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Connolly JG, Fiasconaro M, Tan KS, Cirelli MA, Jones GD, Caso R, Mansour DE, Dycoco J, No JS, Molena D, Isbell JM, Park BJ, Bott MJ, Jones DR, Rocco G. Postinduction therapy pulmonary function retesting is necessary before surgical resection for non–small cell lung cancer. J Thorac Cardiovasc Surg 2021; 164:389-397.e7. [PMID: 35086669 PMCID: PMC9218003 DOI: 10.1016/j.jtcvs.2021.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/09/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Pretreatment-predicted postoperative diffusing capacity of the lung for carbon monoxide (DLCO) has been associated with operative mortality in patients who receive induction therapy for resectable non-small cell lung cancer (NSCLC). It is unknown whether a reduction in pulmonary function after induction therapy and before surgery affects the risk of morbidity or mortality. We sought to determine the relationship between induction therapy and perioperative outcomes as a function of postinduction pulmonary status in patients who underwent surgical resection for NSCLC. METHODS We retrospectively reviewed data for 1001 patients with pathologic stage I, II, or III NSCLC who received induction therapy before lung resection. Pulmonary function was defined according to American College of Surgeons Oncology Group major criteria: DLCO ≥50% = normal; DLCO <50% = impaired. Patients were categorized into 5 subgroups according to combined pre- and postinduction DLCO status: normal-normal, normal-impaired, impaired-normal, impaired-impaired, and preinduction only (without postinduction pulmonary function test measurements). Multivariable logistic regression was used to quantify the relationship between DLCO categories and dichotomous end points. RESULTS In multivariable analysis, normal-impaired DLCO status was associated with an increased risk of respiratory complications (odds ratio, 2.29 [95% CI, 1.12-4.49]; P = .02) and in-hospital complications (odds ratio, 2.83 [95% CI, 1.55-5.26]; P < .001). Type of neoadjuvant therapy was not associated with an increased risk of complications, compared with conventional chemotherapy. CONCLUSIONS Reduced postinduction DLCO might predict perioperative outcomes. The use of repeat pulmonary function testing might identify patients at higher risk of morbidity or mortality.
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Preoperative Thoracic CT Findings Associated With Postoperative Mechanical Ventilation in Patients Undergoing Major Abdominal or Pelvic Surgery: A Matched Case-Control Study. AJR Am J Roentgenol 2021; 218:279-288. [PMID: 34467781 DOI: 10.2214/ajr.21.26411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Postoperative prolonged mechanical ventilation is associated with increased morbidity and mortality. Reliable predictors of postoperative mechanical ventilation after abdominal or pelvic surgeries are lacking. Objective: To explore associations between preoperative thoracic CT findings and need for postoperative mechanical ventilation after major abdominal or pelvic surgeries. Methods: This retrospective case-control study included patients who underwent abdominal or pelvic surgeries (01/01/2014-12/31/2018) and underwent preoperative thoracic CT. Cases were patients who required postoperative mechanical ventilation. Control and case patients were matched at a 3:1 ratio based on age, sex, body mass index, chronic obstructive pulmonary disease, smoking status, and surgery type. Two radiologists (R1, R2) reviewed CT images. Findings were compared between groups. Results: The study included 165 patients (70 female, 95 male; mean age 67.0±9.7 years; 42 cases, 123 matched controls). Bronchial wall thickening and pericardial effusion were more frequent in cases than controls for R2 (10% vs 2%, p=.03; 17% vs 5%, p=.01), but not R1. Pulmonary artery diameter was greater in cases than controls for R2 (2.9±0.5 cm vs 2.8±0.5 cm, p=.045) but not R1. Right lung height was lower in cases than controls for R1 (18.4±2.9 cm vs 19.9±2.7 cm, p=.01) and R2 (18.3±2.9 cm vs 19.8±2.7 cm, p=.01). Left lung height was lower in cases than controls for R1 (19.5±3.1 cm vs 21.1±2.6 cm, p=.01) and R2 (19.6±2.4 cm vs 20.9±2.6 cm, p=.01). Anteroposterior chest diameter was greater for cases than controls for R1 (14.0±2.3 cm vs 12.9±3.7 cm, p=.02) and R2 (14.2±2.2 cm vs 13.2±3.6 cm, p=.04). In multivariable regression model using pooled reader data, bronchial wall thickening exhibited odds ratio (OR) of 4.6 (95% CI: 1.3, 16.5; p=.02); pericardial effusion, OR 5.1 (95% CI: 1.7, 15.5; p=.004); pulmonary artery diameter, OR 1.4 (95% CI: 0.7, 3.0; p=.32); mean lung height, OR 0.8 (95% CI: 0.7, 1.001; p=.05); anteroposterior chest diameter, OR 1.2 (95% CI: 1.013, 1.4; p=.03). Conclusion: CT features are associated with the need for postoperative mechanical ventilation following abdominal or pelvic surgery. Clinical Impact: Many patients undergo thoracic CT before abdominal or pelvic surgery; the CT findings may complement preoperative clinical risk factors.
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Shibazaki T, Mori S, Harada E, Shigemori R, Kato D, Matsudaira H, Hirano J, Ohtsuka T. Measured versus predicted postoperative pulmonary function at repeated times up to 1 year after lobectomy. Interact Cardiovasc Thorac Surg 2021; 33:727-733. [PMID: 34115872 DOI: 10.1093/icvts/ivab168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/10/2021] [Accepted: 05/05/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Postoperative pulmonary function is difficult to predict accurately, because it changes from the time of the operation and is also affected by various factors. The objective of this study was to assess the accuracy of predicted postoperative forced expiratory volume in 1 s (FEV1) at different postoperative times after lobectomy. METHODS This retrospective study enrolled 104 patients who underwent lobectomy by video-assisted thoracic surgery. Pulmonary function tests were performed preoperatively and postoperatively at 3, 6 and 12 months. We investigated time-dependent changes in FEV1. In addition, the ratio of measured to predicted postoperative FEV1 calculated by the subsegmental method was evaluated to identify the factors associated with variations in postoperative FEV1. RESULTS Compared with the predicted postoperative FEV1, the measured postoperative FEV1 was 8% higher at 3 months, 11% higher at 6 months and 13% higher at 12 months. The measured postoperative FEV1 significantly increased from 3 to 6 months (P = 0.002) and from 6 to 12 months (P = 0.015) after lobectomy resected lobe, smoking history and body mass index were significant factors associated with the ratio of measured to predicted postoperative FEV1 at 12 months (P < 0.001, P = 0.036 and P = 0.025, respectively). CONCLUSIONS Postoperative FEV1 increased up to 12 months after lobectomy by video-assisted thoracic surgery. The predicted postoperative pulmonary function was underestimated after 3 months, particularly after lower lobectomy.
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Affiliation(s)
- Takamasa Shibazaki
- Department of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Shohei Mori
- Department of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Eriko Harada
- Department of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Rintaro Shigemori
- Department of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Daiki Kato
- Department of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Hideki Matsudaira
- Department of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Jun Hirano
- Department of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Ohtsuka
- Department of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
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Hanaoka J, Yoden M, Hayashi K, Shiratori T, Okamoto K, Kaku R, Kawaguchi Y, Ohshio Y, Sonoda A. Dynamic perfusion digital radiography for predicting pulmonary function after lung cancer resection. World J Surg Oncol 2021; 19:43. [PMID: 33563295 PMCID: PMC7874664 DOI: 10.1186/s12957-021-02158-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/31/2021] [Indexed: 12/25/2022] Open
Abstract
Background Accurate prediction of postoperative pulmonary function is important for ensuring the safety of patients undergoing radical resection for lung cancer. Dynamic perfusion digital radiography is an excellent and easy imaging method for detecting blood flow in the lung compared with the less-convenient conventional lung perfusion scintigraphy. As such, the present study aimed to confirm whether dynamic perfusion digital radiography can be evaluated in comparison with pulmonary perfusion scintigraphy in predicting early postoperative pulmonary function and complications. Methods Dynamic perfusion digital radiography and spirometry were performed before and 1 and 3 months after radical resection for lung cancer. Correlation coefficients between blood flow ratios calculated using dynamic perfusion digital radiography and pulmonary perfusion scintigraphy were then confirmed in the same cases. In all patients who underwent dynamic perfusion digital radiography, the correlation predicted values calculated from the blood flow ratio, and measured values were examined. Furthermore, ppo%FEV1 or ppo%DLco values, which indicated the risk for perioperative complications, were examined. Results A total of 52 participants who satisfied the inclusion criteria were analyzed. Blood flow ratios measured using pulmonary perfusion scintigraphy and dynamic perfusion digital radiography showed excellent correlation and acceptable predictive accuracy. Correlation coefficients between predicted FEV1 values obtained from dynamic perfusion digital radiography or pulmonary perfusion scintigraphy and actual measured values were similar. All patients who underwent dynamic perfusion digital radiography showed excellent correlation between predicted values and those measured using spirometry. A significant difference in ppo%DLco was observed for respiratory complications but not cardiovascular complications. Conclusions Our study demonstrated that dynamic perfusion digital radiography can be a suitable alternative to pulmonary perfusion scintigraphy given its ability for predicting postoperative values and the risk for postoperative respiratory complications. Furthermore, it seemed to be an excellent modality because of its advantages, such as simplicity, low cost, and ease in obtaining in-depth respiratory functional information. Trial registration Registered at UMIN on October 25, 2017. https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_his_list.cgi?recptno=R000033957 Registration number: UMIN000029716 Supplementary Information The online version contains supplementary material available at 10.1186/s12957-021-02158-w.
