Incidence and risk factors for postoperative pulmonary complications in elective intracranial surgery

2008 ◽  
Vol 109 (2) ◽  
pp. 222-227 ◽  
Author(s):  
Luciana Carrupt Machado Sogame ◽  
Milena Carlos Vidotto ◽  
José Roberto Jardim ◽  
Sonia Maria Faresin
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Prolonged Mechanical Ventilation ◽  
Pulmonary Complications ◽  
Postoperative Pulmonary Complications ◽  
Duration Of Surgery ◽  
Level Of Consciousness ◽  
Type Of Surgery

Object It has been shown that craniotomy may lead to a decrease in lung volumes and arterial blood gas tensions as well as a change in the respiratory pattern. The purpose of this study was to determine the incidence of postoperative pulmonary complications (PPCs) and the mortality rate in patients who have undergone elective craniotomy and to evaluate the associations between preoperative and postoperative variables and PPCs in this population. Methods Two hundred thirty-six patients were followed up based on a protocol including a clinical questionnaire, physical examination and observation of clinical characteristics in the preoperative period, type of surgery performed, duration of surgery, time spent in the intensive care unit (ICU) and hospital, and the occurrence of any PPCs. Results Postoperative pulmonary complications occurred in 58 patients (24.6%) and 23 other patients (10%) died. Predicting factors for PPCs according to multivariate analyses were as follows: type of surgery performed (p < 0.0001), prolonged mechanical ventilation ≥ 48 hours (p < 0.0001), time spent in the ICU > 3 days (p < 0.0001), decrease in level of consciousness (p < 0.002), duration of surgery ≥ 300 minutes (p < 0.01), and previous chronic lung disease (p < 0.04). Conclusions The incidence from March 2003 to March 2005 of PPCs in patients who had undergone craniotomy was 25% and death occurred in 10%. Some risk factors for PPCs may be predicted such as the type of surgery performed, prolonged mechanical ventilation, a longer time in the ICU, a decreased level of consciousness, duration of surgery, and previous chronic lung disease.

Pulmonary vascular dysfunction in preterm lambs with chronic lung disease

2003 ◽  
Vol 285 (1) ◽  
pp. L76-L85 ◽  
Author(s):  
Richard D. Bland ◽  
Con Yee Ling ◽  
Kurt H. Albertine ◽  
David P. Carlton ◽  
Amy J. MacRitchie ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Mechanical Ventilation ◽  
Smooth Muscle ◽  
Vascular Smooth Muscle ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Soluble Guanylate Cyclase ◽  
Prolonged Mechanical Ventilation ◽  
Pulmonary Arteries ◽  
Human Infants

Chronic lung injury from prolonged mechanical ventilation after premature birth inhibits the normal postnatal decrease in pulmonary vascular resistance (PVR) and leads to structural abnormalities of the lung circulation in newborn sheep. Compared with normal lambs born at term, chronically ventilated preterm lambs have increased pulmonary arterial smooth muscle and elastin, fewer lung microvessels, and reduced abundance of endothelial nitric oxide synthase. These abnormalities may contribute to impaired respiratory gas exchange that often exists in infants with chronic lung disease (CLD). Nitric oxide inhalation (iNO) reduces PVR in human infants and lambs with persistent pulmonary hypertension. We wondered whether iNO might have a similar effect in lambs with CLD. We therefore studied the effect of iNO on PVR in lambs that were delivered prematurely at ∼125 days of gestation (term = 147 days) and mechanically ventilated for 3 wk. All of the lambs had chronically implanted catheters for measurement of pulmonary vascular pressures and blood flow. During week 2 of mechanical ventilation, iNO at 15 parts/million for 1 h decreased PVR by ∼20% in 12 lambs with evolving CLD. When the same study was repeated in eight lambs at the end of week 3, iNO had no significant effect on PVR. To see whether this loss of iNO effect on PVR might reflect dysfunction of lung vascular smooth muscle, we infused 8-bromo-guanosine 3′,5′-cyclic monophosphate (cGMP; 150 μg · kg-1 · min-1 iv) for 15–30 min in four of these lambs at the end of week 3. PVR consistently decreased by 30–35%. Lung immunohistochemistry and immunoblot analysis of excised pulmonary arteries from lambs with CLD, compared with control term lambs, showed decreased soluble guanylate cyclase (sGC). These results suggest that loss of pulmonary vascular responsiveness to iNO in preterm lambs with CLD results from impaired signaling, possibly related to deficient or defective activation of sGC, the intermediary enzyme through which iNO induces increased vascular smooth muscle cell cGMP and resultant vasodilation.

