scholarly journals Perioperative Pulmonary Atelectasis: Part II. Clinical Implications

2021 ◽  
Author(s):  
David Lagier ◽  
Congli Zeng ◽  
Ana Fernandez-Bustamante ◽  
Marcos F. Vidal Melo
Keyword(s):  
Ventilatory Support ◽  
Pulmonary Complications ◽  
Anesthetic Technique ◽  
Positive Pressure ◽  
Surgical Patient ◽  
Lung Collapse ◽  
Impedance Tomography ◽  
Pulmonary Atelectasis ◽  
Lung Expansion ◽  
Bedside Diagnosis

The development of pulmonary atelectasis is common in the surgical patient. Pulmonary atelectasis can cause various degrees of gas exchange and respiratory mechanics impairment during and after surgery. In its most serious presentations, lung collapse could contribute to postoperative respiratory insufficiency, pneumonia, and worse overall clinical outcomes. A specific risk assessment is critical to allow clinicians to optimally choose the anesthetic technique, prepare appropriate monitoring, adapt the perioperative plan, and ensure the patient’s safety. Bedside diagnosis and management have benefited from recent imaging advancements such as lung ultrasound and electrical impedance tomography, and monitoring such as esophageal manometry. Therapeutic management includes a broad range of interventions aimed at promoting lung recruitment. During general anesthesia, these strategies have consistently demonstrated their effectiveness in improving intraoperative oxygenation and respiratory compliance. Yet these same intraoperative strategies may fail to affect additional postoperative pulmonary outcomes. Specific attention to the postoperative period may be key for such outcome impact of lung expansion. Interventions such as noninvasive positive pressure ventilatory support may be beneficial in specific patients at high risk for pulmonary atelectasis (e.g., obese) or those with clinical presentations consistent with lung collapse (e.g., postoperative hypoxemia after abdominal and cardiothoracic surgeries). Preoperative interventions may open new opportunities to minimize perioperative lung collapse and prevent pulmonary complications. Knowledge of pathophysiologic mechanisms of atelectasis and their consequences in the healthy and diseased lung should provide the basis for current practice and help to stratify and match the intensity of selected interventions to clinical conditions.

The Effects of Mechanical Insufflation-Exsufflation on Lung Function and Complications in Cardiac Surgery Patients

2020 ◽  
Author(s):  
Meng-Fang Wu ◽  
Tsai-Yu Wang ◽  
Da-Shen Chen ◽  
Shou-Fong Shiao ◽  
Han-Chuang Hu ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Chest Pain ◽  
Lung Function ◽  
Clinical Outcomes ◽  
Tertiary Hospital ◽  
Forced Expiratory Volume ◽  
Pulmonary Complications ◽  
Positive Pressure ◽  
Lung Expansion ◽  
Intermittent Positive Pressure Breathing

Abstract Background: Postoperative positive pressure lung expansion is associated with decreased pulmonary complications and improved clinical outcomes. The aim of the present study was to compare the differences in post-operative pulmonary complications and clinical outcomes between two groups of study subjects who underwent cardiac surgery; one included subjects who received mechanical insufflation-exsufflation (MI-E) and the other included subjects who received intermittent positive pressure breathing (IPPB) therapy.Methods: This retrospective study included 48 subjects, who underwent cardiac surgery in an intensive care unit of a tertiary hospital during the time period from June 2017 to February 2018. After liberation from mechanical ventilation, the subjects received lung expansion therapy by means of two type of positive pressure devices, MI-E (n=20) or IPPB (n=28). The pulmonary complications, lung function, and clinical outcomes were compared between the two groups.Results: Subjects in both groups displayed similar baseline characteristics and underwent similar types of surgical procedures. Compared to subjects who received non-oscillatory therapy, those who received MI-E therapy had higher post-operative force vital capacity (58.9±4.96 % vs. 45.21±3.60 %, p=0.026), forced expiratory volume in one second (63.35±5.4 % vs. 45.48±3.63 %, p=0.007), and peak flow rate (68.5±5.53 % vs. 54.75±4.11 %, p=0.047). However, the incidence of chest pain was higher in the MI-E group (n=13, 65%) than in the IPPB group (n=4, 14.3%; odds ratio, 11.14, 95% confidence interval, 2.74-45.26; p=0.001). The length of hospital and ICU stay, development of atelectasis, pneumonia, and pleural effusion were similar in both the groups.Conclusion: Both IPPB and MI-E therapies have similar effects on preventing post-operative complications in cardiac surgery patients. However, compared to IPPB therapy, MI-E therapy was associated with improved pulmonary function and higher incidence of chest pain.