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Affiliation(s)
- Jun Hanaoka
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan.
| | - Makoto Yoden
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Kazuki Hayashi
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Takuya Shiratori
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Keigo Okamoto
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Ryosuke Kaku
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Yo Kawaguchi
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Yasuhiko Ohshio
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Akinaga Sonoda
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
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Igarashi A, Inoue S, Shibata Y, Nunomiya K, Ota T, Ishibashi Y, Murano H, Furuyam K, Yang S, Machida H, Nakano H, Sato K, Sato M, Nemoto T, Nishiwaki M, Yamauchi K, Suzuki J, Sadahiro M, Watanabe M. Examination of predictable factors of perioperative respiratory complications by preoperative forced oscillation technique parameters. EXCLI JOURNAL 2020; 19:1610-1614. [PMID: 33437226 PMCID: PMC7798088 DOI: 10.17179/excli2020-3087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/10/2020] [Indexed: 11/10/2022]
Abstract
In this study, we investigated whether pulmonary function tests such as forced oscillation technique parameters could predict perioperative respiratory complications. In the results of our study, perioperative respiratory complications cannot be predicted using the results of preoperative pulmonary function tests and forced oscillation technique parameters. Patients who are judged by comprehensive preoperative judgment to be suitable for general anesthesia may not need to consider the risk of perioperative complications using pulmonary function test.
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Affiliation(s)
- Akira Igarashi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Sumito Inoue
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yoko Shibata
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Keiko Nunomiya
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Takahito Ota
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yu Ishibashi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hiroaki Murano
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Kodai Furuyam
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Sujeong Yang
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hiroyoshi Machida
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hiroshi Nakano
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Kento Sato
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Masamichi Sato
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Takako Nemoto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Michiko Nishiwaki
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Keiko Yamauchi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Jun Suzuki
- Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Mitsuaki Sadahiro
- Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
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Hanley C, Donahoe L, Slinger P. "Fit for Surgery? What's New in Preoperative Assessment of the High-Risk Patient Undergoing Pulmonary Resection". J Cardiothorac Vasc Anesth 2020; 35:3760-3773. [PMID: 33454169 DOI: 10.1053/j.jvca.2020.11.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 12/21/2022]
Abstract
Advances in perioperative assessment and diagnostics, together with developments in anesthetic and surgical techniques, have considerably expanded the pool of patients who may be suitable for pulmonary resection. Thoracic surgical patients frequently are perceived to be at high perioperative risk due to advanced age, level of comorbidity, and the risks associated with pulmonary resection, which predispose them to a significantly increased risk of perioperative complications, increased healthcare resource use, and costs. The definition of what is considered "fit for surgery" in thoracic surgery continually is being challenged. However, no internationally standardized definition of prohibitive risk exists. Perioperative assessment traditionally concentrates on the "three-legged stool" of pulmonary mechanical function, parenchymal function, and cardiopulmonary reserve. However, no single criterion should exclude a patient from surgery, and there are other perioperative factors in addition to the tripartite assessment that need to be considered in order to more accurately assess functional capacity and predict individual perioperative risk. In this review, the authors aim to address some of the more erudite concepts that are important in preoperative risk assessment of the patient at potentially prohibitive risk undergoing pulmonary resection for malignancy.
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Affiliation(s)
- Ciara Hanley
- Department of Anesthesia and Pain Management, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada.
| | - Laura Donahoe
- Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Peter Slinger
- Department of Anesthesia and Pain Management, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada
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Fernandes A, Rodrigues J, Lages P, Lança S, Mendes P, Antunes L, Santos CS, Castro C, Costa RS, Lopes CS, da Costa PM, Santos LL. Root causes and outcomes of postoperative pulmonary complications after abdominal surgery: a retrospective observational cohort study. Patient Saf Surg 2019; 13:40. [PMID: 31827617 PMCID: PMC6889593 DOI: 10.1186/s13037-019-0221-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/21/2019] [Indexed: 12/30/2022] Open
Abstract
Background Postoperative pulmonary complications (PPCs) contribute significantly to overall postoperative morbidity and mortality. In abdominal surgery, PPCs remain frequent. The study aimed to analyze the profile and outcomes of PPCs in patients submitted to abdominal surgery and admitted in a Portuguese polyvalent intensive care unit. Methods From January to December 2017 in the polyvalent intensive care unit of Hospital Garcia de Orta, Almada, Portugal, we conducted a retrospective, observational study of inpatients submitted to urgent or elective abdominal surgery who had severe PPCs. We evaluated the perioperative risk factors and associated mortality. Logistic regression was performed to find which perioperative risk factors were most important in the occurrence of PPCs. Results Sixty patients (75% male) with a median age of 64.5 [47-81] years who were submitted to urgent or elective abdominal surgery were included in the analysis. Thirty-six patients (60%) developed PPCs within 48 h and twenty-four developed PPCs after 48 h. Pneumonia was the most frequent PPC in this sample. In this cohort, 48 patients developed acute respiratory failure and needed mechanical ventilation. In the emergency setting, peritonitis had the highest rate of PPCs. Electively operated patients who developed PPCs were mostly carriers of digestive malignancies. Thirty-day mortality was 21.7%. The risk of PPCs development in the first 48 h was related to the need for neuromuscular blocking drugs several times during surgery and preoperative abnormal arterial blood gases. Median abdominal surgical incision, long surgery duration, and high body mass index were associated with PPCs that occurred more than 48 h after surgery. The American Society of Anesthesiologists physical status score 4 and COPD/Asthma determined less mechanical ventilation needs since they were preoperatively optimized. Malnutrition (low albumin) before surgery was associated with 30-day mortality. Conclusion PPCs after abdominal surgery are still a major problem since they have profound effects on outcomes. Our results suggest that programs before surgery, involve preoperative lifestyle changes, such as nutritional supplementation, exercise, stress reduction, and smoking cessation, were an effective strategy in mitigating postoperative complications by decreasing mortality.
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Affiliation(s)
- Antero Fernandes
- 1Experimental Pathology and Therapeutics Group, Instituto Português de Oncologia, Porto, Portugal.,2Polyvalent Intensive Care Unit of Intensive Medicine Service, Hospital Garcia de Orta, E.P.E, Almada, Portugal
| | - Jéssica Rodrigues
- 3Cancer Epidemiology Group, IPO Porto Research Center (CI-IPOP), Instituto Português de Oncologia, Porto, Portugal
| | - Patrícia Lages
- 4General Surgery Service, Hospital Garcia de Orta, E.P.E, Portugal and Faculdade de Medicina da Universidade de Lisboa, Almada, Portugal
| | - Sara Lança
- 2Polyvalent Intensive Care Unit of Intensive Medicine Service, Hospital Garcia de Orta, E.P.E, Almada, Portugal
| | - Paula Mendes
- Polyvalent Intensive Care Unit, Hospital Santo Espírito ilha Terceira, E.P.R, Angra do Heroísmo, Açores Portugal
| | - Luís Antunes
- 3Cancer Epidemiology Group, IPO Porto Research Center (CI-IPOP), Instituto Português de Oncologia, Porto, Portugal
| | - Carla Salomé Santos
- 6Surgical Oncology Department of Portuguese Instituto Português de Oncologia, Porto, Portugal
| | - Clara Castro
- 3Cancer Epidemiology Group, IPO Porto Research Center (CI-IPOP), Instituto Português de Oncologia, Porto, Portugal.,7EPIUnit - Institute of Public Health, Universidade do Porto, Porto, Portugal
| | - Rafael S Costa
- 8IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal.,9REQUIMTE/LAQV, Department of Chemistry, Faculty of Science and Technology, Universidade Nova de Lisboa, Caparica, Portugal
| | - Carlos Silva Lopes
- 10Biomedical Sciences Institute Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Paulo Matos da Costa
- 4General Surgery Service, Hospital Garcia de Orta, E.P.E, Portugal and Faculdade de Medicina da Universidade de Lisboa, Almada, Portugal
| | - Lúcio Lara Santos
- 1Experimental Pathology and Therapeutics Group, Instituto Português de Oncologia, Porto, Portugal.,6Surgical Oncology Department of Portuguese Instituto Português de Oncologia, Porto, Portugal.,10Biomedical Sciences Institute Abel Salazar, Universidade do Porto, Porto, Portugal
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8
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Winkelmann ER, Steffens É, Windmöller P, Fontela PC, da Cruz DT, Battisti IDE. Preoperative expiratory and inspiratory muscle weakness to predict postoperative outcomes in patients undergoing elective cardiac surgery. J Card Surg 2019; 35:128-134. [PMID: 31782832 DOI: 10.1111/jocs.14355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Few studies have evaluated preoperative respiratory muscle strength as a risk factor for postoperative morbidity and mortality. The objective of this study was to evaluate the association of preoperative inspiratory muscle weakness (IMW) and preoperative expiratory muscle weakness (EMW) with duration of mechanical ventilation, length of stay in the intensive care unit (ICU), incidence of postoperative pulmonary complications (PPCs), and mortality in patients undergoing elective cardiac surgery. MATERIALS AND METHODS This was a prospective observational study. Patients admitted for elective cardiac surgery were recruited. Maximal inspiratory and expiratory pressure were measured before surgery. A multivariate regression model was used to adjust for possible confounding variables and test the association of IMW and EMW with the duration of mechanical ventilation, length of stay in the ICU, PPCs, and hospital mortality. RESULTS Two hundred and fifty-five patients were included in this study. The presence of IMW was associated with an increase in the duration of mechanical ventilation (P = .012). The presence of EMW was associated with a reduction in the incidence of PPCs (P = .005). IMW had no significant association with length of stay in the ICU, PPCs, or hospital mortality. EMW had no significant association with the duration of mechanical ventilation, length of stay in the ICU, or hospital mortality. CONCLUSIONS In patients undergoing elective cardiac surgery, preoperative IMW is associated with the duration of mechanical ventilation while preoperative EMW is associated with a decrease in PPCs.
