Respiratory Prehabilitation for the Prevention of Postoperative Pulmonary Complications after Major Surgery

Author(s):  
Ianthe Boden ◽  
Linda Denehy
2020 ◽  
Author(s):  
Isabel Fialho Fontenele Garcia ◽  
Vinicius Cavalheri ◽  
Adriana Claudia Lunardi

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).


2015 ◽  
Vol 123 (3) ◽  
pp. 692-713 ◽  
Author(s):  
Andreas Güldner ◽  
Thomas Kiss ◽  
Ary Serpa Neto ◽  
Sabrine N. T. Hemmes ◽  
Jaume Canet ◽  
...  

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.


2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  

Abstract Introduction This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery. Method International cohort study including adult patients undergoing elective surgery for cancer in areas affected by SARS-CoV-2 up to 19 April 2020 (NCT04384926). Patients suspected preoperatively of SARS-CoV-2 infection were excluded. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery. Results Of 8784 patients (432 hospitals, 53 countries), 2303 patients (26.2%) underwent preoperative testing: 1458 (16.6%) had a swab test, 521 (5.9%) CT only, and 324 (3.7%) swab and CT. The overall pulmonary complication rate was 3.9% and SARS-CoV-2 infection rate was 2.6%. After risk adjustment, only a nasopharyngeal swab test (adjusted odds ratio 0.68, 95% confidence interval 0.68-0.98, p = 0.040) was associated with lower rates of pulmonary complications. Swab testing remained beneficial before major surgery and in high SARS-CoV-2 population risk areas but not before minor surgery in low incidence areas. Conclusions Preoperative nasopharyngeal swab testing was beneficial before major surgery and in high SARS-CoV-2 incidence areas. There was no proven benefit of swab testing before minor surgery in low incidence areas.


2020 ◽  
Vol 17 (5) ◽  
pp. 47-61
Author(s):  
V. V. Kuzkov ◽  
K. S. Lapin ◽  
E. V. Fot ◽  
M. Yu. Kirov

The prophylaxis of ventilator-associated lung injury (VALI) and postoperative pulmonary complications (PPC) is of utmost importance to reduce complications both in the perioperative period of major surgery and in the intensive care unit (ICU).Protective approach to mechanical ventilation comprises a wide range of measures reducing the damage of the lung tissue associated with the stress and strain phenomena. The implementation of the strategy of high positive end-expiratory pressure (PEEP) in combination with alveolar recruitment maneuver has numerous limitations and requires further personalized approaches.When lung injury is self-induced by a patient, it becomes an important contributor to VALI and should be timely diagnosed and prevented both before initiation of mechanical support and during the restoration of spontaneous breathing. This review highlights the key mechanisms of VALI and current understanding of protective ventilation. The concept of damaging energy as well as approaches to the personalized optimization of respiratory settings are discussed in detail. Particular attention is paid to the prognostication of the risk factors of VALI and PPC.


JAMA ◽  
2020 ◽  
Vol 324 (9) ◽  
pp. 848 ◽  
Author(s):  
Dharshi Karalapillai ◽  
Laurence Weinberg ◽  
Philip Peyton ◽  
Louise Ellard ◽  
Raymond Hu ◽  
...  

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