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Balasubbiah N, Saeteng S, Siwachat S, Thuropathum P, Tantraworasin A. Outcomes of pulmonary resection in pulmonary aspergilloma: A retrospective cohort study in a single tertiary-care hospital in Northern Thailand. Asian J Surg 2024:S1015-9584(24)00260-4. [PMID: 38388261 DOI: 10.1016/j.asjsur.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 12/25/2023] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND To date, surgery is the best approach to maximize a cure for symptomatic aspergilloma, but this is not without risk of both morbidity and mortality. The aim of this study is to present the characteristics and outcomes of 77 patients diagnosed with aspergilloma who underwent surgery at Chiang Mai University Hospital (CMUH), and to identify risk factors for composite major postoperative complications (CMPC). METHODS This is an observational retrospective cohort study carried out at CMUH over a period of 11 years from January 1, 2010, to February 28, 2021. Patient characteristics and postoperative outcomes were studied. The primary outcomes were categorized into CMPC. Univariable and multivariable risk regression analysis were used to identify risk factors of CMPC, with risk ratio (RR) and 95% confidence intervals being calculated. RESULTS There were 77 patients included in this study; 27 patients identified as having CMPC and 55 patients as a non-CMPC group. From the multivariable analysis, a factor associated with CMPC included perioperative FFP transfusion (risk ratio (RR) 1.01,95 % CI 1.01-1.02) and preoperative angiogram embolization (RR 8.42, 95 % CI 1.44-49.06) whereas immediate extubation (RR 0.22, 95% CI 0.06-0.81) was less likely to be associated with CMPC. There was a trend of increased risk of CMPC in patients received perioperative blood transfusion, but the data did not reach statistical significance. CONCLUSIONS This study has identified a need for patient profiling before embarking on lung surgery for aspergilloma, to predict outcomes and allocate resources appropriately for safer surgery.
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Affiliation(s)
- Narendran Balasubbiah
- Department of Surgery, Thoracic Unit, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia; General Thoracic Surgery Unit, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Somcharoen Saeteng
- Clinical Surgical Research Center, Chiang Mai University, Chiang Mai, Thailand; General Thoracic Surgery Unit, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sophon Siwachat
- Clinical Surgical Research Center, Chiang Mai University, Chiang Mai, Thailand; General Thoracic Surgery Unit, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pradchaya Thuropathum
- Clinical Surgical Research Center, Chiang Mai University, Chiang Mai, Thailand; General Thoracic Surgery Unit, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Apichat Tantraworasin
- Clinical Surgical Research Center, Chiang Mai University, Chiang Mai, Thailand; General Thoracic Surgery Unit, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Risk Factors for Postoperative Pulmonary Complications Leading to Increased In-Hospital Mortality in Patients Undergoing Thoracotomy for Primary Lung Cancer Resection: A Multicentre Retrospective Cohort Study of the German Thorax Registry. J Clin Med 2022; 11:jcm11195774. [PMID: 36233649 PMCID: PMC9572507 DOI: 10.3390/jcm11195774] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Postoperative pulmonary complications (PPCs) represent the most frequent complications after lung surgery, and they increase postoperative mortality. This study investigated the incidence of PPCs, in-hospital mortality rate, and risk factors leading to PPCs in patients undergoing open thoracotomy lung resections (OTLRs) for primary lung cancer. The data from 1426 patients in this multicentre retrospective study were extracted from the German Thorax Registry and presented after univariate and multivariate statistical processing. A total of 472 patients showed at least one PPC. The presence of two PPCs was associated with a significantly increased mortality rate of 7% (p < 0.001) compared to that of patients without or with a single PPC. Three or more PPCs increased the mortality rate to 33% (p < 0.001). Multivariate stepwise logistic regression analysis revealed male gender (OR 1.4), age > 60 years (OR 1.8), and current or previous smoking (OR 1.6), while the pre-operative risk factors were still CRP levels > 3 mg/dl (OR 1.7) and FEV1 < 60% (OR 1.4). Procedural independent risk factors for PPCs were: duration of surgery exceeding 195 min (OR 1.6), the amount of intraoperative blood loss (OR 1.6), partial ligation of the pulmonary artery (OR 1.5), continuing invasive ventilation after surgery (OR 2.9), and infusion of intraoperative crystalloids exceeding 6 mL/kg/h (OR 1.9). The incidence of PPCs was significantly lower in patients with continuous epidural or paravertebral analgesia (OR 0.7). Optimising perioperative management by implementing continuous neuroaxial techniques and optimised fluid therapy may reduce the incidence of PPCs and associated mortality.