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Affiliation(s)
- Eliane R Winkelmann
- Departamento de Ciências da Vida, Universidade Regional do Noroeste do Estado do Rio Grande do Sul, Ijuí, Rio Grande do Sul, Brasil
| | - Édina Steffens
- Departamento de Ciências da Vida, Universidade Regional do Noroeste do Estado do Rio Grande do Sul, Ijuí, Rio Grande do Sul, Brasil
| | - Pollyana Windmöller
- Departamento de Ciências da Vida, Universidade Regional do Noroeste do Estado do Rio Grande do Sul, Ijuí, Rio Grande do Sul, Brasil
| | - Paula C Fontela
- Faculdade de Medicina, Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil.,Unidade de Terapia Intensiva Coronariana, Instituto do Coração, Hospital de Caridade de Ijuí, Ijuí, Rio Grande do Sul, Brasil
| | - Dante T da Cruz
- Unidade de Terapia Intensiva Coronariana, Instituto do Coração, Hospital de Caridade de Ijuí, Ijuí, Rio Grande do Sul, Brasil
| | - Iara D E Battisti
- Programa de Pós-Graduação em Ambiente e Tecnologias Sustentáveis e Programa de Pós-Graduação em Desenvolvimento e Políticas Públicas, Universidade Federal da Fronteira Sul, Campus Cerro Largo, Cerro Largo, Rio Grande do Sul, Brasil
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Kobayashi K, Saeki Y, Kitazawa S, Kobayashi N, Kikuchi S, Goto Y, Sakai M, Sato Y. Three-dimensional computed tomographic volumetry precisely predicts the postoperative pulmonary function. Surg Today 2017; 47:1303-1311. [PMID: 28378062 DOI: 10.1007/s00595-017-1505-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 02/20/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE It is important to accurately predict the patient's postoperative pulmonary function. The aim of this study was to compare the accuracy of predictions of the postoperative residual pulmonary function obtained with three-dimensional computed tomographic (3D-CT) volumetry with that of predictions obtained with the conventional segment-counting method. METHODS Fifty-three patients scheduled to undergo lung cancer resection, pulmonary function tests, and computed tomography were enrolled in this study. The postoperative residual pulmonary function was predicted based on the segment-counting and 3D-CT volumetry methods. The predicted postoperative values were compared with the results of postoperative pulmonary function tests. RESULTS Regarding the linear correlation coefficients between the predicted postoperative values and the measured values, those obtained using the 3D-CT volumetry method tended to be higher than those acquired using the segment-counting method. In addition, the variations between the predicted and measured values were smaller with the 3D-CT volumetry method than with the segment-counting method. These results were more obvious in COPD patients than in non-COPD patients. CONCLUSIONS Our findings suggested that the 3D-CT volumetry was able to predict the residual pulmonary function more accurately than the segment-counting method, especially in patients with COPD. This method might lead to the selection of appropriate candidates for surgery among patients with a marginal pulmonary function.
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Affiliation(s)
- Keisuke Kobayashi
- Department of Thoracic Surgery, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yusuke Saeki
- Department of Thoracic Surgery, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Shinsuke Kitazawa
- Department of Thoracic Surgery, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Naohiro Kobayashi
- Department of Thoracic Surgery, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Shinji Kikuchi
- Department of Thoracic Surgery, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yukinobu Goto
- Department of Thoracic Surgery, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Mitsuaki Sakai
- Department of Thoracic Surgery, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yukio Sato
- Department of Thoracic Surgery, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
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Abstract
Locally advanced lung cancer remains a surgical indication in selected patients. This condition often demands larger resections. As a consequence preoperative functional workup is of paramount importance to stratify the risk and choose the most appropriate treatment. We reviewed the current evidence on functional evaluation with a special focus on specific aspects related to locally advanced lung cancer stages (i.e., risk after neoadjuvant treatment, pneumonectomy). Evidence is discussed to provide information that could assist clinicians in their preoperative workup of these challenging patients.
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Abstract
Esophageal surgery comprises a variety of procedures of differing complexity to treat functional and structural disorders of the esophagus. Local disease extension, surgical repair technique, and physical status of the patient primarily dictate anesthetic management of patients with esophageal pathology. Because the esophagus is in close proximity to vital organs and structures, a specific knowledge of the anatomy is essential to realize how esophageal pathology can compromise elemental physiological functions. A com prehensive anesthetic plan requires a detailed under standing of the surgical procedure in terms of approach, the extent of the operation, and associated complica tions. Consideration of comorbid conditions is equally important, as esophageal surgery is frequently per formed in debilitated and polytraumatized patients. The following article will review clinical manifestation, surgi cal therapy, and perioperative anesthetic management of the most commonly encountered esophageal disor ders. Specifically, anesthetic considerations in gastro esophageal reflux disease, esophageal carcinoma, esophageal perforation, and a variety of other esopha geal disorders will be discussed.
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Affiliation(s)
- Frank W Dupont
- Department of Anesthesia and Crtical Care, University of Chicago, Chicago, IL
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İlhan S, Günay R, Özkan S, Güvenç TS, Yurtsever N. Arterial Blood Gas Analysis in Chronic Obstructive Pulmonary Disease Patients Undergoing Coronary Artery Bypass Surgery. Turk Thorac J 2016; 17:93-99. [PMID: 29404133 DOI: 10.5578/ttj.30503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 01/20/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We aimed to investigate the impact of arterial blood gas (ABG) on morbidity and mortality in chronic obstructive pulmonary disease (COPD) patients undergoing CABG surgery. MATERIAL AND METHODS The records for 75 COPD patients who underwent elective CABG surgery our institution clinic between November 2008 to 2011 and had a forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ≤ 70% value in the pulmonary function tests (PFT) performed prior to the surgery were evaluated retrospectively. COPD patients were divided into two groups; Group 1; FEV1 ≥ 60% and Group 2; FEV1 ≤ 59%. Groups were compared for mortality and adverse events after identification of other preoperative and postoperative factors that could affect mortality and adverse events. An ABG was obtained immediately before and 3 to 6 hours after surgery to study the predictive value of ABG in seperate COPD groups. RESULTS There were no significant differences in patients with high partial pressure carbondioxide (PaCO2) preoperative values compared to patients with normal values. Also there were no significant differences in patients with lower partial pressure of oxygen (PaO2) preoperative values compared to patients with normal values in terms of mortality. Postoperative myocardial infarction (MI) was significantly higher in patients with low PaO2 values (p< 0.05). CONCLUSION In conclusion, in our study, there could not be found a relation between the degree of preoperative obstruction and mortality for COPD patients who underwent CABG surgery. ABG was not found useful for predicting mortality in COPD patients undergoing CABG surgery, but could be useful to predict postoperative MI in patients with COPD.
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Affiliation(s)
- Sami İlhan
- Clinic of Chest Diseases, Dr. Siyami Ersek Chest Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Rafet Günay
- Clinic of Cardiovascular Surgery, Dr. Siyami Ersek Chest Cardiovascular Surgery Training and Reseacrh Hospital, İstanbul, Turkey
| | - Sevil Özkan
- Clinic of Internal Medicine, Haydarpaşa Numune Training and Reseacrh Hospital, İstanbul, Turkey
| | - Tolga Sinan Güvenç
- Clinic of Cardiology, Dr. Siyami Ersek Chest Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Nurgül Yurtsever
- Clinic of Anesthesiology, Dr. Siyami Ersek Chest Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
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Yoshimi K, Oh S, Suzuki K, Kodama Y, Sekiya M, Seyama K, Fukuchi Y. Impact of Airflow Limitation on Comorbidities and Postoperative Complications in Patients Undergoing Thoracic Surgery: A Retrospective Observational Study. Ann Thorac Cardiovasc Surg 2016; 22:146-52. [PMID: 26935262 DOI: 10.5761/atcs.oa.15-00301] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To assess the frequency of airflow limitation (AFL), and the relationship between AFL and preoperative comorbidities or postoperative complications in patients who had undergone thoracic surgery. METHODS The medical records of patients who underwent non-cardiac thoracic surgery at our institution between August 1996 and January 2013 were retrospectively reviewed. On the basis of preoperative pulmonary function tests, patients were classified with those with FEV1/FVC <70% [AFL(+) group] or with FEV1/FVC ≥70% [AFL(-) group]. Patient characteristics, preoperative comorbidities and postoperative complications were compared between the groups. RESULTS Of the 3667 patients assessed, 738 (20.1%) were allocated to the AFL(+) group. AFL was an independent risk factor for three preoperative comorbidities: chronic obstructive pulmonary disease (odds ratio [OR]: 4.65), bronchial asthma (OR 4.30) and cardiac diseases (OR 1.41). Airflow limitation was also an independent risk factor for postoperative respiratory failure including long-term oxygen therapy (OR 2.14) and atelectasis (OR 1.90) in the patients who underwent lobectomy or partial resection of the lung. CONCLUSIONS Our retrospective study revealed that careful attention needs to be paid to airflow limitation in patients who undergo non-cardiac thoracic surgery since it appears to be an important feature of preoperative comorbidities and to increase postoperative complications.
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Affiliation(s)
- Kaku Yoshimi
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
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Zanini M, Nery RM, Buhler RP, de Lima JB, Stein R. Preoperative maximal expiratory pressure is associated with duration of invasive mechanical ventilation after cardiac surgery: An observational study. Heart Lung 2016; 45:244-8. [PMID: 26907196 DOI: 10.1016/j.hrtlng.2016.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 01/12/2016] [Accepted: 01/13/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the association of maximal expiratory pressure (MEP), maximal inspiratory pressure (MIP), and peak expiratory flow (PEF) with total duration of invasive mechanical ventilation (IMV) in subjects undergoing cardiac surgery. BACKGROUND Prolonged IMV is associated with respiratory infections, prolonged hospitalization, and increased mortality. Pulmonary function tests can help predict postoperative outcomes after cardiac surgery. METHODS We recruited subjects admitted for cardiac surgery. All MIP, MEP, and PEF measurements were performed before surgery. Multivariable analysis was performed using a multiple linear regression model to control for possible confounders and test for association of MIP, MEP, and PEF with IMV duration. RESULTS Overall, 125 subjects were included in the study. Higher MEP was associated with reduced duration of IMV after adjustment for confounders (P = 0.015), but no such association was observed between MIP or PEF and IMV. CONCLUSIONS In subjects undergoing elective cardiac surgery, preoperative MEP is associated with IMV duration.