scholarly journals The Effects of Mechanical Insufflation-Exsufflation on Lung Function and Complications in Cardiac Surgery Patients: A Pilot Study

2020 ◽  
Author(s):  
Meng-Fang Wu ◽  
Tsai-Yu Wang ◽  
Da-Shen Chen ◽  
Hsiu-Fong Hsiao ◽  
Han-Chuang Hu ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Chest Pain ◽  
Lung Function ◽  
Clinical Outcomes ◽  
Tertiary Hospital ◽  
Forced Expiratory Volume ◽  
Pulmonary Complications ◽  
Positive Pressure ◽  
Lung Expansion ◽  
Intermittent Positive Pressure Breathing

Abstract Background: Postoperative positive pressure lung expansion is associated with decreased pulmonary complications and improved clinical outcomes. The aim of the present study was to compare the differences in post-operative pulmonary complications and clinical outcomes between two groups of study subjects who underwent cardiac surgery; one included subjects who received mechanical insufflation-exsufflation (MI-E) and the other included subjects who received intermittent positive pressure breathing (IPPB) therapy. Methods: This retrospective study included 51 subjects, who underwent cardiac surgery in an intensive care unit of a tertiary hospital during the time period from June 2017 to February 2018. After liberation from mechanical ventilation, the subjects received lung expansion therapy by means of two types of positive pressure devices, MI-E (n=21) or IPPB (n=30). The pulmonary complications, lung function, and clinical outcomes were compared between the two groups. Results: Subjects in both groups displayed similar baseline characteristics and underwent similar types of surgical procedures. Compared to subjects who received non-oscillatory therapy, those who received MI-E therapy had higher post-operative force vital capacity (58.4±4.74 % vs. 46.0±3.70 %, p=0.042), forced expiratory volume in one second (62.4±5.23 % vs. 46.8±3.83 %, p=0.017), and peak flow rate (67.1±5.53 L vs. 55.7±4.44 L p=0.111). However, the incidence of chest pain was higher in the MI-E group (n=13, 61.9%) than in the IPPB group (n=4, 16.7%; odds ratio, 0.123, 95% confidence interval, 0.03-0.45; p=0.002). The length of hospital and ICU stay, development of atelectasis, pneumonia, and pleural effusion were similar in both the groups. Conclusion : Both IPPB and MI-E therapies have similar effects on preventing post-operative complications in cardiac surgery patients. However, compared to IPPB therapy, MI-E therapy was associated with better-preserved pulmonary function and higher incidence of chest pain.

scholarly journals The effects of mechanical insufflation-exsufflation on lung function and complications in cardiac surgery patients: a pilot study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Meng-Fang Wu ◽  
Tsai-Yu Wang ◽  
Da-Shen Chen ◽  
Hsiu-Fong Hsiao ◽  
Han-Chuang Hu ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Chest Pain ◽  
Lung Function ◽  
Clinical Outcomes ◽  
Tertiary Hospital ◽  
Forced Expiratory Volume ◽  
Pulmonary Complications ◽  
Positive Pressure ◽  
Lung Expansion ◽  
Intermittent Positive Pressure Breathing

