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Yuen HS, Sandeman J, Hone R. The role of overnight pulse oximetry in risk stratification of paediatric sleep disordered breathing in a district general hospital. Int J Pediatr Otorhinolaryngol 2024; 177:111869. [PMID: 38266379 DOI: 10.1016/j.ijporl.2024.111869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/26/2023] [Accepted: 01/10/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVES Adenoidectomy and tonsillectomy are common surgical interventions in paediatric patients with sleep disordered breathing. Post operative respiratory complications are a recognised risk, and pre-operative risk stratification of patients is important to enable safe delivery of peri-operative care. Due to easy accessibility, overnight pulse oximetry is commonly used for this purpose. However, its limitations have been widely reported and recent national guidance recommends limiting use to patients with significant risk factors. We reviewed the use of overnight pulse oximetry in our local unit to determine if local guidelines should be adapted in line with these national recommendations. METHODS Retrospective analysis of all paediatric patients referred for overnight pulse oximetry over an eighteen month period between August 2020 to February 2022. Data collection included patient age, weight, and relevant co-morbidities. The McGill score was used to risk stratify patients and determine the need for an overnight bed. This was then correlated with the occurrence of post operative respiratory complications. RESULTS 200 patients were referred for overnight pulse oximetry, with a mean age of 7.5 years. 7.5 % (15/200) had significant comorbidities. 64 % (128/200) of patients were subsequently listed for surgery. 20.3 % (26/128) were deemed at risk of post-operative complications due to McGill scores of 3 and 4 and planned for overnight ward observation. Of these, 15 % (4/26) were subsequently discharged the same day. None of our patients developed major respiratory complications in the post operative period. CONCLUSION Our findings support national recommendations that overnight pulse oximetry is not an accurate predictor of post-operative respiratory complications and resulted in unnecessary inpatient stays. Following discussion with the trust paediatric anaesthetist lead, our local guidance was tightened, limiting overnight pulse oximetry to children with relevant identifiable co-morbidities.
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Affiliation(s)
- Huay Shan Yuen
- William Harvey Hospital, Kennington Road, Ashford, TN24 0LZ, United Kingdom.
| | - Jack Sandeman
- Leeds General Infirmary, Great George Street, LS1 3EX, United Kingdom
| | - Robert Hone
- William Harvey Hospital, Kennington Road, Ashford, TN24 0LZ, United Kingdom
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Kim M, Ling K, Tantone RP, Al-Humadi S, Wang K, VanHelmond TA, Komatsu DE, Wang ED. Investigating immediate postoperative medical complication risks relative to in-hospital length of stay after total shoulder arthroplasty. JSES Int 2023; 7:2467-2472. [PMID: 37969519 PMCID: PMC10638588 DOI: 10.1016/j.jseint.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background The purpose of this study was to investigate the association between in-hospital length of stay (LOS) and postoperative complication rates within 30 days of total shoulder arthroplasty (TSA). Methods All patients who underwent either anatomic or reverse TSA between 2015 and 2019 were queried from the American College of Surgeons National Surgical Quality Improvement database. The study population was stratified into three cohorts as follows: LOS 0 (same-day discharge), LOS 1 (next-day discharge), and LOS 2-3 (LOS of 2-3 days). Patient demographics and comorbidities were compared between cohorts using bivariate analysis. Multivariate logistic regression analysis was conducted to investigate the relationship between LOS and postoperative complications. Results In comparison to the LOS 0 day cohort, LOS 2-3 day cohort had a greater likelihood of developing overall complication (OR, 2.598; P < .001), major complication (OR, 1.885; P < .001), minor complication (OR: 3.939; P < .001), respiratory complication (OR: 12.979; P = .011), postoperative anemia requiring transfusion (OR, 23.338; P < .001), non-home discharge (OR, 10.430; P < .001), and hospital readmission (OR, 1.700; P = .012). Similarly, in comparison to the LOS 1 cohort, LOS 2-3 cohort had a greater likelihood of developing overall complication (OR: 2.111; P < .001), major complication (OR, 1.423; P < .001), minor complication (OR, 3.626; P < .001), respiratory complication (OR, 2.057; P < .001), sepsis or septic shock (OR: 2.795; P = .008), urinary tract infection (OR, 1.524; P = .031), postoperative anemia requiring transfusion (OR, 10.792; P < .001), non-home discharge (OR: 10.179; P < .001), hospital readmission (OR, 1.395; P < .001), and return to the operating room (OR. 1.394; P = .014). There was no significant difference in the risk of developing postoperative complications between LOS 0 day and LOS 1 day cohort. On baseline, the LOS 1 and LOS 2-3 day cohort had a higher proportion of patients with the following demographics and comorbidities compared to LOS 0 day cohort: advanced age, higher body mass index, female gender, positive smoking status, insulin-dependent diabetes, noninsulin-dependent diabetes, dyspnea at rest and moderate exertion, partially dependent functional status, an American Society of Anesthesiologists classification of 3 or higher, a history of severe chronic obstructive pulmonary disease, a history of congestive heart failure, the use of hypertension medication, disseminated cancer, wound infection, the use of steroids, and a history of bleeding disorder. Conclusion Patients who were discharged on the same and next day following TSA demonstrated a reduced probability of experiencing respiratory complications, infections, postoperative anemia requiring transfusion, non-home discharge, and readmission in comparison to those with a LOS of 2-3 days. There was no difference in postoperative complications between same and nextday discharged patients. Patients who underwent outpatient arthroplasty were healthier at baseline compared to those who underwent inpatient arthroplasty.
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Affiliation(s)
- Matthew Kim
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Kenny Ling
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - Ryan P. Tantone
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - Samer Al-Humadi
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - Katherine Wang
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Taylor A. VanHelmond
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - David E. Komatsu
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - Edward D. Wang
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
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Garnier M, Constantin JM, Cinotti R, Daoui C, Margetis D, Destruhaut G, Cirenei C, Noll E, Quesnel C, Lecinq A, Lasocki S, Charbonneau H, Abrard S, Quemeneur C, Pastene B, Lapidus N, Leone M. Association of preoperative COVID-19 and postoperative respiratory morbidity during the Omicron epidemic wave: the DROMIS-22 multicentre prospective observational cohort study. EClinicalMedicine 2023; 58:101881. [PMID: 36873425 PMCID: PMC9975647 DOI: 10.1016/j.eclinm.2023.101881] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Preoperative COVID-19 has been associated with excess postoperative morbi-mortality. Consequently, guidelines were developed that recommended the postponement of surgery for at least 7 weeks after the infection. We hypothesised that vaccination against the SARS-CoV-2 and the large predominance of the Omicron variant attenuated the effect of a preoperative COVID-19 on the occurrence of postoperative respiratory morbidity. METHODS We conducted a prospective cohort study in 41 French centres between 15 March and 30 May 2022 (ClinicalTrials NCT05336110), aimed at comparing the postoperative respiratory morbidity between patients with and without preoperative COVID-19 within 8 weeks prior to surgery. The primary outcome was a composite outcome combining the occurrence of pneumonia, acute respiratory failure, unexpected mechanical ventilation, and pulmonary embolism within the first 30 postoperative days. Secondary outcomes were 30-day mortality, hospital length-of-stay, readmissions, and non-respiratory infections. The sample size was determined to have 90% power to identify a doubling of the primary outcome rate. Adjusted analyses were performed using propensity score modelling and inverse probability weighting. FINDINGS Of the 4928 patients assessed for the primary outcome, of whom 92.4% were vaccinated against the SARS-CoV-2, 705 had preoperative COVID-19. The primary outcome was reported in 140 (2.8%) patients. An 8-week preoperative COVID-19 was not associated with increased postoperative respiratory morbidity (odds ratio 1.08 [95% CI 0.48-2.13]; p = 0.83). None of the secondary outcomes differed between the two groups. Sensitivity analyses concerning the timing between COVID-19 and surgery, and the clinical presentations of preoperative COVID-19 did not show any association with the primary outcome, except for COVID-19 patients with ongoing symptoms the day of surgery (OR 4.29 [1.02-15.8]; p = 0.04). INTERPRETATION In our Omicron-predominant, highly immunised population undergoing general surgery, a preoperative COVID-19 was not associated with increased postoperative respiratory morbidity. FUNDING The study was fully funded by the French Society of Anaesthesiology and Intensive Care Medicine (SFAR).
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Affiliation(s)
- Marc Garnier
- Sorbonne Université, AP-HP, GRC29, DMU DREAM, Hôpital Tenon, Service d'Anesthésie-Réanimation et Médecine Périopératoire, 4 rue de la Chine, Paris 75020, France
- CHU de Clermont-Ferrand, Université Clermont Auvergne, Service d'Anesthésie-Réanimation et Médecine Périopératoire, 58 rue Montalembert, Clermont-Ferrand 63000, France
| | - Jean-Michel Constantin
- Sorbonne Université, AP-HP, GRC29, DMU DREAM, Hôpital de la Pitié Salpêtrière, Service d'Anesthésie-Réanimation et Médecine Périopératoire, 91boulevard de l'Hôpital, Paris 75013, France
| | - Raphaël Cinotti
- CHU Nantes, Nantes Université, Department of Anaesthesia and Critical Care, Hôtel Dieu, Nantes F-44000, France
- UMR 1246 SPHERE "MethodS in Patients-centered outcomes and HEalth Research", University of Nantes, University of Tours, INSERM, IRS2 22 Boulevard Benoni Goulin, Nantes 44200, France
| | - Chafia Daoui
- SFAR Research Network, Société Française d'Anesthésie Réanimation et médecine péri-opératoire (SFAR), 74 rue Raynouard, Paris 75016, France
| | - Dimitri Margetis
- Sorbonne Université, AP-HP, GRC29, DMU DREAM, Hôpital de la Pitié Salpêtrière, Service d'Anesthésie-Réanimation et Médecine Périopératoire, 91boulevard de l'Hôpital, Paris 75013, France
| | - Grégory Destruhaut
- Clinique du Sport Bordeaux Mérignac, 4 rue Georges Négrevergne, Mérignac 33700, France
| | - Cédric Cirenei
- Pôle d'Anesthésie-Réanimation, Centre Hospitalier Universitaire de Lille, Boulevard du Professeur Jules Leclerc, Lille Cedex 59037, France
| | - Eric Noll
- Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Service d'Anesthésie-Réanimation-Médecine Périopératoire, 1 Avenue Molière, Strasbourg, France
| | - Christophe Quesnel
- Sorbonne Université, AP-HP, GRC29, DMU DREAM, Hôpital Tenon, Service d'Anesthésie-Réanimation et Médecine Périopératoire, 4 rue de la Chine, Paris 75020, France
| | - Agnes Lecinq
- Université Paris-Saclay, APHP, Hôpital Antoine Béclère, Service d'Anesthésie, 157 rue de la Porte de Trivaux, Clamart 92140, France
| | - Sigismond Lasocki
- Department of Anesthesiology and Critical Care Medicine, Centre Hospitalier Universitire d'Angers, 4 rue Larrey, Angers 49100, France
| | - Hélène Charbonneau
- Department of Anesthesiology and Intensive Care Unit, Clinique Pasteur, 45 avenue de Lombez, BP27617, Toulouse Cedex 03 31076, France
| | - Stanislas Abrard
- Department of Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, 5 Place d'Arsonval, Lyon 69003, France
| | - Cyril Quemeneur
- Sorbonne Université, AP-HP, GRC29, DMU DREAM, Hôpital de la Pitié Salpêtrière, Service d'Anesthésie-Réanimation et Médecine Périopératoire, 91boulevard de l'Hôpital, Paris 75013, France
- Department of Anesthesiology, Clinique Drouot Sport, 37 rue Molitor, Paris 75016, France
| | - Bruno Pastene
- Aix Marseille Université, Assistance Publique-Hôpitaux Universitaire de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, Chemin de Bourrely, Marseille 13015, France
| | - Nathanaël Lapidus
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Saint-Antoine Hospital, Public Health Department, Paris F75012, France
| | - Marc Leone
- Aix Marseille Université, Assistance Publique-Hôpitaux Universitaire de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, Chemin de Bourrely, Marseille 13015, France
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Komatsu R, Nash MG, Wu J, Dinges EM, Delgado CM, Bollag LA. Prediction of postoperative respiratory depression and respiratory complications in patients on preoperative methadone. J Anesth 2023; 37:79-91. [PMID: 36352048 DOI: 10.1007/s00540-022-03134-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/29/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE We developed prediction models for postoperative respiratory depression and respiratory complications for 958 patients who were on methadone preoperatively. METHODS The primary outcome was postoperative respiratory depression as defined by respiratory rate < 10/min, oxygen saturation (SpO2) < 90%, or requirement of naloxone for 48 h postoperatively. Secondary outcome was the composite of postoperative respiratory complications. Prediction models for postoperative respiratory depression and respiratory complications were constructed using multivariate logistic regression with preoperative and intraoperative characteristics as the predictors. RESULTS For the multivariate logistic regression model for postoperative respiratory depression, surgery duration (P = 0.005), body mass index (BMI) (P = 0.008), surgery involving digestive system (P = 0.031), and American Society of Anesthesiologists (ASA) physical status ≥ 4 (P = 0.038) were statistically significant predictors. The area under the receiver operating characteristic curve (AUROC) of the model was 0.581 (0.558-0.601) [median (95% confidence interval (CI))] with fivefold cross-validation. For the model for postoperative respiratory complications, surgery duration (P = 0.001), history of hypertension (P = 0.028), surgery involving musculoskeletal system (P < 0.001), surgery involving integumental system (P = 0.034), surgery categorized to miscellaneous therapeutic procedures (P = 0.028), combined general and regional anesthesia (P = 0.033), ASA physical status 3 (P < 0.001), and ASA physical status ≥ 4 (P < 0.001) were statistically significant predictors, and AUROC of the model was 0.726 (0.712-0.737). CONCLUSIONS Multivariate logistic regression models including preoperative, and intraoperative characteristics as the predictors performed poorly to predict postoperative respiratory depression, and moderately for postoperative respiratory complications. Neither model is accurate enough to be subject to clinical use.
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Affiliation(s)
- Ryu Komatsu
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA. .,Department of General Anesthesiology, Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - Michael G Nash
- Department of Statistics, University of Washington, Seattle, WA, USA
| | - Jiang Wu
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Emily M Dinges
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Carlos M Delgado
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Laurent A Bollag
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
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Wei CF, Chung YT. Laryngeal mask airway facilitates a safe and smooth emergence from anesthesia in patients undergoing craniotomy: a prospective randomized controlled study. BMC Anesthesiol 2023; 23:29. [PMID: 36650435 PMCID: PMC9843947 DOI: 10.1186/s12871-023-01972-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/04/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Endotracheal extubation under deep anesthesia (deep extubation) has been proved to present stable hemodynamics and steady intracranial pressure during emergence from anesthesia in patients undergoing craniotomy. This study aims to examine, in comparison with deep extubation, if a laryngeal mask airway (LMA) could provide a safer and smoother emergence from anesthesia in patients undergoing craniotomy. METHODS This prospective randomized controlled study was conducted on patients undergoing elective craniotomy for brain tumors. After the complement of the surgical procedure, the patients had anesthesia maintained with end-tidal sevoflurane concentration 2.5% and also fully regained muscle power (Time Zero), they were randomly assigned to ETT Group (n = 29) for deep extubation or to LMA Group (n = 29), where the endotracheal tube was replaced by a laryngeal mask airway. The primary outcomes were respiratory complications, airway interventions and hemodynamic changes through emergence from anesthesia till 30 min following Time Zero. The secondary outcomes were re-operation incidence in 24 h, stay time in the intensive care unit and postoperative hospital days. RESULTS At 5 min before Time Zero either oxygen partial pressures (PaO2) or carbon dioxide partial pressures (PaCO2) between the two groups were comparable. No significant PaCO2 change was noted in both groups in 5 min after Time Zero, yet there was a remarkably lower PaO2 in ETT Group at that time point, 188.9 (± 71.1) in ETT Group vs 264.4 (± 85.4) in LMA Group. In ETT Group, coughs and snores were considerably more frequent, and thus more interventions were needed to maintain adequate respiration. From Time Zero on, blood pressures (systolic, diastolic and mean) and heart rates in ETT Group were generally higher than those in LMA Group, but the differences were insignificant at all time points except heart rate at 10 min after Time Zero. The secondary outcomes between the two groups were similar. CONCLUSIONS Compared with deep extubation, a LMA, as a temporary airway replacement, facilitates a safer and smoother emergence from anesthesia for patients undergoing craniotomy, in terms of better oxygen saturation, fewer respiratory complications and fewer airway interventions. TRIAL REGISTRATION The study was conducted after receiving approval from Institutional Review Board of Chang Gung Memorial Hospital, Linkou Branch, Taiwan (registration number 202102115A3; January 27, 2022), and the clinicaltrials.gov (NCT05253404) on 23 February 2022.