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Affiliation(s)
- Maurice Zanini
- Federal University of Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Brazil.
| | - Rosane Maria Nery
- Physical Medicine and Rehabilitation Division, Hospital de Clínicas de Porto Alegre, Brazil
| | | | - Juliana Beust de Lima
- Federal University of Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Brazil
| | - Ricardo Stein
- Department of Medicine, Federal University of Rio Grande do Sul, Brazil
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[Cardiac surgery in underlying chronic pulmonary disease. Prognostic implications and efficient preoperative evaluation]. Herz 2015; 39:45-52. [PMID: 24452760 DOI: 10.1007/s00059-013-4034-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cardiac surgery in patients with chronic pulmonary diseases carries a high risk of postoperative pulmonary complications (ppc) because both are known to cause ppc. Autopsy studies have revealed ppc as the main cause of mortality in approximately 5-8% of patients after cardiac surgery. Not all pulmonary diseases are high risk comorbidities in cardiac surgery: whereas chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea significantly increase the risk of ppc, a well controlled asthma does not carry an additional risk of ppc. A thorough preoperative risk stratification is crucial for risk estimation and some validated risk calculators, such as the Canet risk score exist. Surprisingly the additional value of pulmonary function testing beyond a thorough patient history and physical examination is low. No validated thresholds exist in pulmonary function testing below which cardiac surgery should be denied if clearly indicated. Perioperative strategies for risk reduction should be applied to all patients whenever possible.
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Özkan M, Kırkıl G, Dilektaşlı AG, Söğüt A, Sertoğullarından B, Çetinkaya E, Coşkun F, Ulubay G, Yüksel H, Sezer M, Özbudak Ö, Ulaşlı SS, Arslan S, Kovan T. Summary of Consensus Report on Preoperative Evaluation. Turk Thorac J 2015; 16:43-52. [PMID: 29404077 PMCID: PMC5783046 DOI: 10.5152/ttd.2014.4505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 11/04/2014] [Indexed: 12/31/2022]
Affiliation(s)
| | - Gamze Kırkıl
- Department of Chest Diseases, Fırat University Faculty of Medicine, Elazığ, Turkey
| | | | - Ayhan Söğüt
- Division of Pediatric Allergy and Immunology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | | | - Erdoğan Çetinkaya
- Department of Chest Diseases, Karabük University Faculty of Medicine, Karabük, Turkey
| | - Funda Coşkun
- Department of Chest Diseases, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Gaye Ulubay
- Department of Chest Diseases, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Hasan Yüksel
- Division of Pediatric Chest Diseases, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Murat Sezer
- Department of Chest Diseases, Bezmialem Vakif University Faculty of Medicine, İstanbul, Turkey
| | - Ömer Özbudak
- Department of Chest Diseases, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Sevinç Sarınç Ulaşlı
- Department of Chest Diseases, Afyon Kocatepe University Faculty of Medicine, Afyon, Turkey
| | - Sulhattin Arslan
- Department of Chest Diseases, Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Tezay Kovan
- Clinic of Chest Diseases, Beyşehir State Hospital, Konya, Turkey
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Abstract
Hip fracture is one of the most common orthopedic conditions associated with significant morbidity and mortality. Patients with hip fracture are usually older, with significant comorbidities. Delayed surgical treatment beyond 48 hours after admission is associated with significantly higher mortality. Hereby clinicians are presented with the challenge to optimize the complex hip fracture within a short time period. This article reviews the evidence regarding preoperative, intraoperative, and postoperative considerations, and provides insights into the best strategies with which to optimize the patient's condition and improve perioperative outcomes.
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Affiliation(s)
- Jiabin Liu
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Jaimo Ahn
- Department of Orthopedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Nabil M Elkassabany
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Cukic V. Reduction of pulmonary function after surgical lung resections of different volume. Med Arch 2014; 68:231-5. [PMID: 25568542 PMCID: PMC4240564 DOI: 10.5455/medarh.2014.68.231-235] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 06/25/2014] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION In recent years an increasing number of lung resections are being done because of the rising prevalence of lung cancer that occurs mainly in patients with limited lung function, what is caused with common etiologic factor - smoking cigarettes. OBJECTIVE To determine how big the loss of lung function is after surgical resection of lung of different range. METHODS The study was done on 58 patients operated at the Clinic for thoracic surgery KCU Sarajevo, previously treated at the Clinic for pulmonary diseases "Podhrastovi" in the period from 01.06.2012. to 01.06.2014. The following resections were done: pulmectomy (left, right), lobectomy (upper, lower: left and right). The values of postoperative pulmonary function were compared with preoperative ones. As a parameter of lung function we used FEV1 (forced expiratory volume in one second), and changes in FEV1 are expressed in liters and in percentage of the recorded preoperative and normal values of FEV1. Measurements of lung function were performed seven days before and 2 months after surgery. RESULTS Postoperative FEV1 was decreased compared to preoperative values. After pulmectomy the maximum reduction of FEV1 was 44%, and after lobectomy it was 22% of the preoperative values. CONCLUSION Patients with airway obstruction are limited in their daily life before the surgery, and an additional loss of lung tissue after resection contributes to their inability. Potential benefits of lung resection surgery should be balanced in relation to postoperative morbidity and mortality.
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Affiliation(s)
- Vesna Cukic
- Clinic for Pulmonary Diseases and TB "Podhrastovi", Clinical Centre of Sarajevo University, Bosnia and Herzegovina
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Savas Oz B, Kaya E, Arslan G, Karabacak K, Cingoz F, Arslan M. Pre-treatment before coronary artery bypass surgery improves post-operative outcomes in moderate chronic obstructive pulmonary disease patients. Cardiovasc J Afr 2014; 24:184-7. [PMID: 24217166 PMCID: PMC3748456 DOI: 10.5830/cvja-2013-034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 05/10/2013] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) has traditionally been recognised as a predictor of poorer early outcomes in patients undergoing coronary artery bypass grafting (CABG). The aim of this study was to analyse the impact of different COPD stages, as defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) spirometric criteria, on the early surgical outcomes in patients undergoing primary isolated non-emergency CABG. METHOD Between January 2008 and April 2012, 1 737 consecutive patients underwent isolated CABG in the Department of Cardiovascular Surgery of Gulhane Military Academy of Medicine; 127 patients with the diagnosis of moderate-risk COPD were operated on. Only 104 patients with available pulmonary function tests and no missing data were included in the study. Two different treatment protocols had been used before and after 2010. Before 2010, no treatment was applied to patients with moderate COPD before the CABG procedure. After 2010, a pre-treatment protocol was initiated. Patients who had undergone surgery between 2008 and 2010 were placed in group 1 (no pre-treatment, n = 51) and patients who had undergone surgery between 2010 and 2012 comprised group 2 (pre-treatment group, n = 53). These two groups were compared according to the postoperative morbidity and mortality rates retrospectively, from medical reports. RESULTS The mean ages of the patients in both groups were 62.1 ± 7.6 and 64.5 ± 6.4 years, respectively. Thirty-nine of the patients in group 1 and 38 in group 2 were male. There were similar numbers of risk factors such as diabetes, hypertension, renal disease (two patients in each group), previous stroke and myocardial infarction in both groups. The mean ejection fractions of the patients were 53.3 ± 11.5% and 50.2 ± 10.8%, respectively. Mean EuroSCOREs of the patients were 5.5 ± 2.3 and 5.9 ± 2.5, respectively in the groups. The average numbers of the grafts were 3.1 ± 1.0 and 2.9 ± 0.9. Mean extubation times were 8.52 ± 1.3 hours in group 1 and 6.34 ± 1.0 hours in group 2. The numbers of patients who needed pharmacological inotropic support were 12 in group 1 and five in group 2. Duration of hospital stay of the patients was shorter in group 2. While there were 14 patients with post-operative atrial fibrillation (PAF) in group 1, the number of patients with PAF in group 2 was five. Whereas there were seven patients who had pleural effusions requiring drainage in group 1, there were only two in group 2. There were three mortalities in group 1, and one in group 2. There were no sternal infections and sternal dehiscences in either group. CONCLUSION Pre-treatment in moderate-risk COPD patients improved post-operative outcomes while decreasing adverse events and complications. Therefore for patients undergoing elective CABG, we recommend the use of medical treatment.
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Affiliation(s)
- Bilgehan Savas Oz
- Gulhane Military Medical Academy, Cardiovascular Surgery Department, Etlik, Ankara, Turkey
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Ryu J, Ryu YM, Jung YS, Kim SJ, Lee YJ, Lee EK, Kim SK, Kim TS, Kim TH, Lee CY, Park SY, Chung KW. Extent of thyroidectomy affects vocal and throat functions: A prospective observational study of lobectomy versus total thyroidectomy. Surgery 2013; 154:611-20. [DOI: 10.1016/j.surg.2013.03.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 03/28/2013] [Indexed: 11/28/2022]
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Cukic V, Lovre V. Changes of arterial blood gases after different ranges of surgical lung resection. Mater Sociomed 2013; 24:165-70. [PMID: 23922525 PMCID: PMC3732354 DOI: 10.5455/msm.2012.24.165-170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 08/15/2012] [Indexed: 11/23/2022] Open
Abstract
Introduction: In recent years there has been increase in the number of patients who need thoracic surgery – first of all different types of pulmonary resection because of primary bronchial cancer, and very often among patients whose lung function is impaired due to different degree of bronchial obstruction so it is necessary to assess functional status before and after lung surgery to avoid the development of respiratory insufficiency. Objective: To show the changes in the level of arterial blood gases after various ranges of lung resection. Material and methods: The study was done on 71 patients surgically treated at the Clinic for Thoracic Surgery KCU Sarajevo, who were previously treated at the Clinic for Pulmonary Diseases “Podhrastovi” in the period from 01. 06. 2009. to 01. 09. 2011. Different types of lung resection were made. Patients whose percentage of ppoFEV1 was (prognosed postoperative FEV1) was less than 30% of normal values of FEV1 for that patients were not given a permission for lung resection. We monitored the changes in levels-partial pressures of blood gases (PaO2, PaCO2 and SaO2) one and two months after resection and compared them to preoperative values. As there were no significant differences between the values obtained one and two months after surgery, in the results we showed arterial blood gas analysis obtained two months after surgical resection. Results were statistically analyzed by SPSS and Microsoft Office Excel. Statistical significance was determined at an interval of 95%. Results: In 59 patients (83%) there was an increase, and in 12 patients (17%) there was a decrease of PaO2, compared to preoperative values. In 58 patients (82%) there was a decrease, and in 13 patients (18%) there was an increase in PaCO2, compared to preoperative values. For all subjects (group as whole): The value of the PaO2 was significantly increased after lung surgery compared to preoperative values (p <0.05) so is the value of the SaO2%. The value of the PaCO2 was significantly decreased after lung surgery compared to preoperative values (p <0.05). Respiratory insufficiency was developed in none of patients. Conclusion: If the % ppoFEV1 (% prognosed postoperative FEV1) is bigger than 30% of normal values of FEV1 (according to sex, weight, height, age) in patient planned for lung resection surgery there is no development of respiratory insufficiency after resection.