scholarly journals Do ARISCAT scores help to predict the incidence of postoperative pulmonary complications in elderly patients after upper abdominal surgery? An observational study at a single university hospital

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Jitsupa Nithiuthai ◽  
Arunotai Siriussawakul ◽  
Rangsinee Junkai ◽  
Nutthakorn Horugsa ◽  
Sunit Jarungjitaree ◽  
...  
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Assessment Tool ◽  
Area Under The Curve ◽  
Pulmonary Complications ◽  
University Hospital ◽  
Surgical Patients ◽  
Postoperative Pulmonary Complications ◽  
Duration Of Surgery ◽  
Upper Abdominal

Abstract Background The incidence of postoperative pulmonary complications (PPCs) is increasing in line with the rise in the number of surgical procedures performed on geriatric patients. In this study, we determined the incidence and risk factors of PPCs in elderly Thai patients who underwent upper abdominal procedures, and we investigated whether the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score helps to predict PPCs in Thais. Methods A retrospective study was conducted on upper abdominal surgical patients aged over 65 years who had been admitted to the surgical ward of Siriraj Hospital, Mahidol University, Thailand, between January 2016 and December 2019. Data were collected on significant PPCs using the European Perioperative Clinical Outcome definitions. To identify risk factors, evaluations were made of the relationships between the PPCs and various preoperative, intraoperative, and postoperative factors, including ARISCAT scores. Results In all, 1100 elderly postoperative patients were analyzed. Their mean age was 73.6 years, and 48.5% were male. Nearly half of their operations were laparoscopic cholecystectomies. The incidence of PPCs was 7.7%, with the most common being pleural effusion, atelectasis, and pneumonia. The factors associated with PPCs were preoperative oxygen saturation less than 96% (OR = 2.6, 1.2–5.5), albumin level below 3.5 g/dL (OR = 1.7, 1.0–2.8), duration of surgery exceeding 3 h (OR = 2.0, 1.0–4.2), and emergency surgery (OR = 2.8, 1.4–5.8). There was a relationship between ARISCAT score and PPC incidence, with a correlation coefficient of 0.226 (P < 0.001). The area under the curve was 0.72 (95% CI, 0.665–0.774; P < 0.001). Conclusions PPCs are common in elderly patients. They are associated with increased levels of postoperative morbidities and extended ICU and hospital stays. Using the ARISCAT score as an assessment tool facilitates the classification of Thai patients into PPC risk groups. The ARISCAT scoring system might be able to be similarly applied in other Southeast Asian countries.

scholarly journals Prospective assessment of the risk of postoperative pulmonary complications in patients submitted to upper abdominal surgery

1999 ◽  
Vol 117 (4) ◽  
pp. 151-160 ◽  
Author(s):  
Eanes Delgado Barros Pereira ◽  
Ana Luisa Godoy Fernandes ◽  
Meide da Silva Anção ◽  
Clóvis de Araújo Peres ◽  
Álvaro Nagib Atallah ◽  
...  
Keyword(s):  
Risk Factors ◽  
Abdominal Surgery ◽  
Pulmonary Disease ◽  
Pulmonary Complications ◽  
Smoking Habits ◽  
Chronic Pulmonary Disease ◽  
Postoperative Pulmonary Complications ◽  
Upper Abdominal Surgery ◽  
Duration Of Surgery ◽  
Upper Abdominal

