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Barbagallo M, Schiappa E. Noninvasive Positive Pressure Ventilation in Patients Undergoing Lung Resection Surgery. NONINVASIVE MECHANICAL VENTILATION 2023:645-654. [DOI: 10.1007/978-3-031-28963-7_62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Laurent H, Gravier F. Préparation à une chirurgie thoraco-abdominale : Quelle place pour le masseur-kinésithérapeute ? Rev Mal Respir 2022; 39:376-385. [DOI: 10.1016/j.rmr.2022.02.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 01/04/2022] [Indexed: 11/17/2022]
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Granell-Gil M, Murcia-Anaya M, Sevilla S, Martínez-Plumed R, Biosca-Pérez E, Cózar-Bernal F, Garutti I, Gallart L, Ubierna-Ferreras B, Sukia-Zilbeti I, Gálvez-Muñoz C, Delgado-Roel M, Mínguez L, Bermejo S, Valencia O, Real M, Unzueta C, Ferrando C, Sánchez F, González S, Ruiz-Villén C, Lluch A, Hernández A, Hernández-Beslmeisl J, Vives M, Vicente R. Clinical guide to perioperative management for videothoracoscopy lung resection (Section of Cardiac, Vascular and Thoracic Anesthesia, SEDAR; Spanish Society of Thoracic Surgery, SECT; Spanish Society of Physiotherapy). REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 69:S0034-9356(21)00129-8. [PMID: 34330548 DOI: 10.1016/j.redar.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/09/2021] [Accepted: 03/19/2021] [Indexed: 10/20/2022]
Abstract
The introduction of video-assisted thoracoscopic (VATS) techniques has led to a new approach in thoracic surgery. VATS is performed by inserting a thoracoscope through a small incisions in the chest wall, thus maximizing the preservation of muscle and tissue. Because of its low rate of morbidity and mortality, VATS is currently the technique of choice in most thoracic procedures. Lung resection by VATS reduces prolonged air leaks, arrhythmia, pneumonia, postoperative pain and inflammatory markers. This reduction in postoperative complications shortens hospital length of stay, and is particularly beneficial in high-risk patients with low tolerance to thoracotomy. Compared with conventional thoracotomy, the oncological results of VATS surgery are similar or even superior to those of open surgery. This aim of this multidisciplinary position statement produced by the thoracic surgery working group of the Spanish Society of Anesthesiology and Reanimation (SEDAR), the Spanish Society of Thoracic Surgery (SECT), and the Spanish Association of Physiotherapy (AEF) is to standardize and disseminate a series of perioperative anaesthesia management guidelines for patients undergoing VATS lung resection surgery. Each recommendation is based on an in-depth review of the available literature by the authors. In this document, the care of patients undergoing VATS surgery is organized in sections, starting with the surgical approach, and followed by the three pillars of anaesthesia management: preoperative, intraoperative, and postoperative anaesthesia.
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Affiliation(s)
- M Granell-Gil
- Sección en Anestesiología, Reanimación y T. Dolor, Consorcio Hospital General Universitario de Valencia, Profesor Contratado Doctor en Anestesiología, Universitat de València, Valencia, España
| | - M Murcia-Anaya
- Anestesiología, Reanimación y T. Dolor, Unidad de Cuidados Intensivos, Hospital IMED Valencia, Valencia, España.