Abstract Background Postoperative positive pressure lung expansion is associated with decreased pulmonary complications and improved clinical outcomes. The aim of the present study was to compare the differences in post-operative pulmonary complications and clinical outcomes between two groups of study subjects who underwent cardiac surgery; one included subjects who received mechanical insufflation-exsufflation (MI-E) and the other included subjects who received intermittent positive pressure breathing (IPPB) therapy. Methods This retrospective study included 51 subjects, who underwent cardiac surgery in an intensive care unit of a tertiary hospital during the time period from June 2017 to February 2018. After liberation from mechanical ventilation, the subjects received lung expansion therapy by means of two types of positive pressure devices, MI-E (n = 21) or IPPB (n = 30). The pulmonary complications, lung function, and clinical outcomes were compared between the two groups. Results Subjects in both groups displayed similar baseline characteristics and underwent similar types of surgical procedures. Compared to subjects who received non-oscillatory therapy, those who received MI-E therapy had higher post-operative force vital capacity (58.4 ± 4.74% vs. 46.0 ± 3.70%, p = 0.042), forced expiratory volume in one second (62.4 ± 5.23% vs. 46.8 ± 3.83%, p = 0.017), and peak flow rate (67.1 ± 5.53 L vs. 55.7 ± 4.44 L p = 0.111). However, the incidence of chest pain was higher in the MI-E group (n = 13, 61.9%) than in the IPPB group (n = 4, 16.7%; odds ratio, 0.123, 95% confidence interval, 0.03–0.45; p = 0.002). The length of hospital and ICU stay, development of atelectasis, pneumonia, and pleural effusion were similar in both the groups. Conclusion Both IPPB and MI-E therapies have similar effects on preventing post-operative complications in cardiac surgery patients. However, compared to IPPB therapy, MI-E therapy was associated with better-preserved pulmonary function and higher incidence of chest pain.

Comparison of Lung Expansion Techniques on Thoracoabdominal Mechanics and Incidence of Pulmonary Complications After Upper Abdominal Surgery

CHEST Journal ◽  
2015 ◽  
Vol 148 (4) ◽  
pp. 1003-1010 ◽  
Author(s):  
Adriana C. Lunardi ◽  
Denise M. Paisani ◽  
Cibele C. B. Marques da Silva ◽  
Desiderio P. Cano ◽  
Clarice Tanaka ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Pulmonary Complications ◽  
Upper Abdominal Surgery ◽  
Lung Expansion ◽  
Upper Abdominal

Abstract 59: The Incidence Of Pulmonary Aspiration With Laryngeal Mask Airway Use During Cardiopulmonary Resuscitation And Positive Pressure Ventilation In Swine.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Brian Suffoletto ◽  
James Menegazzi ◽  
Eric Logue ◽  
David Salcido
Keyword(s):  
Laryngeal Mask Airway ◽  
Cardiopulmonary Resuscitation ◽  
Positive Pressure Ventilation ◽  
Validation Cohort ◽  
Pulmonary Aspiration ◽  
Laryngeal Mask ◽  
Positive Pressure ◽  
Suction Catheter ◽  
Chest Compressions ◽  
Lung Expansion

Objective: Pulmonary aspiration of gastric contents occurs 20 –30% of the time during cardiopulmonary resuscitation (CPR) of cardiac arrest. This is due to loss of protective airway reflexes, pressure changes generated during CPR, and positive pressure ventilation (PPV). Even though the American Heart Association (AHA) has recommended the laryngeal mask airway (LMA) as an acceptable alternative airway for use by EMS personnel, concerns over the capacity of the device to protect from pulmonary aspiration remain. We sought to determine the incidence of aspiration after LMA placement, CPR and PPV. Methods: We conducted a prospective study on 16 consecutive post-experimental mixed-breed domestic swine of either sex (mean mass 25.7 ±1.4 kgs). A standard size-4 LMA was modified so that a vacuum catheter could be advanced into and past the LMA diaphragm. The LMA was placed into the hypopharynx and its position confirmed using End-tidal CO 2 and direct visualization of lung expansion. Fifteen milliliters of heparinized blood were instilled into the pharynx. After 5 PPVs with a mechanical ventilator, chest compressions were performed for 60s with asynchronous ventilations continuing at a rate of 12 per minute. After chest compressions, a suction catheter was inserted through the cuff and suction applied for approximately 1 minute. The catheter was removed and inspected for signs of blood. The LMA cuff was deflated and the LMA removed. The intima of the LMA diaphragm was inspected for signs of blood. In a validation cohort of 4 animals, the LMA was reinserted, a cricothyrotomy performed and 5 mL of blood instilled directly into the trachea. Results: There were 0/16 (95% CI=0 –17%) with a positive tests for the presence of blood in both the vacuum catheter and the intima of the LMA diaphragm. In the validation cohort, all four were positive for blood in both the vacuum catheter and the intima of the LMA diaphragm. Conclusions: In this simple model of regurgitation of after LMA placement, there was no sign of pulmonary aspiration, and no evidence that blood had passed beyond the seal created by the LMA cuff. Concerns over aspiration with LMA use may be unfounded. Future studies should determine the frequency of pulmonary aspiration after LMA placement in the clinical setting.