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Bergmann A, Schilling T. [Intraoperative Ventilation Approaches to One-lung Ventilation]. Anasthesiol Intensivmed Notfallmed Schmerzther 2021; 56:329-341. [PMID: 34038972 DOI: 10.1055/a-1189-8031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The management of thoracic surgery patients is challenging to the anesthetist, since one-lung ventilation (OLV) includes at least two major conditions: sufficient oxygenation and lung protection. The first is mainly because the ventilation of one lung is stopped while perfusion to that lung continues; the latter is related to the fact that the whole ventilation is applied to only a single lung. Recommendations for maintaining the oxygenation and methods of lung protection may contradict each other (e. g. high vs. low inspiratory oxygen fraction (FiO2), high vs. low tidal volume, etc.). Therefore, a high degree of pathophysiological understanding and manual skills are required in the management of these patients.In light of recent clinical studies, this review focuses on a current protective strategy for OLV, which includes a possible decrease in FiO2, lowered VT, the application of positive end-expiratory pressure (PEEP) to the dependent and continuous positive airway pressure (CPAP) to the non-dependent lung and alveolar recruitment manoeuvres as well. Other approaches such as the choice of anaesthetics, remote ischemic preconditioning, fluid management and pain therapy can support the success of ventilatory strategy. The present work describes new developments that may change the classical approach in this respect.
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Postoperative complications of pulmonary resection. Clin Radiol 2020; 75:876.e1-876.e15. [PMID: 32600652 DOI: 10.1016/j.crad.2020.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 05/06/2020] [Indexed: 12/25/2022]
Abstract
Thoracic surgery has seen a resurgence in recent years with increasing numbers of cases taken on since the mid-2000s. There has been a paradigm shift in how we manage lung cancer with more emphasis on surgical resection, and this has been aided by minimally invasive video-assisted thoracic surgery (VATS) techniques. As a result, the prevalence of postoperative findings and complications is also increasing, and it is increasingly important for the general radiologist to recognise and diagnose these conditions as thoracic surgical patients may present acutely to non-thoracic surgical institutions. This review will cover both the early and late complications following a variety of lung resection surgeries.
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Taema K, El-Hady Ahmed M, Hamed G, Fawzy S. Predicting acute respiratory distress syndrome in high-risk trauma and surgical patients: validation of previous scores. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2020. [DOI: 10.4103/ejcdt.ejcdt_79_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Zhang W, Chen M, Li H, Yuan J, Li J, Wu F, Zhang Y. Hypoxia preconditioning attenuates lung injury after thoracoscopic lobectomy in patients with lung cancer: a prospective randomized controlled trial. BMC Anesthesiol 2019; 19:209. [PMID: 31711422 PMCID: PMC6849275 DOI: 10.1186/s12871-019-0854-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 09/20/2019] [Indexed: 12/31/2022] Open
Abstract
Background Hypoxic preconditioning (HPC) may protect multiple organs from various injuries. We hypothesized that HPC would reduce lung injury in patients undergoing thoracoscopic lobectomy. Methods In a prospective randomized controlled trial, 70 patients undergoing elective thoracoscopic lobectomy were randomly allocated to the HPC group or the control group. Three cycles of 5-min hypoxia and 3-min ventilation applied to the nondependent lung served as the HPC intervention. The primary outcome was the PaO2/FiO2 ratio. Secondary outcomes included postoperative pulmonary complications, pulmonary function, and duration of hospital stay. Results HPC significantly increased the PaO2/FiO2 ratio compared with the control at 30 min after one-lung ventilation and 7 days after operation. Compared with the control, it also significantly improved postoperative pulmonary function and markedly reduced the postoperative hospital stay duration. No significant differences between groups were observed in the incidence of pulmonary complications or overall postoperative morbidity. Conclusions HPC improves postoperative oxygenation, enhances the recovery of pulmonary function, and reduces the duration of hospital stay in patients undergoing thoracoscopic lobectomy. Trial registration This study was registered in the Chinese Clinical Trial Registry (ChiCTR-IPR-17011249) on April 27, 2017.