| | - S Sevilla
- Sociedad de Cirugía Torácica, Complejo Hospitalario Universitario de Jaén, Jaén, España
| | - R Martínez-Plumed
- Anestesiología, Reanimación y T. Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - E Biosca-Pérez
- Anestesiología, Reanimación y T. Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - F Cózar-Bernal
- Cirugía Torácica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - I Garutti
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario Gregorio Marañón, Madrid, España
| | - L Gallart
- Anestesiología, Reanimación y T. Dolor, Hospital del Mar de Barcelona, Universitat Autònoma de Barcelona, Barcelona, España
| | | | - I Sukia-Zilbeti
- Fisioterapia, Hospital Universitario Donostia, San Sebastián, España
| | - C Gálvez-Muñoz
- Cirugía Torácica, Hospital General Universitario de Alicante, Alicante, España
| | - M Delgado-Roel
- Cirugía Torácica, Complejo Hospitalario Universitario La Coruña, La Coruña, España
| | - L Mínguez
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario La Fe de Valencia, Valencia, España
| | - S Bermejo
- Anestesiología, Reanimación y T. Dolor, Hospital del Mar de Barcelona, Universitat Autònoma de Barcelona, Barcelona, España
| | - O Valencia
- Anestesiología, Reanimación y T. Dolor. Hospital Universitario Doce de Octubre de Madrid, Madrid, España
| | - M Real
- Anestesiología, Reanimación y T. Dolor. Hospital Universitario Doce de Octubre de Madrid, Madrid, España
| | - C Unzueta
- Anestesiología, Reanimación y T. Dolor. Hospital Sant Pau de Barcelona, Barcelona, España
| | - C Ferrando
- Anestesiología, Reanimación y T. Dolor. Hospital Clínic Universitari de Barcelona, Barcelona, España
| | - F Sánchez
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario de la Ribera de Alzira, Valencia, España
| | - S González
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario Donostia de San Sebastián, España
| | - C Ruiz-Villén
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario Reina Sofía de Córdoba, Córdoba, España
| | - A Lluch
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario La Fe de Valencia, Valencia, España
| | - A Hernández
- Anestesiología, Reanimación y T. Dolor, Grupo Policlínica de Ibiza, Ibiza, España
| | - J Hernández-Beslmeisl
- Anestesiología, Reanimación y T. Dolor, Complejo Hospitalario Universitario de Canarias, Canarias, España
| | - M Vives
- Anestesiología, Reanimación y T. Dolor, Hospital Universitari Dr. Josep Trueta de Girona, Girona, España
| | - R Vicente
- Sección de Anestesia Cardiaca, Vascular y Torácica, SEDAR, Anestesiología, Reanimación y T. Dolor. Hospital Universitario La Fe de Valencia, Universitat de València, Valencia, España
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Non-Invasive Ventilation in a Non-Standard Setting – Is it Safe to Ventilate Outside the ICU? ACTA MEDICA BULGARICA 2020. [DOI: 10.2478/amb-2020-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Non-invasive ventilation (NIV) is considered a fundamental method in treating patients with various disorders, requiring respiratory support. Often the lack of beds in the intensive care unit (ICU) and the concomitant medical conditions, which refer patients as unsuitable for aggressive treatment in the ICU, highlight the need of NIV application in general non-monitored wards and unusual settings – most commonly emergency departments, high-dependency units, pulmonary wards, and even ambulances. Recent studies suggest faster improvement of all physiological variables, reduced intubation rates, postoperative pulmonary complications and hospital mortality with better outcome and quality of life by early well-monitored ward-based NIV compared to standard medical therapy in patients with exacerbation of a chronic obstructive pulmonary disease, after a surgical procedure or acute hypoxemic respiratory failure in hematologic malignancies. NIV is a ceiling of treatment and a comfort measure in many patients with do-not-intubate orders due to terminal illnesses. NIV is beneficial only by proper administration with appropriate monitoring and screening for early NIV failure. Successful NIV application in a ward requires a well-equipped area and adequately trained multidisciplinary team. It could be initiated not only by attending physicians, respiratory technicians, and nurses but also by medical emergency teams. Ward-based NIV is supposed to be more cost-effective than NIV in the ICU, but further investigation is required to establish the safety and efficacy in hospital wards with a low nurse to patient ratio.