Pulmonary Diseases: Preoperative Assessment

2018 ◽  
Author(s):  
Suzanne Bennett ◽  
Quinn M Nguyen
Keyword(s):  
Risk Factors ◽  
Pulmonary Disease ◽  
Pulmonary Function Tests ◽  
Preoperative Evaluation ◽  
Pulmonary Complications ◽  
Perioperative Outcomes ◽  
Surgical Patient ◽  
Postoperative Pulmonary Complications ◽  
Related Risk ◽  
Obstructive Sleep

Postoperative pulmonary complications contribute to significant morbidity, mortality, and healthcare costs. The surgical patient with underlying pulmonary disease experiences a higher risk for postoperative pulmonary complications. Evaluation of the patient with pulmonary disease prior to surgery allows for the early identification of risk factors and opportunity for optimization resulting in improved perioperative outcomes for all surgical procedures. Complete understanding of the anesthetic options and their effect on pulmonary physiology and postoperative pulmonary complications assists in the evaluation and management of the patient with pulmonary disease. The patient-related risk factors, procedure-related risk factors, and risk factor stratification must be evaluated and performed while taking into consideration the risk and type of surgery. A thorough preoperative evaluation of the patient with pulmonary disease allows for the rational development of a multidisciplinary perioperative plan with the goal of reducing postoperative pulmonary complications. This review contains 5 figures, 7 tables, and 48 references. Keywords: assessment of perioperative risk, asthma, bronchitis, cessation of smoking, COPD, emphysema, obstructive sleep apnea, perioperative smoking, Pulmonary Function Tests (PFTs), nitrogen washout

scholarly journals Newer Modes of Mechanical Ventilatory Support

1986 ◽  
Vol 14 (3) ◽  
pp. 258-266 ◽  
Author(s):  
P. D. Cameron ◽  
T. E. Oh
Keyword(s):  
Ventilatory Support ◽  
Lung Ventilation ◽  
Intermittent Positive Pressure Ventilation ◽  
Minute Volume ◽  
Positive Pressure ◽  
High Frequency Ventilation ◽  
Volume Ventilation ◽  
Assisted Respiration ◽  
Frequency Ventilation ◽  
Flow Waveforms

Recent modes of ventilatory support aim to facilitate weaning and minimise the physiological disadvantages of intermittent positive pressure ventilation (IPPV). Intermittent mandatory ventilation (IMV) allows the patient to breathe spontaneously in between ventilator breaths. Mandatory minute volume ventilation (MMV) ensures that the patient always receives a preset minute volume, made up of both spontaneous and ventilator breaths. Pressure supported (assisted) respiration is augmentation of a spontaneous breath up to a preset pressure level, and is different from ‘triggering’, which is a patient-initiated ventilator breath. Other modes or refinements of IPPV include high frequency ventilation, expiratory retard, differential lung ventilation, inversed ratio ventilation, ‘sighs’, varied inspiratory flow waveforms and extracorporeal membrane oxygenation. While these techniques have useful applications in selective situations, IPPV remains the mainstay of managing respiratory failure for most patients.

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