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.

The effectiveness of pre- and post-operative rehabilitation for lung cancer: A systematic review and meta-analysis on postoperative pulmonary complications and length of hospital stay

2021 ◽  
pp. 026921552110432
Author(s):  
Xinyi Xu ◽  
Denise Shuk Ting Cheung ◽  
Robert Smith ◽  
Agnes Yuen Kwan Lai ◽  
Chia-Chin Lin
Keyword(s):  
Lung Cancer ◽  
Hospital Stay ◽  
Pulmonary Complication ◽  
Length Of Hospital Stay ◽  
Pulmonary Complications ◽  
Hospital Length Of Stay ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Postoperative Pulmonary Complication ◽  
Postoperative Pulmonary Complications

Objective: To investigate the effects of rehabilitation either before or after operation for lung cancer on postoperative pulmonary complications and the length of hospital stay. Data sources: MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL Plus, SPORTDiscus, PsycInfo and Embase were searched from inception until June 2021. Review methods: Inclusion criteria were patients scheduled to undergo or had undergone operation for lung cancer, randomised controlled trials comparing rehabilitative interventions initiated before hospital discharge to usual care control. Two reviewers independently assessed eligibility, extracted data and risks of bias. Pooled odds ratios (ORs) or standardised mean differences (SMDs) with 95% Confidence Intervals (CI) were estimated using random-effects meta-analyses. Results: Twenty-three studies were included (12 preoperative, 10 postoperative and 1 perioperative), with 2068 participants. The pooled postoperative pulmonary complication risk and length of hospital stay were reduced after preoperative interventions (OR = 0.32; 95% CI = 0.22, 0.47; I2 = 0.0% and SMD = −1.68 days, 95% CI = −2.23, −1.13; I2 = 77.8%, respectively). Interventions delivered during the immediate postoperative period did not have any significant effects on either postoperative pulmonary complication or length of hospital stay (OR = 0.85; 95% CI = 0.56, 1.29; I2 = 0.0% and SMD = −0.23 days, 95% CI = −1.08, 0.63; I2 = 64.6%, respectively). Meta-regression showed an association between a higher number of supervised sessions and shorter hospital length of stay in preoperative studies (β = −0.17, 95% CI = −0.29, −0.05). Conclusion: Preoperative rehabilitation is effective in reducing postoperative pulmonary complications and length of hospital stay associated with lung cancer surgery. Short-term postoperative rehabilitation in inpatient settings is probably ineffective.

scholarly journals PREDICTION VALUE OF OXYGENATION INDEX AS PREDICTOR FOR POSTOPERATIVE PULMONARY COMPLICATIONS IN UROLOGIC SURGERY

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Maja Mojsova Mijovska ◽  
Aleksandra Gavrilovska- Brzanov ◽  
Marija Jovanovski Srceva ◽  
Zuzanne Ehmer Nelepa ◽  
Nikola Brzanov
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Stay ◽  
Multivariate Logistic Regression Analysis ◽  
Length Of Hospital Stay ◽  
Oxygenation Index ◽  
Pulmonary Complications ◽  
Arterial Oxygen ◽  
Postoperative Pulmonary Complications ◽  
Oxygenation Status ◽  
Endotracheal Anesthesia