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Affiliation(s)
- Vesna Cukic
- Clinic for Pulmonary Diseases and TB "Podhrastovi", Clinical center of University of Sarajevo, Bosnia and Herzegovina
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Cukic V. Preoperative prediction of lung function in pneumonectomy by spirometry and lung perfusion scintigraphy. Acta Inform Med 2013; 20:221-5. [PMID: 23378687 PMCID: PMC3558306 DOI: 10.5455/aim.2012.20.221-225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 09/30/2012] [Indexed: 11/26/2022] Open
Abstract
Introduction: Nowadays an increasing number of lung resections are being done because of the rising prevalence of lung cancer that occurs mainly in patients with limited lung function, what is caused by common etiologic factor - smoking cigarettes. Loss of lung tissue in such patients can worsen much the postoperative pulmonary function. So it is necessary to asses the postoperative pulmonary function especially after maximal resection, i.e. pneumonectomy. Objective: To check over the accuracy of preoperative prognosis of postoperative lung function after pneumonectomy using spirometry and lung perfusion scinigraphy. Material and methods: The study was done on 17 patients operated at the Clinic for thoracic surgery, who were treated previously at the Clinic for Pulmonary Diseases “Podhrastovi” in the period from 01. 12. 2008. to 01. 06. 2011. Postoperative pulmonary function expressed as ppoFEV1 (predicted postoperative forced expiratory volume in one second) was prognosticated preoperatively using spirometry, i.e.. simple calculation according to the number of the pulmonary segments to be removed and perfusion lung scintigraphy. Results: There is no significant deviation of postoperative achieved values of FEV1 from predicted ones obtained by both methods, and there is no significant differences between predicted values (ppoFEV1) obtained by spirometry and perfusion scintigraphy. Conclusion: It is necessary to asses the postoperative pulmonary function before lung resection to avoid postoperative respiratory failure and other cardiopulmonary complications. It is absolutely necessary for pneumonectomy, i.e.. maximal pulmonary resection. It can be done with great possibility using spirometry or perfusion lung scintigraphy.
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Affiliation(s)
- Vesna Cukic
- Clinic for pulmonary diseases and TB "Podhrastovi", Clinical center of Sarajevo University, Bosnia and Herzegovina
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Abstract
The incidence of obesity has acquired an epidemic proportion throughout the globe. As a result, increasing number of obese patients is being presented to critical care units for various indications. The attending intensivist has to face numerous challenges during management of such patients. Almost all the organ systems are affected by the impact of obesity either directly or indirectly. The degree of obesity and its prolong duration are the main factors which determine the harmful effect of obesity on human body. The present article reviews few of the important clinical and critical care concerns in critically ill obese patients.
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Affiliation(s)
- Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
| | - Vishal Sehgal
- Department of Internal Medicine, The Commonwealth Medical College Scranton, PA 18510, USA
| | - Sukhwinder Kaur Bajwa
- Department of Obstetrics and Gynaecology, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
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Abstract
PURPOSE OF REVIEW The aim of this review is to underline the need for an adequate clinical and functional evaluation of respiratory function and asthma control in patients undergoing surgical procedures requiring general anesthesia to obtain useful information for an adequate preoperative pharmacological approach. RECENT FINDINGS It has been shown that baseline uncontrolled clinical/functional conditions of airways represent the most important risk factors for perioperative bronchospasm. In nonemergency conditions, asthma patients should undergo clinical/functional assessment at least 1 week before the surgery intervention to obtain, the better feasible control of asthma symptoms in the single patient. Some simple preoperative information given by the patient in preoperative consultation may be sufficient to identify individuals with uncontrolled or poor controlled asthmatic conditions. Spirometric evaluation is essential in individuals with poor control of symptoms, as well as in those patients with uncertain anamnestic data or limited perception of respiratory symptoms, and in those requiring lung resection. SUMMARY A better control of asthma must be considered the 'gold standard' for a patient at 'a reasonable low risk' to develop perioperative/postoperative bronchospasm. International consensus promoted by pulmonologists, anesthesiologists, and allergists might be useful to define a better diagnostic and therapeutic approach.
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Abstract
There have been recent advances in the treatment of non-small cell lung cancer (NSCLC). Surgical resection remains the cornerstone in the treatment of patients with stages I and II NSCLC. Anatomic lobectomy combined with hilar and mediastinal lymphadenectomy constitutes the oncologic basis of surgical resection. The surgical data favor video-assisted thoracic surgery (VATS) lobectomy over open lobectomy and have established VATS lobectomy as a gold standard in the surgical resection of early-stage NSCLC. However, the role of sublobar pulmonary resection, either anatomic segmentectomy or nonanatomic wedge resection, in patients with subcentimeter nodules may become important.
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Affiliation(s)
- Lyall A Gorenstein
- Division of Thoracic Surgery, Columbia Presbyterian Medical Center, New York Presbyterian Hospital, 161 Fort Washington Avenue #301, New York, NY 10032, USA
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Efficacy of functional operability algorithm for octogenarians with primary lung cancer. Gen Thorac Cardiovasc Surg 2012; 60:36-42. [DOI: 10.1007/s11748-011-0842-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Accepted: 05/30/2011] [Indexed: 10/14/2022]
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Lo IL, Siu CW, Tse HF, Lau TW, Leung F, Wong M. Pre-operative pulmonary assessment for patients with hip fracture. Osteoporos Int 2010; 21:S579-86. [PMID: 21057997 PMCID: PMC2924432 DOI: 10.1007/s00198-010-1427-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 09/04/2010] [Indexed: 12/13/2022]
Abstract
Hip fracture is a common injury among the elderly. Although patients who receive hip fracture surgery carry the best functional recovery compared to other treatment modalities, the presence of postoperative pulmonary complications, such as atelectasis, pneumonia, and pulmonary thromboembolism, may contribute to increased length of hospital stay, perioperative morbidity, and mortality. This review aims to provide evidence-based recommendations for preoperative assessment and perioperative strategies to reduce the risk of pulmonary complications after hip fracture surgery. Clinical assessment and basic laboratory results are sufficient to stratify the risk of postoperative pulmonary complications. Well-documented risk factors for pulmonary complications include advanced age, poor general health status, current infections, pre-existing cardiopulmonary diseases, hypoalbuminemia, and impaired renal function. Apart from optimizing the patient's medical conditions, interventions such as lung expansion maneuvers and thromboprophylaxis have been proven to be effective in reducing the risk of pulmonary complications after hip fracture surgery.
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Affiliation(s)
- I.-L. Lo
- Department of Respiratory Medicine, Centro Hospital Conde de Sao Januario, Macau, China
| | - C.-W. Siu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong China
- Research Center of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, Pokfulam, Hong Kong China
| | - H.-F. Tse
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong China
- Research Center of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, Pokfulam, Hong Kong China
| | - T.-W. Lau
- Department of Orthopaedics & Traumatology, The University of Hong Kong, Pokfulam, Hong Kong China
| | - F. Leung
- Department of Orthopaedics & Traumatology, The University of Hong Kong, Pokfulam, Hong Kong China
| | - M. Wong
- Division of Respiratory Medicine, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong China
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Liccardi G, Salzillo A, De Blasio F, D'Amato G. Control of asthma for reducing the risk of bronchospasm in asthmatics undergoing general anesthesia and/or intravascular administration of radiographic contrast media. Curr Med Res Opin 2009; 25:1621-30. [PMID: 19469699 DOI: 10.1185/03007990903010474] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND It is well known that patients suffering from bronchial asthma undergoing surgical procedures requiring general anesthesia (GA) or the administration of water soluble radiographic contrast media (RCM) have an increased risk of potentially severe bronchospasm. Nevertheless, little attention has been devoted to the possible preventive measures to reduce the occurrence of this potentially life-threatening event. It has been shown that the most important risk factor for bronchospasm during GA induction and/or the use of RCM is represented by a high degree of bronchial hyperreactivity with airway instability not adequately controlled by long-term anti-inflammatory treatment. AIMS The aim of this commentary is to underline the need for an accurate clinical and functional evaluation of asthmatics undergoing surgical procedures requiring GA or radiological procedures requiring the administration of RCM, as well as to suggest a stepwise preventive pharmacological approach for reducing the risk of bronchospasm. METHODS The authors' suggestions represent clinical experience of the respiratory section of an internal hospital-based working group whose aim is the prevention of asthmatic/anaphylactic/anaphylactoid reactions during the administration of anesthetics and/or RCM. The MEDLINE database was searched with a combination of keywords: general anesthesia, radio contrast media [and] bronchial asthma. The main limitation of this commentary is the scarcity of available literature on this topic. FINDINGS The authors suggest a therapeutic approach before surgical procedures requiring GA and/or RCM administration based on the degree of asthma control as assessed by clinical/functional criteria. In this setting, in addition to the necessity of obtaining the best control of airway reactivity, the authors suggest that an optimal control of asthma symptoms in 'real life' conditions might likely constitute a safety issue in asthmatic patients in the case of emergency procedures.
