The relationship between mean daily step counts and pulmonary complications after thoracoscopic lobectomy in elderly patients: A propensity score matching study / 中国胸心血管外科临床杂志

@#Objective     To investigate the relationship between preoperative mean daily step counts and pulmonary complications after thoracoscopic lobectomy in elderly patients. Methods     From 2018 to 2021, the elderly patients with pulmonary complications after thoracoscopic lobectomy were included. A 1∶1 propensity score matching was performed with patients without pulmonary complications. The clinical data were compared between the two groups. Results    Totally, 100 elderly patients with pulmonary complications were enrolled, including 78 males and 22 females, aged 66.4±4.5 years. And 100 patients without pulmonary complications were matched, including 71 males and 29 females aged 66.2±5.0 years. There was no significant difference in the preoperative data between the two groups (P>0.05). Compared to the patients with pulmonary complications, the ICU stay was shorter (8.1±4.4 h vs. 12.9±7.5 h, P<0.001), the first out-of-bed activity time was earlier (8.8±4.5 h vs. 11.2±6.1 h, P=0.002), and the tube incubation time was shorter (19.3±9.2 h vs. 22.5±9.4 h, P=0.015) in the patients wihout pulmonary complications. There was no statistical difference in other perioperative data between the two groups (P>0.05). The mean daily step counts in the pulmonary complications group were significantly less than that in the non-pulmonary complications group (4 745.5±2 190.9 steps vs. 6 821.1± 2 542.0 steps, P<0.001). The daily step counts showed an upward trend for three consecutive days in the two groups, but the difference was not significant. Conclusion     The decline of preoperative mean daily step counts is related to pulmonary complications after thoracoscopic lobectomy in elderly patients. Recording daily step counts can promote preoperative active exercise training for hospitalized patients.

Postoperative pulmonary complications following adenotonsillectomy in pediatric patients with obstructive sleep apnea in a tertiary government hospital

Objective@#Our study aimed to identify and describe pulmonary complications and its associated risk factors in children with suspected or confirmed obstructive sleep apnea (OSA) who underwent tonsillectomy or adenotonsillectomy in a tertiary government hospital.@*Methods@#We conducted a retrospective cohort study. Medical charts of pediatric patients with suspected or confirmed OSA who were admitted for tonsillectomy or adenotonsillectomy from January 1, 2016 to December 31, 2020 were retrieved and reviewed. Information of the individual patients including the demographic data, clinical profile, polysomnography results, and presence of postoperative pulmonary complications were recorded. Descriptive statistics was utilized to present continuous data while frequency and percentage for categorical data. Fisher exact test was used to compare the demographic profile of patients with postoperative pulmonary complications from those without. @*Results@#A total of 90 patient records were analyzed. The mean age of the patient population was 7.87 years, 55.6% were male, 17.8% of patients were classified as obese. Thirty-four children had preoperative polysomnography and of these, 47.1% were classified as severe. Only two (2.2%) patients had postoperative pulmonary complications, which were bronchospasm and desaturation, respectively. There were no statistically significant differences noted in comparing the clinicodemographic profile of patients with postoperative pulmonary complications from those without complications. @*Conclusion@#Our results showed that most pediatric patients with suspected or confirmed OSA who underwent adenotonsillectomy did not have pulmonary complications.

Complicaciones respiratorias en el posoperatorio inmediato en pacientes sometidos a cirugías de hemiabdomen superior