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Santos EDCD, Silva JDSD, Assis Filho MTTD, Vidal MB, Lunardi AC. Use of lung expansion techniques on drained and non-drained pleural effusion: survey with 232 physiotherapists. FISIOTERAPIA EM MOVIMENTO 2020. [DOI: 10.1590/1980-5918.33.ao05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Techniques for lung expansion seem to benefit patients with drained and undrained pleural effusion, but there is a lack of evidence to indicate which technique is best in each situation. Currently, the therapeutic choices of respiratory physiotherapists serving this population are not known. Objective: To know which lung expansion techniques are chosen by chest physiotherapists who assist patients with drained and non-drained pleural effusion. Method: Through the announcement of the Federal Council, 232 physiotherapists who work in hospitals in Brazil were questioned about which techniques they apply to patients with drained and non-drained effusion. Results: Initially, 512 were questioned but 232 (45.3%) answered. The physiotherapists associate more than one technique of lung expansion in both types of patients, besides walking. Deep breathing is the most used technique in patients with drained (92%) and non-drained (77%) pleural effusion. Positive pressure exercises in the airways are chosen by 60% of the physiotherapists to treat patients with drained pleural effusion and by 34% to treat patients with non-drained pleural effusion. Yet the incentive spirometry are used with 66% of patients with drained pleural effusion and 42% with non-drained ones. Conclusion: Deep breathing is the most applied lung expansion technique in the treatment of patients with drained and non-drained pleural effusion by chest physiotherapists. In addition, there is association between greatest degree and time of professional performance and the chosen techniques.
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Dos Santos EDC, da Silva JDS, de Assis Filho MTT, Vidal MB, Monte MDC, Lunardi AC. Adding positive airway pressure to mobilisation and respiratory techniques hastens pleural drainage: a randomised trial. J Physiother 2020; 66:19-26. [PMID: 31843426 DOI: 10.1016/j.jphys.2019.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 10/30/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022] Open
Abstract
QUESTIONS In patients with a collection of fluid in the pleural space, do mobilisation and respiratory techniques: shorten the drainage period and length of hospital stay; improve respiratory function and oxygenation; and prevent pulmonary complications? Does the addition of positive airway pressure to this regimen further improve the effects? DESIGN Randomised controlled trial with three intervention arms, concealed allocation, intention-to-treat analysis and blinded assessment. PARTICIPANTS One hundred and fifty-six inpatients with a fluid collection in the pleural space and with chest drainage in situ. INTERVENTION Participants received usual care and were randomly assigned to: a control group that also received sham positive airway pressure (4 cmH2O) only (Con); an experimental group that received incentive spirometry, airway clearance, mobilisation and the same sham positive pressure (Exp1); or an experimental group that received the Exp1 regimen except that the positive airway pressure was 15 cmH2O (Exp2). Treatments were provided three times per day for 7 days. OUTCOME MEASURES Days of chest tube drainage, length of hospital stay, pulmonary complications and adverse events were recorded until hospital discharge. Costs in each group were estimated. RESULTS The Exp2 group had shorter duration of chest tube drainage and length of hospital stay compared with the Exp1 and Con groups. In addition, the Exp2 group had less antibiotic use (18% versus 43% versus 55%) and pneumonia incidence (0% versus 16% versus 20%) compared with the Exp1 and Con groups (all p < 0.01). The groups had similar rates of adverse events (10% versus 2% versus 6%, p > 0.05). Total treatment costs were lower in the Exp2 group than in the Exp1 and Con groups. CONCLUSIONS In patients with a fluid collection in the pleural space, the addition of positive pressure to mobilisation and respiratory techniques decreased the duration of thoracic drainage, length of hospital stay, pulmonary complications, antibiotic use and treatment costs. REGISTRATION ClinicalTrials.govNCT02246946.
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Affiliation(s)
- Elinaldo da Conceição Dos Santos
- Master and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, Brazil; Department of Biological and Health Sciences, Universidade Federal do Amapá, Brazil
| | | | | | - Marcela Brito Vidal
- Department of Biological and Health Sciences, Universidade Federal do Amapá, Brazil
| | | | - Adriana Cláudia Lunardi
- Master and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, Brazil; Department of Physical Therapy, School of Medicine, Universidade de São Paulo, São Paulo, Brazil.