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Affiliation(s)
- Wenjing Zhang
- Department of Anesthesiology, Zhoushan Hospital, No.739 Dingshen Street, Zhoushan, Zhejiang, China
| | - Mo Chen
- Department of Anesthesiology, Suzhou Municipal Hospital (North District), Nanjing Medical University Affiliated Suzhou Hospital, No.242 Guangji Road, Suzhou, Jiangsu, China
| | - Hongbin Li
- Department of Anesthesiology, Zhoushan Hospital, No.739 Dingshen Street, Zhoushan, Zhejiang, China
| | - Jia Yuan
- Department of Anesthesiology, Zhoushan Hospital, No.739 Dingshen Street, Zhoushan, Zhejiang, China
| | - Jingjing Li
- Department of Anesthesiology, Zhoushan Hospital, No.739 Dingshen Street, Zhoushan, Zhejiang, China
| | - Feixiang Wu
- Department of Anesthesiology, Shanghai Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No.225 Changhai Road, Shanghai, China.
| | - Yan Zhang
- Department of Anesthesiology, Zhoushan Hospital, No.739 Dingshen Street, Zhoushan, Zhejiang, China.
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Kaufmann KB, Loop T, Heinrich S. Risk factors for post-operative pulmonary complications in lung cancer patients after video-assisted thoracoscopic lung resection: Results of the German Thorax Registry. Acta Anaesthesiol Scand 2019; 63:1009-1018. [PMID: 31144301 DOI: 10.1111/aas.13388] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/28/2019] [Accepted: 04/30/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Post-operative pulmonary complications (PPCs) represent the most frequent complications after lung surgery. The aim of this study was to identify the modifiable risk factors for PPCs after video-assisted thoracoscopic surgery (VATS) in lung cancer patients. METHODS Data of this retrospective study were extracted from the German Thorax Registry, an interdisciplinary and multicenter database of the German Society of Anesthesiology and Intensive care medicine and the German Society of Thoracic Surgery. Univariate and multivariate stepwise logistic regression analysis of patient-specific and procedural risk factors for PPCs were conducted. RESULTS We analyzed 376 patients with lung cancer who underwent VATS bilobectomy (n = 2), lobectomy (n = 258) or segmentectomy (n = 116) in 2016 and 2017. One-hundred fourteen patients (114/376; 30%) developed PPCs. Two patients died within 30 days after surgery. In the univariate analysis, patients of the PPC group showed significantly more often a body mass index (BMI) ≤ 19 kg/m2 ; a pre-operative forced expiratory volume in 1 second (FEV1 ) ≤ 60%; a pre-operative arterial oxygen partial pressure (pa O2 ) ≤ 60 mm Hg; a higher rate of prolonged duration of surgery (≥2 hours [h]) and a higher frequency of intraoperative blood loss ≥500 mL. The multivariate stepwise logistic regression analysis revealed 4 independent risk factors: FEV1 ≤ 60% (1.9[1.1-3.4] OR [95% CI], P = 0.029); pa O2 ≤ 60 mm Hg (4.6[1.7-12.8] OR [95% CI], P = 0.003; duration of surgery ≥2 hours (2.7[1.5-4.7] OR [95% CI], P = 0.001) and intraoperative crystalloids ≥6 mL/kg/h (2.9[1.2-7.5] OR [95% CI], P = 0.023). CONCLUSION Intraoperative amount of crystalloid fluids should be kept below 6 mL/kg/h and duration of surgery should be below 2 hours to avoid an increased risk for PPCs.