Las complicaciones respiratorias durante el posoperatorio inmediato justifica el interés del anestesiólogo por el conocimiento actualizado con el fin de disminuir la morbimortalidad. Con el objetivo de caracterizar las complicaciones respiratorias más frecuentes que se presentan en el posoperatorio inmediato de cirugía de hemiabdomen superior se realizó estudioobservacional, descriptivo de serie de casos, en 146 pacientes sometidos a cirugía de hemiabdomen superior atendidos en la unidad de cuidados posanestésicos del Hospital Provincial Clínico Quirúrgico Docente "Saturnino Lora", de Santiago de Cuba, duranteenero a diciembre de 2020; los datos se obtuvieron a partir de la historia clínica hospitalaria y examen clínico general realizado, los que fueron plasmados en una planilla confeccionada para el efecto. Fueron utilizados el test del Xi-cuadrado (X2), y la prueba de diferencias de proporciones, con un valor de p = 0,05durante el procesamiento estadístico. Los pacientes con edades mayores de 60 años, del sexo masculino y que presentaban como hábitos tóxicos el tabaquismo, la hipertensión arterial seguida de las neuropatías son las más frecuentes; mientras que los diagnósticos operatorios fueron la colecistitis aguda convencional y el trauma hepático. La intervención quirúrgica urgente, los pacientes ASA II, y los procedimientos que duraron más de 2 horas fueron los más frecuentes. Las complicaciones respiratorias más frecuentes encontradas fue la hipoxia; seguida de la ventilación mecánica prolongada y la atelectasia. Las complicaciones respiratorias encontradas en el posoperatorio inmediato de cirugía de hemiabdomen superior se asociaron desde el punto de vista estadístico con la clasificación ASA.

Respiratory complications during the immediate postoperative period justify the anesthesiologist's interest in updated knowledge in order to reduce morbidity and mortality. In order to characterize the most frequent respiratory complications that occur in the immediate postoperative period of upper hemiabdomen surgery, an observational, descriptive case series study was conducted in 146 patients undergoing upper hemiabdomen surgery attended at the post-anesthetic care unit of the "Saturnino Lora" Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba. during January to December 2020; The data were obtained from the hospital clinical history and general clinical examination performed, which were reflected in a form prepared for this purpose. The Xi-square test (X2) and the proportions differences test were used, with a p value = 0.05 during statistical processing. Patients over 60 years of age, male and who presented smoking as toxic habits, hypertension followed by neuropathies are the most frequent; while the operative diagnoses were conventional acute cholecystitis and liver trauma. Urgent surgery, ASA II patients, and procedures lasting more than 2 hours were the most frequent. The most frequent respiratory complications found were hypoxia; followed by prolonged mechanical ventilation and atelectasis. The respiratory complications found in the immediate postoperative period of upper hemiabdomen surgery were statistically associated with the ASA classification.

As complicações respiratórias no pós-operatório imediato justificam o interesse do anestesiologista em atualizar o conhecimento para reduzir a morbimortalidade. Com o objetivo de caracterizar as complicações respiratórias mais frequentes que ocorrem no pós-operatório imediato de cirurgia de hemiabdome alto, foi realizado um estudo observacional descritivo de série de casos em 146 pacientes submetidos à cirurgia de hemiabdome superior atendidos na unidade de recuperação pós-anestésica do Hospital Provincial Clínico Cirúrgico Universitário "Saturnino Lora" em Santiago de Cuba de janeiro a dezembro de 2020; Os dados foram obtidos da história clínica hospitalar e do exame clínico geral realizados, os quais foram refletidos em um formulário elaborado para esse fim.Utilizou-se o teste do xi-quadrado (X2) e o teste de diferenças de proporções, com valor de p = 0,05 durante o processamento estatístico. Pacientes acima de 60 anos, do sexo masculino e que apresentavam o tabagismo como hábitos tóxicos, sendo a hipertensão arterial seguida de neuropatias os mais frequentes; enquanto os diagnósticos operatórios foram colecistite aguda convencional e trauma hepático. Cirurgias de urgência, pacientes ASA II e procedimentos com duração superior a 2 horas foram os mais frequentes. As complicações respiratórias mais frequentes encontradas foram hipóxia; seguido de ventilação mecânica prolongada e atelectasia. As complicações respiratórias encontradas no pós-operatório imediato de cirurgia de hemiabdome alto foram estatisticamente associadas à classificação ASA.

