Perioperative anaesthetic management of patients with or at risk of acute distress respiratory syndrome undergoing emergency surgery

Abstract ABSTRACT Patients undergoing emergency surgery may present with the acute respiratory distress syndrome (ARDS) or develop this syndrome postoperatively. The incidence of ARDS in the postoperative period is relatively low, but the impact of ARDS on patient outcomes and healthcare costs is relevant [1]. The development of ARDS as a postoperative pulmonary complication (PPC) is associated with prolonged hospitalisation, longer duration of mechanical ventilation, increased intensive care unit length of stay and high morbidity and mortality [2]. In order to mitigate the risk of ARDS after surgery, the anaesthetic management and protective mechanical ventilation strategies play an important role. In particular, a careful integration of general anaesthesia with neuraxial or locoregional techniques might promote faster recovery and reduce opioid consumption. In addition, the use of low tidal volume, minimising plateau pressure and titrating a low-moderate PEEP level based on the patient’s need can improve outcome and reduce intraoperative adverse events. Moreover, perioperative management of ARDS patients includes specific anaesthesia and ventilator settings, hemodynamic monitoring, moderately restrictive fluid administration and pain control. The aim of this review is to provide an overview and evidence- and opinion-based recommendations concerning the management of patients at risk of and with ARDS who undergo emergency surgical procedures.

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Perioperative anaesthetic management of patients with or at risk of acute distress respiratory syndrome undergoing emergency surgery

10.21203/rs.2.9307/v3 ◽

2019 ◽

Author(s):

Denise Battaglini ◽

Chiara Robba ◽

Patricia Rieken Macêdo Rocco ◽

Marcelo Gama De Abreu ◽

Paolo Pelosi ◽

...

Keyword(s):

At Risk ◽

Mechanical Ventilation ◽

Emergency Surgery ◽

Unit Length ◽

Peep Level ◽

Anaesthetic Management ◽

Plateau Pressure ◽

High Morbidity ◽

Postoperative Pulmonary Complication ◽

The Impact

Abstract Patients undergoing emergency surgery may present with the acute respiratory distress syndrome (ARDS) or develop this syndrome postoperatively. The incidence of ARDS in the postoperative period is relatively low, but the impact of ARDS on patient outcomes and healthcare costs is relevant [1]. The development of ARDS as a postoperative pulmonary complication (PPC) is associated with prolonged hospitalisation, longer duration of mechanical ventilation, increased intensive care unit length of stay and high morbidity and mortality [2]. In order to mitigate the risk of ARDS after surgery, the anaesthetic management and protective mechanical ventilation strategies play an important role. In particular, a careful integration of general anaesthesia with neuraxial or locoregional techniques might promote faster recovery and reduce opioid consumption. In addition, the use of low tidal volume, minimising plateau pressure and titrating a low-moderate PEEP level based on the patient’s need can improve outcome and reduce intraoperative adverse events. Moreover, perioperative management of ARDS patients includes specific anaesthesia and ventilator settings, hemodynamic monitoring, moderately restrictive fluid administration and pain control. The aim of this review is to provide an overview and evidence- and opinion-based recommendations concerning the management of patients at risk of and with ARDS who undergo emergency surgical procedures.

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Perioperative anaesthetic management of patients with or at risk of acute distress respiratory syndrome undergoing emergency surgery

10.21203/rs.2.9307/v1 ◽

2019 ◽

Author(s):

Denise Battaglini ◽

Chiara Robba ◽

Patricia Rieken Macêdo Rocco ◽

Marcelo Gama De Abreu ◽

Paolo Pelosi ◽

...

