scholarly journals Effect of Intraoperative Low Tidal Volume vs Conventional Tidal Volume on Postoperative Pulmonary Complications in Patients Undergoing Major Surgery

JAMA ◽  
2020 ◽  
Vol 324 (9) ◽  
pp. 848 ◽  
Author(s):  
Dharshi Karalapillai ◽  
Laurence Weinberg ◽  
Philip Peyton ◽  
Louise Ellard ◽  
Raymond Hu ◽  
...  
Keyword(s):  
Tidal Volume ◽  
Pulmonary Complications ◽  
Major Surgery ◽  
Postoperative Pulmonary Complications ◽  
Low Tidal Volume

scholarly journals Intraoperative Anesthetic Management of Patients with Chronic Obstructive Pulmonary Disease to Decrease the Risk of Postoperative Pulmonary Complications after Abdominal Surgery

2020 ◽  
Vol 9 (1) ◽  
pp. 150
Author(s):  
Sukhee Park ◽  
Eun Jung Oh ◽  
Sangbin Han ◽  
Beomsu Shin ◽  
Sun Hye Shin ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Abdominal Surgery ◽  
Tidal Volume ◽  
Pulmonary Complications ◽  
Chronic Obstructive ◽  
Postoperative Pulmonary Complications ◽  
Obstructive Pulmonary Disease ◽  
Fluid Infusion ◽  
Low Tidal Volume ◽  
Volume Ventilation

Patients with chronic obstructive pulmonary disease (COPD) exhibit airflow limitation and suboptimal lung function, and they are at high risk of developing postoperative pulmonary complications (PPCs). We aimed to determine the factors that would decrease PPC risk in patients with COPD. We retrospectively analyzed 419 patients with COPD who were registered in our institutional PPC database and had undergone an abdominal surgery under general anesthesia. PPCs comprised respiratory failure, pleural effusion, atelectasis, respiratory infection, and bronchospasm; the presence or type of PPC was diagnosed by respiratory physicians and recorded in the database before this study. Binary logistic regression was used for statistical analysis. Of the 419 patients, 121 patients (28.8%) experienced 200 PPCs. Multivariable analysis showed three modifiable anesthetic factors that could decrease PPC risk: low tidal volume ventilation, restricted fluid infusion, and sugammadex-induced neuromuscular blockade reversal. We found that the 90-day mortality risk was significantly greater in patients with PPC than in those without PPC (5.8% vs. 1.3%; p = 0.016). Therefore, PPC risk in patients with COPD can be decreased if low tidal volume ventilation, restricted fluid infusion, and sugammadex-induced reversal during abdominal surgery are efficiently managed, as these factors result in decreased postoperative mortality.

Effects of A Preoperative Exercise Training Program on Postoperative Pulmonary Complications and Exercise Capacity In Patients With Abdominal Cancer: A Systematic Review Protocol of Randomized Controlled Trials

2020 ◽  
Author(s):  
Isabel Fialho Fontenele Garcia ◽  
Vinicius Cavalheri ◽  
Adriana Claudia Lunardi
Keyword(s):  
Systematic Review ◽  
Exercise Training ◽  
Exercise Capacity ◽  
Pulmonary Complications ◽  
Major Surgery ◽  
Controlled Trials ◽  
Postoperative Pulmonary Complications ◽  
Systematic Review Protocol ◽  
Review Protocol ◽  
Preoperative Exercise

Abstract Background Abdominal cancer surgeries have a high incidence of postoperative complications. One strategy to prevent postoperative complications is preoperative exercise training. There are no systematic reviews that have compared the effects of preoperative exercise training programs of different length, frequency and duration on pre and postoperative clinical outcomes as well as on length of hospital stay (LOS) and in-hospital and late mortality in people with abdominal cancer. Methods Searches for randomised controlled trials (RCTs) of preoperative exercise training for people undergoing major surgery for abdominal cancer will be conducted in Pubmed, EMBASE, PEDro (Physiotherapy Evidence Database) and the Cochrane Library. There will be no restrictions on the language or date of publication in the search. The primary outcomes of the systematic review will be incidence of postoperative pulmonary complications as well as post-intervention and postoperative exercise capacity. The risk of bias of included RCTs will be assessed using the PEDro scale. The quality of evidence will be rated using the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). Subgroup analyzes will be conducted based on: intervention performed with or without supervision; types of exercises; and frequency and duration of the intervention. Discussion Our hypothesis is that preoperative exercise training will reduce the incidence of postoperative pulmonary complications in people undergoing major surgery for abdominal cancer by improving their preoperative exercise capacity. We will also explore the effects of the program on LOS and mortality. Systematic review registration: This systematic review protocol was registered with PROSPERO (Prospective International Register of Systematic Reviews) (number CRD42020199765).