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Affiliation(s)
- Kai B. Kaufmann
- Faculty of Medicine, Department of Anesthesiology and Critical Care Medicine Medical Center ‐ University of Freiburg Freiburg Germany
| | - Torsten Loop
- Faculty of Medicine, Department of Anesthesiology and Critical Care Medicine Medical Center ‐ University of Freiburg Freiburg Germany
| | - Sebastian Heinrich
- Faculty of Medicine, Department of Anesthesiology and Critical Care Medicine Medical Center ‐ University of Freiburg Freiburg Germany
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Wise R, Bishop D, Joynt G, Rodseth R. Perioperative ARDS and lung injury: for anaesthesia and beyond. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2018. [DOI: 10.1080/22201181.2018.1449463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Robert Wise
- Perioperative Research Unit, Metropolitan Department of Anaesthetics, Critical Care and Pain Management, Pietermaritzburg, University of KwaZulu-Natal, Discipline of Anaesthesiology and Critical Care, Durban, South Africa
| | - David Bishop
- Perioperative Research Unit, Metropolitan Department of Anaesthetics, Critical Care and Pain Management, Pietermaritzburg, University of KwaZulu-Natal, Discipline of Anaesthesiology and Critical Care, Durban, South Africa
| | - Gavin Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Reitze Rodseth
- Perioperative Research Unit, Metropolitan Department of Anaesthetics, Critical Care and Pain Management, Pietermaritzburg, University of KwaZulu-Natal, Discipline of Anaesthesiology and Critical Care, Durban, South Africa
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA
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Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome After Pneumonectomy. Ann Thorac Surg 2017; 103:881-889. [DOI: 10.1016/j.athoracsur.2016.11.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 10/18/2016] [Accepted: 11/08/2016] [Indexed: 12/22/2022]
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Leuzzi G, Facciolo F, Pastorino U, Rocco G. Methods for the postoperative management of the thoracic oncology patients: lessons from the clinic. Expert Rev Respir Med 2015; 9:751-67. [DOI: 10.1586/17476348.2015.1109453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lung Injury Prediction Score Is Useful in Predicting Acute Respiratory Distress Syndrome and Mortality in Surgical Critical Care Patients. Crit Care Res Pract 2015; 2015:157408. [PMID: 26301105 PMCID: PMC4537732 DOI: 10.1155/2015/157408] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/27/2015] [Accepted: 07/01/2015] [Indexed: 01/06/2023] Open
Abstract
Background. Lung injury prediction score (LIPS) is valuable for early recognition of ventilated patients at high risk for developing acute respiratory distress syndrome (ARDS). This study analyzes the value of LIPS in predicting ARDS and mortality among ventilated surgical patients. Methods. IRB approved, prospective observational study including all ventilated patients admitted to the surgical intensive care unit at a single tertiary center over 6 months. ARDS was defined using the Berlin criteria. LIPS were calculated for all patients and analyzed. Logistic regression models evaluated the ability of LIPS to predict development of ARDS and mortality. A receiver operator characteristic (ROC) curve demonstrated the optimal LIPS value to statistically predict development of ARDS. Results. 268 ventilated patients were observed; 141 developed ARDS and 127 did not. The average LIPS for patients who developed ARDS was 8.8 ± 2.8 versus 5.4 ± 2.8 for those who did not (p < 0.001). An ROC area under the curve of 0.79 demonstrates LIPS is statistically powerful for predicting ARDS development. Furthermore, for every 1-unit increase in LIPS, the odds of developing ARDS increase by 1.50 (p < 0.001) and odds of ICU mortality increase by 1.22 (p < 0.001). Conclusion. LIPS is reliable for predicting development of ARDS and predicting mortality in critically ill surgical patients.
