Respiratory Tract Microecology and Bronchopulmonary Dysplasia in Preterm Infants

Bronchopulmonary dysplasia (BPD) is a severe respiratory complication in preterm infants. Although the etiology and pathogenesis of BPD are complex and remain to be clarified, recent studies have reported a certain correlation between the microecological environment of the respiratory tract and BPD. Changes in respiratory tract microecology, such as abnormal microbial diversity and altered evolutional patterns, are observed prior to the development of BPD in premature infants. Therefore, research on the colonization and evolution of neonatal respiratory tract microecology and its relationship with BPD is expected to provide new ideas for its prevention and treatment. In this paper, we review microecological changes in the respiratory tract and the mechanisms by which they can lead to BPD in preterm infants.

Assessing the respiratory impact caused when giant hernias are reinserted into the abdominal cavity, in order to determine the optimal surgical approach

The reinsertion of a large hernia into the abdominal cavity provokes an increase in abdominal volume and pressure that can result in intra-abdominal hypertension. This, in turn, may generate a series of complex changes in cardiopulmonary physiology and induce severe respiratory insufficiency. At present, no objective method exists to evaluate the possibility of this respiratory complication occurring. Accordingly, the present study was undertaken to measure the respiratory consequences of abdominal volume restriction. The data obtained were used to construct a reference table, from which the reduction in FEV1 can be predicted according to the hernia volume reinserted. Thus, the surgeon has access to more accurate information, which greatly facilitates the treatment of large abdominal hernias.

519 PERIOPERATIVE FLUID MANAGEMENT IN ESOPHAGECTOMY FOR CANCER AND ITS RELATION TO POSTOPERATIVE RESPIRATORY COMPLICATIONS

The optimal perioperative fluid management during esophagectomy is still not clear. Liberal regimens have been associated with higher morbidity and respiratory complications. Restrictive regimens might raise concerns for kidney function and increase the need to associate vasopressors. Recently, perioperative care is changing towards goal-directed fluid regimens as part of early recovery programs. The aim of this study was to investigate retrospectively the perioperative fluid administration during esophagectomy and to correlate this with postoperative respiratory outcome. Methods All patients who underwent esophagectomy between January–December 2016 were retrospectively analyzed. Patient characteristics, type of surgery and postoperative course were reviewed. Fluid administration and vasopressor use were calculated intra-operatively and during the postoperative stay at the recovery room. Fluid overload was defined as a positive fluid balance of more than 125 mL/m2/h during the first 24 hours. Patients were divided in 3 groups: GRP0 (no fluid overload/no vasopressors); GRP1 (need for vasopressors); GRP2 (fluid overload with/without vasopressors). Postoperative complications were prospectively recorded according to Esophagectomy Complications Consensus Group criteria. Multivariable analysis (binary logistic regression) for “any respiratory complication” was performed. Results 103 patients were analyzed: 35 (34%) GRP0, 50 (49%) GRP1 and 18 (17%) GRP2. No significant differences were found for age, treatment (neoadjuvant vs. primary), type of surgery (Open/MIE), histology and comorbidities. There were significant (p ≤ 0.001) differences in fluid balance/m2/h (75 ± 21 mL; 86 ± 22 mL and 144 ± 20 mL) across GRP0, GRP1 and GRP2 respectively. We found differences in respiratory complications GRP0 (20%) versus GRP1 (42%;p = 0.034) and GRP0 (20%) versus GRP2 (61%;p = 0.002)) and “Comprehensive Complications Index” GRP0 (20.5) versus GRP1 (34.6;p = 0.015) and GRP0 (20.5) versus GRP2 (35.1;p = 0.009). Multivariable analysis for any respiratory complication is presented in FIGURE 1. Conclusion Among patients undergoing esophagectomy, there is a wide variety in the administration of fluid during the first 24 hours. There was a higher incidence of respiratory complications if patients received higher amounts of fluid or if vasopressors were used. Type of surgery (open versus MIE) did not impact respiratory outcome. We believe that a personalized and protocolized fluid administration algorithm should be implemented and that individual risk factors for patients at risk should be identified.

Factors Affecting Hospital Morbidity and Mortality after Esophageal Resection for Esophageal Carcinoma