OBJECTIVE: To investigate associations between preoperative variables and postoperative pulmonary complications (PPC) in elective upper abdominal surgery. DESIGN: Prospective clinical trial. SETTING: A tertiary university hospital. PATIENTS: 408 patients were prospectively analyzed during the preoperative period and followed up postoperatively for pulmonary complications. MEASUREMENTS: Patient characteristics, with clinical and physical evaluation, related diseases, smoking habits, and duration of surgery. Preoperative pulmonary function tests (PFT) were performed on 247 patients. RESULTS: The postoperative pulmonary complication rate was 14 percent. The significant predictors in univariate analyses of postoperative pulmonary complications were: age >50, smoking habits, presence of chronic pulmonary disease or respiratory symptoms at the time of evaluation, duration of surgery >210 minutes and comorbidity (p <0.04). In a logistic regression analysis, the statistically significant predictors were: presence of chronic pulmonary disease, surgery lasting >210 and comorbidity (p <0.009). CONCLUSIONS: There were three major clinical risk factors for pulmonary complications following upper abdominal surgery: chronic pulmonary disease, comorbidity, and surgery lasting more than 210 minutes. Those patients with three risk factors were three times more likely to develop a PPC compared to patients without any of these risk factors (p <0.001). PFT is indicated when there are uncertainties regarding the patient’s pulmonary status.

scholarly journals The Incidence and Risk Factors of Postoperative Pulmonary Complications in Restrictive Pulmonary Disorders

2019 ◽  
Author(s):  
Oya BAYDAR ◽  
Ezgi OZYILMAZ ◽  
Alper AVCI ◽  
Yasemin SAYGIDEGER
Keyword(s):  
Risk Factors ◽  
Blood Gas Analysis ◽  
Pulmonary Complications ◽  
Gas Analysis ◽  
Blood Gas ◽  
Postoperative Pulmonary Complications ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Arterial Blood Gas Analysis ◽  
Duration Of Surgery

Abstract Background The incidence of postoperative pulmonary complications (POPCs) in restrictive pulmonary disorders remains indefinite especially in adults. Therefore, this study is structured to evaluate the incidence and risk factors of POPCs in restrictive pulmonary disorders. Methods 2177 preoperative consultations have been prospectively evaluated from May 2015 to May 2016 in Cukurova University, Department of Chest Diseases. 60 of them (2.8%) met restrictive pulmonary function tests (PFTs) criteria and all of them were enrolled in the study. Each participant was evaluated at the 7th day and has been followed-up until 30th day after surgery. Clinical, surgical, PFT and arterial blood gas analysis parameters were evaluated to analyse risk factors of POPCs. Results The incidence of early and late POPCs as 10% and 11.7% in restrictive pulmonary disorders. Preoperative PaO2 ≤ 68 mmHg is an independent risk factor of POPCs. Surgery site, duration of surgery, age, previous or current smoking, preoperative PFT results, physical status, cardiopulmonary risk points, abnormal chest radiography were not significantly related with an increased risk in our study. Conclusions The incidence of POPCs in restrictive pulmonary disorders is high. The patients with restrictive pulmonary disorders should be evaluated with particular care perioperatively. Arterial blood gas analysis may give additional knowledge about increased POPCs risk.

scholarly journals Root causes and outcomes of postoperative pulmonary complications after abdominal surgery: a retrospective observational cohort study

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Antero Fernandes ◽  
Jéssica Rodrigues ◽  
Patrícia Lages ◽  
Sara Lança ◽  
Paula Mendes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Abdominal Surgery ◽  
Pulmonary Complications ◽  
Perioperative Risk ◽  
Postoperative Pulmonary Complications ◽  
Elective Abdominal Surgery ◽  
Perioperative Risk Factors