scholarly journals Driving Pressure during Thoracic Surgery

2019 ◽  
Vol 130 (3) ◽  
pp. 385-393 ◽  
Author(s):  
MiHye Park ◽  
Hyun Joo Ahn ◽  
Jie Ae Kim ◽  
Mikyung Yang ◽  
Burn Young Heo ◽  
...  
Keyword(s):  
Thoracic Surgery ◽  
Tidal Volume ◽  
Odds Ratio ◽  
Lung Ventilation ◽  
Pulmonary Complications ◽  
Protective Ventilation ◽  
Driving Pressure ◽  
Pressure Group ◽  
Postoperative Pulmonary Complications ◽  
One Lung Ventilation

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Recently, several retrospective studies have suggested that pulmonary complication is related with driving pressure more than any other ventilatory parameter. Thus, the authors compared driving pressure–guided ventilation with conventional protective ventilation in thoracic surgery, where lung protection is of the utmost importance. The authors hypothesized that driving pressure–guided ventilation decreases postoperative pulmonary complications more than conventional protective ventilation. Methods In this double-blind, randomized, controlled study, 292 patients scheduled for elective thoracic surgery were included in the analysis. The protective ventilation group (n = 147) received conventional protective ventilation during one-lung ventilation: tidal volume 6 ml/kg of ideal body weight, positive end-expiratory pressure (PEEP) 5 cm H2O, and recruitment maneuver. The driving pressure group (n = 145) received the same tidal volume and recruitment, but with individualized PEEP which produces the lowest driving pressure (plateau pressure–PEEP) during one-lung ventilation. The primary outcome was postoperative pulmonary complications based on the Melbourne Group Scale (at least 4) until postoperative day 3. Results Melbourne Group Scale of at least 4 occurred in 8 of 145 patients (5.5%) in the driving pressure group, as compared with 18 of 147 (12.2%) in the protective ventilation group (P = 0.047, odds ratio 0.42; 95% CI, 0.18 to 0.99). The number of patients who developed pneumonia or acute respiratory distress syndrome was less in the driving pressure group than in the protective ventilation group (10/145 [6.9%] vs. 22/147 [15.0%], P = 0.028, odds ratio 0.42; 95% CI, 0.19 to 0.92). Conclusions Application of driving pressure–guided ventilation during one-lung ventilation was associated with a lower incidence of postoperative pulmonary complications compared with conventional protective ventilation in thoracic surgery.

Intraoperative Protective Mechanical Ventilation for Prevention of Postoperative Pulmonary Complications

2015 ◽  
Vol 123 (3) ◽  
pp. 692-713 ◽  
Author(s):  
Andreas Güldner ◽  
Thomas Kiss ◽  
Ary Serpa Neto ◽  
Sabrine N. T. Hemmes ◽  
Jaume Canet ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Relevant Literature ◽  
Length Of Hospital Stay ◽  
Pulmonary Complications ◽  
Major Surgery ◽  
Postoperative Pulmonary Complication ◽  
Postoperative Pulmonary Complications ◽  
Ventilator Induced Lung Injury ◽  
Ventilation Strategies ◽  
Protective Mechanical Ventilation

Abstract Postoperative pulmonary complications are associated with increased morbidity, length of hospital stay, and mortality after major surgery. Intraoperative lung-protective mechanical ventilation has the potential to reduce the incidence of postoperative pulmonary complications. This review discusses the relevant literature on definition and methods to predict the occurrence of postoperative pulmonary complication, the pathophysiology of ventilator-induced lung injury with emphasis on the noninjured lung, and protective ventilation strategies, including the respective roles of tidal volumes, positive end-expiratory pressure, and recruitment maneuvers. The authors propose an algorithm for protective intraoperative mechanical ventilation based on evidence from recent randomized controlled trials.

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