Introduction: It is believed that pressure/flow (P/F) ratio (arterial oxygen to inspired oxygen fraction) does not give the best expression of oxygenation status in mechanically ventilated patients. Therefore, a new oxygenation index (OI) where the mean airway pressure (MAP) is incorporated (PaO2/FiOxMAP) is showed as superior to P/F in expression of the lung oxygenation status. In this article we wanted to assess the prediction value of OI calculated during urological surgeries as a predictive marker for developing postoperative pulmonary complications (PPC). Material and methods: We evaluated all elective urologic patients operated in general endotracheal anesthesia, aged 18 to 65 years, without any known history of respiratory disease for the period from January till December 2017. We calculated the P/F ratio and the OI at three time points: after induction in general endotracheal anesthesia in the beginning of mechanical ventilation, 1 hour after induction in anesthesia, and at the end of the surgery before weaning the mechanical ventilation. The primary outcomes were PPC defined by European Society of Anesthesia. The second outcomes were: length of hospital stay, admission to intensive care unit (ICU) and mortality.   Results: A total of 240 patients who met the inclusion criteria were included in this evaluation and finally analyzed. PPC were diagnosed in 25% of patients and respectively 75% were without complications. Postoperative hospital stay was longer in PPC group no matter they were operated laparoscopically or with classic open surgery (PPC laparoscopy 4.9 ± 2.2 vs. non PPC laparoscopy 3.3 ± 1.7, PPC laparotomy 6.8 ± 5.2 vs. non PPC 5.6 ± 2.1 laparotomy). Ten patients were admitted to ICU, 8 from PPC group and 2 from non PPC group. In PPC group patients were admitted to ICU for mean 3.7 ± 2.4 days, and in non PPC group patients were hospitalized in ICU only for 2 days. All evaluated patients were discharged from the hospital and no mortality was observed in the 30 postoperative days. In the univariate and multivariate logistic regression analysis neither OI nor P/F were significantly associated with PPC. Conclusion:  This study does not offer a conclusive answer to the prediction value of OI for PPC. It would be fruitful to pursue further research about predictive variables for pulmonary complications.

scholarly journals Imaging atelectrauma in Ventilator-Induced Lung Injury using 4D X-ray microscopy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Luca Fardin ◽  
Ludovic Broche ◽  
Goran Lovric ◽  
Alberto Mittone ◽  
Olivier Stephanov ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Lung Injury ◽  
Lung Parenchyma ◽  
Contrast Imaging ◽  
Barrier Dysfunction ◽  
Mechanically Ventilated ◽  
Ventilator Induced Lung Injury ◽  
Regional Lung ◽  
Ventilation Strategies ◽  
Protective Mechanical Ventilation

AbstractMechanical ventilation can damage the lungs, a condition called Ventilator-Induced Lung Injury (VILI). However, the mechanisms leading to VILI at the microscopic scale remain poorly understood. Here we investigated the within-tidal dynamics of cyclic recruitment/derecruitment (R/D) using synchrotron radiation phase-contrast imaging (PCI), and the relation between R/D and cell infiltration, in a model of Acute Respiratory Distress Syndrome in 6 anaesthetized and mechanically ventilated New-Zealand White rabbits. Dynamic PCI was performed at 22.6 µm voxel size, under protective mechanical ventilation [tidal volume: 6 ml/kg; positive end-expiratory pressure (PEEP): 5 cmH2O]. Videos and quantitative maps of within-tidal R/D showed that injury propagated outwards from non-aerated regions towards adjacent regions where cyclic R/D was present. R/D of peripheral airspaces was both pressure and time-dependent, occurring throughout the respiratory cycle with significant scatter of opening/closing pressures. There was a significant association between R/D and regional lung cellular infiltration (p = 0.04) suggesting that tidal R/D of the lung parenchyma may contribute to regional lung inflammation or capillary-alveolar barrier dysfunction and to the progression of lung injury. PEEP may not fully mitigate this phenomenon even at high levels. Ventilation strategies utilizing the time-dependence of R/D may be helpful in reducing R/D and associated injury.

scholarly journals Effect of Intraoperative Ventilation Strategies on Postoperative Pulmonary Complications: A Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Min Lei ◽  
Qi Bao ◽  
Huanyu Luo ◽  
Pengfei Huang ◽  
Junran Xie
Keyword(s):  
Mechanical Ventilation ◽  
Pleural Effusion ◽  
Meta Analysis ◽  
Conventional Mechanical Ventilation ◽  
Pulmonary Complications ◽  
Aspiration Pneumonitis ◽  
Cochrane Library ◽  
Postoperative Pulmonary Complications ◽  
Ventilation Strategies ◽  
Intraoperative Ventilation