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Affiliation(s)
- Cheng-Fong Wei
- Deparment of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fushin St. Kweishan District, 33305 Taoyuan City, Taiwan
| | - Yung-Tai Chung
- Deparment of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fushin St. Kweishan District, 33305 Taoyuan City, Taiwan
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Hosseini H, Ayatollahi V, Rahimianfar AA, Rahimianfar F. The Effect of Low-Dose of Propofol on the Respiratory Complications Immediately After Tracheal Extubation in Children Undergoing Tonsillectomy. Indian J Otolaryngol Head Neck Surg 2022; 74:5147-5150. [PMID: 36742760 PMCID: PMC9895254 DOI: 10.1007/s12070-021-03037-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 12/07/2021] [Indexed: 02/07/2023] Open
Abstract
The aim of this study was to determine the effect of low-dose propofol on the respiratory complications immediately after tracheal extubation in children undergoing tonsillectomy. In this randomized double blinded clinical trial study, 70 children (2-12) years old with ASA class I undergoing elective tonsillectomy involved. General anesthesia was performed by the same anesthesiologist and in the same way. The patients were then intubated with oxygen after 3 min of ventilation. After the surgery and muscle relaxant injection and before extubation, 0.5 mg propofol/kg was injected into the intervention group. The control group received normal saline. Finally, the presence of post-extubation laryngospasm, cough and nausea and vomiting was recorded and all data analyzed between two groups. There was no significant difference in age (p value = 0.425), gender (p value = 0.851), cough (p value = 0.239), nausea (p value = 1) and weight (p value = 0.624) between two groups. There was a significant different in incidence of laryngospasm between two groups (p value = 0.04). It can be concluded that the administration of 0.5 mg/kg of propofol before extubation could prevent laryngospasm in patients undergoing tonsillectomy, without inducing any side effects.
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Affiliation(s)
- Habibollah Hosseini
- Department of Anesthesiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Vida Ayatollahi
- Department of Anesthesiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ali Akbar Rahimianfar
- MSc in Critical Care Nursing, Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Fatemeh Rahimianfar
- Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Reiter AJ, Ingram MCE, Raval MV, Garcia E, Hill M, Aranda A, Chandler NM, Gonzalez R, Born K, Mack S, Lamoshi A, Lipskar AM, Han XY, Fialkowski E, Spencer B, Kulaylat AN, Barde A, Shah AN, Adoumie M, Gross E, Mehl SC, Lopez ME, Polcz V, Mustafa MM, Gander JW, Sullivan TM, Sulkowski JP, Ghani O, Huang EY, Rothstein D, Muenks EP, St. Peter SD, Fisher JC, Levy-Lambert D, Reichl A, Ignacio RC, Slater BJ, Tsao K, Berman L. Postoperative respiratory complications in SARS-CoV-2 positive pediatric patients across 20 United States hospitals: A Cohort Study. J Pediatr Surg 2022:S0022-3468(22)00716-3. [PMID: 36428183 PMCID: PMC9632239 DOI: 10.1016/j.jpedsurg.2022.10.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/20/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Data examining rates of postoperative complications among SARS-CoV-2 positive children are limited. The purpose of this study was to evaluate the impact of symptomatic and asymptomatic SARS-CoV-2 positive status on postoperative respiratory outcomes for children. METHODS This retrospective cohort study included SARS-CoV-2 positive pediatric patients across 20 hospitals who underwent general anesthesia from March to October 2020. The primary outcome was frequency of postoperative respiratory complications, including: high-flow nasal cannula/non invasive ventilation, reintubation, pneumonia, Extracorporeal Membrane Oxygenation (ECMO), and 30-day respiratory-related readmissions or emergency department (ED) visits. Univariate analyses were used to evaluate associations between patient and procedure characteristics and stratified analyses by symptoms were performed examining incidence of complications. RESULTS Of 266 SARS-CoV-2 positive patients, 163 (61.7%) were male, and the median age was 10 years (interquartile range 4-14). The majority of procedures were emergent or urgent (n = 214, 80.5%). The most common procedures were appendectomies (n = 78, 29.3%) and fracture repairs (n = 40,15.0%). 13 patients (4.9%) had preoperative symptoms including cough or dyspnea. 26 patients (9.8%) had postoperative respiratory complications, including 15 requiring high-flow oxygen, 8 with pneumonia, 4 requiring non invasive ventilation, 3 respiratory ED visits, and 2 respiratory readmissions. Respiratory complications were more common among symptomatic patients than asymptomatic patients (30.8% vs. 8.7%, p = 0.01). Higher ASA class and comorbidities were also associated with postoperative respiratory complications. CONCLUSIONS Postoperative respiratory complications are less common in asymptomatic versus symptomatic SARS-COV-2 positive children. Relaxation of COVID-19-related restrictions for time-sensitive, non urgent procedures in selected asymptomatic patients may be reasonably considered. Additionally, further research is needed to evaluate the costs and benefits of routine testing for asymptomatic patients. LEVEL OF EVIDENCE Iii, Respiratory complications.
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Affiliation(s)
- Audra J. Reiter
- Division of Pediatric Surgery, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, 633N. St. Clair St., 20th floor, Chicago, IL 60611, United States,Corresponding author
| | - Martha-Conley E. Ingram
- Division of Pediatric Surgery, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, 633N. St. Clair St., 20th floor, Chicago, IL 60611, United States
| | - Mehul V. Raval
- Division of Pediatric Surgery, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, 633N. St. Clair St., 20th floor, Chicago, IL 60611, United States
| | - Elisa Garcia
- Division of Pediatric Surgery, Department of Surgery, McGovern Medical School at University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston TX, United States
| | - Madelyn Hill
- Division of Pediatric Surgery, Dayton Children's Hospital, Wright State University, Dayton, OH, United States
| | - Arturo Aranda
- Division of Pediatric Surgery, Dayton Children's Hospital, Wright State University, Dayton, OH, United States
| | - Nicole M Chandler
- Division of Pediatric Surgery, Department of Surgery, John's Hopkins All Children's Hospital, St. Petersburg, FL, United States
| | - Raquel Gonzalez
- Division of Pediatric Surgery, Department of Surgery, John's Hopkins All Children's Hospital, St. Petersburg, FL, United States
| | - Kristen Born
- Division of Pediatric Surgery, Department of Surgery, Nemours Children's Hospital - Delaware, Wilmington DE, United States
| | - Shale Mack
- Division of Pediatric Surgery, Department of Surgery, Nemours Children's Hospital - Delaware, Wilmington DE, United States
| | - Abdulraouf Lamoshi
- Department of Pediatric Surgery, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, United States
| | - Aaron M. Lipskar
- Department of Pediatric Surgery, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, United States
| | - Xiao-Yue Han
- Division of Pediatric Surgery, Department of Surgery, OHSU School of Medicine, Doernbecher Children's Hospital, Portland, OR, United States
| | - Elizabeth Fialkowski
- Division of Pediatric Surgery, Department of Surgery, OHSU School of Medicine, Doernbecher Children's Hospital, Portland, OR, United States
| | - Brianna Spencer
- Division of Pediatric Surgery, Department of Surgery, Penn State Children's Hospital, Hershey, PA, United States
| | - Afif N. Kulaylat
- Division of Pediatric Surgery, Department of Surgery, Penn State Children's Hospital, Hershey, PA, United States
| | - Amrene Barde
- Division of Pediatric Surgery, Department of Surgery, Rush University, Chicago, IL, United States
| | - Ami N. Shah
- Division of Pediatric Surgery, Department of Surgery, Rush University, Chicago, IL, United States
| | - Maeva Adoumie
- Division of Pediatric Surgery, Department of Surgery, Stony Brook Children's Hospital, Stony Brook, NY, United States
| | - Erica Gross
- Division of Pediatric Surgery, Department of Surgery, Stony Brook Children's Hospital, Stony Brook, NY, United States
| | - Steven C. Mehl
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston TX, United States
| | - Monica E. Lopez
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital, Nashville TN, United States
| | - Valerie Polcz
- Division of Pediatric Surgery, Department of Surgery, UF Health, University of Florida, Gainesville, FL, United States
| | - Moiz M. Mustafa
- Division of Pediatric Surgery, Department of Surgery, UF Health, University of Florida, Gainesville, FL, United States
| | - Jeffrey W. Gander
- Division of Pediatric Surgery, Department of Surgery, UVA Children's Hospital, Charlottesville, VA, United States
| | - Travis M. Sullivan
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital of Richmond at VCU, Richmond VA, United States
| | - Jason P. Sulkowski
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital of Richmond at VCU, Richmond VA, United States
| | - Owais Ghani
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital, Nashville TN, United States
| | - Eunice Y. Huang
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital, Nashville TN, United States
| | - David Rothstein
- Division of Pediatric Surgery, Department of Surgery, Seattle Children's Hospital, Seattle WA, United States
| | - E. Peter Muenks
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Kansas City, Kansas City MO, United States
| | - Shawn D. St. Peter
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Kansas City, Kansas City MO, United States
| | - Jason C. Fisher
- Division of Pediatric Surgery, Department of Surgery, Hassenfeld Children's Hospital at NYU Langone, New York City, NY, United States
| | - Dina Levy-Lambert
- Division of Pediatric Surgery, Department of Surgery, Hassenfeld Children's Hospital at NYU Langone, New York City, NY, United States
| | - Allison Reichl
- Division of Pediatric Surgery, Department of Surgery, Rady Children's Hospital, University of California San Diego School of Medicine, San Diego, CA, United States
| | - Romeo C. Ignacio
- Division of Pediatric Surgery, Department of Surgery, Rady Children's Hospital, University of California San Diego School of Medicine, San Diego, CA, United States
| | - Bethany J. Slater
- Division of Pediatric Surgery, Department of Surgery, Comer Children's Hospital, University of Chicago, Chicago, IL, United States
| | - KuoJen Tsao
- Division of Pediatric Surgery, Department of Surgery, McGovern Medical School at University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston TX, United States
| | - Loren Berman
- Division of Pediatric Surgery, Department of Surgery, Nemours Children's Hospital - Delaware, Wilmington DE, United States
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8
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Tazerout S, Martinez O, Monsonis B, Millet I, Taourel P, Capdevila X, Charbit J. Acute post-traumatic muscle atrophy on CT scan predicts prolonged mechanical ventilation and a worse outcome in severe trauma patients. Injury 2022; 53:2501-10. [PMID: 35613963 DOI: 10.1016/j.injury.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/23/2022] [Accepted: 05/06/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of present study was to assess the association between acute post-traumatic atrophy (APTMA) determined on psoas computed tomography [CT] scan and the duration of mechanical ventilation and outcomes in severe trauma patients. METHODS A retrospective analysis of severe trauma patients (Injury Severity Score [ISS], >15) hospitalized in the intensive care unit (ICU) for more than 7 days between January 2010 and December 2015 was performed. The psoas muscle index (PMI) was measured on admission and at delayed CT scan. ΔPMI was calculated as the percentage PMI loss between these two scans. Three groups were defined and compared a posteriori using the quartiles of the ΔPMI values: low (lower quartile), moderate, and severe (higher quartile) APTMA groups. Linear regression analysis was performed to predict the duration of mechanical ventilation, of catecholamines, length of stay (LOS) in the ICU and hospital, and complications were assessed. RESULTS A total of 114 trauma patients were included (median age, 40 years; [IQR, 25-54 years]; ISS, 33 [IQR, 25-41]). Based on the ΔPMI determination, 29 patients were allocated in the low APTMA group (range ∆PMI, 0%-6%), 56 in the moderate APTMA group (range ∆PMI, 6%-18%), and 29 in the APTMA group (range ∆PMI, ≥19%). Severity of APTMA was significantly associated with the duration of mechanical ventilation and catecholamines, ICU and hospital LOS (P<0.001). Delayed pneumonia (P=0.006) and other delayed infections (P=0.014), as well as thromboembolic events (P=0.04) were statistically associated with the severity of APTMA, whereas mortality did not differ between the three groups (P=0.20). Using linear regression analysis, each ∆PMI increase of 1% was significantly associated with 0.90 supplementary days of mechanical ventilation (P<0.001), 0.29 supplementary days of catecholamines (P<0.001) and 0.82 supplementary days of hospitalization (P<0.001). All these statistical associations were confirmed in multivariate analysis (P<0.001). CONCLUSION Acute muscle atrophy diagnosed on CT scan by psoas area measurement (ΔPMI) was strongly associated with poor outcomes in severe trauma patients.
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Birrer DL, Kuemmerli C, Obwegeser A, Liebi M, von Felten S, Pettersson K, Horisberger K. INSPIRA: study protocol for a randomized-controlled trial about the effect of spirometry-assisted preoperative inspiratory muscle training on postoperative complications in abdominal surgery. Trials 2022; 23:473. [PMID: 35672861 PMCID: PMC9172146 DOI: 10.1186/s13063-022-06254-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/29/2022] [Indexed: 11/28/2022] Open
Abstract
Background Rehabilitation strategies after abdominal surgery enhance recovery and improve outcome. A cornerstone of rehabilitation is respiratory physiotherapy with inspiratory muscle training to enhance pulmonary function. Pre-habilitation is the process of enhancing functional capacity before surgery in order to compensate for the stress of surgery and postoperative recovery. There is growing interest in deploying pre-habilitation interventions prior to surgery. The aim of this study is to assess the impact of preoperative inspiratory muscle training on postoperative overall morbidity. The question is, whether inspiratory muscle training prior to elective abdominal surgery reduces the number of postoperative complications and their severity grade. Methods We describe a prospective randomized-controlled single-centre trial in a tertiary referral centre. The primary outcome is the Comprehensive Complication Index (CCI) at 90 days after surgery. The CCI expresses morbidity on a continuous numeric scale from 0 (no complication) to 100 (death) by weighing all postoperative complications according to the Clavien-Dindo classification for their respective severity. In the intervention group, patients will be instructed by physiotherapists to perform inspiratory muscle training containing of 30 breaths twice a day for at least 2 weeks before surgery using Power®Breathe KHP2. Depending on the surgical schedule, training can be extended up to 6 weeks. In the control group, no preoperative inspiratory muscle training will be performed. After the operation, both groups receive the same physiotherapeutic support. Discussion Existing data about preoperative inspiratory muscle training on postoperative complications are ambiguous and study protocols are often lacking a clear design and a clearly defined endpoint. Most studies consist of multi-stage concepts, comprehensively supervised and long-term interventions, whose implementation in clinical practice is hardly possible. There is a clear need for randomized-controlled studies with a simple protocol that can be easily transferred into clinical practice. This study examines the effortless adjustment of the common respiratory physiotherapy from currently postoperative to preoperative. The external measurement by the device eliminates the diary listing of patients’ performances and allows the exercise adherence and thus the effect to be objectively recorded. Trial registration ClinicalTrials.govNCT04558151. Registered on September 15, 2020.