Research progress on preoperative inspiratory muscle training for prevention of postoperative pulmonary complications in adult cardiac surgery / 中国胸心血管外科临床杂志

@#In the past two decades, adult cardiac surgery has developed by leaps and bounds in both anesthetic techniques and surgical methods, whereas the incidence of postoperative pulmonary complications (PPCs) has not changed. Until now PPCs are still the most common complications after cardiac surgery, resulting in poor prognosis, significantly prolonged hospital stays and increased medical costs. With the promotion of the concept of enhanced recovery after surgery (ERAS), pre-rehabilitation has been becoming a basic therapy to prevent postoperative complications. Among them, preoperative inspiratory muscle training as a very potential intervention method has been widely and deeply studied. However, there is still no consensus about the definition and diagnostic criteria of PPCs around the world; and there is significant heterogeneity in preoperative inspiratory muscle training in the prevention of pulmonary complications after cardiac surgery in adults, which impedes its clinical application. This paper reviewed the definition, mechanism, and evaluation tools of PPCs, as well as the role, implementation plan and challenges of preoperative inspiratory muscle training in the prevention of PPCs in patients undergoing cardiac surgery, to provide reference for clinical application.

elationship between preoperative fasting plasma glucose and postoperative pulmonary complications after lung resection in type 2 diabetic patients / 中国胸心血管外科临床杂志

@#Objective     To explore the relationship between preoperative fasting plasma glucose (FPG) and postoperative pulmonary complications (PPCs) in type 2 diabetic patients undergoing elective thoracoscopic lung resection, and provide a reference for prediction and prevention of PPCs in the clinic. Methods     A retrospective analysis was performed on the type 2 diabetic patients who underwent elective thoracoscopic lung resection for the first time in our hospital from January 2017 to March 2021. According to the level of FPG one day before the operation, the patients were divided into three groups: a hypoglycemia group (<6.1 mmol/L), a medium level blood glucose group (≥6.1 mmol/L and <8.0 mmol/L) and a high blood glucose group (≥8.0 mmol/L). Besides, the patients were divided into a PPCs group and a non-PPCs group according to whether PPCs occurred. The risk factors for PPCs were analyzed by logistic regression analysis, and the predictive value of preoperative FPG level on PPCs was estimated by the area under the receiver operating characteristic curve (AUC). Results     A total of 130 patients were included, including 75 (57.7%) males and 55 (42.3%) females with an average age of 63.5±9.0 years. Logistic regression analysis showed that compared to non-PPCs patients, the level of preoperative FPG (P=0.023) and smoking history ratio (P=0.036) were higher and the operation time was longer (P=0.004) in the PPCs patients. High FPG level on preoperative day 1 and longer operation time were associated with PPCs risk. Besides, the preoperative FPG of 6.79 mmol/L was the threshold value to predict the occurrence of PPCs [AUC=0.653, 95%CI (0.559, 0.747), P=0.003]. Conclusion     There is a certain correlation between preoperative FPG level and postoperative PPCs, which may be used as an index to predict the occurrence of PPCs.

Effect of ventilation mode on pulmonary complications after thoracoscopic lung resection: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective     To evaluate the association between pressure-controlled ventilation-volume guaranteed (PCV-VG) mode and volume-controlled ventilation (VCV) mode on postoperative pulmonary complications (PPCs) in patients undergoing thoracoscopic lung resection. Methods     A retrospective cohort analysis of 329 patients undergoing elective thoracoscopic lung resection in West China Hospital of Sichuan University between September 2020 and March 2021 was conducted, including 213 females and 116 males, aged 53.6±11.3 years. American Society of Anesthesiologists (ASA) grade wasⅠ-Ⅲ. The patients who received lung-protective ventilation strategy during anesthesia were divided into a PCV-VG group (n=165) and a VCV group (n=164) according to intraoperative ventilation mode. Primary outcome was the incidence of PPCs during hospitalization. Results     A total of 73 (22.2%) patients developed PPCs during hospitalization. The PPCs incidence of PCV-VG and VCV was 21.8% and 22.6%, respectively (RR=0.985, 95%CI 0.569-1.611, P=0.871). Multivariate logistic regression analysis showed that there was no statistical difference in the incidence of PPCs between PCV-VG and VCV mode during hospitalization (OR=0.846, 95%CI 0.487-1.470, P=0.553). Conclusion     Among patients undergoing thoracoscopic lung resection, intraoperative ventilation mode (PCV-VG or VCV) is not associated with the risk of PPCs during hospitalization.

