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 Is respiratory physiotherapy effective on pulmonary complications after lobectomy for lung cancer?

2020 ◽  
Vol 28 (4) ◽  
pp. 638-647
Author(s):  
Hüseyin Ulaş Çınar
Keyword(s):  
Lung Cancer ◽  
Hospital Stay ◽  
Hospital Cost ◽  
Multivariate Logistic Regression Analysis ◽  
Length Of Hospital Stay ◽  
Pulmonary Complications ◽  
Total Hospital Cost ◽  
Postoperative Pulmonary Complications ◽  
Physiotherapy Program ◽  
Respiratory Physiotherapy

Background: The aim of this study was to investigate the effects of a postoperative respiratory physiotherapy program on pulmonary complications, length of hospital stay, and hospital cost after lobectomy for lung cancer. Methods: A total of 90 patients (75 males, 15 females; mean age 63.1±10.4 years; range, 30 to 82 years) who underwent elective lobectomy through thoracotomy due to lung cancer between June 2014 and December 2019 were retrospectively analyzed. The patients were divided into two groups as Group S who received standard postoperative care (n=50) and Group P who received postoperative respiratory physiotherapy in addition to standard care (n=40). Both groups were compared in terms of postoperative pulmonary complications, 30-day mortality, length of hospital stay, and hospital cost. Results: The preoperative and surgical characteristics of the groups were similar. Group P had a lower incidence of postoperative pulmonary complications (10% vs. 38%, respectively; p=0.002) than Group S. The median length of stay in the hospital was six (range, 4 to 12) days in Group P and seven (range, 4 to 40) days in Group S (p=0.001). The drug cost (639.70 vs. 1,211.46 Turkish Liras, respectively; p=0.001) and the total hospital cost (2,031.10 vs. 3,778.68 Turkish Liras, respectively; p=0.001) of the patients in Group P were significantly lower. The multivariate logistic regression analysis showed that respiratory physiotherapy had a protective effect on the development of postoperative pulmonary complications (odds ratio =0.063, 95% confidence interval: 0.010-0.401, p=0.003). Conclusion: An intensive physiotherapy program focusing on respiratory exercises is a cost-effective practice which reduces the risk of development of postoperative pulmonary complications in patients undergoing lobectomy for lung cancer.

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.

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.

666 EARLY EXTUBATION AFTER ESOPHAGECTOMY IS SAFE. A SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Maria Serafim ◽  
Clara Santos ◽  
Marina Orlandini ◽  
Letícia Datrino ◽  
Guilherme Tavares ◽  
...  
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Risk Difference ◽  
Pulmonary Complications ◽  
Mean Difference ◽  
Early Extubation ◽  
Icu Length Of Stay ◽  
Anastomotic Fistula

Abstract   Esophagectomy has high morbidity and mortality, mainly due to pulmonary complications. Consequently, ventilatory support is a cornerstone in postoperative management. However, there is still no consensus on the timing for extubation. There is a fear that untimely extubation would lead to a high risk for an urgent reintubation. On the other hand, there is a risk for pulmonary damage in prolonged intubation. Thus, the present study aimed to compare early and late extubation after esophagectomy. Methods A systematic review was carried out on PubMed, Lilacs, Cochrane Library Central, and Embase, comparing early and late extubation after esophagectomy. The primary outcome was reintubation. Secondary outcomes included mortality; complications; pulmonary complications; pneumonia; anastomotic fistula; length of hospital stay; and ICU length of stay. The inclusion criteria were: a) clinical trials and cohort studies; b) adult patients (> 18 years); and c) patients with esophageal cancer undergoing esophagectomy. The results were summarized by risk difference and mean difference. 95% confidence interval and random model were applied. Results Four articles were selected, comprising 490 patients. Early extubation did not increase the risk for reintubation, with a risk difference of 0.01 (95%CI -0.03; 0.04). Also, there was no difference for mortality −0.01 (95%CI -0.04; 0.03); complications −0.09 (95%CI -0.22; 0.05); pulmonary complications −0.05 (95%CI -0.13; 0.03); pneumonia −0.06 (95% CI-0.18; 0.05); anastomotic fistula −0.01 (95% CI -0.09; 0.08). In addition, there was no significant mean difference for: length of hospital stay −0.10 (95%CI -0.38; 0.1); and ICU length of stay 0.00 (95%CI -0.22; 0.22). Conclusion Early extubation after esophagectomy does not increase the risk for reintubation, mortality, complications, and lenght of stay.

scholarly journals Implementation of Minimally Invasive Esophagectomy From a Randomized Controlled Trial Setting to National Practice

2020 ◽  
Vol 38 (19) ◽  
pp. 2130-2139 ◽  
Author(s):  
Sheraz R. Markar ◽  
Melody Ni ◽  
Suzanne S. Gisbertz ◽  
Leonie van der Werf ◽  
Jennifer Straatman ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Minimally Invasive Esophagectomy ◽  
Univariate Analysis ◽  
Length Of Hospital Stay ◽  
Time Trial ◽  
Pulmonary Complications ◽  
Invasive Technique ◽  
Invasive Esophagectomy

PURPOSE The aim of this study was to examine the external validity of the randomized TIME trial, when minimally invasive esophagectomy (MIE) was implemented nationally in the Netherlands, using data from the Dutch Upper GI Cancer Audit (DUCA) for transthoracic esophagectomy. METHODS Original patient data from the TIME trial were extracted along with data from the DUCA dataset (2011-2017). Multivariate analysis, with adjustment for patient factors, tumor factors, and year of surgery, was performed for the effect of MIE versus open esophagectomy on clinical outcomes. RESULTS One hundred fifteen patients from the TIME trial (59 MIE v 56 open) and 4,605 patients from the DUCA dataset (2,652 MIE v 1,953 open) were included. In the TIME trial, univariate analysis showed that MIE reduced pulmonary complications and length of hospital stay. On the contrary, in the DUCA dataset, MIE was associated with increased total and pulmonary complications and reoperations; however, benefits included increased proportion of R0 margin and lymph nodes harvested, and reduced 30-day mortality. Multivariate analysis from the TIME trial showed that MIE reduced pulmonary complications (odds ratio [OR], 0.19; 95% CI, 0.06 to 0.61). In the DUCA dataset, MIE was associated with increased total complications (OR, 1.36; 95% CI, 1.19 to 1.57), pulmonary complications (OR, 1.50; 95% CI, 1.29 to 1.74), reoperations (OR, 1.74; 95% CI, 1.42 to 2.14), and length of hospital stay. Multivariate analysis of the combined and MIE datasets showed that inclusion in the TIME trial was associated with a reduction in reoperations, Clavien-Dindo grade > 1 complications, and length of hospital stay. CONCLUSION When adopted nationally outside the TIME trial, MIE was associated with an increase in total and pulmonary complications and reoperation rate. This may reflect nonexpert surgeons outside of high-volume centers performing this minimally invasive technique in a nonstandardized fashion outside of a controlled environment.

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