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Affiliation(s)
- Gennaro Liccardi
- Department of Chest Diseases, Division of Pneumology and Allergology, A. Cardarelli High Speciality Hospital, Naples, Italy.
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Song JE, Yang HJ, Park SC, Chun DH, Chung KH, Lee JY. Anesthetic management for cesarean section in a patient with Budd-Chiari syndrome - A case report -. Korean J Anesthesiol 2009; 57:793-795. [DOI: 10.4097/kjae.2009.57.6.793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Ji-Eun Song
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Hyeon Jeong Yang
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Seong-Cheol Park
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Duk-Hee Chun
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Kum-Hee Chung
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jong-Yeon Lee
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Harvey KP, Adair J, Basoor A, Just J. Resection of Lung Cancer after Contralateral Bullectomy in a High Risk Patient. Am Surg 2008. [DOI: 10.1177/000313480807401118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - James Adair
- St. Joseph Mercy Oakland Hospital Pontiac, Michigan
| | | | - Jorge Just
- St. Joseph Mercy Oakland Hospital Pontiac, Michigan
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Ohno Y, Koyama H, Takenaka D, Nogami M, Kotani Y, Nishimura Y, Yoshimura M, Yoshikawa T, Sugimura K. Coregistered ventilation and perfusion SPECT using krypton-81m and Tc-99m-labeled macroaggregated albumin with multislice CT utility for prediction of postoperative lung function in non-small cell lung cancer patients. Acad Radiol 2007; 14:830-8. [PMID: 17574133 DOI: 10.1016/j.acra.2007.03.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2006] [Revised: 03/23/2007] [Accepted: 03/23/2007] [Indexed: 01/20/2023]
Abstract
RATIONALE AND OBJECTIVE Co-registered SPECT and CT imaging (SPECT-CT) has potential for more precise evaluation of regional pulmonary function and may be useful for prediction of postoperative lung function in non-small cell lung cancer (NSCLC) patients. The purpose of the present study was to prospectively assess the capability of co-registered SPECT-CT using krypton-81m (Kr-81m) and technetium-99m-labeled macroaggregated albumin (Tc-99m MAA) for prediction of postoperative lung function of NSCLC patients compared with SPECT and planar imaging. MATERIALS AND METHODS Sixty consecutive patients considered candidates for lung resection underwent 16-slice CT, ventilation and perfusion scintigraphy with SPECT examinations, and preoperative and postoperative measurement of FEV(1)%. In each subject, SPECT and CT data were automatically fused by using commercially available software. Each postoperative FEV(1)% value was predicted from uptakes of Kr-81m and Tc-99m MAA within total and resected lungs. Then, reproducibility coefficients and the limits of agreement between actual and each predicted postoperative lung function were statistically assessed. RESULTS Reproducibility coefficients of SPECT-CT (Kr-81m: 5.1%, Tc-99m MAA: 5.2%) were smaller than those of SPECT and planar image using Kr-81m (SPECT: 7.4%, planar image: 12.1%) and using Tc-99m MAA (SPECT: 7.2%, planar image: 11.8%). The limits of agreement for SPECT-CT (Kr-81m: 3.3 +/- 10.5%, Tc-99m MAA: 5.4 +/- 11.0%) were also smaller than that of SPECT and planar image and small enough for clinical purposes. CONCLUSIONS Co-registered SPECT-CT using Kr-81m and Tc-99m MAA was able to more reproducibly and accurately predict postoperative lung function compared with SPECT and planar imaging.
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Affiliation(s)
- Yoshiharu Ohno
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
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Kanat F, Golcuk A, Teke T, Golcuk M. Risk factors for postoperative pulmonary complications in upper abdominal surgery. ANZ J Surg 2007; 77:135-41. [PMID: 17305986 DOI: 10.1111/j.1445-2197.2006.03993.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pulmonary complications are the most frequent cause of postoperative morbidity and mortality in upper abdominal surgery (UAS). We aimed to examine the influence of possible preoperative, operative and postoperative risk factors on the development of early postoperative pulmonary complications (POPC) after UAS. METHODS A prospective study of 60 consecutive patients was conducted who underwent elective UAS in general surgical unit. Each patient's preoperative respiratory status was assessed by an experienced chest physician using clinical examination, chest radiographs, spirometry and blood gas analysis . Anaesthetical risks, surgical indications, operation time, incision type, duration of nasogastric catheter and mobilization time were noted. Forty-eight hours after the operation, pulmonary examinations of the patients were repeated. RESULTS Postoperative pulmonary complications were observed in 35 patients (58.3%). The most common complication was pneumonia, followed by pneumonitis, atelectasis, bronchitis, pulmonary emboli and acute respiratory failure. The presence of preoperative respiratory symptoms and the spirometric parameter of forced expiratory volume in 1 s/forced vital capacity were the most valuable risk factors for early prediction of POPC. The sensitivity, specificity and diagnostic efficiency of the presence of preoperative respiratory symptoms in the POPC prediction were 70, 61 and 66%, respectively. CONCLUSION We recommend a detailed pulmonary examination and spirometry in patients who will undergo UAS by chest physicians to identify the patients at high risk for POPC, to manage respiratory problems of the patients before surgery and also to help surgeons to take early measures in such patients before a most likely POPC occurrence. Improvement of lung function in those patients at risk for POPC before operation may decrease morbidity in surgical patients.
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Affiliation(s)
- Fikret Kanat
- Department of Chest Diseases, Meram Medical School of Selcuk University, Konya, Turkey.
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Perrin C, Jullien V, Vénissac N, Berthier F, Padovani B, Guillot F, Coussement A, Mouroux J. Prophylactic use of noninvasive ventilation in patients undergoing lung resectional surgery. Respir Med 2007; 101:1572-8. [PMID: 17257820 DOI: 10.1016/j.rmed.2006.12.002] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2006] [Revised: 11/27/2006] [Accepted: 12/03/2006] [Indexed: 11/18/2022]
Abstract
QUESTION OF THE STUDY We studied whether prophylactic use of noninvasive pressure support ventilation (NIPSV) administered pre- and postoperatively may reduce the postoperative pulmonary function impairment. PATIENTS AND METHODS Prospective randomized clinical trial. Thirty-nine patients with a preoperative FEV(1) <70% of the predicted value scheduled for elective lobectomy related to lung cancer were enrolled. Seven patients were excluded after enrollment. Patients were required to follow standard treatment without (control group, n=18) or with NIPSV (study group, n=14) during 7 days at home before surgery, and during 3 days postoperatively. Primary outcome variable was the changes on arterial blood gases on room air. RESULTS Two hours after surgery, PaO(2), FVC and FEV(1) values were significantly better in the NIPSV group. On day 1, 2 and 3, PaO(2) was significantly improved in the NIPSV group. Also on day 1, FVC and FEV(1) improved significantly in the NIPSV group. The hospital stay was significantly longer in the control group than in the study group (p=0.04). The incidence of major atelectasis was 14.2% in the NIPSV group and 38.9% in the no-NIPSV group (p=0.15). ANSWER TO THE QUESTION: Prophylactic use of NIPSV in a pre- and postoperative manner significantly reduces pulmonary dysfunction after lung resection. As a result, recovery of preoperative respiratory function is accelerated.
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Affiliation(s)
- Christophe Perrin
- Service de Pneumologie, Centre Hospitalier et Universitaire de Nice, France.
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Uzunkoy A, Ozgonul A, Ceylan E, Gencer M. The effects of isothermic and hypothermic carbon dioxide pneumoperitoneum on respiratory function test results. ACTA ACUST UNITED AC 2006; 13:567-70. [PMID: 17139433 DOI: 10.1007/s00534-006-1121-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Accepted: 03/14/2006] [Indexed: 01/04/2023]
Abstract
BACKGROUND/PURPOSE This study investigated the effects of isothermic and hypothermic carbon dioxide, used for pneumoperitoneum during laparoscopic cholecystectomy, on respiratory function test results. METHODS Thirty patients who underwent elective laparoscopic cholecystectomy were enrolled in this prospective randomized study. The patients were divided into two groups. Carbon dioxide at 37 degrees C (isothermic) was used in the isothermic group, and carbon dioxide at 21 degrees C (hypothermic) was used in the hypothermic group. Respiratory function tests were performed in the preoperative period and at 12 h after the operation. RESULTS Mean forced vital capacity (FVC), forced expiratory volume (FEV1), maximum peak expiratory flow (PEF), and the FEV1/FVC ratio were significantly higher in the isothermic group than in the hypothermic group (P < 0.05). CONCLUSIONS Using isothermic carbon dioxide for pneumoperitoneum has fewer negative effects than hypothermic carbon dioxide on respiratory function tests results. Isothermic carbon dioxide may be preferable for patients with respiratory problems.