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Affiliation(s)
- D L Birrer
- Department of Transplantation and Surgery, University Hospital of Zurich, Zurich, Switzerland.
| | - C Kuemmerli
- Department of Surgery, Clarunis-University Centre for Gastrointestinal and Liver Diseases Basel, Basel, Switzerland
| | - A Obwegeser
- Department of Physiotherapy and Occupational Therapy, University Hospital of Zurich, Zurich, Switzerland
| | - M Liebi
- Department of Physiotherapy and Occupational Therapy, University Hospital of Zurich, Zurich, Switzerland
| | - S von Felten
- Department of Biostatistics, Epidemiology and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - K Pettersson
- Department of Transplantation and Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - K Horisberger
- Department of Transplantation and Surgery, University Hospital of Zurich, Zurich, Switzerland.,Department of Surgery and Transplantation, University Hospital Mainz, Mainz, Germany
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10
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James A, De Jong A, Jeanmougin T, Blanie A, Figueiredo S, Goffin P, Le Guen M, Kantor E, Cipriani F, Campion S, Raux M, Jaber S, Futier E, Constantin JM. Characteristics and outcomes of patients undergoing anesthesia while SARS-CoV-2 infected or suspected: a multicenter register of consecutive patients. BMC Anesthesiol 2022; 22:46. [PMID: 35164679 PMCID: PMC8842968 DOI: 10.1186/s12871-022-01581-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/25/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND There are limited data to detail the perioperative anesthetic management and the incidence of postoperative respiratory complications among patients requiring an anesthetic procedure while being SARS-CoV-2 positive or suspected. METHODS An observational multicenter cohort study was performed including consecutive patients who were SARS-CoV-2 confirmed or suspected and who underwent scheduled and emergency anesthesia between March 17 and May 26, 2020. RESULTS A total of 187 patients underwent anesthesia with SARS-CoV-2 confirmed or suspected, with ultimately 135 (72.2%) patients positive and 52 (27.8%) negative. The median SOFA score was 2 [0; 5], and the median ARISCAT score was 49 [36; 67]. The major respiratory complications rate was 48.7% (n = 91) with 40.4% (n = 21) and 51.9% (n = 70) in the SARS-CoV-2-negative and -positive groups, respectively (p = 0.21). Among both positive and negative groups, patients with a high ARISCAT risk score (> 44) had a higher risk of presenting major respiratory complications (p < 0.01 and p = 0.1, respectively). DISCUSSION When comparing SARS-COV-2-positive and -negative patients, no significant difference was found regarding the rate of postoperative complications, while baseline characteristics strongly impact these outcomes. This finding suggests that patients should be scheduled for anesthetic procedures based on their overall risk of postoperative complication, and not just based on their SARS-CoV-2 status.
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Affiliation(s)
- Arthur James
- Département d'Anesthésie Réanimation, Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, 75013, Paris, France.
| | - Audrey De Jong
- Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, 9214CEDEX 5, Montpellier, France
| | - Thomas Jeanmougin
- Département d'Anesthésie Réanimation, Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, 75013, Paris, France
| | - Antonia Blanie
- Department of Anesthesiology and Intensive Care Unit, Kremlin Bicêtre, France
| | - Samy Figueiredo
- Department of Anesthesiology and Intensive Care Unit, Kremlin Bicêtre, France
| | - Pierre Goffin
- Department of Anesthesiology and Critical Care, Groupe Santé CHC, MontLegia Hospital, Liège, Belgium
| | - Morgan Le Guen
- Department of Anesthesiology and Pain Medicine, University of Versailles Saint Quentin, Hôpital Foch, Suresnes, France
| | - Elie Kantor
- Department of Anesthesia and Surgical Critical Care, DMU PARABOL, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Flora Cipriani
- Department of Anesthesiology and Critical Care, Hôpital Beaujon, Clichy, France
| | - Sébastien Campion
- Département d'Anesthésie Réanimation, Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, 75013, Paris, France
| | - Mathieu Raux
- Département d'Anesthésie Réanimation, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Sorbonne Université, 75013, Paris, France
| | - Samir Jaber
- Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, 9214CEDEX 5, Montpellier, France
| | - Emmanuel Futier
- Département de Médecine Périopératoire, Anesthésie Et Réanimation, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France.,GReD; UMR/CNRS6293; INSERM U1103, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Jean-Michel Constantin
- Département d'Anesthésie Réanimation, Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, 75013, Paris, France
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11
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Starke H, Canadas KT, Minard CG, Kancherla BS, Kapoor R, Handley MM, Zelisko MB, Ryan LW, Baijal RG. Can pediatric sleep questions be incorporated into a risk model to predict respiratory complications following adenotonsillectomy? Int J Pediatr Otorhinolaryngol 2022; 153:111015. [PMID: 34973525 DOI: 10.1016/j.ijporl.2021.111015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/02/2021] [Accepted: 12/25/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Adenotonsillectomy, one of the most frequent surgical procedures in children, is usually performed for sleep-disordered breathing, a disease spectrum from primary snoring to obstructive sleep apnea. Children undergoing an adenotonsillectomy may be at risk for perioperative respiratory complications, necessitating intervention or escalation of care. However, there is no effective preoperative screening or risk-stratification model for perioperative respiratory complications that incorporates not only clinical history and physical examination but also sleep question responses for children as there is for adults. OBJECTIVES The aim of this prospective observational study was to develop a risk-stratification model for perioperative respiratory complications in children undergoing an adenotonsillectomy incorporating not only clinical history and physical examination but also sleep question responses. METHODS A 25-question sleep questionnaire was prospectively administered preoperatively for 1895 children undergoing an adenotonsillectomy from November 2015 to December 2017. The primary outcome measure was overall perioperative respiratory complications, collected prospectively and defined as having at least one major or minor complication intraoperatively or postoperatively. RESULTS The incidence of overall perioperative respiratory complications was 20.4%. Preoperative factors associated with perioperative respiratory complications in the multiple regression model were age, race, preoperative tonsil size, the presence of a syndrome, and the presence of a pulmonary disease. None of the sleep questionnaire responses remained in the multivariable analysis. The area under the ROC curve for the risk stratification model incorporating sleep question responses was only 0.6114% (95% CI: 0.60, 0.67). CONCLUSION Preoperative sleep question responses may be unable to predict overall perioperative respiratory complications in children undergoing an adenotonsillectomy. A robust risk stratification model incorporating sleep question responses with clinical history and physical examination was unable to discriminate or predict perioperative respiratory complications in our population undergoing an adenotonsillectomy.
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12
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Kandregula S, Birk HS, Savardekar A, Newman WC, Beyl R, Trosclair K, Guthikonda B, Sin A. Spinal Fractures in Ankylosing Spondylitis: Patterns, Management, and Complications in the United States - Analysis of Latest Nationwide Inpatient Sample Data. Neurospine 2022; 18:786-797. [PMID: 35000333 PMCID: PMC8752689 DOI: 10.14245/ns.2142712.356] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/13/2021] [Indexed: 11/19/2022] Open
Abstract
Objective Ankylosing spondylitis (AS) is a rheumatic inflammatory disease marked by chronic inflammation of the axial skeleton. This condition, particularly when severe, can lead to increased risk of vertebral fractures attributed to decreased ability of the stiffened spinal column to sustain normal loads. However, little focus has been placed on understanding the locations of spinal fractures and associated complications and assessing the correlation between these. In this review, we aim to summarize the complications and treatment patterns in the United States in AS patients with spinal fractures, using the latest Nationwide Inpatient Sample (NIS) database (2016–2018).
Methods We analyzed the NIS data of years 2016–2018 to compare the fracture patterns and complications.
Results A total of 5,385 patients were included. The mean age was 71.63 years (standard deviation [SD], 13.21), with male predominance (83.8%). The most common population is Whites (77.4%), followed by Hispanics (7.9%). The most common fracture level was thoracic level (58.3%), followed by cervical level (38%). Multiple fracture levels were found in 13.3% of the patients. Spinal cord injury (SCI) was associated with 15.8% of the patients. The cervical level had a higher proportion of SCI (26.5%), followed by thoracic level (9.2%). The mean Elixhauser comorbidity score was 4.82 (SD, 2.17). A total of 2,365 patients (43.9%) underwent surgical treatment for the fractures. The overall complication rate was 40.8%. Respiratory complications, including pneumonia and respiratory insufficiency, were the predominant complications in the overall cohort. Based on the regression analysis, there was no significant difference (p=0.45) in the complication rates based on the levels. The presence of SCI increased the odds of having a complication by 2.164 times (95% confidence interval, 1.722–2.72; p≤0.001), and an increase in Elixhauser comorbidity score predicted the complication and in-hospital mortality rate (p≤0.001).
Conclusion AS patients with spinal fractures have higher postoperative complications than the general population. The most common fracture location was thoracic in our study, although it differs with few studies, with SCI occurring in 1/6th of the patients.
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Affiliation(s)
- Sandeep Kandregula
- Department of Neurosurgery, Ochsner LSU Health Shreveport, Shreveport, LA, USA
| | - Harjus S Birk
- Department of Neurosurgery, Ochsner LSU Health Shreveport, Shreveport, LA, USA
| | - Amey Savardekar
- Department of Neurosurgery, Ochsner LSU Health Shreveport, Shreveport, LA, USA
| | | | - Robbie Beyl
- Department of Statistics, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Krystle Trosclair
- Department of Neurosurgery, Ochsner LSU Health Shreveport, Shreveport, LA, USA
| | - Bharat Guthikonda
- Department of Neurosurgery, Ochsner LSU Health Shreveport, Shreveport, LA, USA
| | - Anthony Sin
- Department of Neurosurgery, Ochsner LSU Health Shreveport, Shreveport, LA, USA
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13
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Liu Y, Fu M, Zhou Q, Tian M, Zhang X, Wang Z. The application of patient-centered care bundle significantly reduces incidence of perioperative respiratory complications in hip fracture patients aged 80 and over. Geriatr Nurs 2021; 43:213-218. [PMID: 34929520 DOI: 10.1016/j.gerinurse.2021.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 01/07/2023]
Abstract
This study was designed as a pilot test to analyze the effect of patient-centered care (PCC) bundle intervention on perioperative respiratory complications and other outcomes in hip fracture patients aged ≥80. Between Jan 2018 and Dec 2019, 198 patients comprised the routine care group and 187 comprised the PCC bundle group. After propensity score matching, 151 remained in each group. Incidence of perioperative respiratory complications in the PCC bundle group was significantly lower than in the routine care group (all P < 0.05). Furthermore, significant reductions were observed in surgery delay, length of stay, incidence of arrhythmia, hypoproteinemia, and electrolyte disturbance (all P < 0.05) in the PCC bundle group. Age-Adjusted Charlson Comorbidity Index score was related, but only weakly, to length of stay and the number of perioperative complications. These results suggested that the PCC bundle might be a more suitable care modality for patients ≥80 with hip fracture.
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Affiliation(s)
- Yan Liu
- The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P.R. China
| | - Mingming Fu
- Department of Geriatric Orthopedics, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P.R. China
| | - Qi Zhou
- Department of Geriatric Orthopedics, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P.R. China
| | - Miao Tian
- Department of Geriatric Orthopedics, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P.R. China
| | - Xiuguo Zhang
- The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P.R. China.
| | - Zhiqian Wang
- Department of Geriatric Orthopedics, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P.R. China.
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14
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Caetta A, Timashpolsky A, Tominaga SM, D'Souza N, Goldstein NA. Postoperative respiratory complications after adenotonsillectomy in children with obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2021; 148:110835. [PMID: 34280801 DOI: 10.1016/j.ijporl.2021.110835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/20/2021] [Accepted: 07/11/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Children with obstructive sleep apnea are considered high risk for postoperative respiratory complications, but opinions differ regarding the polysomnography (PSG) criteria that suggest the need for postoperative admission. Our objective was to determine if otherwise healthy children age ≥3 years with an apnea-hypopnea index (AHI) < 24 on overnight PSG can be safely discharged on the same day of surgery. METHODS Case series with chart review of children age <18 years with positive PSG (AHI > 2) who underwent adenotonsillectomy (T&A) between January 2013 and August 2019. Data collected included patient demographics, medical history, comorbidities, PSG results, operative details, length of stay, intraoperative and postoperative respiratory complications and management. Potential predictors of respiratory complications were evaluated using chi-square/Fisher's exact test and 2-tailed unpaired t tests with the Bonferroni adjustment for multiple comparison artifact. The percentages of healthy children age ≥3 years who were discharged on the day of surgery at various PSG cutoffs were calculated. RESULTS Of the 560 children, mean (SD) age was 6.4 (3.7) years, 318 (56.8%) were male, 438 (78.2%) were African American, 243 (43.4%) were obese, 16 (2.9%) had Down Syndrome and 12 (2.1%) had sickle cell disease. Median (range) AHI was 12.3 (2-145). Fifteen children (2.7% [95% CI 1.3, 4.0]) had an intraoperative or postoperative respiratory complication. Minor complications including mild desaturation, stridor, croupy cough, and laryngospasm occurred in 9 patients and did not prolong the planned ambulatory or hospital stay. Of the 6 children with more severe complications including prolonged desaturation, tachypnea, atelectasis, intercostal retraction and obstructive apnea requiring continuous positive airway pressure, all were planned admissions based on age, severe sleep study indices (AHI ≥ 24 or oxygen saturation nadir < 80%) or underlying medical condition. Of the 165 children age ≥3 without medical comorbidities known to be predictive of postoperative complications with an AHI ≥10 but <24, 113 (68.5%) were discharged home on the same day of surgery without additional respiratory sequelae. CONCLUSIONS This study demonstrates a low risk of respiratory complications after T&A. Otherwise healthy children age ≥3 years with AHI <24 may be considered for ambulatory discharge.
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Affiliation(s)
- Alfonso Caetta
- Division of Pediatric Otolaryngology, SUNY Downstate Medical Center, 450 Clarkson Avenue MSC 126, Brooklyn, NY, 11203, USA.
| | - Alisa Timashpolsky
- Division of Pediatric Otolaryngology, SUNY Downstate Medical Center, 450 Clarkson Avenue MSC 126, Brooklyn, NY, 11203, USA.
| | - Stephanie M Tominaga
- Division of Pediatric Otolaryngology, SUNY Downstate Medical Center, 450 Clarkson Avenue MSC 126, Brooklyn, NY, 11203, USA.
| | - Neeta D'Souza
- Division of Pediatric Otolaryngology, SUNY Downstate Medical Center, 450 Clarkson Avenue MSC 126, Brooklyn, NY, 11203, USA. neeta.d'
| | - Nira A Goldstein
- Division of Pediatric Otolaryngology, SUNY Downstate Medical Center, 450 Clarkson Avenue MSC 126, Brooklyn, NY, 11203, USA.