Introduction: The role of intraoperative ventilation strategies in subjects undergoing surgery is still contested. This meta-analysis study was performed to assess the relationship between the low tidal volumes strategy and conventional mechanical ventilation in subjects undergoing surgery.Methods: A systematic literature search up to December 2020 was performed in OVID, Embase, Cochrane Library, PubMed, and Google scholar, and 28 studies including 11,846 subjects undergoing surgery at baseline and reporting a total of 2,638 receiving the low tidal volumes strategy and 3,632 receiving conventional mechanical ventilation, were found recording relationships between low tidal volumes strategy and conventional mechanical ventilation in subjects undergoing surgery. Odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CIs) were calculated between the low tidal volumes strategy vs. conventional mechanical ventilation using dichotomous and continuous methods with a random or fixed-effect model.Results: The low tidal volumes strategy during surgery was significantly related to a lower rate of postoperative pulmonary complications (OR, 0.60; 95% CI, 0.44–0.83, p < 0.001), aspiration pneumonitis (OR, 0.63; 95% CI, 0.46–0.86, p < 0.001), and pleural effusion (OR, 0.72; 95% CI, 0.56–0.92, p < 0.001) compared to conventional mechanical ventilation. However, the low tidal volumes strategy during surgery was not significantly correlated with length of hospital stay (MD, −0.48; 95% CI, −0.99–0.02, p = 0.06), short-term mortality (OR, 0.88; 95% CI, 0.70–1.10, p = 0.25), atelectasis (OR, 0.76; 95% CI, 0.57–1.01, p = 0.06), acute respiratory distress (OR, 1.06; 95% CI, 0.67–1.66, p = 0.81), pneumothorax (OR, 1.37; 95% CI, 0.88–2.15, p = 0.17), pulmonary edema (OR, 0.70; 95% CI, 0.38–1.26, p = 0.23), and pulmonary embolism (OR, 0.65; 95% CI, 0.26–1.60, p = 0.35) compared to conventional mechanical ventilation.Conclusions: The low tidal volumes strategy during surgery may have an independent relationship with lower postoperative pulmonary complications, aspiration pneumonitis, and pleural effusion compared to conventional mechanical ventilation. This relationship encouraged us to recommend the low tidal volumes strategy during surgery to avoid any possible complications.

scholarly journals Management of Intraoperative Mechanical Ventilation to Prevent Postoperative Complications after General Anesthesia: A Narrative Review

2021 ◽  
Vol 10 (12) ◽  
pp. 2656
Author(s):  
Alberto Fogagnolo ◽  
Federica Montanaro ◽  
Lou’i Al-Husinat ◽  
Cecilia Turrini ◽  
Michela Rauseo ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Tidal Volume ◽  
Pulmonary Complications ◽  
Point Of View ◽  
Whole Body ◽  
Positive End Expiratory Pressure ◽  
Ventilation Strategies ◽  
Harmful Effects ◽  
Ventilation Induced Lung Injury ◽  
Different Levels

Mechanical ventilation (MV) is still necessary in many surgical procedures; nonetheless, intraoperative MV is not free from harmful effects. Protective ventilation strategies, which include the combination of low tidal volume and adequate positive end expiratory pressure (PEEP) levels, are usually adopted to minimize the ventilation-induced lung injury and to avoid post-operative pulmonary complications (PPCs). Even so, volutrauma and atelectrauma may co-exist at different levels of tidal volume and PEEP, and therefore, the physiological response to the MV settings should be monitored in each patient. A personalized perioperative approach is gaining relevance in the field of intraoperative MV; in particular, many efforts have been made to individualize PEEP, giving more emphasis on physiological and functional status to the whole body. In this review, we summarized the latest findings about the optimization of PEEP and intraoperative MV in different surgical settings. Starting from a physiological point of view, we described how to approach the individualized MV and monitor the effects of MV on lung function.

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