patients were divided into two groups according to the amount of FGF. Minimal-flow anaesthesia (0.5 L min^-1 FGF) was applied to group I and medium-flow anaesthesia (2 L min^-1 FGF) was applied to group II during maintenance of anaesthesia. Following the termination of inhalation anaesthesia, recovery times were recorded. The evaluation of cognitive functions was performed using the Addenbrooke's Cognitive Examination (ACE-R).

Results

There was no significant difference between the two groups in terms of demographic characteristics and recovery (P > 0.05). There was no significant difference between the two groups in terms of the preoperative day, the first postoperative day, and the third postoperative day; ACE-R scores (P > 0.05). In group II, on the third postoperative day ACE-R scores were found to be significantly lower than the preoperative ACE-R scores (P=0.04). In group II, third postoperative day ACE-R memory sub-scores (14.53 ± 3.34) were found to be significantly lower than preoperative ACE-R memory sub-scores (15.03 ± 3.57) (P=0.04).

Conclusion

In geriatric patients, minimal-flow anaesthesia was not superior to medium-flow anaesthesia in terms of recovery properties and cognitive functions. Keeping in mind that hypoxaemia and changes in anaesthesia levels may occur with the reduction of FGF, both minimal- and medium-flow anaesthesia can be applied with appropriate monitoring without adverse effects on recovery and cognitive functions.

Development and Validation of a Nomogram for Predicting Postoperative Pulmonary Infection in Patients Undergoing Lung Surgery

OBJECTIVES

To develop and validate a nomogram for predicting postoperative pulmonary infection (PPI) in patients undergoing lung surgery.

DESIGN

Single-center retrospective cohort analysis.

SETTING

A university-affiliated cancer hospital PARTICIPANTS: A total of 1,501 adult patients who underwent lung surgery from January 2018 to December 2020.

INTERVENTIONS

Observation for PPI within 7 days after lung surgery.

MEASUREMENTS AND MAIN RESULTS

A complete set of demographics, preoperative variables, and postoperative follow-up data was recorded. The primary outcome was PPI; a total of 125 (8.3%) out of 1,501 patients developed PPI. The variables with p < 0.1 in univariate logistic regression were included in the multivariate regression, and multivariate logistic regression analysis showed that surgical procedure, surgical duration, the inspired fraction of oxygen in one-lung ventilation, and postoperative pain were independent risk factors for PPI. A nomogram based on these factors was constructed in the development cohort (area under the curve: 0.794, 95% CI 0.744-0.845) and validated in the validation cohort (area under the curve: 0.849, 95% CI 0.786-0.912). The calibration slope was 1 in the development and validation cohorts. Decision curve analysis indicated that when the threshold probability was within a range of 0.02-to-0.58 and 0.02-to-0.42 for the development and validation cohorts, respectively, the nomogram model could provide a clinical net benefit.

CONCLUSIONS

The authors developed and validated a nomogram for predicting PPI in patients undergoing lung surgery. The prediction model can predict the development of PPI and identify high-risk groups.

Effects of lung-protective ventilation strategy on lung aeration loss and postoperative pulmonary complications in moderate-risk patients undergoing abdominal surgery

BACKGROUND

There is a controversy about whether the use of a lung-protective ventilation strategy(LPVS) can reduce the incidence of postoperative pulmonary complications (PPCs) and improve the clinical outcomes in moderate-risk patients were assessed by the Assess Respiratory Risk in Surgical Patients in Catalonia(ARISCAT).

METHODS

One hundred moderate-risk patients predicted by the ARISCAT, scheduled to undergo abdominal surgery were randomized into two groups: conventional ventilation strategy group (G<inf>0</inf>) and lung-protective ventilation strategy group (G<inf>1</inf>). Lung ultrasonography (LUS) and the LUS score were performed before induction of anesthesia (T<inf>0</inf>), 30min after extubation (T<inf>1</inf>), and 24h (T<inf>2</inf>), 72h (T<inf>3</inf>) after surgery. The incidence and severity of PPCs within the postoperative 7 days, the duration of postoperative oxygen supplementation, and postoperative hospital stay (PHS) were recorded.

RESULTS

The LUS score of both groups at T<inf>1-3</inf> was higher than those at T<inf>0</inf> (P<0.05), moreover, the LUS score of G<inf>1</inf> was lower than that of G<inf>0</inf> at T<inf>1-3</inf>. The incidence of PPCs of G<inf>1</inf> (10.9%) was lower than that of G<inf>0</inf> (29.8%) (relative risk, 0.37; 95% confidence interval [CI], 0.14 to 0.93; P=0.02) and the severity of PPCs of G<inf>1</inf> were lower than those of G<inf>0</inf> (P<0.05). The PHS of G<inf>1</inf> was less than that of G<inf>0</inf> (8[7-10] vs. 9[8-11], P<0.05).

CONCLUSIONS

The LPVS can decrease lung aeration loss assessed by LUS and reduce the incidence of PPCs in moderate-risk patients.