Analysis of risk factors for pulmonary complications in patients with spontaneous pneumothorax after micro single-port video-assisted thoracoscopic surgery / 中国胸心血管外科临床杂志

@#Objective    To analyze the occurrence of postoperative pulmonary complications (PPC) and the risk factors in patients with spontaneous pneumothorax who underwent micro single-port video-assisted thoracoscopic surgery (VATS). Methods    A total of 158 patients with spontaneous pneumothorax who underwent micro single-port VATS in our hospital from April 2017 to December 2019 were retrospectively included, including 99 males and 59 females, with an average age of 40.53±9.97 years. The patients were divided into a PPC group (n=21) and a non-PPC group (n=137) according to whether PPC occurred after the operation, and the risk factors for the occurrence of PPC were analyzed. Results    All 158 patients successfully completed the micro single-port VATS, and there was no intraoperative death. The postoperative chest tightness, chest pain, and dyspnea symptoms basically disappeared. During the postoperative period, there were 3 patients of pulmonary infection, 7 patients of atelectasis, 4 patients of pulmonary leak, 6 patients of pleural effusion, 1 patient of atelectasis and pleural effusion, and the incidence of PPC was 13.29% (21/158). Multivariate logistic regression analysis showed that lung disease [OR=32.404, 95%CI (2.717, 386.452), P=0.006], preoperative albumin level≤35 g/L [OR=14.912, 95%CI (1.719, 129.353), P=0.014], severe pleural adhesions [OR=26.023, 95%CI (3.294, 205.557), P=0.002], pain grade Ⅱ-Ⅲ 24 hours after the surgery [OR=64.024, 95%CI (3.606, 1 136.677), P=0.005] , age [OR=1.195, 95%CI (1.065, 1.342), P=0.002], intraoperative blood loss [OR=1.087, 95%CI (1.018, 1.162), P=0.013] were the risk factors for PPC after micro single-port VATS. Conclusion    There is a close relationship between PPC after micro single-port VATS and perioperative indexes in patients with spontaneous pneumothorax. Clinically, targeted prevention and treatment can be implemented according to the age, pulmonary disease, preoperative albumin level, intraoperative blood loss, degree of pleural adhesion and pain grading 24 hours after surgery.

Perioperative nebulization of ipratropium bromide in patients with chronic obstructive pulmonary disease under thoracic surgery: A randomized, double-blind, placebo-controlled, parallel-group, multi-centre trial / 中国胸心血管外科临床杂志

@#Objective    To evaluate the effect of perioperative nebulization of ipratropium bromide on preoperative pulmonary function and incidence of postoperative pulmonary complications as well as safety in chronic obstructive pulmonary disease (COPD) patients who underwent lung resection in thoracic surgery. Methods    During November 18, 2013 to August 12, 2015, 192 COPD patients with a necessity of selective surgical procedures of lobectomy or right bilobectomy or segmentectomy under general anaesthesia in 10 centers were 1 : 1 randomized to an ipratropium bromide group (96 patients) and a placebo group (96 patients), to compare the effect on preoperative pulmonary function and incidence of postoperative pulmonary complications. The average age of treated patients was 62.90±6.50 years, with 168 male patients and 22 female patients. Results     The demographic and baseline characteristics were well-balanced between the two groups. The adjusted mean increase of forced expiratory volume in one second (FEV1) in the ipratropium bromide group was significantly higher than that in the placebo group (169.90±29.07 mL vs. 15.00±29.35 mL, P<0.05). The perioperative use of ipratropium bromide significantly decreased incidence of postoperative pneumonia (2.6% vs. 14.1%, P<0.05). There was no ipratropium bromide related adverse event (AE) observed in this trial. Conclusion    This trial indicates that perioperative nebulization of ipratropium bromide significantly improves preoperative lung function and reduces postoperative pneumonia in COPD patients undergoing lung resection in thoracic surgery, and has good safety profile.