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15
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Marjanovic V, Budic I, Golubovic M, Breschan C. Perioperative respiratory adverse events during ambulatory anesthesia in obese children. Ir J Med Sci 2021; 191:1305-1313. [PMID: 34089150 PMCID: PMC9135828 DOI: 10.1007/s11845-021-02659-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/21/2021] [Indexed: 11/05/2022]
Abstract
Obesity is one of the most common clinical conditions in the pediatric population with an increasing prevalence ranging from 20 to 30% worldwide. It is well known that during ambulatory anesthesia, obese children are more prone to develop perioperative respiratory adverse events (PRAEs) associated with obesity. To avoid or at least minimize these adverse effects, a thorough preoperative assessment should be undertaken as well as consideration of specific anesthetic approaches such as preoxygenation before induction of anesthesia and optimizing drug dosing. The use of short-acting opioid and nonopioid analgesics and the frequent implementation of regional anesthesia should also be included. Noninvasive airway management, protective mechanical ventilation, and complete reversion of neuromuscular blockade and awake extubation also proved to be beneficial in preventing PRAEs. During the postoperative period, continuous monitoring of oxygenation and ventilation is mandatory in obese children. In the current review, we sought to provide recommendations that might help to reduce the severity of perioperative respiratory adverse events in obese children, which could be of particular importance for reducing the rate of unplanned hospitalizations and ultimately improving the overall postoperative recovery.
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Affiliation(s)
- Vesna Marjanovic
- Faculty of Medicine, University of Nis, Blvd. dr Zorana Djindjica 81, 18000, Nis, Serbia. .,Clinic for Anesthesia and Intensive Therapy, Clinical Centre Nis, Blvd. dr Zorana Djindjica 48, 18000, Nis, Serbia.
| | - Ivana Budic
- Faculty of Medicine, University of Nis, Blvd. dr Zorana Djindjica 81, 18000, Nis, Serbia.,Clinic for Anesthesia and Intensive Therapy, Clinical Centre Nis, Blvd. dr Zorana Djindjica 48, 18000, Nis, Serbia
| | - Mladjan Golubovic
- Faculty of Medicine, University of Nis, Blvd. dr Zorana Djindjica 81, 18000, Nis, Serbia.,Clinic for Anesthesia and Intensive Therapy, Clinical Centre Nis, Blvd. dr Zorana Djindjica 48, 18000, Nis, Serbia
| | - Christian Breschan
- Department of Anesthesia, Klinikum Klagenfurt, Feschigstrasse 11, 9020, Klagenfurt, Austria
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Le Fevre ER, McGrath KH, Fitzgerald DA. Pulmonary Manifestations of Gastrointestinal, Pancreatic, and Liver Diseases in Children. Pediatr Clin North Am 2021; 68:41-60. [PMID: 33228942 DOI: 10.1016/j.pcl.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pulmonary manifestations of gastrointestinal (GI) diseases are often subtle, and underlying disease may precede overt symptoms. A high index of suspicion and a low threshold for consultation with a pediatric pulmonologist is warranted in common GI conditions. This article outlines the pulmonary manifestations of different GI, pancreatic, and liver diseases in children, including gastroesophageal reflux disease, inflammatory bowel disease, pancreatitis, alpha1-antitrypsin deficiency, nonalcoholic fatty liver disease, and complications of chronic liver disease (hepatopulmonary syndrome and portopulmonary hypertension).
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Affiliation(s)
- Emily R Le Fevre
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, New South Wales 2145, Australia
| | - Kathleen H McGrath
- Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria 3052, Australia
| | - Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, New South Wales 2145, Australia; Faculty Health Sciences, University of Sydney, Sydney, New South Wales, Australia.
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Badelt G, Goeters C, Becke-Jakob K, Deitmer T, Eich C, Höhne C, Stuck BA, Wiater A. [German S1 guideline: obstructive sleep apnea in the context of tonsil surgery with or without adenoidectomy in children-perioperative management]. HNO 2020; 69:3-13. [PMID: 33354732 DOI: 10.1007/s00106-020-00970-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
Otolaryngologic surgery is one of the most frequent operative interventions performed in children. Tonsil surgery with or without adenoidectomy due to hyperplasia of the tonsils and adenoids with obstruction of the upper airways with or without tympanic ventilation disorder is the most common of these procedures. Children with a history of sleep apnoea (OSA) suffer from a significantly increased risk of perioperative respiratory complications. Cases of death and severe permanent neurologic damage have been reported due to apnoea and increased opioid sensitivity. The current guideline represents a pragmatic risk-adjusted approach. Patients with confirmed or suspected OSA should be treated perioperatively according to their individual risks and requirements, in order to avoid severe permanent damage.
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Affiliation(s)
- G Badelt
- Klinik für Anästhesie und Kinderanästhesie, Krankenhaus Barmherzige Brüder Regensburg, Klinik St. Hedwig, Steinmetzstraße 1-3, 93049, Regensburg, Deutschland. .,Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V. (DGAI)
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Nürnberg, Deutschland.
| | - C Goeters
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V. (DGAI)
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Nürnberg, Deutschland
| | - K Becke-Jakob
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V. (DGAI)
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Nürnberg, Deutschland
| | - T Deitmer
- Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V. (DGHNO KHC), Friedrich-Wilhelm-Str. 2, 53113, Bonn, Deutschland
| | - C Eich
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V. (DGAI)
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Nürnberg, Deutschland
| | - C Höhne
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V. (DGAI)
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Nürnberg, Deutschland
| | - B A Stuck
- Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V. (DGHNO KHC), Friedrich-Wilhelm-Str. 2, 53113, Bonn, Deutschland
| | - A Wiater
- Kinder- und Jugendmedizin/Schlafmedizin, Deutsche Gesellschaft für Schlafforschung und Schlafmedizin (DGSM)
- Arbeitsgruppe Pädiatrie im Konvent der Deutschen Gesllschaft für Kinder- und Jugendmedizin, Schwalmstadt-Treysa, Deutschland
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Kunin A, Sargheini N, Birkenbihl C, Moiseeva N, Fröhlich H, Golubnitschaja O. Voice perturbations under the stress overload in young individuals: phenotyping and suboptimal health as predictors for cascading pathologies. EPMA J 2020; 11:517-527. [PMID: 33200009 PMCID: PMC7658305 DOI: 10.1007/s13167-020-00229-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 10/30/2020] [Indexed: 12/12/2022]
Abstract
Verbal communication is one of the most sophisticated human motor skills reflecting both-the mental and physical health of an individual. Voice parameters and quality changes are usually secondary towards functional and/or structural laryngological alterations under specific systemic processes, syndrome and pathologies. These include but are not restricted to dry mouth and Sicca syndromes, body dehydration, hormonal alterations linked to pubertal, menopausal, and andropausal status, respiratory disorders, gastrointestinal reflux, autoimmune diseases, endocrinologic disorders, underweight versus overweight and obesity, and diabetes mellitus. On the other hand, it is well-established that stress overload is a significant risk factor of cascading pathologies, including but not restricted to neurodegenerative and psychiatric disorders, diabetes mellitus, cardiovascular disease, stroke, and cancers. Our current study revealed voice perturbations under the stress overload as a potentially useful biomarker to identify individuals in suboptimal health conditions who might be strongly predisposed to associated pathologies. Contextually, extended surveys applied in the population might be useful to identify, for example, persons at high risk for respiratory complications under pandemic conditions such as COVID-19. Symptoms of dry mouth syndrome, disturbed microcirculation, altered sense regulation, shifted circadian rhythm, and low BMI were positively associated with voice perturbations under the stress overload. Their functional interrelationships and relevance for cascading associated pathologies are presented in the article. Automated analysis of voice recordings via artificial intelligence (AI) has a potential to derive digital biomarkers. Further, predictive machine learning models should be developed that allows for detecting a suboptimal health condition based on voice recordings, ideally in an automated manner using derived digital biomarkers. Follow-up stratification and monitoring of individuals in suboptimal health conditions are recommended using disease-specific cell-free nucleic acids (ccfDNA, ctDNA, mtDNA, miRNA) combined with metabolic patterns detected in body fluids. Application of the cost-effective targeted prevention within the phase of reversible health damage is recommended based on the individualised patient profiling.
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Affiliation(s)
- A. Kunin
- Departments of Maxillofacial Surgery and Hospital Dentistry, Voronezh N.N. Burdenko State Medical University, Voronezh, Russia
| | - N. Sargheini
- Center of Molecular Biotechnology, CEMBIO, Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - C. Birkenbihl
- Department of Bioinformatics, Fraunhofer Institute for Algorithms and Scientific Computing (SCAI), Schloss Birlinghoven, 53757 Sankt Augustin, Germany
- Bonn-Aachen International Center for IT, Rheinische Friedrich-Wilhelms-Universität Bonn, 53115 Bonn, Germany
| | - N. Moiseeva
- Departments of Maxillofacial Surgery and Hospital Dentistry, Voronezh N.N. Burdenko State Medical University, Voronezh, Russia
| | - Holger Fröhlich
- Department of Bioinformatics, Fraunhofer Institute for Algorithms and Scientific Computing (SCAI), Schloss Birlinghoven, 53757 Sankt Augustin, Germany
- Bonn-Aachen International Center for IT, Rheinische Friedrich-Wilhelms-Universität Bonn, 53115 Bonn, Germany
| | - Olga Golubnitschaja
- Predictive, Preventive and Personalised (3P) Medicine, Department of Radiation Oncology, University Hospital Bonn, Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
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Yelamanchi R, Gupta N, Durga CK, Korpal M. Comparative study between P- POSSUM and Apache II scores in predicting outcomes of perforation peritonitis: Prospective observational cohort study. Int J Surg 2020; 83:3-7. [PMID: 32927143 DOI: 10.1016/j.ijsu.2020.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/31/2020] [Accepted: 09/05/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Scoring systems are needed to prognosticate, compare and audit surgical procedures. Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and morbidity (P-POSSUM) and Acute Physiological and Chronic Health Evaluation II (APACHE II) are well known and validated scores to predict surgical outcomes. The objective of this study was to compare P-POSSUM and APACHE II scores in predicting morbidity and mortality of patients who underwent emergency surgery for perforation peritonitis. MATERIALS AND METHODS A prospective single-center cohort study was conducted with a sample size of 56 patients of perforation peritonitis from November 2018 to March 2020. All patients were followed up prospectively for a period of 30 days to monitor the primary outcome variable mortality and secondary outcome variables such as wound infection, wound dehiscence, anastomotic leak, respiratory complications, Intensive Care Unit (ICU) stay and hospital stay. RESULTS Mean age of patients was 37.1 years and 67.86% were males. Ileum was the most common site of perforation followed by the stomach. The most common post-operative complication was wound infection (71.43%) followed by respiratory complications (64.29%) and wound dehiscence (35.71%). ICU stay was required for a majority of patients (74.42%). The mean hospital stay was 8.93 days and the mortality rate was 23.21% in this study. P-POSSUM and APACHE II scores had a good association with mortality, post-operative wound dehiscence, respiratory complications, ICU stay and hospital stay. However, there was no statistical difference between the two scores in predicting the above outcomes. Post-operative wound infection and anastomotic leak had no association with P-POSSUM or APACHE II scores. CONCLUSION As the APACHE II score is based only on preoperative parameters and is easier to calculate we recommend its use for patients of perforation peritonitis over the P-POSSUM score as both have similar predictability.
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Affiliation(s)
- Raghav Yelamanchi
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar LohiaHospital, New Delhi, 110001, India.
| | - Nikhil Gupta
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar LohiaHospital, New Delhi, 110001, India
| | - C K Durga
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar LohiaHospital, New Delhi, 110001, India
| | - Manit Korpal
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar LohiaHospital, New Delhi, 110001, India
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20
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Kayem G, Lecarpentier E, Deruelle P, Bretelle F, Azria E, Blanc J, Bohec C, Bornes M, Ceccaldi PF, Chalet Y, Chauleur C, Cordier AG, Desbrière R, Doret M, Dreyfus M, Driessen M, Fermaut M, Gallot D, Garabédian C, Huissoud C, Luton D, Morel O, Perrotin F, Picone O, Rozenberg P, Sentilhes L, Sroussi J, Vayssière C, Verspyck E, Vivanti AJ, Winer N, Alessandrini V, Schmitz T. A snapshot of the Covid-19 pandemic among pregnant women in France. J Gynecol Obstet Hum Reprod 2020; 49:101826. [PMID: 32505805 PMCID: PMC7270811 DOI: 10.1016/j.jogoh.2020.101826] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 05/31/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To describe the course over time of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in French women from the beginning of the pandemic until mid-April, the risk profile of women with respiratory complications, and short-term pregnancy outcomes. METHODS We collected a case series of pregnant women with COVID-19 in a research network of 33 French maternity units between March 1 and April 14, 2020. All cases of SARS-CoV-2 infection confirmed by a positive result on real-time reverse transcriptase polymerase chain reaction tests of a nasal sample and/or diagnosed by a computed tomography chest scan were included and analyzed. The primary outcome measures were COVID-19 requiring oxygen (oxygen therapy or noninvasive ventilation) and critical COVID-19 (requiring invasive mechanical ventilation or extracorporeal membrane oxygenation, ECMO). Demographic data, baseline comorbidities, and pregnancy outcomes were also collected. RESULTS Active cases of COVID-19 increased exponentially during March 1-31, 2020; the numbers fell during April 1-14, after lockdown was imposed on March 17. The shape of the curve of active critical COVID-19 mirrored that of all active cases. By April 14, among the 617 pregnant women with COVID-19, 93 women (15.1 %; 95 %CI 12.3-18.1) had required oxygen therapy and 35 others (5.7 %; 95 %CI 4.0-7.8) had had a critical form of COVID-19. The severity of the disease was associated with age older than 35 years and obesity, as well as preexisting diabetes, previous preeclampsia, and gestational hypertension or preeclampsia. One woman with critical COVID-19 died (0.2 %; 95 %CI 0-0.9). Among the women who gave birth, rates of preterm birth in women with non-severe, oxygen-requiring, and critical COVID-19 were 13/123 (10.6 %), 14/29 (48.3 %), and 23/29 (79.3 %) before 37 weeks and 3/123 (2.4 %), 4/29 (13.8 %), and 14/29 (48.3 %) before 32 weeks, respectively. One neonate (0.5 %; 95 %CI 0.01-2.9) in the critical group died from prematurity. CONCLUSION COVID-19 can be responsible for significant rates of severe acute, potentially deadly, respiratory distress syndromes. The most vulnerable pregnant women, those with comorbidities, may benefit particularly from prevention measures such as a lockdown.