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Affiliation(s)
- Ali Uzunkoy
- Department of Surgery, Faculty of Medicine, Harran University, 63300 Sanliurfa, Turkey
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Sinha PK, Neema PK, Unnikrishnan KP, Varma PK, Jaykumar K, Rathod RC. Effect of Lung Ventilation With 50% Oxygen in Air or Nitrous Oxide Versus 100% Oxygen on Oxygenation Index After Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth 2006; 20:136-42. [PMID: 16616650 DOI: 10.1053/j.jvca.2005.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2005] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study was designed to assess the use of 100% oxygen or 50% oxygen in air or nitrous oxide after cardiopulmonary bypass (CPB) on atelectasis, as evidenced by the oxygenation index (PaO2/F(I)O2), after coronary artery bypass graft (CABG) surgery. DESIGN Prospective, randomized clinical study. SETTING University teaching hospital. PARTICIPANT Thirty-six adult patients undergoing CABG surgery. INTERVENTIONS Patients either received 50% O2 in air (50% O2 group), 50% O2 in N2O (50% N2O group), or 100% O2 (100% O2 group) after CPB. MEASUREMENTS AND MAIN RESULTS Apart from demographic and perioperative clinical data, extubation time, mediastinal drainage, and pulmonary complications were also recorded. After CPB, arterial blood gases done at various time points until 3 hours postextubation and oxygenation index were calculated. No significant differences were noted in demographic and perioperative data except preoperative hemoglobin and fluid use. Significant deterioration in arterial oxygenation was noted in the 100% O2 group from the baseline value, whereas significant improvement was seen in the 50% O2 group at 4 time points from baseline value and at all time points from the 100% O2 group. After initial deterioration in oxygenation, no further change was evident in the 50% N2O group. Furthermore, there was a greater increase in the oxygenation index as compared with the 100% O2 group. Time to extubation was also longer in the 100% O2 group than the 50% O2 group. CONCLUSION Significant deterioration in arterial oxygenation and an increase in the extubation time occurred with the use of 100% O2 after CPB, whereas better oxygenation was evident with the use of 50% O2 in air.
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Affiliation(s)
- Prabhat Kumar Sinha
- Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Kerala, India.
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Sverzellati N, Chetta A, Calabrò E, Carbognani P, Internullo E, Olivieri D, Zompatori M. Reliability of quantitative computed tomography to predict postoperative lung function in patients with chronic obstructive pulmonary disease having a lobectomy. J Comput Assist Tomogr 2005; 29:819-24. [PMID: 16272858 DOI: 10.1097/01.rct.0000179595.09092.ee] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To verify the reliability of quantitative computed tomography (CT) to estimate the postoperative lung function in patients with mild to severe chronic obstructive pulmonary disease (COPD) who underwent a lobectomy. METHODS Nine COPD patients with lung cancer having a lung lobectomy with preoperative CT were enrolled. By applying a density mask technique and a specific equation, predicted postoperative forced expiratory volume in 1 second (FEV1) and vital capacity (VC) were calculated. Predicted values were correlated with postoperative measured values. RESULTS Estimated FEV1 and VC were always significantly lower than the corresponding postoperative values; however, CT-estimated postresection FEV1 values were better than the postresection VC values (biases between estimated and measured values were -0.14 and -0.536 L, respectively, according to the Bland-Altman method). Quantitative CT predicted postoperative FEV1 (r = 0.97, P < 0.001) and VC (r = 0.93, P < 0.001) well in all patients, however. CONCLUSIONS Quantitative CT may be an alternative tool to perfusion scan to predict postresection lung function, even in patients with borderline pulmonary function undergoing a lobectomy.
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Affiliation(s)
- Nicola Sverzellati
- Department of Clinical Sciences, Section of Radiology, University of Parma, Parma, Italy.
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Pierce RJ, Sharpe K, Johns J, Thompson B. Pulmonary artery pressure and blood flow as predictors of outcome from lung cancer resection. Respirology 2005; 10:620-8. [PMID: 16268916 DOI: 10.1111/j.1440-1843.2005.00759.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Pulmonary hypertension is a putative risk factor for lung resection but catheter measurements are invasive. The aim of the present study was to assess prediction of mortality and complications from lung resection by Doppler echocardiographic estimates of pulmonary artery pressure (PAp) and soluble gas uptake estimates of effective pulmonary blood flow (Q(RB)). METHODOLOGY In 33 lung cancer patients, resting PAp (sys) and Q(RB) were measured preoperatively. In 13 patients, supine exercise estimates of PAp (sys) were also made and in five patients catheter PAp estimates were made. RESULTS Baseline PAp (sys) was 35 +/- 5 mmHg in four patients who died and 35 +/- 5 mmHg in 27 survivors. Post-exercise PAp (sys) was 58 +/- 11 mmHg in non-survivors and 60 +/- 11 mmHg in survivors (both not significant). Resting Q(RB) was 3.9 +/- 0.35 L/min in two non-survivors compared with 4.7 +/- 0.90 L/min in 22 survivors (P = 0.12) and was significantly lower in those experiencing complications. Regression analysis showed no significant relationship between resting or post-exercise PAp and mortality, although low Q(RB) tended towards predicting mortality (P = 0.07). There were also trends for higher PAp (sys) to predict respiratory and cardiac complications (P = 0.08) and for lower Q(RB) to predict unspecified or surgical complications. CONCLUSION PAp and Q(RB) did not predict outcome from lung resection better than baseline respiratory function indices.
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Affiliation(s)
- Robert J Pierce
- Department of Respiratory, The University of Melbourne, Victoria, Australia.
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Compton CN, Dillavou ED, Sheehan MK, Rhee RY, Makaroun MS. Is abdominal aortic aneurysm repair appropriate in oxygen-dependent chronic obstructive pulmonary disease patients? J Vasc Surg 2005; 42:650-3. [PMID: 16242549 DOI: 10.1016/j.jvs.2005.03.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2004] [Accepted: 03/30/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND The life expectancy of patients with oxygen-dependent chronic obstructive pulmonary disease (COPD) is significantly reduced, but the risk of any intervention is considered prohibitive. However, severe COPD may increase the risk of abdominal aortic aneurysm (AAA) rupture. We reviewed our experience with AAA repair in oxygen-dependent patients to determine whether operative risk and expected long-term survival justify surgical intervention. METHODS A retrospective review of 44 consecutive patients with oxygen-dependent COPD undergoing AAA repair over an 8-year period was performed. Information was recorded for survival, length of follow-up, patient age, medical comorbidities, pulmonary function tests, and operative approach. Survival data were analyzed by Kaplan-Meier curves and compared with published cohorts of oxygen-dependent patients and the natural history of untreated aneurysms. RESULTS Twenty-four patients underwent endovascular aneurysm repair (EVAR), and 20 underwent open procedures (14 retroperitoneal and 6 transabdominal). The mean AAA diameter was 6.1 cm (range, 5-9.5 cm). The mean age was 71.4 years, and 82% of patients were male. Operative mortality was 0%. The mean length of stay was 11.2 days for open procedures and 4.3 days for EVAR (significantly longer than that for standard-risk patients). The mean survival time was 37.9 months (range, 2-91 months). Preoperative medical comorbidities, type of repair, and pulmonary function tests were not predictive of survival. Postoperative morbidity was significantly higher with open repair. Long term survival was comparable to historical series of the natural history of O2 dependent patients without AAA but better than untreated 6 cm AAA cohorts. At 42 months, almost 50% of patients in our study group were still alive, compared to 20% survival at 34 months for those with untreated 6 cm AAAs. CONCLUSIONS It is reasonable to continue to offer AAA repair to home oxygen-dependent COPD patients who are ambulatory and medically optimized and who are without untreated coronary artery disease. Although EVAR may be the most suitable treatment for oxygen-dependent COPD patients, our results show that even open repair may be safely performed in this population, with acceptable results.
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Affiliation(s)
- Christopher N Compton
- Division of Vascular Surgery, University of Pittsburgh Medical Center, PA 15213, USA.
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Abstract
Sex determination and gametogenesis are key processes in human reproduction, and any defect can lead to infertility. We describe here the molecular mechanisms of male sex determination and testis formation; defects in sex determination lead to a female phenotype despite the presence of a Y chromosome, more rarely to a male phenotype with XX chromosomes, or to intersex phenotypes. Interestingly, these phenotypes are often associated with other developmental malformations. In testis, spermatozoa are produced from renewable stem cells in a complex differentiation process called spermatogenesis. Gene expression during spermatogenesis differs to a surprising degree from gene expression in somatic cells, and we discuss here mechanistic differences and their effect on the differentiation process and male fertility.
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Affiliation(s)
- L. Ronfani
- San Raffaele Scientific Institute and San Raffaele University, via Olgettina 58, 20132 Milan, Italy
| | - M. E. Bianchi
- San Raffaele Scientific Institute and San Raffaele University, via Olgettina 58, 20132 Milan, Italy
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Cetindag IB, Olson W, Hazelrigg SR. Acute and chronic reduction of pulmonary function after lung surgery. Thorac Surg Clin 2004; 14:317-23. [PMID: 15382763 DOI: 10.1016/s1547-4127(04)00019-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Pulmonary function is affected by several variables. The more marginal the patient, the more important the preoperative and perioperative assessment becomes. VATS might be tolerated well with regard to pulmonary function in the early postoperative period. It has allowed thoracic surgeons to expand surgical indications to patients that previously would not have been considered.
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Affiliation(s)
- Ibrahim Bulent Cetindag
- Division of General Surgery, Southern Illinois University School of Medicine, 800 North Rutledge, Room D319, Springfield, IL 62702, USA
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Abstract
OBJECTIVE Often, the critically ill are not optimized in terms of their chronic diseases and are with little physiologic reserves. DATA SOURCES This article contains a review of the pathophysiology of the major preexisting and chronic pulmonary disease encountered in the critically ill, such as asthma, emphysematous disease, and chronic bronchitis. It also includes a summary of other significant disease processes such as acute respiratory disease syndrome, cigarette smoking, and pulmonary alveolar proteinosis and the implications of obesity and obstructive sleep apnea. When confronted with critical illness, the morbidity is magnified. Close observation of patients for evidence that the underlying disease may complicate their pulmonary status, and vice versa, creates an environment where the whole patient can heal and recover from illness. CONCLUSION The aim of the intensive care unit team should be recognition of the patient at risk, use of necessary therapies (i.e., bronchodilators) as early as feasible, and treatment titrated to realistic endpoints as the acute illness progresses and subsequently resolves.