Effect of intraoperative ventilation modes on postoperative pulmonary complications after cardiac surgery under cardiopulmonary bypass: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To evaluate the association of intraoperative ventilation modes with postoperative pulmonary complications (PPCs) in adult patients undergoing selective cardiac surgery under cardiopulmonary bypass (CPB). Methods    The clinical data of 604 patients who underwent selective cardiac surgical procedures under CPB in the West China Hospital, Sichuan University from June to December 2020 were retrospectively analyzed. There were 293 males and 311 females with an average age of 52.0±13.0 years. The patients were divided into 3 groups according to the ventilation modes, including a pressure-controlled ventilation-volume guarantee (PCV-VG) group (n=201), a pressure-controlled ventilation (PCV) group (n=200) and a volume-controlled ventilation (VCV) group (n=203). The association between intraoperative ventilation modes and PPCs (defined as composite of pneumonia, respiratory failure, atelectasis, pleural effusion and pneumothorax within 7 days after surgery) was analyzed using modified poisson regression. Results    The PPCs were found in a total of 246 (40.7%) patients, including 86 (42.8%) in the PCV-VG group, 75 (37.5%) in the PCV group and 85 (41.9%) in the VCV group. In the multivariable analysis, there was no statistical difference in PPCs risk associated with the use of either PCV-VG mode (aRR=0.951, 95%CI 0.749-1.209, P=0.683) or PCV mode (aRR= 0.827, 95%CI 0.645-1.060, P=0.133) compared with VCV mode. Conclusion    Among adults receiving selective cardiac surgery, PPCs risk does not differ significantly by using different intraoperative ventilation modes.

Effects of anesthetics on postoperative pulmonary complications in patients undergoing cardiac surgery / 中国胸心血管外科临床杂志

@#Objective    To evaluate the association of anesthesia regime (volatile or intravenous anesthetics) with the occurrence of postoperative pulmonary complications (PPCs) in adult patients undergoing elective cardiac surgery under cardiopulmonary bypass (CPB). Methods    The electronic medical records of 194 patients undergoing elective cardiac surgery under CPB at West China Hospital, Sichuan University between September 2018 and February 2019 were reviewed, including 92 males and 102 females with an average age of 53 years. The patients were classified into a volatile group (n=94) or a total intravenous anesthesia (TIVA) group (n=100) according to anesthesia regimen during surgery (including CPB). The primary outcome was the incidence of PPCs within first 7 d after surgery. Secondary outcomes included incidence of reintubation, duration of mechanical ventilation, ICU stay and hospital stay. Results    There was no significant difference in the incidence of PPCs between the two groups (RR=1.020, 95%CI 0.763-1.363, P=0.896), with an incidence of 48.9% in the volatile group and 48.0% in the TIVA group. Secondary outcomes were also found no significant difference between the two groups (P>0.05). Conclusion    No association of anesthesia regimen with the incidence of PPCs is found in adult patients undergoing elective cardiac surgery under CPB.

Relationship between drainage volume on the first postoperative day and complications after video-assisted thoracoscopic surgery lobectomy / 中国胸心血管外科临床杂志

@#Objective 聽 聽To investigate the correlation between the postoperative day 1 (POD1) drainage volume and postoperative pulmonary complications (PPCs). Methods 聽 聽The clinical data of 254 non-small cell lung cancer (NSCLC) patients undergoing thoracoscopic lobectomy at our department from January 2014 to June 2018 were retrospectively reviewed. According to whether there were PPCs after operation, patients were divided into a PPCs group (51 patients, 33 males and 18 females, aged 65.2卤7.3 years) and a non-PPCs group (203 patients, 110 males and 93 females, aged 62.4卤8.2 years). The correlation between POD1 drainage volume and PPCs was analyzed. Results 聽 聽The POD1 drainage volume in the PPCs group was significantly more than that in the non-PPCs group (337.5卤127.4 ml vs. 208.7卤122.9 ml, P=0.000). The result of regression analysis showed that POD1 drainage volume was an independent risk factor for the occurrence of PPCs. Receiver operating characteristic curve (ROC curve) analysis showed that POD1 drainage volume of 265 ml was the cut-off point to predict PPCs. The rate of PPCs in the group of POD1 drainage volume less than 265 ml was significantly lower than that in the group of drainage volume more than 265 ml (8.3% vs. 43.0%, P=0.000). Conclusion 聽 聽The POD1 drainage volume is closely related to the occurrence of PPCs, which can be used to predict the occurrence of PPCs.