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Torres MFS, Porfírio GJM, Carvalho APV, Riera R. Non-invasive positive pressure ventilation for prevention of complications after pulmonary resection in lung cancer patients. Cochrane Database Syst Rev 2019; 3:CD010355. [PMID: 30840317 PMCID: PMC6402531 DOI: 10.1002/14651858.cd010355.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Pulmonary complications are often seen during the postoperative period following lung resection for patients with lung cancer. Some situations such as intubation, a long stay in the intensive care unit, the high cost of antibiotics and mortality may be avoided with the prevention of postoperative pulmonary complications. Non-invasive positive pressure ventilation (NIPPV) is widely used in hospitals, and is thought to reduce the number of pulmonary complications and mortality after this type of surgery. Therefore, a systematic review is needed to critically assess the benefits and harms of NIPPV for patients undergoing lung resection. This is an update of a Cochrane review first published in 2015. OBJECTIVES To assess the effectiveness and safety of NIPPV for preventing complications in patients following pulmonary resection for lung cancer. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS and PEDro until 21 December 2018, to identify potentially eligible trials. We did not use any date or language restrictions in the electronic searches. We searched the reference lists of relevant papers and contacted experts in the field for information about additional published and unpublished studies. We also searched the Register of Controlled Trials (www.controlled-trials.com) and ClinicalTrials.gov (clinicaltrials.gov) to identify ongoing studies. SELECTION CRITERIA We considered randomised or quasi-randomised clinical trials that compared NIPPV in the immediate postoperative period after pulmonary resection with no intervention or conventional respiratory therapy. DATA COLLECTION AND ANALYSIS Two authors collected data and assessed trial risk of bias. Where possible, we pooled data from the individual studies using a fixed-effect model (quantitative synthesis), but where this was not possible we tabulated or presented the data in the main text (qualitative synthesis). Where substantial heterogeneity existed, we applied a random-effects model. MAIN RESULTS Of the 190 references retrieved from the searches, 7 randomised clinical trials (RCTs) (1 identified with the new search) and 1 quasi-randomised trial fulfilled the eligibility criteria for this review, including a total of 486 patients. Five studies described quantitative measures of pulmonary complications, with pooled data showing no difference between NIPPV compared with no intervention (RR 1.03; 95% CI 0.72 to 1.47). Three studies reported intubation rates and there was no significant difference between the intervention and control groups (RR 0.55; 95% CI 0.25 to 1.20). Five studies reported measures of mortality on completion of the intervention period. There was no statistical difference between the groups for this outcome (RR 0.60; 95% CI 0.24 to 1.53). Similar results were observed in the subgroup analysis considering ventilatory mode (bi-level versus continuous positive airway pressure (CPAP). No study evaluated the postoperative use of antibiotics. Two studies reported the length of intensive care unit stay and there was no significant difference between the intervention and control groups (MD -0.75; 95% CI -3.93 to 2.43). Four studies reported the length of hospital stay and there was no significant difference between the intervention and control groups (MD -0.12; 95% CI -6.15 to 5.90). None of the studies described any complications related to NIPPV. Of the seven included studies, four studies were considered as 'low risk of bias' in all domains, two studies were considered 'high risk of bias' for the allocation concealment domain, and one of these was also considered 'high risk of bias' for random sequence generation. One other study was considered 'high risk of bias' for including participants with more severe disease. The new study identified could not be included in the meta-analysis as its intervention differed from the other studies (use of pre and postoperative NIPPV in the same population). AUTHORS' CONCLUSIONS This review demonstrated that there was no additional benefit of using NIPPV in the postoperative period after pulmonary resection for all outcomes analysed (pulmonary complications, rate of intubation, mortality, postoperative consumption of antibiotics, length of intensive care unit stay, length of hospital stay and adverse effects related to NIPPV). However, the quality of evidence is 'very low', 'low' and 'moderate' since there were few studies, with small sample size and low frequency of outcomes. New well-designed and well-conducted randomised trials are needed to answer the questions of this review with greater certainty.