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Affiliation(s)
- Gilles Kayem
- Assistance Publique-Hôpitaux de Paris, 75004, Paris, France.
| | | | - Philippe Deruelle
- Centre Hospitalo-Universitaire de Strasbourg, 67000, Strasbourg, France
| | | | - Elie Azria
- Groupe Hospitalier Saint-Joseph, 75014, Paris, France
| | - Julie Blanc
- Assistance Publique-Hôpitaux de Marseille, 13000, Marseille, France
| | | | - Marie Bornes
- Assistance Publique-Hôpitaux de Paris, 75004, Paris, France
| | | | - Yasmine Chalet
- Assistance Publique-Hôpitaux de Paris, 75004, Paris, France
| | - Céline Chauleur
- Centre Hospitalo-Universitaire de Saint-Etienne, 42000, Saint-Etienne, France
| | | | | | | | - Michel Dreyfus
- Centre Hospitalo-Universitaire de Caen, 14000, Caen, France
| | | | - Marion Fermaut
- Assistance Publique-Hôpitaux de Paris, 75004, Paris, France
| | - Denis Gallot
- Centre Hospitalo-Universitaire Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Charles Garabédian
- Centre Hospitalier Régional Universitaire de Lille, 59000, Lille, France
| | | | | | | | - Franck Perrotin
- Centre Hospitalier Régional Universitaire de Tours, 37000, Tours, France
| | - Olivier Picone
- Assistance Publique-Hôpitaux de Paris, 75004, Paris, France
| | | | - Loïc Sentilhes
- Centre Hospitalo-Universitaire de Bordeaux, 33000, Bordeaux, France
| | - Jeremy Sroussi
- Assistance Publique-Hôpitaux de Paris, 75004, Paris, France
| | | | - Eric Verspyck
- Centre Hospitalo-Universitaire de Rouen, 76000, Rouen, France
| | | | - Norbert Winer
- Centre Hospitalo-Universitaire de Nantes, 44000, Nantes, France
| | | | - Thomas Schmitz
- Assistance Publique-Hôpitaux de Paris, 75004, Paris, France
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21
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Miller J, Bruen C, Schnaus M, Zhang J, Ali S, Lind A, Stoecker Z, Stauderman K, Hebbar S. Auxora versus standard of care for the treatment of severe or critical COVID-19 pneumonia: results from a randomized controlled trial. Crit Care 2020; 24:502. [PMID: 32795330 PMCID: PMC7427272 DOI: 10.1186/s13054-020-03220-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/03/2020] [Indexed: 12/15/2022]
Abstract
Background Calcium release-activated calcium (CRAC) channel inhibitors stabilize the pulmonary endothelium and block proinflammatory cytokine release, potentially mitigating respiratory complications observed in patients with COVID-19. This study aimed to investigate the safety and efficacy of Auxora, a novel, intravenously administered CRAC channel inhibitor, in adults with severe or critical COVID-19 pneumonia. Methods A randomized, controlled, open-label study of Auxora was conducted in adults with severe or critical COVID-19 pneumonia. Patients were randomized 2:1 to receive three doses of once-daily Auxora versus standard of care (SOC) alone. The primary objective was to assess the safety and tolerability of Auxora. Following FDA guidance, study enrollment was halted early to allow for transition to a randomized, blinded, placebo-controlled study. Results In total, 17 patients with severe and three with critical COVID-19 pneumonia were randomized to Auxora and nine with severe and one with critical COVID-19 pneumonia to SOC. Similar proportions of patients receiving Auxora and SOC experienced ≥ 1 adverse event (75% versus 80%, respectively). Fewer patients receiving Auxora experienced serious adverse events versus SOC (30% versus 50%, respectively). Two patients (10%) receiving Auxora and two (20%) receiving SOC died during the 30 days after randomization. Among patients with severe COVID-19 pneumonia, the median time to recovery with Auxora was 5 days versus 12 days with SOC; the recovery rate ratio was 1.87 (95% CI, 0.72, 4.89). Invasive mechanical ventilation was needed in 18% of patients with severe COVID-19 pneumonia receiving Auxora versus 50% receiving SOC (absolute risk reduction = 32%; 95% CI, − 0.07, 0.71). Outcomes measured by an 8-point ordinal scale were significantly improved for patients receiving Auxora, especially for patients with a baseline PaO2/FiO2 = 101–200. Conclusions Auxora demonstrated a favorable safety profile in patients with severe or critical COVID-19 pneumonia and improved outcomes in patients with severe COVID-19 pneumonia. These results, however, are limited by the open-label study design and small patient population resulting from the early cessation of enrollment in response to regulatory guidance. The impact of Auxora on respiratory complications in patients with severe COVID-19 pneumonia will be further assessed in a planned randomized, blinded, placebo-controlled study. Trial registration ClinicalTrials.gov, NCT04345614. Submitted on 7 April 2020. Graphical abstract ![]()
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Affiliation(s)
| | - Charles Bruen
- Regions Hospital, Health Partners, St. Paul, MN, USA
| | - Michael Schnaus
- Regions Hospital, Health Partners, St. Paul, MN, USA.,Methodist Hospital, Park Nicollet, St. Louis Park, MN, USA.,University of Minnesota, Minneapolis, MN, USA
| | | | - Sadia Ali
- Methodist Hospital, Park Nicollet, St. Louis Park, MN, USA
| | - April Lind
- Methodist Hospital, Park Nicollet, St. Louis Park, MN, USA
| | | | - Kenneth Stauderman
- CalciMedica, Inc., 505 Coast Blvd. South Suite 202, La Jolla, CA, 92037, USA
| | - Sudarshan Hebbar
- CalciMedica, Inc., 505 Coast Blvd. South Suite 202, La Jolla, CA, 92037, USA.
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22
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Gori E, Pierini A, Ceccherini G, Citi S, Mannucci T, Lippi I, Marchetti V. Pulmonary complications in dogs with acute presentation of pancreatitis. BMC Vet Res 2020; 16:209. [PMID: 32571307 PMCID: PMC7310026 DOI: 10.1186/s12917-020-02427-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 06/15/2020] [Indexed: 12/31/2022] Open
Abstract
Background In humans, respiratory complications in patients with acute pancreatitis (AP) are a common life-threatening comorbidity. Since possible lung impairment has not been individually evaluated in canine AP, the aims of the present study were to: (1) describe the prevalence, types and severity of pulmonary complications in dogs with acute presentation of AP, and (2) evaluate their association with mortality. AP diagnosis was based on compatible clinical and laboratory parameters, abnormal canine pancreatic-lipase test, and positive abdominal ultrasound within 48 h from admission. The canine acute pancreatitis severity score (CAPS) was calculated for each dog at admission. Arterial blood gas analysis and thoracic radiography were performed at admission. Thoracic radiography was classified on the basis of pulmonary pattern (normal, interstitial or alveolar) and a modified lung injury score (mLIS) was applied to the ventrodorsal projections for each dog. VetALI/VetARDS were diagnosed using current veterinary consensus. Dogs were divided into non-survivors or survivors (hospital discharge). Clinical, radiological and blood gas parameters collected at presentation were compared between survivors and non-survivors and associated with mortality. Results This prospective cohort study included twenty-six client-owned dogs with AP. Twelve out of twenty-six dogs (46%) died or were euthanized. At admission, thirteen dogs showed respiratory distress at physical examination, which was associated with death (P < 0.001). Radiographic abnormalities were found in twenty-one dogs: alveolar (n = 11) and interstitial pattern (n = 10). Radiographic alterations and mLIS score were both associated with death (P = 0.02 and P = 0.0023). The results of the arterial blood-gas evaluation showed that non-survivors had lower PaCO2 and HCO3− levels, and higher A-a gradient than survivors (P = 0.0014, P = 0.019 and P = 0.004, respectively). Specifically, three dogs had aspiration pneumonia, and VetALI was diagnosed in nine dogs (34.6%), and no dogs met the criteria for VetARDS. The presence of VetALI was associated with mortality (P < 0.001). Conclusions As with humans, possible lung impairments, such as VetALI, should be investigated in dogs with acute presentation of pancreatitis.
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Affiliation(s)
- Eleonora Gori
- Department of Veterinary Sciences, Veterinary Teaching Hospital "Mario Modenato", University of Pisa, Via Livornese Lato monte, San Piero a Grado, 56122, Pisa, Italy
| | - Alessio Pierini
- Department of Veterinary Sciences, Veterinary Teaching Hospital "Mario Modenato", University of Pisa, Via Livornese Lato monte, San Piero a Grado, 56122, Pisa, Italy.
| | - Gianila Ceccherini
- Department of Veterinary Sciences, Veterinary Teaching Hospital "Mario Modenato", University of Pisa, Via Livornese Lato monte, San Piero a Grado, 56122, Pisa, Italy
| | - Simonetta Citi
- Department of Veterinary Sciences, Veterinary Teaching Hospital "Mario Modenato", University of Pisa, Via Livornese Lato monte, San Piero a Grado, 56122, Pisa, Italy
| | - Tommaso Mannucci
- Department of Veterinary Sciences, Veterinary Teaching Hospital "Mario Modenato", University of Pisa, Via Livornese Lato monte, San Piero a Grado, 56122, Pisa, Italy
| | - Ilaria Lippi
- Department of Veterinary Sciences, Veterinary Teaching Hospital "Mario Modenato", University of Pisa, Via Livornese Lato monte, San Piero a Grado, 56122, Pisa, Italy
| | - Veronica Marchetti
- Department of Veterinary Sciences, Veterinary Teaching Hospital "Mario Modenato", University of Pisa, Via Livornese Lato monte, San Piero a Grado, 56122, Pisa, Italy
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23
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Harris VC, Dalesio NM, Clark J, Nellis JC, Tunkel DE, Lee AH, Skinner M. Postoperative respiratory complications and disposition in patients with type 1 laryngeal clefts undergoing injection or repair - A single institution experience. Int J Pediatr Otorhinolaryngol 2020; 131:109844. [PMID: 31901483 DOI: 10.1016/j.ijporl.2019.109844] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Identify incidence and factors associated with respiratory complications after type 1 cleft repair. METHODS Retrospective chart review of patients who underwent cleft repair over a 5-year period performed by a single surgeon. Primary endpoint was respiratory complications (oxygen desaturation <90%). Fisher's exact test was used to identify differences between repair types (endoscopic carbon dioxide laser-assisted repair and injection laryngoplasty). Logistic regression was used to identify predictors of respiratory events. RESULTS Fifty-five patients were included. Thirty-four (62%) patients underwent endoscopic carbon dioxide laser-assisted repair and 21 (38%) underwent injection laryngoplasty. Average hospital stay for each group was 1.6 days (SD = 3.1) and 0.6 days (SD = 0.9), respectively. Desaturations occurred in three patients (9%) in the laser-assisted repair group and one patient (4%) in the injection group. All occurred within 3 h after surgery and resolved with supplemental oxygen, oral airway placement, and/or mask ventilation. Two affected patients had comorbid diagnosis of asthma (one had poor medication compliance), and one had a history of developmental delay and hypotonia. In the injection group, desaturations occurred in one patient with a history of tracheal stenosis and double aortic arch. No correlation existed between repair type and desaturation (p = 0.57). No variables were significant predictors of events. CONCLUSIONS In this cohort, respiratory events after type 1 laryngeal cleft repair occurred early in the postoperative period, in children with cardiac and pulmonary comorbidities. This suggests postoperative admission may only be necessary for a select group of patients undergoing type 1 cleft repair. However, further research is needed to determine criteria for same-day discharge.
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Affiliation(s)
- Vandra C Harris
- Department of Otolaryngology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Nicholas M Dalesio
- Department of Otolaryngology, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - James Clark
- Department of Otolaryngology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Jason C Nellis
- Department of Otolaryngology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - David E Tunkel
- Department of Otolaryngology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Andrew H Lee
- Department of Otolaryngology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Margaret Skinner
- Department of Otolaryngology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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24
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Schieren M, Wappler F, Klodt D, Sakka SG, Lefering R, Jäcker V, Defosse J. Continuous lateral rotational therapy in thoracic trauma--A matched pair analysis. Injury 2020; 51:51-58. [PMID: 31757469 DOI: 10.1016/j.injury.2019.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 11/08/2019] [Accepted: 11/09/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Given the lack of reliable evidence on the utility of continuous lateral rotational therapy (CLRT) in chest trauma, we performed a single-centre retrospective matched-pair analysis of patients treated either with CLRT or non-continuous manual turning after blunt thoracic trauma. METHODS We included adult patients that were admitted to our level 1 trauma centre from 2010-2014 and presented with severe thoracic injuries (AISThorax ≥3) within 24 h after the injury and required at least 72 h of mechanical ventilation. Patients were either treated with manual turning every 2-4 h or CLRT. To ensure comparable injury severity and a similar risk for posttraumatic respiratory complications, we matched for thoracic injury severity, age, additional injuries (head, abdomen, extremities) and need for massive transfusion. RESULTS A total of 22 pairs (n = 44 patients) were successfully matched and analysed. The use of CLRT did not have a statistically significant impact on respiratory function, gas exchange, duration of mechanical ventilation, ICU or hospital length of stay, or overall patient outcomes (e.g. pneumonia, sepsis, ARDS, mortality). During active rotation the level of sedation was lower compared to manual turning (Richmond Agitation Sedation Scale; manual turning: -3.6; CLRT: -4.0; p = 0.01). Patient agitation was noticed more frequently in the CLRT group (manual turning: n = 2 (9%); CLRT: n = 9 (41%); p = 0.02). DISCUSSION In this well-matched sample, the use of CLRT did not seem to translate into relevant clinical benefits in patients with thoracic trauma in the setting of modern ICU care with the widespread implementation of lung protective ventilation. However, statistical power and generalisability were limited by the small sample size and single centre design. A large RCT is required to provide conclusive results.
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Affiliation(s)
- Mark Schieren
- University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Anaesthesiology and Intensive Care Medicine, Ostmerheimer Str, 200, Cologne, Germany.
| | - Frank Wappler
- University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Anaesthesiology and Intensive Care Medicine, Ostmerheimer Str, 200, Cologne, Germany.
| | - Daniel Klodt
- Krankenhaus der Augustinerinnen, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Cologne, Gemany.
| | - Samir G Sakka
- University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Anaesthesiology and Intensive Care Medicine, Ostmerheimer Str, 200, Cologne, Germany.
| | - Rolf Lefering
- IFOM - Institute for Research in Operative Medicine, University Witten/Herdecke, Cologne, Germany.
| | - Vera Jäcker
- University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Traumatology and Orthopaedic Surgery, Cologne, Germany.
| | - Jerome Defosse
- University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Anaesthesiology and Intensive Care Medicine, Ostmerheimer Str, 200, Cologne, Germany.
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Pacoricona Alfaro DL, Lemoine P, Ehlinger V, Molinas C, Diene G, Valette M, Pinto G, Coupaye M, Poitou-Bernert C, Thuilleaux D, Arnaud C, Tauber M. Causes of death in Prader-Willi syndrome: lessons from 11 years' experience of a national reference center. Orphanet J Rare Dis 2019; 14:238. [PMID: 31684997 PMCID: PMC6829836 DOI: 10.1186/s13023-019-1214-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/24/2019] [Indexed: 12/12/2022] Open
Abstract
Background In the last 20 years, substantial improvements have been made in the diagnosis, treatment and management of patients with Prader-Willi syndrome (PWS). Few data on causes of death are available since those improvements were made. Our study assessed the causes of death among French patients with PWS over the first 11 years of experience of the nationwide French Reference Center for PWS (FRC-PWS). Methods Our study relied on two sources of mortality information at national level between 2004 and 2014: The French Epidemiological Centre for the Medical Causes of Death (CépiDc) Registry and the FRC-PWS database. Causes of death were classified into seven categories: respiratory, cardiovascular, gastrointestinal, severe infection, sudden death, other causes, and unknown. Descriptive statistics were calculated separately for children (< 18 years-old) and adults (≥18 years-old). Results One hundred and four deaths were identified in France from 2004 to 2014. The median age at death was 30 years, ranging from less than 1 month to 58 years. Seventeen deaths occurred in patients under 18 years, with 70% of them in children under 2 years. Respiratory causes accounted for more than 50% of the deaths in patients with PWS in both children and adults. Both cause and age of death did not significantly differ according to gender or genetic subtype. Conclusions Patients with PWS die prematurely due to a respiratory cause in most cases at all ages. In those adult patients with data on obesity, 98% were reported to be obese.