Application of lung protective ventilation strategy in radiofrequency ablation of atrial fibrillation / 实用医学杂志

Objective To observe the clinical significance of lung protective ventilation strategy in pa-tients with radiofrequency ablation of atrial fibrillation under general anesthesia through clinical controlled study. Methods Sixty patients undergoing radiofrequency catheter ablation were randomly divided into group L (n=30) and group C(n=30).Breathing parameters were set after tracheal intubation of general anesthesia.Arterial blood gas was collected.PETCO2and airway pressure were recorded during the operation.The operative time,ablation time,flu-oroscopy time and operation-related complications were recorded together with the surgeon satisfaction. Patients were followed up postoperatively for pulmonary complications. The length of patient′s hospital-stay was recorded. Results There was no significant difference in operation time, fluoroscopy time, ablation time and hospitalization days between the two groups (P>0.05). There was no significant difference in the occurrence and grade of PPCs between the two groups (P>0.05). There was significant difference in surgeon satisfaction between the two groups (P<0.01).Conclusion LPVS is suitable for ventilation management in radiofrequency ablation of atrial fibrillation.

Analysis of risk factors for postoperative pulmonary complications in colorectal cancer patients / 实用医学杂志

Objective To investigate the risk factors for postoperative pulmonary complications (PPCs) in colorectal cancer patients.Methods From January 2014 to June 2016,risk factors for postoperative pulmonary complications in colorectal cancer patients were analyzed retrospectively.The data was analyzed by individual elcment,then the statistically significant factors were analyzed by logistic regression analysis.Results Forty-one out of 352 had PPCs,the incidence rate was 11.6％.The incidence of PPCs was significantly increased in patients with age over 65,a history of smoking,the combined chronic obstructive pulmonary disease (COPD),body mass index (BMI) over 25 kg/m2,operation time (3 h) or longer and preoperative neoadjuvant chemotherapy (P ＜ 0.05) with single factor analysis.In the six kinds of risk factors,age over 65,body mass index (BMI) over 25 kg/m2,COPD and operation time (3 h) or longer wcre the independent risk factors for multiple factors analysis (P ＜ 0.05).Conclusion For elderly patients with colorectal cancer,especially with a history of COPD or obesity,if the operation time was long,more attention should be paid for the happen of PPCs.

Clinical application of incentive spirometry in patients with chronic obstructive pulmonary disease after thora-cotomy / 局解手术学杂志

Objective To discuss the feasibility on reducing the postoperative pulmonary complications ( PPC) incidence after thoracot-omy on chronic obstructive pulmonary disease ( COPD) though application of incentive spirometry ( IS) . Methods 62 patients with COPD concurrent thoracotomy were divided into control group and observation group,the control group was given routine nebulization,expectoration and other physical treatment;the observation group were given IS besides the conventional treatment. The incidence of PPC,prognosis,and the changes on pulmonary function were compared between these two groups. Results The incidence of PPC and mortality of observation group were significantly lower than those of control group,and the inspiratory capacity( IC) from 3~5 days was significantly higher than that of con-trol group. Conclusion Application of IS can reduce the PPC incidence after thoracotomy on COPD patients,and promote the recovery of pulmonary function.

Papel da estratégia protetora de ventilação mecânica na lesão pulmonar induzida pelo ventilador mecânico em pacientes sem síndrome do desconforto respiratório agudo: uma meta-análise de dados individuais de pacientes / Protective ventilation and ventilator-induced lung injury in patients without acute respiratory distress syndrome: an individual patient data meta-analysis