Abstract Background Postoperative pulmonary complications (PPCs) contribute significantly to overall postoperative morbidity and mortality. In abdominal surgery, PPCs remain frequent. The study aimed to analyze the profile and outcomes of PPCs in patients submitted to abdominal surgery and admitted in a Portuguese polyvalent intensive care unit. Methods From January to December 2017 in the polyvalent intensive care unit of Hospital Garcia de Orta, Almada, Portugal, we conducted a retrospective, observational study of inpatients submitted to urgent or elective abdominal surgery who had severe PPCs. We evaluated the perioperative risk factors and associated mortality. Logistic regression was performed to find which perioperative risk factors were most important in the occurrence of PPCs. Results Sixty patients (75% male) with a median age of 64.5 [47–81] years who were submitted to urgent or elective abdominal surgery were included in the analysis. Thirty-six patients (60%) developed PPCs within 48 h and twenty-four developed PPCs after 48 h. Pneumonia was the most frequent PPC in this sample. In this cohort, 48 patients developed acute respiratory failure and needed mechanical ventilation. In the emergency setting, peritonitis had the highest rate of PPCs. Electively operated patients who developed PPCs were mostly carriers of digestive malignancies. Thirty-day mortality was 21.7%. The risk of PPCs development in the first 48 h was related to the need for neuromuscular blocking drugs several times during surgery and preoperative abnormal arterial blood gases. Median abdominal surgical incision, long surgery duration, and high body mass index were associated with PPCs that occurred more than 48 h after surgery. The American Society of Anesthesiologists physical status score 4 and COPD/Asthma determined less mechanical ventilation needs since they were preoperatively optimized. Malnutrition (low albumin) before surgery was associated with 30-day mortality. Conclusion PPCs after abdominal surgery are still a major problem since they have profound effects on outcomes. Our results suggest that programs before surgery, involve preoperative lifestyle changes, such as nutritional supplementation, exercise, stress reduction, and smoking cessation, were an effective strategy in mitigating postoperative complications by decreasing mortality.

scholarly journals Postoperative Pulmonary Complications’ Association with Sugammadex versus Neostigmine

2021 ◽  
Author(s):  
Gen Li ◽  
Robert E. Freundlich ◽  
Rajnish K. Gupta ◽  
Christina J. Hayhurst ◽  
Chi H. Le ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Propensity Score ◽  
Neuromuscular Blockade ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Medical Center ◽  
Prolonged Mechanical Ventilation ◽  
Pulmonary Complications ◽  
Postoperative Pulmonary Complications ◽  
Vanderbilt University

Background Postoperative residual neuromuscular blockade related to nondepolarizing neuromuscular blocking agents may be associated with pulmonary complications. In this study, the authors sought to determine whether sugammadex was associated with a lower risk of postoperative pulmonary complications in comparison with neostigmine. Methods Adult patients from the Vanderbilt University Medical Center National Surgical Quality Improvement Program database who underwent general anesthesia procedures between January 2010 and July 2019 were included in an observational cohort study. In early 2017, a wholesale switch from neostigmine to sugammadex occurred at Vanderbilt University Medical Center. The authors therefore identified all patients receiving nondepolarizing neuromuscular blockades and reversal with neostigmine or sugammadex. An inverse probability of treatment weighting propensity score analysis approach was applied to control for measured confounding. The primary outcome was postoperative pulmonary complications, determined by retrospective chart review and defined as the composite of the three postoperative respiratory occurrences: pneumonia, prolonged mechanical ventilation, and unplanned intubation. Results Of 10,491 eligible cases, 7,800 patients received neostigmine, and 2,691 received sugammadex. A total of 575 (5.5%) patients experienced postoperative pulmonary complications (5.9% neostigmine vs. 4.2% sugammadex). Specifically, 306 (2.9%) patients had pneumonia (3.2% vs. 2.1%), 113 (1.1%) prolonged mechanical ventilation (1.1% vs. 1.1%), and 156 (1.5%) unplanned intubation (1.6% vs. 1.0%). After propensity score adjustment, the authors found a lower absolute incidence rate of postoperative pulmonary complications over time (adjusted odds ratio, 0.91 [per year]; 95% CI, 0.87 to 0.96; P &lt; .001). No difference was observed on the odds of postoperative pulmonary complications in patients receiving sugammadex in comparison with neostigmine (adjusted odds ratio, 0.89; 95% CI, 0.65 to 1.22; P = 0.468). Conclusions Among 10,491 patients at a single academic tertiary care center, the authors found that switching neuromuscular blockade reversal agents was not associated with the occurrence of postoperative pulmonary complications. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Prediction of Abnormal Pulmonary Follow-up in Premature Infants

PEDIATRICS ◽  
1988 ◽  
Vol 82 (4) ◽  
pp. 670-671
Author(s):  
EDUARDO BANCALARI
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Lung Disease ◽  
Premature Infants ◽  
Chronic Lung Disease ◽  
Oxygen Therapy ◽  
Prolonged Mechanical Ventilation ◽  
Respiratory Outcome ◽  
Definition Of