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Extravascular lung water and pulmonary vascular permeability index as markers predictive of postoperative acute respiratory distress syndrome: a prospective cohort investigation. Crit Care Med 2015; 43:665-73. [PMID: 25513786 DOI: 10.1097/ccm.0000000000000765] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Robust markers of subclinical perioperative lung injury are lacking. Extravascular lung water indexed to predicted body weight and pulmonary vascular permeability index are two promising early markers of lung edema. We aimed to evaluate whether extravascular lung water indexed to predicted body weight and pulmonary vascular permeability index would identify patients at risk for clinically significant postoperative pulmonary edema, particularly resulting from the acute respiratory distress syndrome. DESIGN Prospective cohort study. SETTING Tertiary care academic medical center. PATIENTS Adults undergoing high-risk cardiac or aortic vascular surgery (or both) with risk of acute respiratory distress syndrome. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Extravascular lung water indexed to predicted body weight and pulmonary vascular permeability index measurements were obtained intraoperatively and in the early postoperative period. We assessed the accuracy of peak extravascular lung water indexed to predicted body weight and pulmonary vascular permeability index as predictive markers of clinically significant pulmonary edema (defined as acute respiratory distress syndrome or cardiogenic pulmonary edema) using area under the receiver-operating characteristic curves. Associations between extravascular lung water indexed to predicted body weight and pulmonary vascular permeability patient-important with important outcomes were assessed. Of 150 eligible patients, 132 patients (88%) had extravascular lung water indexed to predicted body weight and pulmonary vascular permeability index measurements. Of these, 13 patients (9.8%) had postoperative acute respiratory distress syndrome and 15 patients (11.4%) had cardiogenic pulmonary edema. Extravascular lung water indexed to predicted body weight effectively predicted development of clinically significant pulmonary edema (area under the receiver-operating characteristic curve, 0.79; 95% CI, 0.70-0.89). Pulmonary vascular permeability index discriminated acute respiratory distress syndrome from cardiogenic pulmonary edema alone or no edema (area under the receiver-operating characteristic curve, 0.77; 95% CI, 0.62-0.93). Extravascular lung water indexed to predicted body weight was associated with the worst postoperative PaO2/FIO2, duration of mechanical ventilation, ICU stay, and hospital stay. Peak values for extravascular lung water indexed to predicted body weight and pulmonary vascular permeability index were obtained within 2 hours of the primary intraoperative insult for the majority of patients (> 80%). CONCLUSIONS Perioperative extravascular lung water indexed to predicted body weight is an early marker that predicts risk of clinically significant postoperative pulmonary edema in at-risk surgical patients. Pulmonary vascular permeability index effectively discriminated postoperative acute respiratory distress syndrome from cardiogenic pulmonary edema. These measures will aid in the early detection of subclinical lung injury in at-risk surgical populations.
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Ashes C, Slinger P. Volume Management and Resuscitation in Thoracic Surgery. CURRENT ANESTHESIOLOGY REPORTS 2014. [DOI: 10.1007/s40140-014-0081-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Predicting risk of postoperative lung injury in high-risk surgical patients: a multicenter cohort study. Anesthesiology 2014; 120:1168-81. [PMID: 24755786 DOI: 10.1097/aln.0000000000000216] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) remains a serious postoperative complication. Although ARDS prevention is a priority, the inability to identify patients at risk for ARDS remains a barrier to progress. The authors tested and refined the previously reported surgical lung injury prediction (SLIP) model in a multicenter cohort of at-risk surgical patients. METHODS This is a secondary analysis of a multicenter, prospective cohort investigation evaluating high-risk patients undergoing surgery. Preoperative ARDS risk factors and risk modifiers were evaluated for inclusion in a parsimonious risk-prediction model. Multiple imputation and domain analysis were used to facilitate development of a refined model, designated SLIP-2. Area under the receiver operating characteristic curve and the Hosmer-Lemeshow goodness-of-fit test were used to assess model performance. RESULTS Among 1,562 at-risk patients, ARDS developed in 117 (7.5%). Nine independent predictors of ARDS were identified: sepsis, high-risk aortic vascular surgery, high-risk cardiac surgery, emergency surgery, cirrhosis, admission location other than home, increased respiratory rate (20 to 29 and ≥30 breaths/min), FIO2 greater than 35%, and SpO2 less than 95%. The original SLIP score performed poorly in this heterogeneous cohort with baseline risk factors for ARDS (area under the receiver operating characteristic curve [95% CI], 0.56 [0.50 to 0.62]). In contrast, SLIP-2 score performed well (area under the receiver operating characteristic curve [95% CI], 0.84 [0.81 to 0.88]). Internal validation indicated similar discrimination, with an area under the receiver operating characteristic curve of 0.84. CONCLUSIONS In this multicenter cohort of patients at risk for ARDS, the SLIP-2 score outperformed the original SLIP score. If validated in an independent sample, this tool may help identify surgical patients at high risk for ARDS.