INTRODUÇÃO: Estudos recentes sugerem que o uso da estratégia protetora de ventilação mecânica no intra-operatório pode reduzir a incidência de complicações pulmonares pós-operatórias (CPP). O objetivo desta meta-análise de dados individuais de pacientes é avaliar o efeito independente do volume corrente e da pressão positiva ao final da expiração (PEEP) na ocorrência de CPP. MÉTODOS: Foram incluídos ensaios clínicos randomizados que compararam a estratégia protetora de ventilação mecânica com a estratégia convencional em pacientes submetidos à anestesia para cirurgia. O desfecho primário foi o desenvolvimento de CPP. Diversos fatores prognósticos pré-definidos foram testados por meio da regressão logística multivariada. RESULTADOS: Quatorze ensaios clínicos randomizados foram incluídos (2.095 pacientes). Houve 97 casos de CPP em 1.102 pacientes (8,8%) ventilados com a estratégia protetora e 148 casos em 993 pacientes (14,9%) ventilados com a estratégia convencional (risco ajustado relativo [RR], 0,64; 95% intervalo de confiança [IC], 0,46 - 0,88, p < 0,01). Houve 85 casos de CPP em 957 pacientes (8,9%) ventilados com volume corrente baixo e PEEP alto e 63 casos em 525 pacientes (12%) ventilados com volume corrente baixo e PEEP baixo (RR, 0,93; 95% CI, 0,64 - 1,37, p = 0,72). Foi encontrada uma relação de dose-resposta entre o aparecimento de CPP e o volume corrente (R2 por meio termo quadrático = 0,390), mas não entre o aparecimento de CPP e o nível de PEEP (R2 = 0,082). A manutenção de uma driving pressure inferior a 13 cmH2O durante a cirurgia está associado a menor incidência de síndrome do desconforto respiratório agudo (SDRA). CONCLUSÃO: Esta meta-análise de dados individuais suporta os efeitos benéficos da estratégia protetora de ventilação mecânica em pacientes submetidos à cirurgia e sugere que altos níveis de PEEP, na vigência de volume corrente baixo, não acrescentam benefícios...

INTRODUCTION: Recent studies show that intraoperative mechanical ventilation using low tidal volumes can prevent postoperative pulmonary complications (PPC). The aim of this individual patient data meta-analysis is to evaluate the individual associations between tidal volume size and PEEP level, and occurrence of PPC. METHODS: Randomized controlled trials comparing protective ventilation and conventional ventilation in patients undergoing general surgery were screened for inclusion. The primary outcome was development of PPC. Predefined prognostic factors were tested using multivariate logistic regression. RESULTS: Fourteen randomized controlled trials were included (2095 patients). There were 97 cases of PPC in 1102 patients (8.8%) assigned to protective ventilation and 148 cases in 993 patients (14.9%) assigned to conventional ventilation (adjusted relative risk [RR], 0.64; 95% confidence interval [CI], 0.46 - 0.88; p < 0.01). There were 85 cases of PPC in 957 patients (8.9%) assigned to ventilation with low tidal volume and high PEEP levels and 63 cases in 525 patients (12%) assigned to ventilation with low tidal volume and low PEEP levels (RR, 0.93; 95% CI, 0.64 - 1.37; p = 0.72). A dose-response relationship was found between the appearance of PPC and tidal volume size (R2 for mean quadratic term = 0.390), but not between the appearance of PPC and PEEP level (R2 = 0.082). The maintenance of a driving pressure below 13 cmH2O during surgery is associated with reduced incidence of acute respiratory distress syndrome. CONCLUSION: This individual data meta-analysis supports the beneficial effects of protective ventilation settings in patients undergoing surgery and suggests no benefit from high PEEP levels with use of low tidal volume...

Frecuencia de complicaciones respiratorias en cirugía electiva general. Experiencia en un hospital universitario / Frequency of respiratory complications in elective general surgery. Experience of a university hospital