Keyword(s):

At Risk ◽

Mechanical Ventilation ◽

Emergency Surgery ◽

Unit Length ◽

Peep Level ◽

Anaesthetic Management ◽

Plateau Pressure ◽

High Morbidity ◽

Postoperative Pulmonary Complication ◽

The Impact

Abstract Patients undergoing emergency surgery may present with the acute respiratory distress syndrome (ARDS) or develop this syndrome postoperatively. The incidence of ARDS in the postoperative period is relatively low, but the impact of ARDS on patient outcomes and healthcare costs is relevant [1]. The development of ARDS as a postoperative pulmonary complication (PPC) is associated with prolonged hospitalisation, longer duration of mechanical ventilation, increased intensive care unit length of stay and high morbidity and mortality [2]. In order to mitigate the risk of ARDS after surgery, the anaesthetic management and protective mechanical ventilation strategies play an important role. In particular, a careful integration of general anaesthesia with neuraxial or locoregional techniques might promote faster recovery and reduce opioid consumption. In addition, the use of low tidal volume, minimising plateau pressure and titrating a low-moderate PEEP level based on the patient’s need can improve outcome and reduce intraoperative adverse events. Moreover, perioperative management of ARDS patients includes specific anaesthesia and ventilator settings, hemodynamic monitoring, moderately restrictive fluid administration and pain control. The aim of this review is to provide an overview and evidence- and opinion-based recommendations concerning the management of patients at risk of and with ARDS who undergo emergency surgical procedures.

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An Appraisal of Respiratory System Compliance In Mechanically Ventilated Covid-19 Patients

10.21203/rs.3.rs-125428/v1 ◽

2020 ◽

Author(s):

Gianluigi Li Bassi ◽

Jacky Suen ◽

Heidi Dalton ◽

Nicole White ◽

Sally Shrapnel ◽

...

Keyword(s):

Mechanical Ventilation ◽

Respiratory System ◽

National Level ◽

Data Gathering ◽

Case Series ◽

Plateau Pressure ◽

Mechanically Ventilated ◽

Observational Cohort ◽

Novel Coronavirus ◽

The Impact

Abstract Background Heterogeneous respiratory system static compliance (CRS) values and levels of hypoxemia in patients with novel coronavirus disease (COVID-19) requiring mechanical ventilation have been reported in previous small-case series or studies conducted at a national level. Methods We designed a retrospective observational cohort study with rapid data gathering from the international COVID-19 Critical Care Consortium study to comprehensively describe the impact of CRS on the ventilatory management and outcomes of COVID-19 patients on mechanical ventilation (MV), admitted to intensive care units (ICU) worldwide. Results We enrolled 318 COVID-19 patients enrolled into the study from January 14th through September 31th, 2020 in 19 countries and stratified into two CRS groups. CRS was calculated as: tidal volume/[airway plateau pressure-positive end-expiratory pressure (PEEP)] and available within 48 h from commencement of MV in 318 patients. Patients were mean ± SD of 58.0 ± 12.2, predominantly from Europe (54%) and males (68%). Median CRS (IQR) was 34.1 mL/cmH2O (26.5–45.5) and PaO2/FiO2 was 119 mmHg (87.1–164) and was not correlated with CRS. Female sex presented lower CRS than in males (95% CI: -13.8 to -8.5 P < 0.001) and higher body mass index (34.7 ± 10.9 vs 29.1 ± 6.0, p < 0.001). Median (IQR) PEEP was 12 cmH2O (10–15), throughout the range of CRS, while median (IQR) driving pressure was 12.3 (10–15) cmH2O and significantly decreased as CRS improved (p < 0.001). No differences were found in comorbidities and clinical management between CRS strata. In addition, 28-day ICU mortality and hospital mortality did not differ between CRS groups. Conclusions This multicentre report provides a comprehensive account of CRS in COVID-19 patients on MV – predominantly males or overweight females, in their late 50 s – admitted to ICU during the first international outbreaks. Phenotypes associated with different CRS upon commencement of MV could not be identified. Trial documentation: Available at https://www.covid-critical.com/study. Trial registration ACTRN12620000421932.