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Affiliation(s)
| | - Perrine Lemoine
- Endocrinology, Obesity, Bone Diseases, Genetics and Gynecology Unit, Children's Hospital, University Hospital Center of Toulouse, Toulouse, France
| | | | - Catherine Molinas
- Endocrinology, Obesity, Bone Diseases, Genetics and Gynecology Unit, Children's Hospital, University Hospital Center of Toulouse, Toulouse, France.,French National Reference Center for Prader-Willi Syndrome, Children's Hospital, University Hospital Center of Toulouse, 330, avenue de Grande-Bretagne - TSA 40031, 31059, Toulouse cedex 9, France.,Centre de Physiopathologie de Toulouse-Purpan, UMR 5282 CNRS, UMR 1043 Inserm, Paul Sabatier University, Toulouse, France
| | - Gwénaëlle Diene
- UMR 1027 Inserm- Paul Sabatier University, Toulouse, France.,Endocrinology, Obesity, Bone Diseases, Genetics and Gynecology Unit, Children's Hospital, University Hospital Center of Toulouse, Toulouse, France.,French National Reference Center for Prader-Willi Syndrome, Children's Hospital, University Hospital Center of Toulouse, 330, avenue de Grande-Bretagne - TSA 40031, 31059, Toulouse cedex 9, France
| | - Marion Valette
- Endocrinology, Obesity, Bone Diseases, Genetics and Gynecology Unit, Children's Hospital, University Hospital Center of Toulouse, Toulouse, France.,French National Reference Center for Prader-Willi Syndrome, Children's Hospital, University Hospital Center of Toulouse, 330, avenue de Grande-Bretagne - TSA 40031, 31059, Toulouse cedex 9, France
| | - Graziella Pinto
- Pediatric Endocrinology, Diabetology and Gynecology Department, Assistance-Publique Hôpitaux de Paris (AP-HP), Necker Children's University Hospital, Paris, France
| | - Muriel Coupaye
- French National Reference Center for Prader-Willi Syndrome, Nutrition Department, Assistance-Publique Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Paris, France
| | - Christine Poitou-Bernert
- French National Reference Center for Prader-Willi Syndrome, Nutrition Department, Assistance-Publique Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Paris, France.,Nutriomics team, Sorbonne University, UPMC University Paris 06, Inserm, Paris, France
| | - Denise Thuilleaux
- French National Reference Center for Prader-Willi Syndrome, Prader-Willi Unit, Assistance Publique Hôpitaux de Paris (AP-HP), Marine Hendaye Hospital, Hendaye, France
| | - Catherine Arnaud
- UMR 1027 Inserm- Paul Sabatier University, Toulouse, France.,Unité de Soutien Méthodologique à la Recherche, University Hospital Center of Toulouse, Toulouse, France
| | - Maithé Tauber
- Endocrinology, Obesity, Bone Diseases, Genetics and Gynecology Unit, Children's Hospital, University Hospital Center of Toulouse, Toulouse, France. .,French National Reference Center for Prader-Willi Syndrome, Children's Hospital, University Hospital Center of Toulouse, 330, avenue de Grande-Bretagne - TSA 40031, 31059, Toulouse cedex 9, France. .,Centre de Physiopathologie de Toulouse-Purpan, UMR 5282 CNRS, UMR 1043 Inserm, Paul Sabatier University, Toulouse, France.
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Thalji L, Shi Y, Hanson KT, Wakeam E, Habermann EB, Hyder JA. Characterizing the spectrum of body mass index associated with severe postoperative pulmonary complications in children. J Anesth 2019; 33:372-380. [PMID: 30976907 DOI: 10.1007/s00540-019-02639-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/01/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE While high body mass index (BMI) is a recognized risk factor for pulmonary complications in adults, its importance as a risk factor for complications following pediatric surgery is poorly described. We evaluated the association between BMI and severe pediatric perioperative pulmonary complications (PPCs). METHODS In this retrospective cohort study, we evaluated pediatric patients (aged 2-17 years) undergoing elective procedures in the 2015 Pediatric National Surgical Quality Improvement Program (NSQIP-P). Severe PPCs were defined as either pneumonia/reintubation within 3 days of surgery, or pneumonia/reintubation as an index complication within 7 days. Univariate and multivariable logistic regression analyses adjusting for patient factors and surgical case-mix tested associations between BMI class-using the Centers for Disease Control age- and sex-dependent BMI percentiles-and severe PPCs. RESULTS Among 40,949 patients, BMI class was distributed as follows: 2740 (6.7%) were underweight, 23,630 (57.7%) normal weight, 6161 (15.0%) overweight, and 8418 (20.6%) obese. Overweight BMI class was not associated with PPCs in univariate analyses, but became statistically significant after adjustment [OR 1.84 (95% CI 1.07-3.15), p = 0.03], and persisted across multiple adjustment approaches. Neither underweight [OR 1.01 (95% CI 0.53-1.94), p = 0.97] nor obesity [OR 1.10 (95% CI 0.63-1.94), p = 0.73] were associated with PPCs after adjustment. CONCLUSION Overweight pediatric patients have an elevated, previously underappreciated risk of severe PPCs. Contrary to prior studies, the present study found no greater risk in obese children, perhaps due to bias, confounding, or practice migration from "availability bias". Findings from the present study, taken with prior work describing pulmonary risks of obesity, suggest that both obese and overweight children may be evaluated for tailored perioperative care to improve outcomes.
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Affiliation(s)
- Leanne Thalji
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Yu Shi
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kristine T Hanson
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Elliot Wakeam
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Elizabeth B Habermann
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Joseph A Hyder
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Rochester, MN, USA.,Division of Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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Abstract
Infants born in the late preterm period and via non-labour caesarean section in the early term period are at increased risk of respiratory morbidity when compared to their term-born counterparts. The morbidity in these infants is less frequent and severe than in early preterm infants. Antenatal corticosteroids reduce respiratory morbidity in these populations; however, the magnitude of the reduction appears to be small and predominantly in the self-limiting condition of transient tachypnoea of the neonate. The smaller benefit, along with possible harmful effects of corticosteroids, raises a question about the role of antenatal corticosteroids in this population. Special obstetric populations such as twin pregnancies and pregnancies complicated by diabetes and growth restriction are at increased risk of prematurity and more vulnerable to its complications. Nevertheless, there is limited evidence regarding the benefits of corticosteroids in these populations and potential concern regarding adverse effects. We recommend an individualised approach when administering corticosteroids at later gestations. In these specific obstetric populations, we do not currently recommend administering corticosteroids in the late preterm/early term periods until more evidence is available.
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Affiliation(s)
- Hagar Rahel Haviv
- Department of Obstetrics and Gynaecology, Women's and Children's Hospital, Adelaide, Australia.
| | - Joanne Said
- Maternal Fetal Medicine, Sunshine Hospital, Western Health, Saint Albans, VIC, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC, Australia
| | - Ben Willem Mol
- Department of Obstetrics and Gynaecology, Women's and Children's Hospital, Adelaide, Australia; Robinson Research Institute, Adelaide Medical School, North Adelaide, SA, Australia; Department of Obstetrics and Gynaecology, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
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Marjani M, Moeinpour M, Moniri A, Khabiri S, Hashemian SM, Tabarsi P, Velayati AA. Etiology of Respiratory Complications among Iranian HIV Infected Patients. Tanaffos 2019; 18:96-103. [PMID: 32440296 PMCID: PMC7230122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Infection with Human Immune deficiency Virus (HIV) is a growing problem in developing countries. Among HIV infected cases, respiratory complications are common, dissimilar in different setting and their diagnosis is challenging. The aim of this study was to determine the spectrum of infectious and non-infectious pulmonary complications among HIV infected patients. MATERIALS AND METHODS The retrospective study was done among 710 HIV infected patients admitted in Masih Daneshvari Hospital, National Research Institute of Tuberculosis and Lung Diseases, Tehran, Iran from January 2003 to March 2017. Demographic, clinical, radiologic and laboratory data of 836 episodes of pulmonary complications were reviewed and final diagnosis were extracted. RESULTS Mean of CD4 cell count was 90±131 ×106 cells/L. Definite etiology was found for 653 episodes (78.1%) of pulmonary complications. Infectious respiratory diseases were clearly more common than non-infectious etiologies, 86.1 and 7.6%, respectively. Pulmonary tuberculosis, as the leading cause, involved 542 cases (64.8%) and Pneumocystis jiroveci (P. jiroveci) was the second infectious agent that was found in 111 cases (13.2%). Among non- infectious causes, bronchiectasis and Chronic Obstructive Pulmonary Disease (COPD) exacerbation were on the top of the list, 21 of 64 (32.8%) and 18 0f 64 (28.1%), respectively. Many patients had more than one etiology. P. jiroveci had the highest tendency for dual infections (43 episodes). CONCLUSION Pulmonary complications, especially infections are common among HIV cases in Iran, among them tuberculosis is the most common. Respiratory problems may be the first presentation of HIV infection. Clinicians should be aware about the risk of dual infections. Screening for HIV among all tuberculosis cases and vice versa is recommend.
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Affiliation(s)
- Majid Marjani
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,,Correspondence to: Marjani M, Address: Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Email address:
| | - Mahtab Moeinpour
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afshin Moniri
- Virology Research Center, NRITLD, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shadi Khabiri
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammadreza Hashemian
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payam Tabarsi
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Akbar Velayati
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Luhmann SJ, Furdock R. Preoperative Variables Associated With Respiratory Complications After Pediatric Neuromuscular Spine Deformity Surgery. Spine Deform 2019; 7:107-111. [PMID: 30587301 DOI: 10.1016/j.jspd.2018.05.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 05/02/2018] [Accepted: 05/05/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The objective of this study is to identify preoperative laboratory values and patient factors that are associated with postoperative respiratory complications in pediatric neuromuscular scoliosis (NMS) populations undergoing posterior spinal fusion (PSF) with instrumentation. SUMMARY OF BACKGROUND DATA PSF in NMS patients are high-risk surgeries. Respiratory complications are the most common postoperative event, with rates up to 28.2% following surgery. METHODS A single-surgeon, two-hospital pediatric spine surgery database was reviewed to identify all patients who underwent PSF for NMS. Diagnoses included cerebral palsy (n=83), myelomeningocele (n=13), spinal muscular atrophy (n=4), and other (n=11). This study defined respiratory complications as postoperative pneumonia, pleural effusion, pneumothorax, need for reintubation, respiratory status requiring a return to the pediatric intensive care unit (PICU), or prolonged (>4-day) need for mechanical ventilation. Preoperative laboratory values for transferrin, prealbumin, hemoglobin/hematocrit, total protein, albumin, and total lymphocyte count were collected. RESULTS There were 50 males and 61 females with a mean age of 14 years 2.5 months (8-20 years). Seventeen patients (15.3%) experienced postoperative respiratory complications. On univariate analysis, any history of pneumonia, the presence of gastrostomy tube, and low transferrin levels were associated with postoperative respiratory complications, and a strong trend (p=.06) was observed for tracheostomy. On multivariate analysis, the presence of gastrostomy tube and history of pneumonia remained as clinically significant predictors of postoperative respiratory complications. CONCLUSION Pediatric NMS patients undergoing PSF that have history of pneumonia or gastrostomy tube present at time of surgery are at increased risk for postoperative respiratory complications. The univariate associations of tracheostomy presence and low transferrin levels with postoperative respiratory complications deserve further examination. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Scott J Luhmann
- Pediatric Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
| | - Ryan Furdock
- Pediatric Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
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Abstract
Late preterm infants (LPIs) are born between 34 0/7 and 36 6/7 weeks' gestation and account for 72% of all preterm births in the United States. Born as much as 6 weeks early, the LPI misses the critical growth and development specific to the third trimester. The loss of this critical period leaves the LPI physiologically and metabolically immature and prone to various morbidities. Common morbidities include respiratory complications, feeding difficulty, hypoglycemia, temperature instability, hyperbilirubinemia, and neurodevelopmental delays.
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Affiliation(s)
- Julie E Williams
- Department of Neonatology, The Johns Hopkins Hospital, The Charlotte R. Bloomberg Children Center Building, 1800 Orleans Street, Baltimore, MD 21287, USA.
| | - Yvette Pugh
- Department of Pediatrics, Community Neonatal Associates, Holy Cross Hospital, 1500 Forest Glen Road, Silver Spring, MD 20910, USA
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Kidane B, Palma DC, Badner NH, Hamilton M, Leydier L, Fortin D, Inculet RI, Malthaner RA. The Potential Dangers of Recruitment Maneuvers During One Lung Ventilation Surgery. J Surg Res 2018; 234:178-183. [PMID: 30527471 DOI: 10.1016/j.jss.2018.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 08/09/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Existing evidence regarding lung-protective ventilation (LPV) during one-lung ventilation (OLV) focuses on surrogate outcomes. Our objective was to assess whether an LPV protocol during OLV surgery is associated with reduced respiratory complications. MATERIALS AND METHODS This was a matched control retrospective cohort study of patients undergoing pulmonary resection at a tertiary Canadian hospital. The experimental group (n = 50) was derived from primary data of two crossover RCTs, which utilized protocolized LPV strategies with varying levels of positive end-expiratory pressure and recruitment maneuvers. The control group was drawn from a prospectively maintained database; these patients received conventional nonprotocolized ventilation (2000-2010). Each experimental group patient was matched 1:1 with a control group patient with respect to clinically relevant variables (age, sex, diagnosis, smoking status, cardiovascular disease status, comorbidity, BMI, preoperative forced expiratory volume in 1 s, surgery type). Major respiratory complications were defined as composite of acute respiratory distress syndrome, need for new positive-pressure ventilation, and atelectasis requiring bronchoscopy. Paired and unpaired statistical tests were used. RESULTS Patients appeared well matched. Major respiratory complications occurred in 8% (n = 4) and 2% (n = 1) of patients in experimental and control groups, respectively (P = 0.50). There was a trend toward increased mortality (4 versus 0, P = 0.06) with protocolized LPV. The patients who died had respiratory complications; one had acute respiratory distress syndrome and two had profound hypoxemia. CONCLUSIONS There was a nonsignificant trend toward increased mortality with LPV during OLV. Although limited by a small sample size, our findings identify a potential danger to excessive recruitment maneuvers. Larger studies, with clinically important outcomes are needed to better define the risk/benefit trade-offs for LPV during OLV.
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Affiliation(s)
- Biniam Kidane
- Section of Thoracic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; Division of Thoracic Surgery, Western University, London, Ontario, Canada.
| | | | - Neal H Badner
- Department of Anesthesiology, Western University, London, Ontario, Canada
| | - Melissa Hamilton
- Division of Thoracic Surgery, Western University, London, Ontario, Canada
| | - Larissa Leydier
- Section of Thoracic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dalilah Fortin
- Division of Thoracic Surgery, Western University, London, Ontario, Canada; Division of Critical Care Medicine, Department of Medicine, Western University, London, Ontario, Canada
| | - Richard I Inculet
- Division of Thoracic Surgery, Western University, London, Ontario, Canada
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Keefer K, Bender R, Liao J, Sivik J, Van de Louw A. Characteristics of pulmonary complications in non-Hodgkin's lymphoma patients treated with rituximab-containing chemotherapy and impact on survival. Ann Hematol 2018; 97:2373-2380. [PMID: 30030570 PMCID: PMC7102168 DOI: 10.1007/s00277-018-3448-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/17/2018] [Indexed: 11/29/2022]
Abstract
Patients with non-Hodgkin’s lymphoma (NHL) receiving rituximab-containing chemotherapy are at risk of developing respiratory complications, but comprehensive information on these complications and their impact on survival is lacking. We performed a retrospective cohort analysis on 123 NHL patients who received rituximab-containing chemotherapy between 2009 and 2016 in order to describe the incidence, etiologies and effect on survival of respiratory complications defined by new or worsening respiratory symptoms requiring diagnostic work-up or hospitalization. Thirty patients (24%) developed respiratory complications during a follow-up time of 825 (555–1338) days after chemotherapy. They had a higher prevalence of congestive heart failure and lung or pleural involvement at diagnosis as compared to patients who did not develop complications. Overall, 58 episodes of pulmonary complications were observed after median (interquartile) times from the first and last rituximab doses of 205 (75–580) days and 27 (14–163) days respectively. Infectious etiologies accounted for 75% of the respiratory complications, followed by heart failure exacerbation, lymphomatous involvement, and ARDS. Two Pneumocystis jirovecii pneumonias were observed, and no complication was ascribed to rituximab toxicity. Respiratory complications required ICU admission in 19 cases (33%) and invasive mechanical ventilation in 14 cases (24%). Using a time-dependent Cox regression analysis, we observed that the occurrence of respiratory complications was associated with a 170% increase in death hazard (hazard ratio 2.65, 95% CI 1.60–4.40, p = 0.001). In conclusion, respiratory complications in NHL patients receiving chemotherapy are relatively frequent, severe, and mostly infectious and are associated with increased mortality.