Las complicaciones respiratorias post quirúrgicas (CRPq) son causa importante de morbimortalidad asociada a la cirugía general. Objetivos: 1-Estimar la frecuencia de CRPq en cirugía electiva general. 2- Identificar factores asociados con el riesgo de CRPq, simples y accesibles desde la perspectiva del neumonólogo. Diseño: Estudio prospectivo, descriptivo y transversal. Pacientes y métodos: De una muestra de 233 evaluaciones prequirúrgicas respiratorias (EPR) consecutivas, en 156 pacientes operados en el Hospital de Clínicas “José de San Martín”, la edad, localización de la cirugía, tabaquismo, un score de riesgo respiratorio, espirometría, clasificación de la Sociedad Americana de Anestesiólogos (ASA), los hallazgos clínicos, la prescripción de medicamentos y la preexistencia de enfermedad respiratoria (EPOC y SAOS) fueron evaluados para predecir riesgo de CRPq, con prueba de X² para los respectivos intervalos de confianza (CI). El análisis de regresión logística múltiple buscó identificar predictores independientes de riesgo. Resultados: Se presentaron 26 complicaciones respiratorias en 19 pacientes (12%). El examen respiratorio anormal, el patrón obstructivo, la clasificación de ASA, el score de riesgo respiratorio y la cirugía torácica o abdominal superior se asociaron a CRPq en el análisis individual. La localización de la cirugía, la obstrucción severa de la vía aérea y el score de riesgo respiratorio resultaron predictores independientes de complicaciones. Conclusiones: Se hallaron CRPq en 12% de las cirugías estudiadas. Los factores hallados como predictores independientes coinciden en general con la revisión bibliográfica realizada. En este trabajo, el patrón ventilatorio obstructivo severo resultó un predictor significativo de CRPq.

Postoperative Respiratory Complications (PRCs) are important causes of morbidity and mortality associated to general surgery. Objectives: 1-To estimate the frequency of PRCs in General Elective Surgery. 2- To identify risk factors associated to PRCs from the pulmonologist’s perspective. Design: Prospective, descriptive and transversal study. Methods: In a sample of 233 consecutive preoperative respiratory evaluations, 156 patients were studied for PPCs risk before undergoing elective surgery at the Buenos Aires University Hospital. Age, surgery site, smoking habit, respiratory risk score, spirometry, American Society of Anesthesiology (ASA) classification, clinical respiratory findings, prescribed medication, and respiratory concomitant disease (COPD, Obstructive Sleep Apnea) were assessed to predict the risk of PRCs, through Chi Square analysis (X²) for the corresponding confidence intervals. Variables significantly associated to PPCs were evaluated with multivariate logistic regression analysis. Results: In 19 patients, 26 PPCs were observed (12% of surgical interventions). Abnormal clinical findings, obstructive and severe obstructive pattern in spirometry, ASA classification, respiratory risk score, thoracic and upper abdominal surgery were associated to PPCs in the monovariate analysis. Surgery site, severe airway obstruction, and respiratory risk score were significantly associated to PPCs, in the multivariate analysis. Conclusions: PPCs was found in 12 % of performed surgeries. Respiratory risk factors were similar to those reported in the literature. Additionally, the analysis indicated that severe airway obstruction was a significant predictor of PRCs in this study.

The Prediction of Postoperative Pulmonary Complications in the Elderly Patients / 결핵

BACKGROUND: we have evaluated the association of age, smoking, type of anesthesia, type of operation, duration of surgery, previous history of chronic pulmonary diseases with postoperative pulmonary complications and identified which parameter of preoperative spirometry was a predictor of postoperative pulmonary complications. METHOD: In 270 patients older than 60 years, the postoperative pulmonary complications were evaluated according to age, smoking, type of anesthesia, type of operation, duration of surgery, previous history of chronic pulmonary diseases and the parameters of preoperative spirometry were analyzed. RESULTS: The postoperative pulmonary complications rates were significant higher among patients older than 70 years, and among those with previous chronic pulmonary diseases or their smoking history. The pulmonary complications were increased among patients with general anesthesia or duration of surgery more than 2 hours. The pulmonary complications rates did not differ according to sex, type of operation. The patients with hypercarbia(PaCO2> 45mmHg) have more increased postoperative complications. The preoperative FEVl less than 1 liter, FVC, MMEFR & MVV less than 50% of predicted respectively were predictive of complications. CONCLUSION: Age 70, history of smoking,duration of operation more than 2 hours, general anesthesia, previous chronic pulmonary disease and hypercarbia (> or=45mmHg) on preoperative arterial blood gas analysis were predictivd of pulmonary complications. Among the parameters of spirometry, FEV1, FVC, MMEFR and MVV were indicator of predicting postoperative pulmonary complications.