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Perioperative anaesthetic management of patients with or at risk of acute distress respiratory syndrome undergoing emergency surgery

BMC Anesthesiology ◽

10.1186/s12871-019-0804-9 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 4

Author(s):

Denise Battaglini ◽

Chiara Robba ◽

Patricia Rieken Macêdo Rocco ◽

Marcelo Gama De Abreu ◽

Paolo Pelosi ◽

...

Keyword(s):

At Risk ◽

Emergency Surgery ◽

Anaesthetic Management ◽

Acute Distress

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Nebulized Heparin With N-Acetylcysteine and Albuterol Reduces Duration of Mechanical Ventilation in Patients With Inhalation Injury

Journal of Pharmacy Practice ◽

10.1177/0897190017747143 ◽

2017 ◽

Vol 32 (2) ◽

pp. 163-166 ◽

Cited By ~ 12

Author(s):

Kaitlin A. McGinn ◽

Katie Weigartz ◽

Alicia Lintner ◽

Michael J. Scalese ◽

Steven A. Kahn

Keyword(s):

Mechanical Ventilation ◽

Unit Length ◽

Total Body Surface Area ◽

Inhalation Injury ◽

Burn Patients ◽

Inclusion Criteria ◽

Mechanically Ventilated ◽

Total Body ◽

Injury Outcomes ◽

The Impact

Objective: Nebulized heparin has been proposed to improve pulmonary function in patients with inhalation injuries. The purpose of this study was to evaluate the impact of nebulized heparin with N-acetylcysteine (NAC) and albuterol on the duration of mechanical ventilation in burn patients. Methods: This is a retrospective study evaluating mechanically ventilated adult patients admitted to a regional burn center with inhalation injury. Outcomes were compared between patients who were prescribed a combination of nebulized heparin with NAC and albuterol versus similar patients who did not. Results: A total of 48 patients met inclusion criteria (heparin n = 22; nonheparin n = 26). Patients in the nonheparin group had higher percentage of total body surface area (TBSA) burned (29.00 [5.75-51.88] vs 5.25 [0.50-13.25] %TBSA; P = .009), longer duration of mechanical ventilation (6.50 [2.75-17.00] vs 3.00 [1.00-8.25] days; P = .022), and longer intensive care unit length of stay (LOS) (3.00 [3.00-28.75] vs 5.50 days [2.00-11.25]; P = .033). Upon regression, use of heparin was the only variable associated with reducing the duration of mechanical ventilation ( P = .039). Conclusion: Nebulized heparin in combination with NAC and albuterol was associated with a significant reduction in the duration of mechanical ventilation.

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High Morbidity Seen in Emergency Surgery

Hospitalist News ◽

10.1016/s1875-9122(10)70224-8 ◽

2010 ◽

Vol 3 (9) ◽

pp. 10

Author(s):

DIANA MAHONEY

Keyword(s):

Emergency Surgery ◽

High Morbidity

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The Democratic Costs of Constitutionalization— The European Case

10.1093/oso/9780198805120.003.0005 ◽

2017 ◽

Author(s):

Dieter Grimm

Keyword(s):

At Risk ◽

Economic Integration ◽

Fundamental Rights ◽

European Law ◽

European Court ◽

Political Implications ◽

The Impact ◽

The Relationship ◽

The Eu

This chapter examines the democratic costs of constitutionalization by focusing on the European case. It first considers the interdependence of democracy and constitutionalism before discussing how constitutionalization can put democracy at risk. It then explores the tension between democracy and fundamental rights, the constitutionalization of the European treaties, and the European Court of Justice’s (ECJ) two separate judgments regarding the relationship between European law and national law. It also assesses the impact of the ECJ’s jurisprudence on democracy, especially in the area of economic integration. The chapter argues that the legitimacy problem the EU faces is caused in part by over-constitutionalization and that the remedy to this problem is re-politicization of decisions with significant political implications.

