RESUMO
BACKGROUND: Lung protective ventilation during the intraoperative period is now well established. However, the additional role of positive end-expiratory pressure (PEEP) during the intraoperative period remains uncertain in major laparoscopic gynecological surgery. The authors hypothesized that compliance-based optimum PEEP titration reduces postoperative lung atelectasis and improves outcomes. METHODS: Patients undergoing major laparoscopic pelvic gynecological surgeries with healthy lungs were randomized to the fixed PEEP group (PEEP 5 cm H2O and recruitment maneuver {RM}) and optimum PEEP group (compliance-based PEEP and RM). Lung ultrasound and arterial blood gas analysis were performed at four time points. Modified lung ultrasound scoring was done, and the same was used as means of assessing lung aeration and the amount of lung atelectasis. Postoperative supplemental oxygen requirement and duration were also assessed and compared. RESULTS: Lung ultrasound score (LUS) 30 minutes after extubation in fixed (Group F) and optimum (Group O) PEEP groups were median (interquartile range {IQR}) 3 (2-3) versus 1 (1-2), p=0.0001. Ventilatory parameters between Group F and Group O after lung recruitment were tidal volume (mean 357 mL {SD: 35} versus 362 mL {SD: 22}, p=0.46), PEEP (median, 5 cm H2O {IQR: 5-5} versus median 16 cm H2O {IQR: 14-18}), peak airway pressure (median 26 cm H2O {IQR: 24-28} versus median 30 cm H2O {IQR: 28-32} p<0.0001), plateau pressure (median 22 cm H2O {IQR: 20-24} versus median 26 cm H2O {IQR: 24-28} p<0.0001), static compliance (32.07±8.36 mL cm H2O-1 versus 39.58±8.99 mL cm H2O-1, p=0.0002). The number of patients requiring postoperative oxygen therapy to maintain SpO2 >94% after extubation in postanesthesia care unit (PACU) was statistically significantly greater in group F (39/41 {95%} versus 30/41 {73%}, p=0.007). Median (IQR) duration of oxygenation therapy in the first 24 hours of the postoperative period between Group F and Group O differed with statistical significance, with the median (IQR) values being 25 (20-30) minutes versus 10 (0-15) minutes (p<0.0001). CONCLUSIONS: The modified lung ultrasound score significantly differed intraoperatively between the two groups, with lower scores in the optimum PEEP group. This has reflected improved postoperative outcomes in optimum PEEP group patients, with fewer patients requiring postoperative oxygen supplementation and reduced supplemental oxygen requirement duration.
RESUMO
OBJECTIVES: Most of the adult mental health disorder occurs either during childhood or adolescent stage. Assessment of positive mental health among adolescents will help in predicting the future physical and mental health outcome. Hence, this study was done to determine the prevalence and factors associated with positive mental health among adolescents in rural Puducherry. METHODS: A cross-sectional study was conducted among adolescents (10-19 years) during April and May 2018. Mental Health Continuum-Short Form (MHC-SF), a validated questionnaire was used for the assessment of positive mental health. Prevalence of positive mental health was expressed as proportion with 95% confidence interval. RESULTS: Of the total 245 adolescents interviewed, almost half of them belonged to the age group of mid-adolescence (14-16 years). Majority (66.5%) were boys and more than one third were studying in secondary class.Prevalence of positive mental health was 51.8% (95% CI: 45.6-58.1). Mother's education between primary and secondary (aPR-0.77 95% CI: 0.60-0.98), upper middle (aPR-1.74 95% CI: 1.03-2.94) and middle socioeconomic status (aPR-1.80 95% CI: 1.11-2.87) were significantly associated with positive mental health. CONCLUSION: Current study found that more than half of the rural adolescents had positive mental health. Maternal education and upper socioeconomic status were found to be significant predictors of positive mental health. Our findings on the burden and risk factors as well as protective factors of mental health can contribute to the mental health strategy in public health action.