Background: Since its introduction, esophageal resection has been notable for high rates of morbidity and mortality. Despite many retrospective reviews, conclusions regarding which patients may be at undue risk for complications are difficult to infer. Aim of this study was to evaluate the preoperative and postoperative factors affecting the hospital morbidity and mortality following esophageal resection for esophageal carcinoma. The study has been performed to standardize the criteria of patient selection and intensive postoperative care for patients undergoing esophageal surgery for esophageal carcinoma. Methods: It is a descriptive longitudinal study, performed in department of thoracic surgery, Dhaka Medical College Hospital from 1st July 2015 to 30th June 2016. Total 50 cases were included in this study. Purposive sampling was done and surgical intervention was carried out by surgeon’s ranked assistant professor or above. Results: Of the 50 collected cases, mean age was 52.10 (±14.69) years with minimum age of 32 and maximum, 80 years. 78% were male and 22% female. 28 (56%) patients underwent one stage esophageal resection for esophageal carcinoma and 22 (44%) patients underwent two stage esophageal resection. Out of 50 patients undergoing esophageal resection, complications occurred in 52% of patients leading to postoperative morbidity, 10% patients died following surgery during hospital stay and uneventful recovery occurred in 38% of patients. Respiratory complication was the leading cause of hospital morbidity (42.30%) following esophageal resection with predominance (30.77%) among stage III patients. Mortality rates were 5.26% in stage I patients, 11.11% in stage II patients and 15.38% in stage III patients. Comparison among different classes of ASA (American Society of Anaesthesiologists) score revealed better post operative outcome in patients with Class I and poor results in Class III patients. Post operative mortality rates of age group 61 to 70 and 71 to 80 were 33.33% and 50% respectively compared to 00.0% in 31-40 age group. Outcome of patients with squamous cell carcinoma and adenocarcinoma were quite similar. Conclusion: This study showed that respiratory complication was the leading cause of hospital morbidity and mortality following esophageal resection for esophageal carcinoma. Old age, poor lung function test results, high ASA score and stage III disease have been found to be associated with poor post operative outcome after esophageal resection Journal of Surgical Sciences (2019) Vol. 23 (1) : 3-9

Respiratory Complications of Adenotonsillectomy for Obstructive Sleep Apnea in the Pediatric Population

Objective. To determine the prevalence of respiratory complications in the early postoperative period of children with sleep apnea who required adenotonsillectomy at a tertiary pediatric hospital and to establish recommendations for postoperative monitoring. Methods. Retrospective cohort study of children with obstructive sleep apnea (OSA) diagnosed by polysomnogram (PSG), who underwent adenotonsillectomy for treatment of OSA. The prevalence of respiratory complications in the first 24 postoperative hours was measured. Patients with craniofacial malformations, obesity, and severe cardiovascular comorbidities were excluded. The prevalence of postoperative respiratory complications was compared with the severity of OSA according to the Apnea Hypopnea Index (AHI) and NADIR. All data were taken in patients residing in Bogotá city, Colombia, at 2.640 meters above sea level (m.a.s.l). Results. Between May 2014 and February 2017, 167 patients (108 males) required adenotonsillectomy for OSA, with an age range of 1 and 15 years (mean 5.3 years +/- 2.7). The prevalence of postoperative respiratory complications was 3.59% (6/167). There was a statistically significant relationship between the presence of respiratory complication and AHI greater than 44/h (p <0.04). There was an inverse correlation between the AHI and NADIR values. Risk groups of patients younger than 3 years and NADIR less than 70% had a higher prevalence of respiratory complications; however, this correlation was not statistically significant (p <0.08 and 0.89, respectively). Conclusions. The prevalence of respiratory complications in OSA patients undergoing adenotonsillectomy in high altitudes is similar to that reported in other heights. Preoperative AHI greater than 44/h could be considered a risk factor for early respiratory complication. We suggest ambulatory management after 6 hours in Postanesthetic Care Unit (PACU) observation in patients older than 3 years, with AHI less than 44/h and NADIR greater than 70% in altitudes higher than 2.500 m.a.s.l. Further research must be done to confirm this hypothesis.

Effect of CRP and lactate clearance in predicting outcome of emergency abdominal surgeries

Background: Emergency abdominal condition had good prognosis if they diagnosed early and had better prognosis. Many biological parameters were considered to reduce postoperative complications. This study aims to study the effects of CRP and 24-hour lactate clearance on morbidity and mortality of patients undergoing emergency abdominal surgery.Methods: All the patients undergone surgery for emergency abdominal conditions over a period of 1 year were included. Patient age of below 15 years and above 70 years were excluded.Results: In the present study of 86 patients, patients whose preoperative CRP level <150 mg/dl and preoperatively CRP >150 mg/dl had mortality of 1 and 9 patients respectively (p = 0.049), wound discharge among 12 and 9 patients respectively (p = 0.113), wound dehiscence among 7 and 9 patients respectively (p = 0.909) and respiratory complications among 2 and 11 patients respectively (p = 0.049). In the present study of 86 patients, patients whose 24 hour lactate clearance of <10% and >10% had mortality of 4 and 3 patients respectively (p = 0.0003), wound discharge among 5 and 16 patients (p = 0.119), wound dehiscence among 5 and 11 patients (p = 0.023), respiratory complication among 5 and 8 patients (p = 0.002), prolonged ileus among 3 and 3 patients respectively (0.007).Conclusions: Preoperative CRP level >150 mg/l associated with higher chances of mortality, respiratory complication and postoperative ileus. 24-hour lactate clearance < 10 % associated with higher chances of mortality, wound dehiscence, respiratory complication and postoperative ileus.