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Affiliation(s)
- Kimberly Keefer
- Department of Pharmacy, Pennsylvania State University College of Medicine and Milton S Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - Regis Bender
- Department of Pharmacy, Pennsylvania State University College of Medicine and Milton S Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - Jason Liao
- Department of Public Health Sciences, Pennsylvania State University College of Medicine and Milton S Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - Jeffrey Sivik
- Department of Pharmacy, Pennsylvania State University College of Medicine and Milton S Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - Andry Van de Louw
- Division of Pulmonary and Critical Care Medicine, Pennsylvania State University College of Medicine and Milton S Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA.
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Ozgunay SE, Karasu D, Dulger S, Yilmaz C, Tabur Z. [Relationship between cigarette smoking and the carbon monoxide concentration in the exhaled breath with perioperative respiratory complications]. Rev Bras Anestesiol 2018; 68:462-471. [PMID: 30025946 DOI: 10.1016/j.bjan.2018.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 02/01/2018] [Accepted: 02/19/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The purpose of the current study was to determine the effects of preoperative cigarette smoking and the carbon monoxide level in the exhaled breath on perioperative respiratory complications in patients undergoing elective laparoscopic cholecystectomies. METHODS One hundred and fifty two patients (smokers, Group S and non-smokers, Group NS), who underwent laparoscopic cholecystectomies under general anesthesia, were studied. Patients completed the Fagerstrom Test for Nicotine Dependence. The preoperative carbon monoxide level in the exhaled breath levels were determined using the piCO+Smokerlyzer 12h before surgery. Respiratory complications were recorded during induction of anesthesia, intraoperatively, during extubation, and in the recovery room. RESULTS Statistically significant increases were noted in group S with respect to the incidence of hypoxia during induction of anesthesia, intraoperative bronchospasm, bronchodilator treatment intraoperatively, and bronchospasm during extubation. The carbon monoxide level in the exhaled breath and the Fagerstrom Test for Nicotine Dependence, and number of cigarettes smoked 12h preoperatively were designated as covariates in the regression model. Logistic regression analysis of anesthetic induction showed that a 1 unit increase in the carbon monoxide level in the exhaled breath level was associated with a 1.16 fold increase in the risk of hypoxia (OR=1.16; 95% CI 1.01-1.34; p=0.038). Logistic regression analysis of the intraoperative course showed that a 1 unit increase in the number of cigarettes smoked 12h preoperatively was associated with a 1.16 fold increase in the risk of bronchospasm (OR=1.16; 95% CI 1.04-1.30; p=0.007). While in the recovery room, a 1 unit increase in the Fagerstrom Test for Nicotine Dependence score resulted in a 1.73 fold increase in the risk of bronchospasm (OR=1.73; 95% CI 1.04-2.88; p=0.036). CONCLUSIONS Cigarette smoking was shown to increase the incidence of intraoperative respiratory complications while under general anesthesia. Moreover, the estimated preoperative carbon monoxide level in the exhaled breath level may serve as an indicator of the potential risk of perioperative respiratory complications.
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Affiliation(s)
- Seyda Efsun Ozgunay
- University of Health Sciences, Bursa Yuksek Ihtisas Research and Education Hospital, Department of Anesthesiology and Reanimation, Bursa, Turquia.
| | - Derya Karasu
- University of Health Sciences, Bursa Yuksek Ihtisas Research and Education Hospital, Department of Anesthesiology and Reanimation, Bursa, Turquia
| | - Seyhan Dulger
- University of Health Sciences, Bursa Yuksek Ihtisas Research and Education Hospital, Department of Chest Disease, Bursa, Turquia
| | - Canan Yilmaz
- University of Health Sciences, Bursa Yuksek Ihtisas Research and Education Hospital, Department of Anesthesiology and Reanimation, Bursa, Turquia
| | - Zeynep Tabur
- University of Health Sciences, Bursa Yuksek Ihtisas Research and Education Hospital, Department of Anesthesiology and Reanimation, Bursa, Turquia
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Abstract
BACKGROUND The objective of heartworm treatment is to improve the clinical condition of the patient and to eliminate pre-cardiac, juvenile, and adult worm stages with minimal complications. Pulmonary thromboembolisms are an inevitable consequence of worm death and can result in severe pulmonary reactions and even death of the patient. To minimize these reactions, various treatment protocols involving melarsomine, the only adulticidal drug approved by the US Food and Drug Administrations (FDA), in conjunction with macrocyclic lactone heartworm preventives and glucocorticosteroids have been advocated. The discovery of the bacterial endosymbiont Wolbachia in Dirofilaria immitis has led to several experimental studies examining the effects of administering doxycycline to reduce or eliminate Wolbachia organism. These studies have shown a decrease in gross and microscopic pathology of pulmonary parenchyma in experimental heartworm infections pretreated with doxycycline before melarsomine administration. METHODS Electronic medical records from a large veterinary practice in northeast Alabama were searched to identify dogs treated for heartworms with melarsomine from January 2005 through December 2012. The search was refined further to select for dogs that met the following criteria: 1) received two or three doses of ivermectin heartworm preventive prior to melarsomine injections, 2) received one injection of melarsomine followed by two injections 4 to 8 weeks later, and 3) were treated with prednisone following melarsomine injections. The dogs were then divided into those that also were treated with doxycycline 10 mg/kg BID for 4 weeks (Group A, n = 47) and those that did not receive doxycycline (Group B, n = 47). The medical notes of all 94 cases were then reviewed for comments concerning coughing, dyspnea, or hemoptysis in the history, physical exam template, or from telephone conversations with clients the week following each visit. Any dog that died within one year of treatment from either cardiovascular or pulmonary problems was noted. RESULTS Dogs from Group A receiving doxycycline had fewer respiratory complications (6.52%) and heartworm disease-related deaths (0%) than Group B (19.14% and 4.25%, respectively). CONCLUSIONS Although there are not enough cases to indicate statistical significance, the results strongly suggest that including doxycycline into canine heartworm treatment protocols decreases post-treatment complications and mortality in naturally infected clinical cases.
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Affiliation(s)
- C Thomas Nelson
- Animal Medical Centers of NE Alabama, 719 Quintard Ave, Anniston, AL, 36201-5757, USA.
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Vimalanathan S, Schoop R, Suter A, Hudson J. Prevention of influenza virus induced bacterial superinfection by standardized Echinacea purpurea, via regulation of surface receptor expression in human bronchial epithelial cells. Virus Res 2017; 233:51-59. [PMID: 28279802 DOI: 10.1016/j.virusres.2017.03.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 02/21/2017] [Accepted: 03/01/2017] [Indexed: 01/30/2023]
Abstract
Viral infections may predispose the airways to secondary bacterial infections that can lead to unfavorable progression of principally self-limiting illnesses. Such complicated respiratory infections include pneumonia, bronchitis, sinusitis, acute otitis media, and sepsis, which cause high morbidity and lethality. Some of the pathogenic consequences of viral infections, like the expression of bacterial adhesion receptors and the disturbance of physical barrier integrity due to inflammation, may create permissive conditions for co-infections. Influenza virus A (H3N2) is a major pathogen that causes secondary bacterial infections and inflammation that lead to pneumonia. The herbal medicine Echinacea purpurea, on the other hand, has been widely used to prevent and treat viral respiratory infections, and recent clinical data suggest that it may prevent secondary infection complications as well. We investigated the role of standardized E. purpurea (Echinaforce® extract or EF) on H3N2-induced adhesion of live nontypeable Haemophilus influenzae (NTHi) and Staphylococcus aureus, along with the expression of bacterial receptors, intracellular adhesion molecule-1 (ICAM-1), fibronectin, and platelet activating factor receptor (PAFr), by BEAS-2B cells. Inflammatory processes were investigated by determining the cellular expression of IL-6 and IL-8 and the involvement of Toll-like receptor (TLR-4) and NFκB p65. We found that influenza virus A infection increased the adhesion of H. influenzae and S. aureus to bronchial epithelial cells via upregulated expression of the ICAM-1 receptor and, to some extent, of fibronectin and PAFr. Echinaforce (EF) significantly reduced the expression of ICAM-1, fibronectin, and PAFr and consequently the adhesion of both bacterial strains. EF also effectively prevented the super-expression of inflammatory cytokines by suppressing the expression of NFκB and possibly TLR-4. These results indicate that E. purpurea has the potential to reduce the risk of respiratory complications by preventing virus-induced bacterial adhesion and through the inhibition of inflammation super-stimulation (cytokine storms).
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Affiliation(s)
- Selvarani Vimalanathan
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada V6T 2B5.
| | - Roland Schoop
- Medical Department, A. Vogel Bioforce AG, Roggwil TG, Switzerland
| | - Andy Suter
- Medical Department, A. Vogel Bioforce AG, Roggwil TG, Switzerland
| | - James Hudson
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada V6T 2B5
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Abstract
OPINION STATEMENT Esophageal atresia is a rare congenital anomaly, but improved surgical and critical care has resulted in survival rates exceeding 90%. Long-term survival is associated with numerous management challenges including chronic motility disorders, dysphagia, strictures, reflux, esophagitis and attendant complications, tracheomalacia and chronic restrictive lung disease, and recurrent pulmonary infections. No guidelines for adolescents and younger or older adults exist for the treatment and monitoring of this specialized patient population. As such, patients with esophageal atresia can experience life-long sequelae of their disease and are best served by intentional transition to adult care for surveillance and monitoring, specifically for chronic lung disease, reflux, and its complications. This is best accomplished in a multidisciplinary fashion at experienced esophageal and lung centers.
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Affiliation(s)
- Abby White
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Mail: 75 Francis Street, Boston, MA, 02115, USA.
| | - Raphael Bueno
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Mail: 75 Francis Street, Boston, MA, 02115, USA
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Dombernowsky T, Kristensen MØ, Rysgaard S, Gluud LL, Novovic S. Risk factors for and impact of respiratory failure on mortality in the early phase of acute pancreatitis. Pancreatology 2016; 16:756-60. [PMID: 27424478 DOI: 10.1016/j.pan.2016.06.664] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 06/24/2016] [Accepted: 06/30/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The incidence of respiratory failure and other respiratory complications in the early phase of acute pancreatitis (AP) is not well investigated. OBJECTIVE To evaluate the incidence and risk factors of respiratory failure, and its impact on mortality in the early phase AP. METHODS Retrospective cohort study including 359 patients admitted with acute pancreatitis. Information was gathered from electronic patient records. We defined respiratory failure based on the modified Marshall scoring system in the revised Atlanta criteria. Predictors of respiratory failure were evaluated in univariable and multivariable logistic regression analysis. RESULTS The cohort included 188 women and 171 men with a mean age of 56.1 years. Respiratory complications including pleural effusion, pneumonia and atelectasis were registered in 80 patients (22%), 100 (29%) needed oxygen therapy, 27 (8%) continuous positive airway pressure, and six (2%) mechanical ventilation. Thirty-two patients (9%) were treated with bronchodilators and 12 (3%) with steroids. Thirty-one patients (9%) fulfilled the diagnostic criteria for respiratory failure. Five of these patients (16%) did not have effusion, atelectasis or pneumonia. Predictors of respiratory failure in multivariable analysis were age (OR 1.04; CI 95% (1.03-1.07)) and smoking (OR 2.67; CI 95% (1.21-5.86)). Thirteen patients died in hospital. The Kaplan-Meier curves and log-rank tests showed that patients with respiratory failure had increased in-hospital mortality as did patients with cardiovascular and renal failure (P < 0.01 for all analyses). CONCLUSIONS Respiratory complications are frequent in the early phase of AP. Respiratory, cardiovascular and renal failure is associated with a poor outcome. The fact that patients without effusion, atelectasis, or pneumonia may develop respiratory failure, suggests that acute lung injury, possibly associated with systemic inflammation, may be important.
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Affiliation(s)
- Tilde Dombernowsky
- Department of Gastroenterology and Gastrointestinal Surgery, Copenhagen University Hospital Hvidovre, Denmark
| | | | - Sisse Rysgaard
- Department of Gastroenterology and Gastrointestinal Surgery, Copenhagen University Hospital Hvidovre, Denmark
| | - Lise Lotte Gluud
- Department of Gastroenterology and Gastrointestinal Surgery, Copenhagen University Hospital Hvidovre, Denmark
| | - Srdan Novovic
- Department of Gastroenterology and Gastrointestinal Surgery, Copenhagen University Hospital Hvidovre, Denmark.
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Rao Kadam V, Danesh M. Post operative capnostream monitoring in patients with obstructive sleep apnoea symptoms - Case series. Sleep Sci 2016; 9:142-146. [PMID: 28123650 PMCID: PMC5241624 DOI: 10.1016/j.slsci.2016.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 11/07/2016] [Accepted: 12/07/2016] [Indexed: 11/28/2022] Open
Abstract
Obstructive sleep apnoea (OSA) patients on opioid analgesic have an increased incidence of postoperative respiratory complications; prevention of these may be possible with appropriate post-operative monitoring. We recruited 4 OSA patients who had general anaesthesia for orthopaedic and septoplasty surgery. They required Patient Controlled Analgesia (PCA) or oral opioids in the post-operative period, hence continuous Saturation of Oxygen (Spo2), End Tidal Carbon dioxide (EtCo2) monitoring on Capnostream monitor with Integrated Pulmonary Index (IPI) was organized in high dependency unit. Overnight data was collected every 30 s which included pulse rate, respiratory rate, EtCo2, Spo2, and IPI. The nursing staff was also asked to document if any intervention was carried out due to altered IPI. For first two patient events occurred during various hours but there were no significant events in early night even though increased opioid use at that time. During the period of desaturation nurse intervention required to increase the O2 flow in the first patient but corrected spontaneously in the second patient. IPI index improved over a period of 2 min in most of the events. The duration of desaturation did not correspond with the IPI in only once, remaining period the clinical symptoms were consistent with fall in O2 saturation. The microstream capnography with IPI may provide complete respiratory status of the patient because of its comprehensive parameters on one screen. Main limitation was duration of monitoring was limited to overnight. Capnostream monitoring with IPI may have a role in patients monitoring with OSA on PCA in the postoperative ward but more trials are necessary.