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Affiliation(s)
- Maria FS Torres
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeBrazilian Cochrane CentreRua Borges Lagoa, 564 cj 63São PauloSPBrazil04038‐000
| | - Gustavo JM Porfírio
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilRua Borges Lagoa, 564 cj 63São PauloSPBrazil04038‐000
| | - Alan PV Carvalho
- Universidade Federal de São PauloUrgency MedicineRua Pedro de Toledo, 598São PauloSão PauloBrazil04039‐001
| | - Rachel Riera
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilRua Borges Lagoa, 564 cj 63São PauloSPBrazil04038‐000
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Rotolo N, Cattoni M, D'Andria M, Cavanna L, Patrizio G, Imperatori A, Nicolini A. Comparison of an expiratory flow accelerator device versus positive expiratory pressure for tracheobronchial airway clearance after lung cancer lobectomy: a preliminary study. Physiotherapy 2019; 110:34-41. [PMID: 33563372 DOI: 10.1016/j.physio.2019.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 01/06/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE A new type of device has recently been introduced in chest physiotherapy as an aid to tracheo-bronchial airway clearance: expiratory flow accelerator (EFA). It promotes mucus clearance without generating any pressure gradient, allowing patients to breathe at tidal volume against no resistance. DESIGN Pilot randomized controlled study. SETTING Tertiary hospital. PARTICIPANTS Fifty adult patients who underwent lung cancer lobectomy were randomized to undergo chest physiotherapy with EFA (n=26) or PEP (n=24). INTERVENTIONS EFA; PEP bottle. MAIN OUTCOMES Incidence of postoperative pulmonary complications (PPC) and length of stay. SECONDARY OUTCOMES trends in inspiratory capacity, respiratory rate, oxygen saturation, and dyspnoea. Patients rated user-friendliness of the two devices on a 5-point Likert scale. RESULTS A slightly different incidence of PPCs was observed between the EFA and PEP group. Nevertheless, the length of stay was similar in the two groups. No substantial differences were seen in trends of inspiratory capacity, respiratory rate, oxygen saturation, dyspnoea between the two groups. Patient-reported user-friendliness of the two devices did not differ significantly, although the use of the EFA device appeared less strenuous. CONCLUSIONS Results of this pilot study point to the use of EFA as an alternative treatment option rather than as a replacement for the PEP bottle in chest physiotherapy following lung cancer lobectomy. EFA may be preferable for weaker patients and/or with airway leakages in whom PEP has limited indications. Further investigation in a larger sample is required to statistically confirm the findings. Clinical Trial Registration Number ChiCTR-ONC-17013255.
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Affiliation(s)
- Nicola Rotolo
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Maria Cattoni
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Michele D'Andria
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Laura Cavanna
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Giorgia Patrizio
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
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Larsen KS, Skoffer B, Gregersen Oestergaard L, Van Tulder M, Petersen AK. The effects of various respiratory physiotherapies after lung resection: a systematic review. Physiother Theory Pract 2019; 36:1201-1219. [DOI: 10.1080/09593985.2018.1564095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Karoline Stentoft Larsen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital (AUH), Aarhus N., Denmark
- Centre of Research in Rehabilitation (CORIR), Institute of Clinical Medicine, Aarhus University and AUH, Aarhus N., Denmark
| | - Birgit Skoffer
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital (AUH), Aarhus N., Denmark
- Centre of Research in Rehabilitation (CORIR), Institute of Clinical Medicine, Aarhus University and AUH, Aarhus N., Denmark
| | - Lisa Gregersen Oestergaard
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital (AUH), Aarhus N., Denmark
- Centre of Research in Rehabilitation (CORIR), Institute of Clinical Medicine, Aarhus University and AUH, Aarhus N., Denmark
- Department of Public Health, Aarhus University, Aarhus N., Denmark
| | - Maurits Van Tulder
- Department of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Annemette Krintel Petersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital (AUH), Aarhus N., Denmark
- Centre of Research in Rehabilitation (CORIR), Institute of Clinical Medicine, Aarhus University and AUH, Aarhus N., Denmark
- Institute of Clinical Medicine, Aarhus University, Aarhus N., Denmark
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External validation in an intermediate unit of a respiratory decompensation model trained in an intensive care unit. Surgery 2016; 161:760-770. [PMID: 27894709 DOI: 10.1016/j.surg.2016.09.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/12/2016] [Accepted: 09/14/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Preventing urgent intubation and upgrade in level of care in patients with subclinical deterioration could be of great utility in hospitalized patients. Early detection should result in decreased mortality, duration of stay, and/or resource use. The goal of this study was to externally validate a previously developed, vital sign-based, intensive care unit, respiratory instability model on a separate population, intermediate care patients. METHODS From May 2014 to May 2016, the model calculated relative risk of adverse events every 15 minutes (n = 373,271 observations) for 2,050 patients in a surgical intermediate care unit. RESULTS We identified 167 upgrades and 57 intubations. The performance of the model for predicting upgrades within 12 hours was highly significant with an area under the curve of 0.693 (95% confidence interval, 0.658-0.724). The model was well calibrated with relative risks in the highest and lowest deciles of 2.99 and 0.45, respectively (a 6.6-fold increase). The model was effective at predicting intubation, with a demonstrated area under the curve within 12 hours of the event of 0.748 (95% confidence interval, 0.685-0.800). The highest and lowest deciles of observed relative risk were 3.91 and 0.39, respectively (a 10.1-fold increase). Univariate analysis of vital signs showed that transfer upgrades were associated, in order of importance, with rising respiration rate, rising heart rate, and falling pulse-oxygen saturation level. CONCLUSION The respiratory instability model developed previously is valid in intermediate care patients to predict both urgent intubations and requirements for upgrade in level of care to an intensive care unit.