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Static and dynamic response of sandwich beams with lattice and pantographic cores

Journal of Sandwich Structures & Materials ◽

10.1177/10996362211033896 ◽

2021 ◽

pp. 109963622110338

Author(s):

Yury Solyaev ◽

Arseniy Babaytsev ◽

Anastasia Ustenko ◽

Andrey Ripetskiy ◽

Alexander Volkov

Keyword(s):

Mechanical Performance ◽

Lattice Structure ◽

Unit Length ◽

Experimental Tests ◽

Plane Geometry ◽

Sandwich Beams ◽

Static Tests ◽

Three Point Bending ◽

The Core ◽

The Impact

Mechanical performance of 3d-printed polyamide sandwich beams with different type of the lattice cores is investigated. Four variants of the beams are considered, which differ in the type of connections between the elements in the lattice structure of the core. We consider the pantographic-type lattices formed by the two families of inclined beams placed with small offset and connected by stiff joints (variant 1), by hinges (variant 2) and made without joints (variant 3). The fourth type of the core has the standard plane geometry formed by the intersected beams lying in the same plane (variant 4). Experimental tests were performed for the localized indentation loading according to the three-point bending scheme with small span-to-thickness ratio. From the experiments we found that the plane geometry of variant 4 has the highest rigidity and the highest load bearing capacity in the static tests. However, other three variants of the pantographic-type cores (1–3) demonstrate the better performance under the impact loading. The impact strength of such structures are in 3.5–5 times higher than those one of variant 4 with almost the same mass per unit length. This result is validated by using numerical simulations and explained by the decrease of the stress concentration and the stress state triaxiality and also by the delocalization effects that arise in the pantographic-type cores.

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The negative effects of COVID-19 and national lockdown on emergency surgery morbidity due to delayed access

World Journal of Emergency Surgery ◽

10.1186/s13017-021-00382-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Francesco A. Ciarleglio ◽

Marta Rigoni ◽

Liliana Mereu ◽

Cai Tommaso ◽

Alessandro Carrara ◽

...

Keyword(s):

Emergency Department ◽

Blood Transfusion ◽

Emergency Surgery ◽

Surgical Care ◽

Close Correlation ◽

Negative Effects ◽

Group 2 ◽

Retrospective Comparative Study ◽

The Impact ◽

Group 1

Abstract Background The aim of this retrospective comparative study was to assess the impact of COVID-19 and delayed emergency department access on emergency surgery outcomes, by comparing the main clinical outcomes in the period March–May 2019 (group 1) with the same period during the national COVID-19 lockdown in Italy (March–May 2020, group 2). Methods A comparison (groups 1 versus 2) and subgroup analysis were performed between patients’ demographic, medical history, surgical, clinical and management characteristics. Results Two-hundred forty-six patients were included, 137 in group 1 and 109 in group 2 (p = 0.03). No significant differences were observed in the peri-operative characteristics of the two groups. A declared delay in access to hospital and preoperative SARS-CoV-2 infection rates were 15.5% and 5.8%, respectively in group 2. The overall morbidity (OR = 2.22, 95% CI 1.08–4.55, p = 0.03) and 30-day mortality (OR = 1.34, 95% CI 0.33–5.50, =0.68) were significantly higher in group 2. The delayed access cohort showed a close correlation with increased morbidity (OR = 3.19, 95% CI 0.89–11.44, p = 0.07), blood transfusion (OR = 5.13, 95% CI 1.05–25.15, p = 0.04) and 30-day mortality risk (OR = 8.00, 95% CI 1.01–63.23, p = 0.05). SARS-CoV-2-positive patients had higher risk of blood transfusion (20% vs 7.8%, p = 0.37) and ICU admissions (20% vs 2.6%, p = 0.17) and a longer median LOS (9 days vs 4 days, p = 0.11). Conclusions This article provides enhanced understanding of the effects of the COVID-19 pandemic on patient access to emergency surgical care. Our findings suggest that COVID-19 changed the quality of surgical care with poorer prognosis and higher morbidity rates. Delayed emergency department access and a “filter effect” induced by a fear of COVID-19 infection in the population resulted in only the most severe cases reaching the emergency department in time.

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