scholarly journals Intraoperative Mechanical Ventilation and Postoperative Pulmonary Complications after Cardiac Surgery: Erratum

2020 ◽  
Vol 132 (1) ◽  
pp. 217-217
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Pulmonary Complications ◽  
Postoperative Pulmonary Complications

Utility of Perioperative Lung Ultrasound in Pediatric Cardiac Surgery

2018 ◽  
Vol 128 (4) ◽  
pp. 718-727 ◽  
Author(s):  
In-Kyung Song ◽  
Eun-Hee Kim ◽  
Ji-Hyun Lee ◽  
Pyoyoon Kang ◽  
Hee-Soo Kim ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Lung Ultrasound ◽  
Ultrasound Examination ◽  
Recruitment Maneuver ◽  
Intervention Group ◽  
Pulmonary Complications ◽  
Control Group ◽  
Postoperative Pulmonary Complications ◽  
Ultrasound Guided

Abstract Background Pediatric cardiac patients are at risk for perioperative respiratory insufficiency. The objective of this study was to assess the utility of perioperative lung ultrasound examination in pediatric cardiac surgery. Methods In this randomized, controlled trial, children (5 yr old or younger) undergoing cardiac surgery were allocated into a control (n = 61) or intervention (n = 61) group. The control group received only lung ultrasound examinations at the end of surgery and 6 to 12 h after surgery. The intervention group received lung ultrasound examinations and an ultrasound-guided recruitment maneuver depending on ultrasound findings after inducing anesthesia, at the end of surgery, and 6 to 12 h after surgery. Primary outcomes were incidences of intra- and postoperative desaturation, and postoperative pulmonary complications. Multiple comparisons were corrected (P ≤ 0.017) in the primary outcome analysis. Results Of the 120 children included in the analysis, postoperative desaturation (64% vs. 27%; P < 0.001; odds ratio [OR], 0.210; 95% CI, 0.097 to 0.456) occurred more in the control group. The incidences of intraoperative desaturation (36% vs. 19%; P = 0.033; OR, 0.406; 95% CI, 0.176 to 0.939) and postoperative pulmonary complications (12% vs. 3%; P = 0.093; OR, 0.271; 95% CI, 0.054 to 1.361) were similar between the groups. Lung ultrasound scores were better in the intervention group than in the control group. Duration of mechanical ventilation was longer in the control group than in the intervention group (38 ± 43 vs. 26 ± 25 h; 95% CI of mean difference, 0 to 25; P = 0.048). Conclusions Perioperative lung ultrasound examination followed by ultrasound-guided recruitment maneuver helped decrease postoperative desaturation events and shorten the duration of mechanical ventilation in pediatric cardiac patients.

scholarly journals Anesthetics to Prevent Lung Injury in Cardiac Surgery (APLICS): A protocol for a randomized, controlled trial

2019 ◽  
Author(s):  
Brian O'Gara ◽  
Balachundhar Subramaniam ◽  
Shahzad Shaefi ◽  
Ariel Mueller ◽  
Valerie Banner-Goodspeed ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Lung Injury ◽  
Ischemia Reperfusion ◽  
Controlled Trial ◽  
Pulmonary Inflammation ◽  
Pulmonary Complications ◽  
Postoperative Pulmonary Complications ◽  
Randomized Controlled

Abstract Background Patients undergoing cardiac surgery with cardiopulmonary bypass are at an increased risk of developing postoperative pulmonary complications, potentially leading to excess morbidity and mortality. It is likely that pulmonary ischemia-reperfusion (IR) injury during cardiopulmonary bypass is a major contributor to perioperative lung injury. Therefore, interventions that can minimize IR injury would be valuable in reducing the excess burden of this potentially preventable disease process. Volatile anesthetics including sevoflurane have been shown in both preclinical and human trials to effectively limit pulmonary inflammation in a number of settings including ischemia-reperfusion injury. However, this finding has not yet been demonstrated in the cardiac surgery population. The Anesthetics to Prevent Lung Injury in Cardiac Surgery (APLICS) trial is a randomized, controlled trial investigating whether sevoflurane anesthetic maintenance can modulate pulmonary inflammation occurring during cardiac surgery with cardiopulmonary bypass, and whether this potential effect can translate to a reduction in postoperative pulmonary complications. Methods APLICS is a prospective, randomized controlled trial of adult cardiac surgical patients. Subjects will be randomized to receive intraoperative anesthetic maintenance with either sevoflurane or propofol. Patients in both groups will be ventilated according to protocols intended to minimize the influences of ventilator induced lung injury and hyperoxia. Bronchoalveolar lavage (BAL) and blood sampling will take place after anesthetic induction and between two to four hours after pulmonary reperfusion. The primary outcome is a difference between groups in the degree of post-bypass lung inflammation, defined by BAL concentrations of TNFa. Secondary outcomes will include differences in additional relevant BAL and systemic inflammatory markers and the incidence of postoperative pulmonary complications. Discussion APLICS investigates whether anesthetic choice can influence lung inflammation and pulmonary outcomes following cardiac surgery with cardiopulmonary bypass. A positive result from this trial would add to the growing body of evidence describing the lung protective properties of the volatile anesthetics and potentially reduce unnecessary morbidity for cardiac surgery patients. Trial Registration ClinicalTrials.gov identifier NCT02918877, registered on September 29, 2016.

scholarly journals Mechanical ventilation is controlled by volume or pressure during neurosurgery. Is there an advantage?