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Gilliland S, Brainard J. Postoperative Noninvasive Ventilation Following Cardiothoracic Surgery. Semin Cardiothorac Vasc Anesth 2015; 19:302-8. [DOI: 10.1177/1089253215572699] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Postoperative pulmonary complications following cardiac and thoracic surgery are common and associated with significant morbidity and mortality. Noninvasive ventilation has emerged as a successful and well-validated strategy to treat various acute medical conditions. More recently, noninvasive ventilation has been studied in selective surgical patient populations with the goal of preventing postoperative complications and treating acute respiratory failure. In this clinical review, we will briefly examine the incidence of pulmonary complications following cardiothoracic surgery and the physiology and mechanics of acute respiratory failure and noninvasive ventilation. We then present a systematic review of the indications, patient selection, and current literature investigating the specific use of noninvasive ventilation in this population.
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Torres MFS, Porfirio GJM, Carvalho APV, Riera R. Non-invasive positive pressure ventilation for prevention of complications after pulmonary resection in lung cancer patients. Cochrane Database Syst Rev 2015:CD010355. [PMID: 26407182 DOI: 10.1002/14651858.cd010355.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Pulmonary complications are often observed during the postoperative period of lung resection for patients with lung cancer. Some conditions such as intubation, a long stay in the intensive care unit, the high cost of antibiotics and mortality may be avoided with the prevention of postoperative pulmonary complications. Non-invasive positive pressure ventilation (NIPPV) is widely accepted and often used in hospitals, and may reduce the number of pulmonary complications and mortality after this type of surgery. Therefore, a systematic review is required to map and critically assess the benefits and harms of NIPPV for patients undergoing lung resection. OBJECTIVES To assess the efficacy and safety of NIPPV for preventing complications in patients who underwent pulmonary resection for lung cancer. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS and PEDro, to identify potentially eligible trials. We did not use any date or language restrictions in the electronic searches. The databases were last searched on 17 March 2015. We searched the reference lists of relevant papers and contacted experts in the field for information about additional published and unpublished studies. We also searched the Register of Controlled Trials (www.controlled-trials.com) and ClinicalTrials.gov (clinicaltrials.gov) to identify ongoing studies. SELECTION CRITERIA We considered randomised or quasi-randomised clinical trials that compared NIPPV in the immediate postoperative period after pulmonary resection with no intervention or conventional respiratory therapy. DATA COLLECTION AND ANALYSIS Two authors collected data and assessed trial risk of bias. Where possible, we pooled data from the individual studies using a fixed-effect model (quantitative synthesis), but where this was not possible we tabulated or presented the data in the main text (qualitative synthesis). Where substantial heterogeneity existed, we applied a random-effects model. MAIN RESULTS Of the 155 references retrieved from searches, 6 randomised clinical trials (RCTs) and 1 quasi-randomised trial fulfilled the eligibility criteria for this review, including a total of 436 patients. Five studies described quantitative measures of pulmonary complications, with pooled data showing no difference between NIPPV compared with no intervention (RR 1.03; 95% CI 0.72 to 1.47). Three studies reported intubation rates and there was no significant difference between the intervention and control groups (RR 0.55; 95% CI 0.25 to 1.20). Five studies reported measures of mortality on completion of the intervention period. There was no statistical difference between the groups for this outcome (RR 0.60; 95% CI 0.24 to 1.53). Similar results were observed in the subgroup analysis considering ventilatory mode (bi-level versus continuous positive airway pressure (CPAP). No study evaluated the postoperative consumption of antibiotics. Two studies reported the length of intensive care unit stay and there was no significant difference between the intervention and control groups (MD -0.75; 95% CI -3.93 to 2.43). Four studies reported the