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Kalimeris K. Lung preconditioning in anesthesia: Review of the literature. World J Anesthesiol 2014; 3:105-110. [DOI: 10.5313/wja.v3.i1.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 09/19/2013] [Accepted: 11/03/2013] [Indexed: 02/06/2023] Open
Abstract
Lung injury can arise during or after anesthesia and can lead to a complicated postoperative course with great implications for the patient. Unfortunately, treatment of acute lung injury is at the moment mainly supportive and rates of recovery have not really improved in the recent years. In many cases, lung injury can be anticipated and preventive measures seem possible. This represents a unique challenge to the anesthesiologist, as some new opportunities to reduce the frequency and/or severity of lung injury seem now available. These chances may arise from the potency of preconditioning the lungs before the main injury, with smaller injurious insults. Although preconditioning began to be applicated first on the myocardium, experimental studies have shown potentially beneficial results also for the lungs. This review summarizes the main methods of lung preconditioning that have been tried in experimental studies in the literature and the main mechanisms that are perhaps involved. Emphasis is given in the two main methods of preconditioning that seem readily applicable in the clinical praxis, that is ischemic preconditioning, as well as preconditioning with volatile anesthetics. The few, but interesting clinical studies are also summarized and the future research points in this evolving field of anesthesia are stressed.
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Chau EHL, Slinger P. Perioperative fluid management for pulmonary resection surgery and esophagectomy. Semin Cardiothorac Vasc Anesth 2013; 18:36-44. [PMID: 23719773 DOI: 10.1177/1089253213491014] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Perioperative fluid management is of significant importance during pulmonary resection surgery and esophagectomy. Excessive fluid administration has been consistently shown as a risk factor for lung injury after thoracic procedures. Probable causes of this serious complication include fluid overload, lung lymphatics and pulmonary endothelial damage. Along with new insights regarding the Starling equation and the absence of a third space, current evidence supports a restrictive fluid regimen for patients undergoing pulmonary resection surgery and esophagectomy. Multiple minimally invasive hemodyamic monitoring devices, including pulse pressure/stroke volume variation, esophageal Doppler, and extravascular lung water measurement, were evaluated for optimizing perioperative fluid therapy. Further research regarding the prevention, diagnosis, and treatment of acute lung injury after pulmonary resection and esophagectomy is required.
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Suksompong S, Thamtanavit S, von Bormann B, Thongcharoen P. Thoracic surgery mortality and morbidity in a university hospital. Asian Cardiovasc Thorac Ann 2012; 20:182-7. [DOI: 10.1177/0218492311436017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study was undertaken to determine the mortality and morbidity of lung resection surgery in the 2,415-bed Siriraj University Hospital, Thailand, and compare them to rates in similar facilities (benchmarking). Demographic and clinical data as well as perioperative outcome variables of patients who underwent elective thoracic surgery from January 2006 to May 2010 were reviewed retrospectively. There were 558 cases of lung resection. Mortality was 0.9% and perioperative morbidity was 8.2%. Univariate analysis identified age >75 years, history of pulmonary disease, preoperative rehabilitation consultation, and operative time >2 h as predictors of mortality and morbidity. With less statistical power, hypertension, cancer, peripheral vascular disease, and thoracotomy also contributed to perioperative outcome. Comparisons with data from the current literature place our results in the range of good quality. Following benchmarking criteria, perioperative outcomes after lung resection surgery in our hospital are good. To further improve quality, we will pay special attention to patients with advanced age and history of pulmonary disease.
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Affiliation(s)
- Sirilak Suksompong
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sarawut Thamtanavit
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Benno von Bormann
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Punnaruk Thongcharoen
- Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Abstract
BACKGROUND Acute lung injury (ALI) is a serious postoperative complication with limited treatment options. A preoperative risk-prediction model would assist clinicians and scientists interested in ALI. The objective of this investigation was to develop a surgical lung injury prediction (SLIP) model to predict risk of postoperative ALI based on readily available preoperative risk factors. METHODS Secondary analysis of a prospective cohort investigation including adult patients undergoing high-risk surgery. Preoperative risk factors for postoperative ALI were identified and evaluated for inclusion in the SLIP model. Multivariate logistic regression was used to develop the model. Model performance was assessed with the area under the receiver operating characteristic curve and the Hosmer-Lemeshow goodness-of-fit test. RESULTS Out of 4,366 patients, 113 (2.6%) developed early postoperative ALI. Predictors of postoperative ALI in multivariate analysis that were maintained in the final SLIP model included high-risk cardiac, vascular, or thoracic surgery, diabetes mellitus, chronic obstructive pulmonary disease, gastroesophageal reflux disease, and alcohol abuse. The SLIP score distinguished patients who developed early postoperative ALI from those who did not with an area under the receiver operating characteristic curve (95% CI) of 0.82 (0.78-0.86). The model was well calibrated (Hosmer-Lemeshow, P = 0.55). Internal validation using 10-fold cross-validation noted minimal loss of diagnostic accuracy with a mean ± SD area under the receiver operating characteristic curve of 0.79 ± 0.08. CONCLUSIONS Using readily available preoperative risk factors, we developed the SLIP scoring system to predict risk of early postoperative ALI.