2021 ◽  
Vol 17 (8) ◽  
pp. 51-54
Author(s):  
R.O. Merza ◽  
Ya.M. Pidhirnyi
Keyword(s):  
Mechanical Ventilation ◽  
Pulmonary Ventilation ◽  
Intermittent Positive Pressure Ventilation ◽  
Pulmonary Complications ◽  
Volume Control ◽  
Positive Pressure ◽  
Postoperative Pulmonary Complications ◽  
Oxygen Fraction ◽  
Number Of Patients ◽  
Neurosurgical Patients

Background. One of the main technologies of modern anesthesiology is mechanical ventilation (MV). At present, the protective technology of MV is widely recognized. The feasibi-lity of using this technology in the operating room, especially in patients with intact lungs, is not so obvious. Most of the scientific sources that cover this problem relate to patients with abdominal pathology, and less coverage remains in patients with neurosurgical pathology. However, patients who are operated on for neurosurgical pathology belong to the group of patients of high surgical risk, which forced us to conduct this study. The study was aimed to examine the feasibility of using protective MV during surgery in neurosurgical patients. Materials and methods. We examined 46 patients who were hospitalized in KNP 8 MKL in Lviv for spinal pathology and who underwent surgery for vertebroplasty with spondylodesis. Patients were divided into two groups: in the first group (34 patients), MV was performed by S-IPPV technology — synchronized intermittent positive pressure ventilation with volume control; and in the second group (12 patients), MV was performed by PCV technology — controlled ventilation pressure. Results. We retrospectively determined the incidence of post-operative pulmonary complications (POPC) in patients of the first and second groups. Of the 34 patients of the first group, the signs of POPC were detected in 17 patients (50 %), and of 12 patients of the second group, POPC were detected in 4 patients (33.3 %). It should be noted that MV in patients of both groups did not differ in such parameters as respiratory rate, end-alveolar pressure, and the fraction of oxygen in the respiratory mixture. Conclusions. A relatively small number of patients clearly do not allow the conclusions to be drawn, but it should be noted that MV (especially volume-controlled) contributes to postoperative pulmonary complications in patients with intact lungs in the preoperative period. And pressure-controlled MV tends to reduce the incidence of postoperative pulmonary complications in the postoperative period. Given that respiration rate, end-alveolar expiratory pressure and oxygen fraction in the respiratory mixture were comparable in patients of both groups, it can be assumed that the factor influencing the incidence of POPC is the mechanics of pulmonary ventilation.

scholarly journals Anesthetics to Prevent Lung Injury in Cardiac Surgery (APLICS): A protocol for a randomized, controlled trial

2019 ◽  
Author(s):  
Brian P. O’Gara ◽  
Balachundhar Subramaniam ◽  
Shahzad Shaefi ◽  
Ariel Mueller ◽  
Valerie Banner-Goodspeed ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Lung Injury ◽  
Ischemia Reperfusion ◽  
Controlled Trial ◽  
Pulmonary Inflammation ◽  
Pulmonary Complications ◽  
Postoperative Pulmonary Complications ◽  
Randomized Controlled

Abstract Background Patients undergoing cardiac surgery with cardiopulmonary bypass are at an increased risk of developing postoperative pulmonary complications, potentially leading to excess morbidity and mortality. It is likely that pulmonary ischemia-reperfusion (IR) injury during cardiopulmonary bypass is a major contributor to perioperative lung injury. Therefore, interventions that can minimize IR injury would be valuable in reducing the excess burden of this potentially preventable disease process. Volatile anesthetics including sevoflurane have been shown in both preclinical and human trials to effectively limit pulmonary inflammation in a number of settings including ischemia-reperfusion injury. However, this finding has not yet been demonstrated in the cardiac surgery population. The Anesthetics to Prevent Lung Injury in Cardiac Surgery (APLICS) trial is a randomized, controlled trial investigating whether sevoflurane anesthetic maintenance can modulate pulmonary inflammation occurring during cardiac surgery with cardiopulmonary bypass, and whether this potential effect can translate to a reduction in postoperative pulmonary complications. Methods APLICS is a prospective, randomized controlled trial of adult cardiac surgical patients. Subjects will be randomized to receive intraoperative anesthetic maintenance with either sevoflurane or propofol. Patients in both groups will be ventilated according to protocols intended to minimize the influences of ventilator induced lung injury and hyperoxia. Bronchoalveolar lavage (BAL) and blood sampling will take place after anesthetic induction and between two to four hours after pulmonary reperfusion. The primary outcome is a difference between groups in the degree of post-bypass lung inflammation, defined by BAL concentrations of TNFa. Secondary outcomes will include differences in additional relevant BAL and systemic inflammatory markers and the incidence of postoperative pulmonary complications. Discussion APLICS investigates whether anesthetic choice can influence lung inflammation and pulmonary outcomes following cardiac surgery with cardiopulmonary bypass. A positive result from this trial would add to the growing body of evidence describing the lung protective properties of the volatile anesthetics and potentially reduce unnecessary morbidity for cardiac surgery patients. Trial Registration ClinicalTrials.gov identifier NCT02918877, registered on September 29, 2016.

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