scholarly journals Preoperative intervention reduces postoperative pulmonary complications but not length of stay in cardiac surgical patients: a systematic review

2014 ◽  
Vol 60 (2) ◽  
pp. 66-77 ◽  
Author(s):  
David Snowdon ◽  
Terry P Haines ◽  
Elizabeth H Skinner
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Pulmonary Complications ◽  
Surgical Patients ◽  
Postoperative Pulmonary Complications

666 EARLY EXTUBATION AFTER ESOPHAGECTOMY IS SAFE. A SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Maria Serafim ◽  
Clara Santos ◽  
Marina Orlandini ◽  
Letícia Datrino ◽  
Guilherme Tavares ◽  
...  
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Risk Difference ◽  
Pulmonary Complications ◽  
Mean Difference ◽  
Early Extubation ◽  
Icu Length Of Stay ◽  
Anastomotic Fistula

Abstract   Esophagectomy has high morbidity and mortality, mainly due to pulmonary complications. Consequently, ventilatory support is a cornerstone in postoperative management. However, there is still no consensus on the timing for extubation. There is a fear that untimely extubation would lead to a high risk for an urgent reintubation. On the other hand, there is a risk for pulmonary damage in prolonged intubation. Thus, the present study aimed to compare early and late extubation after esophagectomy. Methods A systematic review was carried out on PubMed, Lilacs, Cochrane Library Central, and Embase, comparing early and late extubation after esophagectomy. The primary outcome was reintubation. Secondary outcomes included mortality; complications; pulmonary complications; pneumonia; anastomotic fistula; length of hospital stay; and ICU length of stay. The inclusion criteria were: a) clinical trials and cohort studies; b) adult patients (> 18 years); and c) patients with esophageal cancer undergoing esophagectomy. The results were summarized by risk difference and mean difference. 95% confidence interval and random model were applied. Results Four articles were selected, comprising 490 patients. Early extubation did not increase the risk for reintubation, with a risk difference of 0.01 (95%CI -0.03; 0.04). Also, there was no difference for mortality −0.01 (95%CI -0.04; 0.03); complications −0.09 (95%CI -0.22; 0.05); pulmonary complications −0.05 (95%CI -0.13; 0.03); pneumonia −0.06 (95% CI-0.18; 0.05); anastomotic fistula −0.01 (95% CI -0.09; 0.08). In addition, there was no significant mean difference for: length of hospital stay −0.10 (95%CI -0.38; 0.1); and ICU length of stay 0.00 (95%CI -0.22; 0.22). Conclusion Early extubation after esophagectomy does not increase the risk for reintubation, mortality, complications, and lenght of stay.

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 Effects of intraoperative PEEP on postoperative pulmonary complications in high-risk patients undergoing laparoscopic abdominal surgery: study protocol for a randomised controlled trial

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e028464
Author(s):  
Zhen-feng Zhou ◽  
Jun-biao Fang ◽  
Hong-fa Wang ◽  
Ying He ◽  
Yong-jian Yu ◽  
...  
Keyword(s):  
High Risk ◽  
Length Of Stay ◽  
Abdominal Surgery ◽  
Fluid Management ◽  
Pulmonary Complications ◽  
Hospital Length Of Stay ◽  
Lung Protective Ventilation ◽  
Postoperative Pulmonary Complications ◽  
Protective Ventilation Strategy ◽  
Registration Number

IntroductionPostoperative pulmonary complications (PPCs), strongly associated with higher mortality risk, can develop in up to 58% of patients undergoing abdominal surgery. More and more evidence shows that the use of a lung-protective ventilation strategy has a lung protection effect in patients undergoing abdominal surgery, however, the role of positive end-expiratory pressure (PEEP) during the intraoperative period in preventing PPCs for laparoscopic surgery is not clearly defined.Methods and analysisA total of 208 patients with a high risk of PPC, undergoing laparoscopic abdominal surgery, will be enrolled and randomised into a standard PEEP (6–8 cm H2O) group and a low PEEP (≤2 cm H2O) group. Both groups will receive a fraction of inspired oxygen of 0.50 and a tidal volume of 8 mL/kg ideal body weight (IBW). Standard perioperative fluid management and analgesic treatments are applied in both groups. The primary end point is PPC within 7 days after surgery. Secondary end points are the modified Clinical Pulmonary Infection Score, postoperative extrapulmonary complications, postoperative surgical complications, intensive care unit length of stay, hospital length of stay, 30-day mortality.Ethics and disseminationThe study was approved by the Ethics Committee of Zhejiang Provincial People’s Hospital (People’s Hospital of Hangzhou Medicine College) (registration number KY2018026) on 22 October 2018. The first participant was recruited on 15 April 2019 and the estimated completion date of the study is October 2021. The results of this trial will be submitted to a peer-reviewed journal.Trial registration numberhttp://www.chictr.org.cn, ID: ChiCTR1800019865. Registered on 2 December 2018; preresults.

Prospective External Validation of a Predictive Score for Postoperative Pulmonary Complications

2014 ◽  
Vol 121 (2) ◽  
pp. 219-231 ◽  
Author(s):  
Valentín Mazo ◽  
Sergi Sabaté ◽  
Jaume Canet ◽  
Lluís Gallart ◽  
Marcelo Gama de Abreu ◽  
...  
Keyword(s):  
Eastern Europe ◽  
Likelihood Ratio ◽  
Risk Score ◽  
Western Europe ◽  
Positive Likelihood Ratio ◽  
Pulmonary Complications ◽  
Surgical Patients ◽  
Prospective Evaluation ◽  
Postoperative Pulmonary Complications ◽  
C Statistic

Abstract Background: No externally validated risk score for postoperative pulmonary complications (PPCs) is currently available. The authors tested the generalizability of the Assess Respiratory Risk in Surgical Patients in Catalonia risk score for PPCs in a large European cohort (Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe). Methods: Sixty-three centers recruited 5,859 surgical patients receiving general, neuraxial, or plexus block anesthesia. The Assess Respiratory Risk in Surgical Patients in Catalonia factors (age, preoperative arterial oxygen saturation in air, acute respiratory infection during the previous month, preoperative anemia, upper abdominal or intrathoracic surgery, surgical duration, and emergency surgery) were recorded, along with PPC occurrence (respiratory infection or failure, bronchospasm, atelectasis, pleural effusion, pneumothorax, or aspiration pneumonitis). Discrimination, calibration, and diagnostic accuracy measures of the Assess Respiratory Risk in Surgical Patients in Catalonia score’s performance were calculated for the Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe cohort and three subsamples: Spain, Western Europe, and Eastern Europe. Results: The full Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe data set included 5,099 patients; 725 PPCs were recorded for 404 patients (7.9%). The score’s discrimination was good: c-statistic (95% CI), 0.80 (0.78 to 0.82). Predicted versus observed PPC rates for low, intermediate, and high risk were 0.87 and 3.39% (score <26), 7.82 and 12.98% (≥26 and <45), and 38.13 and 38.01% (≥45), respectively; the positive likelihood ratio for a score of 45 or greater was 7.12 (5.93 to 8.56). The score performed best in the Western Europe subsample—c-statistic, 0.87 (0.83 to 0.90) and positive likelihood ratio, 11.56 (8.63 to 15.47)—and worst in the Eastern Europe subsample. The predicted (5.5%) and observed (5.7%) PPC rates were most similar in the Spain subsample. Conclusions: The Assess Respiratory Risk in Surgical Patients in Catalonia score predicts three levels of PPC risk in hospitals outside the development setting. Performance differs between geographic areas.

Sign in / Sign up

Export Citation Format

Share Document