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Affiliation(s)
- Vasanth Rao Kadam
- Department of Anaesthesia, The Queen Elizabeth Hospital and Senior Clinical Lecturer, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Mazyar Danesh
- The Queen Elizabeth Hospital, Royal Brisbane Hospital, Australia
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Haerter F, Eikermann M. Reversing neuromuscular blockade: inhibitors of the acetylcholinesterase versus the encapsulating agents sugammadex and calabadion. Expert Opin Pharmacother 2016; 17:819-33. [PMID: 26799963 DOI: 10.1517/14656566.2016.1145667] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Acetylcholinesterase inhibitors (neostigmine, edrophonium) and encapsulating agents (sugammadex and calabadion) can be used to reverse residual neuromuscular blockade (NMB). AREAS COVERED This review provides information about efficacy, effectiveness, and side effects of drugs (acetylcholinesterase inhibitors and encapsulating agents) used to reverse neuromuscular blocking agents (NMBAs). EXPERT OPINION The therapeutic range of acetylcholinesterase-inhibitors is narrow and effectiveness studies demonstrate clinicians don't use these unspecific reversal agents effectively to increase postoperative respiratory safety. The encapsulating drugs sugammadex and calabadion reverse all levels of NMB, and complete recovery of muscle strength can be achieved almost immediately after administration. For this reason encapsulating agents can be used as a solution for "cannot intubate cannot ventilate"- situations. Poor binding selectivity of encapsulating agents carries the risk of displacement of the NMBA by a competitively binding drug, which may lead to recurarization. In order to avoid side-effects, related to unspecific binding of endogenous proteins and drugs administered perioperatively it is prudent to titrate the dose of reversal agents to the minimal effective dose, depending on the depth of neuromuscular transmission block identified by neuromuscular transmission monitoring. Calabadions provide a diversified (increased binding selectivity) and expanded (reversal of benzylisoquinolines) spectrum of possible indications.
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Affiliation(s)
- Friederike Haerter
- a Department of Anesthesia, Critical Care and Pain Medicine , Massachusetts General Hospital and Harvard Medical School , Boston , MA , USA
| | - Matthias Eikermann
- a Department of Anesthesia, Critical Care and Pain Medicine , Massachusetts General Hospital and Harvard Medical School , Boston , MA , USA.,b Department of Anesthesia and Critical Care Medicine , University Hospital Essen, University Duisburg-Essen , Essen , Germany
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Gómez Garrido A, León Espitia AM, Montesinos Magraner L, Ramirez Galceran L, Soler Canudes E, González Viejo MA. [Spanish validation of the International Spinal Cord Injury Pulmonary Function Basic Data Set questionnaire for the study of the repercussion of spinal cord injury in the respiratory system]. Med Clin (Barc) 2015; 145:477-81. [PMID: 26055634 DOI: 10.1016/j.medcli.2015.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 04/04/2015] [Accepted: 04/09/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND OBJECTIVE The dysfunction of the respiratory system and the breathing complications in persons with injured spinal cord has an effect on the morbidity and the mortality of the disease. The objectives were: 1) to translate to Spanish and validate the questionnaire of international consensus: International Spinal Cord Injury Pulmonary Function Basic Data Set, and 2) to determine the influence of chronic spinal cord injury in the respiratory system in terms of respiratory functionalism. MATERIALS AND METHOD Translation to Spanish and validation of the questionnaire of international consensus intended for the study of the pulmonary function in spinal cord injury disease. We tested the reliability of that questionnaire. We conducted a descriptive transversal study to determine the degree of involvement of the respiratory system in spinal cord injury. RESULTS A percentage of 91.9 did not have any respiratory pathology before spinal cord injury and 54.8% of patients smoked. A percentage of 27.4 of patients presented breathing complications one year after the injury. Results of the respiratory function tests were: FVC 67%, FEV1 72% and PEF 70%. Concordance and reliability were 98%. CONCLUSION The Spanish version of the questionnaire of international consensus about the pulmonary function is a useful tool for the study of the respiratory involvement in spinal cord injury.
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Affiliation(s)
- Alba Gómez Garrido
- Unidad de Rehabilitación Cardiorrespiratoria, Servicio de Rehabilitación, Hospital Universitario Vall d'Hebron, Instituto de Recerca Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España.
| | - Ana María León Espitia
- Unidad de Rehabilitación Cardiorrespiratoria, Servicio de Rehabilitación, Hospital Universitario Vall d'Hebron, Instituto de Recerca Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España
| | - Lluïsa Montesinos Magraner
- Unidad de Lesionados Medulares, Servicio de Rehabilitación, Hospital Universitario Vall d'Hebron, Instituto de Recerca Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España
| | - Lucrecia Ramirez Galceran
- Unidad de Lesionados Medulares, Servicio de Rehabilitación, Hospital Universitario Vall d'Hebron, Instituto de Recerca Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España
| | - Emilia Soler Canudes
- Unidad de Rehabilitación Cardiorrespiratoria, Servicio de Rehabilitación, Hospital Universitario Vall d'Hebron, Instituto de Recerca Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España
| | - Miguel Angel González Viejo
- Unidad de Lesionados Medulares, Servicio de Rehabilitación, Hospital Universitario Vall d'Hebron, Instituto de Recerca Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España
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Abstract
Neuromuscular blocking agents are used to facilitate tracheal intubation in patients undergoing ambulatory surgery. The use of high-dose neuromuscular blocking agents to achieve muscle paralysis throughout the case carries an increased risk of residual post-operative neuromuscular blockade, which is associated with increased respiratory morbidity. Visually monitoring the train-of-four (TOF) fade is not sensitive enough to detect a TOF fade between 0.4 and 0.9. A ratio <0.9 indicates inadequate recovery. Quantitative neuromuscular transmission monitoring (e.g., acceleromyography) should be used to exclude residual neuromuscular blockade at the end of the case. Residual neuromuscular blockade needs to be reversed with neostigmine, but it's use must be guided by TOF monitoring results since deep block cannot be reversed, and neostigmine administration after complete recovery of the TOF-ratio can induce muscle weakness. The development and use of new selectively binding reversal agents (sugammadex and calabadion) warrants reevaluation of this area of clinical practice.
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Affiliation(s)
- Hassan Farhan
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, 55, Fruit Street, Boston, MA 02115, USA
| | - Ingrid Moreno-Duarte
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, 55, Fruit Street, Boston, MA 02115, USA
| | - Duncan McLean
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, 55, Fruit Street, Boston, MA 02115, USA
| | - Matthias Eikermann
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, 55, Fruit Street, Boston, MA 02115, USA
- Universitaet Duisburg-Essen, Essen, Germany
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Abstract
This article focuses on common respiratory complications in the postanesthesia care unit (PACU). Approximately 1 in 10 children present with respiratory complications in the PACU. The article highlights risk factors and at-risk populations. The physiologic and pathophysiologic background and causes for respiratory complications in the PACU are explained and suggestions given for an optimization of the anesthesia management in the perioperative period. Furthermore, the recognition, prevention, and treatment of these complications in the PACU are discussed.
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Affiliation(s)
- Britta S von Ungern-Sternberg
- Department of Anesthesia and Pain Management, Princess Margaret Hospital for Children, Roberts Road, Subiaco, Western Australia 6008, Australia; School of Medicine and Pharmacology, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia.
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Hack H. An audit of the use of an opiate sparing, multimodal analgesic regime in children with Sleep Disordered Breathing/Obstructive Sleep Apnoea undergoing adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2014; 78:119-23. [PMID: 24290004 DOI: 10.1016/j.ijporl.2013.10.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 10/25/2013] [Accepted: 10/29/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Children with Sleep Disordered Breathing/Obstructive Sleep Apnoea have an increased incidence of respiratory complications following adenotonsillectomy. This may be partly related to an increase in sensitivity to opiates. An audit of such cases undergoing adenotonsillectomy was performed with the following aims: METHODS All patients had Sleep Disordered Breathing/Obstructive Sleep Apnoea confirmed preoperatively by Overnight Oximetry Studies. Oximetry data was expressed as the lowest recorded saturation (SpO2 Low %) and number of significant desaturations (see text) per hour (ODI4%). Case notes and oximetry studies were scrutinized for relevant perioperative anaesthetic and analgesic data, risk factors and complications. RESULTS The overall incidence of major and minor respiratory complications was low (1.6% and 27% respectively). Children who suffered any complication were more likely to be younger (p=0.0078), have a lower SpO2 Low (p=0.004) and higher ODI4% (p=<0.0001). Multiple logistic regression showed ODI4% to be the best predictor of a potential respiratory complication (p=0.0032). An ODI4% of >8 may be the best cut off point in predicting complications (AUC=0.78, sensitivity=0.90) but it showed a poor specificity (0.57). Primary/secondary haemorrhage occurred in 0.4%/1.2% respectively and postoperative nausea and vomiting in 4.4%. CONCLUSIONS A low dose opiate-based, multi modal analgesic regime appears to be effective and safe in children with Sleep Disordered Breathing/Obstructive Sleep Apnoea undergoing adenotonsillectomy.
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Affiliation(s)
- Henrik Hack
- Department of Paediatric Anaesthesia, Royal Manchester Children's Hospital, Manchester, UK.
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Feltracco P, Carollo C, Barbieri S, Pettenuzzo T, Ori C. Early respiratory complications after liver transplantation. World J Gastroenterol 2013; 19:9271-9281. [PMID: 24409054 PMCID: PMC3882400 DOI: 10.3748/wjg.v19.i48.9271] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 09/04/2013] [Accepted: 09/17/2013] [Indexed: 02/06/2023] Open
Abstract
The poor clinical conditions associated with end-stage cirrhosis, pre-existing pulmonary abnormalities, and high comorbidity rates in patients with high Model for End-Stage Liver Disease scores are all well-recognized factors that increase the risk of pulmonary complications after orthotopic liver transplantation (OLT) surgery. Many intraoperative and postoperative events, such as fluid overload, massive transfusion of blood products, hemodynamic instability, unexpected coagulation abnormalities, renal dysfunction, and serious adverse effects of reperfusion syndrome, are other factors that predispose an individual to postoperative respiratory disorders. Despite advances in surgical techniques and anesthesiological management, the lung may still suffer throughout the perioperative period from various types of injury and ventilatory impairment, with different clinical outcomes. Pulmonary complications after OLT can be classified as infectious or non-infectious. Pleural effusion, atelectasis, pulmonary edema, respiratory distress syndrome, and pneumonia may contribute considerably to early morbidity and mortality in liver transplant patients. It is of paramount importance to accurately identify lung disorders because infectious pulmonary complications warrant speedy and aggressive treatment to prevent diffuse lung injury and the risk of evolution into multisystem organ failure. This review discusses the most common perioperative factors that predispose an individual to postoperative pulmonary complications and these complications’ early clinical manifestations after OLT and influence on patient outcome.
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Mocanu SN, Balagué Ponz MC, Targarona Soler EM, Roque Figuls M, Trias Folch M. [Influence of the type of thoracic access on postesophagectomy respiratory complications]. Cir Esp 2013; 91:563-73. [PMID: 24050831 DOI: 10.1016/j.ciresp.2013.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 03/15/2013] [Accepted: 03/22/2013] [Indexed: 11/21/2022]
Abstract
INTRODUCTION A systematic review of the literature was performed with the aim to determine differences in the rate of respiratory complications after esophagectomy for esophageal cancer using minimally invasive access vs traditional thoracic access. METHODS A literature search was performed using Medline and Cochrane Library, identifying studies that compared the 2 types of thoracic access, regardless of the type of abdominal access (laparotomy/laparoscopy). The studies selected described respiratory complications in absolute numbers and different categories. Studies that considered minithoracotomy as a minimally invasive technique were excluded. Inclusion criteria were: studies decribing the different types of respiratory complications (9 in total), and analysing the most common complications: respiratory infection, respiratory failure and pleural effusion. RESULTS Nine studies were selected (one prospective randomized trial and 8 case control studies) including 1,190 patients, 1,167 of which were operated on for esophageal cancer: 482 patients by thoracotomy and 708 by thoracoscopy. Three studies included definitions of respiratory complications, and one stratified them. The more frequent complications that allowed a meta-analysis were: respiratory infections, pleural effusion, and respiratory failure. No significant differences were found between the 2 types of access in the global analysis. DISCUSSION The type of thoracic access (thoracotomy or thoracoscopy) does not seem to influence the development of respiratory complications after esophagectomy for cancer. However, the design of the studies analysed, the absence of clear definitions and stratification of the complications makes this conclusion questionable. A consensus on the definition of complications and further prospective randomized clinical trials are necessary.
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Karcz M, Papadakos PJ. Respiratory complications in the postanesthesia care unit: A review of pathophysiological mechanisms. Can J Respir Ther 2013; 49:21-9. [PMID: 26078599 PMCID: PMC4456822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
General anesthesia and mechanical ventilation impair pulmonary function, even in normal individuals, and result in decreased oxygenation in the postanesthesia period. They also cause a reduction in functional residual capacity of up to 50% of the preanesthesia value. It has been shown that pulmonary atelectasis is a common finding in anesthetized individuals because it occurs in 85% to 90% of healthy adults. Furthermore, there is substantial evidence that atelectasis, in combination with alveolar hypoventilation and ventilation-perfusion mismatch, is the core mechanism responsible for postoperative hypoxemic events in the majority of patients in the postanesthesia care unit (PACU). Many concomitant factors also must be considered, such as respiratory depression from the type and anatomical site of surgery altering lung mechanics, the consequences of hemodynamic impairment and the residual effects of anesthetic drugs, most notably residual neuromuscular blockade. The appropriate use of anesthetic and analgesic techniques, when combined with meticulous postoperative care, clearly influences pulmonary outcomes in the PACU. The present review emphasizes the major pathophysiological mechanisms and treatment strategies of critical respiratory events in the PACU to provide health care workers with the knowledge needed to prevent such potentially adverse outcomes from occurring.
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Affiliation(s)
- Marcin Karcz
- Correspondence: Dr Marcin Karcz, Department of Anesthesiology, University of Rochester, 601 Elmwood Avenue, Rochester, New York 14642, USA. Telephone 585-764-4099, e-mail
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Alinaghi SA, Vaghari B, Roham M, Badie BM, Jam S, Foroughi M, Djavid GE, Hajiabdolbaghi M, Hosseini M, Mohraz M, McFarland W. Respiratory Complications in Iranian Hospitalized Patients with HIV/AIDS. Tanaffos 2011; 10:49-54. [PMID: 25191376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 05/14/2011] [Indexed: 02/08/2023]
Abstract
Background The respiratory tract has been the most commonly affected site of illness in HIV-infected patients. The current study was done to identify the frequency of respiratory complications in a consecutive case series of HIV-positive patients in Iran. Materials and Methods This study was a retrospective analysis at the national academic reference medical center of Imam-Khomeini Hospital, in Tehran, Iran. The study included 199 new admissions for 177 HIV-infected patients between 2000 and 2005. Demographic characteristics, risk factors for HIV infection, respiratory complications, and CD4+ lymphocyte counts were evaluated in these patients. Results All patients were males. The mean age was 35 years (age range: 15 to 63 years). Among 34 cases with available CD4+ lymphocyte count results, 70.6% had results <200 cells/mm3. Nearly half the patients (47.7%) had respiratory symptoms. The most common pulmonary complications were cough (86.3%), sputum (71.6%), dyspnea (54.7%), and hemoptysis (10.5%). The most common diagnosis was pulmonary tuberculosis (27.1%), followed by other bacterial pneumonias (16.6%) and pneumocystis carinii pneumonia (4.5%). Intravenous drug users who had history of incarceration had the highest risk factors for Mycobacterium tuberculosis infection (59%), and other bacterial pneumonias (52%). Conclusion Our study demonstrates that respiratory complications are highly frequent in HIV patients in Iran and that pulmonary tuberculosis is still a common complication in HIV infected patients, despite the availability of effective treatment. Results suggest the need for more effective preventive and prophylactic measures, wider use of antiretroviral treatment and effective chemotherapy for Iranian patients with HIV/AIDS.
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