The article by Shennan and collaborators1 raises some interesting questions concerning the diagnosis of chronic lung disease and the predictability of respiratory outcome in early infancy. The first question addressed by the authors relates to the definition of bronchopulmonary dysplasia. This term was introduced by Northway et al2 in 1967 to describe a group of infants in whom severe chronic lung changes developed after prolonged mechanical ventilation and oxygen therapy. Most of these were infants with birth weights greater than 1000 g in whom chronic respiratory failure developed and whose chest radiographs appeared abnormal. In recent years, there has been an increase in the survival rate of infants with birth weights less than 1000 g, which has resulted in an increase in the population at risk for the development of chronic lung disease.

COMPARISON OF MORTALITY RELATED RISK FACTORS OF COVID-19 AND SARI DEATH DURING THE PEAK OF PANDEMIC IN A TERTIARY CARE CENTRE.

2021 ◽  
pp. 136-139
Author(s):  
K. Anbananthan ◽  
A. Manimaran ◽  
A. Ramasamy ◽  
S. A. Natesh ◽  
AnuSree. S. C
Keyword(s):  
Risk Factors ◽  
Liver Disease ◽  
Cerebrovascular Disease ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Poor Prognosis ◽  
Severe Acute Respiratory Infection ◽  
Viral Infectious Disease ◽  
Study Population ◽  
D Dimer

Background: COVID-19 is a viral infectious disease caused by the SARS CoV-2 virus which causes severe respiratory distress in a certain number of patients with specic risk factors. This study compares the mortality risk factors of COVID 19 and Severe Acute Respiratory Infection (SARI) deaths and also determines the most likely causes that lead to such a poor prognosis Objectives: To evaluate the risk factors of COVID 19 and SARI causing mortality. To compare the most likely risk factors that lead to such a poor prognosis Materials And Methods: This was a Cross sectional study done on 190 patients which includes all cases of covid 19 and SARI deaths within the peak of pandemic period (August 2020). Patient datas were collected from MRD registry at Thanjavur Medical College. Results: Among the study population of 190, age distribution of the patients died due to covid-19 was minimum 26 years to maximum 89 years and mean age of 61years. Most commonly affected were in the age around 60years. Distribution of male is around 72.1%.This study showed 47.9% were covid positive and 42.1% were suspected based on CT chest nding and clinical features. Around 84.7% were diabetic and 56.3% were hypertensive. There is no signicant difference between the exposure rate of diabetes, hypertension, CKD, chronic lung disease, cerebrovascular disease, liver disease, malignancy among covid and SARI group. Among these study population 94.7% had elevated d-dimer level. Conclusion: This study showed various comorbidities, complications, and demographic variables including diabetes, hypertension, chronic kidney disease,, chronic lung disease,liver disease, Cerebrovascular disease, cancer, increased D-dimer, male gender, older age(>50), smoking, and obesity are clinical risk factors for a fatal outcome associated with COVID 19.

Reflections on the HIFI Trial

PEDIATRICS ◽  
1991 ◽  
Vol 87 (4) ◽  
pp. 565-567
Author(s):  
A. CHARLES BRYAN ◽  
ALISON B. FROESE
Keyword(s):  
Carbon Dioxide ◽  
Mechanical Ventilation ◽  
Lung Disease ◽  
Prolonged Mechanical Ventilation ◽  
Mechanical Ventilators ◽  
History Of ◽  
Closing Pressure

Mechanical ventilators have only two functions: to provide a flux to eliminate carbon dioxide from those who will not or cannot breathe and to establish an adequate gas-exchanging volume to reduce shunting. The concept of volume recruitment to reduce shunting goes back at least to Mead and Collier in 1959,1 who showed that without periodic inflations there was a progressive fall in compliance during prolonged mechanical ventilation. Much of the subsequent history of mechanical ventilation in acute lung disease has really been the search for better methods of volume recruitment. The lung has to be inflated past the pressure at which atelectatic lung begins to open and be maintained above its closing pressure (that pressure below which alveoli and airways start to close again).

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