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Senturk E, Senturk Z, Sen S, Ture M, Avkan N. Mortality and associated factors in a thoracic surgery ICU. J Bras Pneumol 2011; 37:367-74. [PMID: 21755193 DOI: 10.1590/s1806-37132011000300014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Accepted: 05/09/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess mortality and identify mortality risk factors in patients admitted to a thoracic surgery ICU. METHODS We retrospectively evaluated 141 patients admitted to the thoracic surgery ICU of the Denizli State Hospital, located in the city of Denizli, Turkey, between January of 2006 and August of 2008. We collected data regarding gender, age, reason for admission, invasive interventions and operations, invasive mechanical ventilation, infections, and length of ICU stay. RESULTS Of the 141 patients, 103 (73.0%) were male, and 38 (23.0%) were female. The mean age was 52.1 years (range, 12-92 years), and the mortality rate was 16.3%. The most common reason for admission was trauma. Mortality was found to correlate with advanced age (p < 0.05), requiring invasive mechanical ventilation (OR = 42.375; p < 0.05), prolonged ICU stay (p < 0.05), and specific reasons for admission-trauma, gunshot wound, stab wound, and malignancy (p < 0.05 for all). CONCLUSIONS Among patients in a thoracic surgery ICU, the rates of morbidity and mortality are high. Increased awareness of mortality risk factors can improve the effectiveness of treatment, which should reduce the rates of morbidity and mortality, thereby providing time savings and minimizing costs.
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Chiumello D, Chevallard G, Gregoretti C. Non-invasive ventilation in postoperative patients: a systematic review. Intensive Care Med 2011; 37:918-29. [PMID: 21424246 DOI: 10.1007/s00134-011-2210-8] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 01/20/2011] [Indexed: 01/01/2023]
Abstract
BACKGROUND Postoperative pulmonary complications, generally defined as any pulmonary abnormality occurring in the postoperative period, are still a significant issue in clinical practice increasing hospital length of stay, morbidity and mortality. Non-invasive ventilation (NIV), primarily applied in cardiogenic pulmonary edema, decompensated COPD and hypoxemic pulmonary failure, is nowadays also used in perioperative settings. OBJECTIVE Investigate the application and results of preventive and therapeutic NIV in postsurgical patients. DESIGN A systematic review. DATA SOURCES Medical literature databases were searched for articles about "clinical trials," "randomized controlled trials" and "meta-analyses." The keywords "cardiac surgery," "thoracic surgery," "lung surgery," "abdominal surgery," "solid organ transplantation," "thoraco-abdominal surgery" and "bariatric surgery" were combined with any of these: "non-invasive positive pressure ventilation," "continuous positive airway pressure," "bilevel ventilation," "postoperative complications," "postoperative care," "respiratory care," "acute respiratory failure," "acute lung injury" and "acute respiratory distress syndrome." RESULTS Twenty-nine articles (N=2,279 patients) met the inclusion criteria. Nine studies evaluated NIV in post-abdominal surgery, three in thoracic surgery, eight in cardiac surgery, three in thoraco-abdominal surgery, four in bariatric surgery and two in post solid organ transplantation used both for prophylactic and therapeutic purposes. NIV improved arterial blood gases in 15 of the 22 prophylactic and in 4 of the 7 therapeutic studies, respectively. NIV reduced the intubation rate in 11 of the 29 studies and improved outcome in only 1. CONCLUSIONS Despite these limited data and the necessity of new randomized trials, NIV could be considered as a prophylactic and therapeutic tool to improve gas exchange in postoperative patients.
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Affiliation(s)
- D Chiumello
- U.O. Anestesia e Rianimazione, Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122 Milan, Italy.
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