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Affiliation(s)
- Paul C Tamul
- Section of Critical Care Medicine, Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Jules-Elysee K, Urban MK, Urquhart BL, Susman MH, Brown AC, Kelsey WT. Pulmonary complications in anterior-posterior thoracic lumbar fusions. Spine J 2004; 4:312-6. [PMID: 15125855 DOI: 10.1016/j.spinee.2003.11.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2003] [Accepted: 11/19/2003] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Surgery for adult spinal deformity may require both an anterior and posterior approach in order to stabilize the spine and achieve the desired correction. These procedures can be associated with significant pulmonary complications, including atelectasis, pneumonia and respiratory failure. The etiology of some of the respiratory complications is clear: poor inspiratory effort from incision pain and previous pulmonary disease. However, for many patients the direct cause of these complications is not obvious. PURPOSE To delineate the incidence, severity and risks associated with pulmonary complications in the setting of major spine surgery. STUDY DESIGN/SETTING Retrospective chart review study of adult patients undergoing combined anterior-posterior thoracic, lumbar and sacral fusion spine surgery. PATIENT SAMPLE A total of 60 charts were reviewed for this study. OUTCOME MEASURES Radiographic abnormalities correlated with clinical findings, postoperative need for ventilation and lengths of hospital stay were used as outcome measures. METHODS Perioperative pulmonary complications were assessed for 60 patients with spinal deformities who underwent combined anterior-posterior thoracic, lumbar and sacral fusion over a 2-year period. RESULTS One patient was eliminated from analysis because of multiple surgeries during his hospital course. Of the remaining 59 patients, 38 (64%) developed roentgenographic abnormalities. The most common radiographic finding was an effusion found in 66% of these patients, followed by atelectasis in 53%. Twenty-one percent (8 of 38) had infiltrates. Five (5 of 38) or 13% had evidence of partial or complete lobar collapse; in two bronchoscopy was required because of profound hypoxemia. Two patients had pneumonia requiring antibiotic treatment. All but two patients were extubated within 36 hours of surgery. They were kept intubated because of hemodynamic instability. There was no statistically significant difference in the group of patients with and without roentgenographic abnormalities with regard to age, weight, American Society of Anesthesiologists class, smoking history, pulmonary function test results, blood loss, perioperative blood and crystalloid requirement and length of surgery. Patients with radiographic abnormalities were more likely to have had invasion of their thoracic cavity (p=.02) and had a longer mean hospital stay of 13.5 versus 10.2 days (p=.009). CONCLUSION Radiographic abnormalities of the lungs are common after major spine surgery involving both an anterior and posterior approach, especially when the thoracic cavity is invaded. In view of the morbidity and longer hospital stay associated with such findings, close monitoring of pulmonary status with aggressive pulmonary toilet are indicated.
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Affiliation(s)
- Kethy Jules-Elysee
- Department of Anesthesiology, The Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY 10021, USA
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Burke JR, Duarte IG, Thourani VH, Miller JI. Preoperative risk assessment for marginal patients requiring pulmonary resection. Ann Thorac Surg 2003; 76:1767-73. [PMID: 14602342 DOI: 10.1016/s0003-4975(03)00650-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Surgical resection remains the mainstay of treatment for pulmonary malignancy. The ability of patients to undergo resection is dependent on the anatomic characteristics of the tumor, and the respiratory and cardiovascular status of the patient. There have been recent advances in our understanding of respiratory function in the patient with marginal lung function that have allowed surgical therapy of lung cancer in patients previously deemed inoperable. This review will define the marginal patients who can safely undergo pulmonary resection.
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Affiliation(s)
- J Ryan Burke
- Department of Surgery, Emory University, School of Medicine, Georgia, Atlanta, USA
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Abstract
Lung cancer continues to be the leading case of cancer deaths in the United States. In patients with resectable non-small cell lung cancer, surgical resection is the treatment of choice. An accurate preoperative general and pulmonary-specific evaluation is essential as postoperative complications and morbidity of lung resection surgery are significant. After confirming anatomic resectability, patients must undergo a thorough evaluation to determine their ability to withstand the surgery and the loss of the resected lung. The measurement of spirometric indexes (ie, FEV(1)) and diffusing capacity of the lung for carbon monoxide (DLCO) should be performed first. If FEV(1) and DLCO are > 60% of predicted, patients are at low risk for complications and can undergo pulmonary resection, including pneumonectomy, without further testing. However, if FEV(1) and DLCO are < 60% of predicted, further evaluation by means of a quantitative lung scan is required. If lung scan reveals a predicted postoperative (ppo) values for FEV(1) and DLCO of > 40%, the patient can undergo lung resection. If the ppo FEV(1) and ppo DLCO are < 40%, exercise testing is necessary. If this reveals a maximal oxygen uptake (O(2)max) of > 15 mL/kg, surgery can be undertaken. If the O(2)max is < 15 mL/kg, surgery is not an option. This review discusses the existing modalities for preoperative evaluation prior to lung resection surgery.
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Affiliation(s)
- Debapriya Datta
- Department of Pulmonary & Critical Care Medicine, St. Francis Hospital & Medical Center, Hartford, CT 06105, USA
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Affiliation(s)
- Katherine P Grichnik
- Department of Anesthesiology, Division of Cardiothoracic Anesthesia, Duke Heart Center, Duke University Health Care Systems, Durham, NC 27710, USA.
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48
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Hsieh CH. Laparoscopic cholecystectomy for patients with chronic obstructive pulmonary disease. J Laparoendosc Adv Surg Tech A 2003; 13:5-9. [PMID: 12676014 DOI: 10.1089/109264203321235395] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
PURPOSE Laparoscopic cholecystectomy (LC) is accepted as a "gold standard" for treating most gallbladder diseases because it is superior to the open method, causes less postoperative pulmonary dysfunction, and promotes earlier postoperative recovery. The laparoscopically associated adverse effects of a carbon dioxide (CO(2)) pneumoperitoneum, however, such as hypercarbia and arterial acidosis, are more pronounced in patients with chronic obstructive pulmonary disease (COPD). The clinical results of LC for patients with COPD are analyzed in this study. METHODS Twenty-two patients with COPD (group 1) and undergoing LC were compared with 25 control patients without COPD and also undergoing LC (group 2). Patient demographics, intraoperative end-tidal CO(2) (both before and after CO(2) insufflation), and clinical outcome, including surgical duration, length of postoperative hospital stay, and any associated complications, were analyzed. RESULTS The procedure of one group 1 patient was converted to the open method, and this patient was excluded from the study. Comprising the COPD group were 20 patients with mild COPD and one patient with moderate COPD. With similar settings of tidal volume and ventilation rate for the two groups, the measured end-tidal CO(2) value was significantly greater for group 1 than for group 2 patients after the creation of a CO(2) pneumoperitoneum (34.2 +/- 2.7 vs. 30.7 +/- 3.6 mm Hg; P =.012). The duration of surgery was similar for groups 1 and 2 (88.9 +/- 36.0 vs. 83.2 +/- 38.3 minutes), as was the duration of the postoperative hospital stay (3.3 +/- 1.6 vs. 3.4 +/- 2.2 days). No pulmonary complications were noted for any of the patients. CONCLUSIONS LC can be safely performed in COPD patients with mild or even a moderate degree of airway obstruction. Intraoperative CO(2) retention did not complicate the postoperative recovery in terms of the complication rate or the duration of the postoperative hospital stay.
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Affiliation(s)
- Chi-Hsun Hsieh
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.
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49
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Abstract
Postoperative pulmonary complications in the elderly are common and are a significant source of morbidity, mortality, and prolonged length of stay. Risk factors differ from the well-known risk factors for cardiac complications and can be divided into patient- and procedure-related factors. Patient-related factors include COPD, recent cigarette use, poor general health status as defined by Goldman or ASA class, dependent functional status, and laboratory parameters including abnormal chest radiograph, renal insufficiency, and low serum albumin. Age is a minor risk factor when adjusted for comorbidities and confers approximately a two-fold increase in risk. Elderly patients who are otherwise acceptable surgical candidates should not be denied surgery based solely on age and concern for postoperative pulmonary complications. The surgical site is the single most important predictor of pulmonary complications. High-risk surgeries include thoracic, upper abdominal, aortic, neurosurgery, and peripheral vascular. Other procedure-related risk factors include surgery lasting longer than 3 hours, the use of general anesthesia, pancuronium use, and emergency surgery. Clinicians should not recommend routine preoperative spirometry before high-risk surgery because it is no more accurate in predicting risk than clinical evaluation. Patients who might benefit from preoperative spirometry include those who have unexplained dyspnea or exercise intolerance and those who have COPD or asthma in whom uncertainty exists as to the status of airflow obstruction when compared with baseline. After identifying patients at risk for postoperative pulmonary complications, clinicians can recommend strategies to reduce risk throughout the operative period. In addition to minimizing or avoiding the above risk factors, optimization of COPD or asthma, deep breathing exercises, incentive spirometry, and epidural local anesthetics reduce the risk of postoperative pulmonary complications in elderly surgical patients.
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Affiliation(s)
- Gerald W Smetana
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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50
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Arozullah AM, Conde MV, Lawrence VA. Preoperative evaluation for postoperative pulmonary complications. Med Clin North Am 2003; 87:153-73. [PMID: 12575888 DOI: 10.1016/s0025-7125(02)00151-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Preoperative risk assessment for postoperative pulmonary complications is essential when counseling patients about the risks of surgery because of their significant associated morbidity and mortality. There are many patient-related, operation-related, and anesthesia-related risk factors for the development of PPCs. Though many of these risk factors are not modifiable, they can be useful in evaluating preoperative risk, especially when combined into formal risk indices. Preoperative risk assessment enables clinicians to target preoperative testing and perioperative risk reduction strategies to high-risk patients. Reducing PPC risk at the patient level will require a greater understanding of the impact of modifying risk factors through interventional trials. Reducing hospital PPC rates will require future research into the processes of care associated with PPCs through controlled observational and interventional trials.
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Affiliation(s)
- Ahsan M Arozullah
- Veterans Affairs Chicago Healthcare System, Westside Division, Chicago, IL, USA.
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