length of hospital stay and there was no significant difference between the intervention and control groups (MD -0.12; 95% CI -6.15 to 5.90). None of the studies described any complications related to NIPPV. Of the seven included studies, four studies were considered as 'low risk of bias' in all domains, two studies were considered 'high risk of bias' for the allocation concealment domain, and one of these was also considered 'high risk of bias' for random sequence generation. One other study was considered 'high risk of bias' for including participants with more severe disease. AUTHORS' CONCLUSIONS This review demonstrated that there was no additional benefit of using NIPPV in postoperative pulmonary resection for all outcomes analysed (pulmonary complications, rate of intubation, mortality, rate of non-pulmonary complications, postoperative consumption of antibiotics, length of intensive care unit stay, length of hospital stay and adverse effects related to NIPPV). However, the quality of evidence is 'very low', 'low' and 'moderate' since there were few studies, with small sample size and low frequency of outcomes. New well-designed and well-conducted randomised trials are needed to answer the questions of this review with greater certainty.
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Affiliation(s)
- Maria F S Torres
- Brazilian Cochrane Centre, Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde, Rua Borges Lagoa, 564 cj 63, São Paulo, SP, Brazil, 04038-000
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Dos Santos EDC, Lunardi AC. The effect of non-invasive positive airway pressure therapy following thoracic surgical procedures: protocol for a systematic review. Syst Rev 2015; 4:83. [PMID: 26066487 PMCID: PMC4465161 DOI: 10.1186/s13643-015-0073-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 06/03/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Thoracic surgical procedures impair respiratory function, decreasing ventilation and oxygenation and increasing the risk of acute respiratory failure and pulmonary complications. To prevent these clinical repercussions, positive airway pressure therapy is widely used to increase pulmonary ventilation, decrease muscle overload, and ensure adequate oxygenation; however, the benefit of this therapy remains unclear. METHODS/DESIGN A systematic search of the literature including PubMed, CINAHL, AMED, PsycINFO, LILACS, Scielo, Scopus, PEDro, and the Cochrane Library will identify the randomized and quasi-randomized trials that used CPAP, Bilevel, or IPPB compared with a control without intervention, a sham treatment or other lung expansion techniques following thoracic surgical procedures. From these trials, we will extract data on a predefined list of outcomes, including oxygenation, ventilation, respiratory failure, pulmonary complications, and time of resolution of the clinical condition. The methodological quality of each trial included will be assessed using the PEDro scale. The strength of the recommendations will be summarized using the GRADE scale. Meta-analyses will be performed, if appropriate. DISCUSSION This review aims to promote greater knowledge regarding the efficiency of the use of non-invasive positive airway pressure on recovery of respiratory function and on prevention of pulmonary complications following thoracic surgical procedures. This review could help health professionals improve the care for patients undergoing thoracic surgical procedures. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015019004.
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Affiliation(s)
- Elinaldo da Conceição Dos Santos
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Cesário Galeno Street, 448/475, Sao Paulo, 03071-000, Brazil.
- Department of Biological and Health Sciences, Universidade Federal do Amapá, Macapá, Brazil.
| | - Adriana Claudia Lunardi
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Cesário Galeno Street, 448/475, Sao Paulo, 03071-000, Brazil.
- Department of Physical Therapy, School of Medicine, Universidade de São Paulo, São Paulo, Brazil.
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Garutti I, Puente-Maestu L. Reply from the authors. Br J Anaesth 2015; 114:524-5. [PMID: 25694560 DOI: 10.1093/bja/aev010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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La ventilation non invasive en chirurgie pulmonaire. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1021-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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