1
|
Mazzinari G, Albers-Warlé KI, Rovira L, Warlé MC, Diaz Cambronero O, Navarro MPA. The why and how of the minimally invasive pneumoperitoneum in present-day laparoscopic surgery. Am J Surg 2024; 232:149-151. [PMID: 38302368 DOI: 10.1016/j.amjsurg.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/23/2023] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Affiliation(s)
- Guido Mazzinari
- Perioperative Medicine Research Group, Hospital Universitario y Politécnico la Fe, Valencia, Spain; Department of Anesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain; Department of Statistics and Operational Research, University of Valencia, Valencia, Spain.
| | - Kim I Albers-Warlé
- Department of Anesthesiology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands.
| | - Lucas Rovira
- Department of Anesthesiology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Michiel C Warlé
- Departments of Surgery, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands.
| | - Oscar Diaz Cambronero
- Perioperative Medicine Research Group, Hospital Universitario y Politécnico la Fe, Valencia, Spain; Department of Anesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - Maria Pilar Argente Navarro
- Perioperative Medicine Research Group, Hospital Universitario y Politécnico la Fe, Valencia, Spain; Department of Anesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| |
Collapse
|
2
|
Mazzinari G, Rovira L, Albers-Warlé KI, Warlé MC, Argente-Navarro P, Flor B, Diaz-Cambronero O. Underneath Images and Robots, Looking Deeper into the Pneumoperitoneum: A Narrative Review. J Clin Med 2024; 13:1080. [PMID: 38398395 PMCID: PMC10889570 DOI: 10.3390/jcm13041080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/05/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
Laparoscopy offers numerous advantages over open procedures, minimizing trauma, reducing pain, accelerating recovery, and shortening hospital stays. Despite other technical advancements, pneumoperitoneum insufflation has received little attention, barely evolving since its inception. We explore the impact of pneumoperitoneum on patient outcomes and advocate for a minimally invasive approach that prioritizes peritoneal homeostasis. The nonlinear relationship between intra-abdominal pressure (IAP) and intra-abdominal volume (IAV) is discussed, emphasizing IAP titration to balance physiological effects and surgical workspace. Maintaining IAP below 10 mmHg is generally recommended, but factors such as patient positioning and surgical complexity must be considered. The depth of neuromuscular blockade (NMB) is explored as another variable affecting laparoscopic conditions. While deep NMB appears favorable for surgical stillness, achieving a balance between IAP and NMB depth is crucial. Temperature and humidity management during pneumoperitoneum are crucial for patient safety and optical field quality. Despite the debate over the significance of temperature drop, humidification and the warming of insufflated gas offer benefits in peritoneal homeostasis and visual clarity. In conclusion, there is potential for a paradigm shift in pneumoperitoneum management, with dynamic IAP adjustments and careful control of insufflated gas temperature and humidity to preserve peritoneal homeostasis and improve patient outcomes in minimally invasive surgery.
Collapse
Affiliation(s)
- Guido Mazzinari
- Perioperative Medicine Research Group, Health Research Institute la Fe, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain; (P.A.-N.); (O.D.-C.)
- Department of Anesthesiology, La Fe University Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain
- Department of Statistics and Operational Research, University of Valencia, Calle Doctor Moliner 50, 46100 Burjassot, Spain
| | - Lucas Rovira
- Department of Anesthesiology, Consorcio Hospital General Universitario de Valencia, Av. de les Tres Creus, 2, L’Olivereta, 46014 València, Spain; (L.R.); (B.F.)
| | - Kim I. Albers-Warlé
- Department of Colorectal Surgery, La Fe University Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain;
- Department of Anesthesiology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Michiel C. Warlé
- Departments of Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands;
| | - Pilar Argente-Navarro
- Perioperative Medicine Research Group, Health Research Institute la Fe, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain; (P.A.-N.); (O.D.-C.)
| | - Blas Flor
- Department of Anesthesiology, Consorcio Hospital General Universitario de Valencia, Av. de les Tres Creus, 2, L’Olivereta, 46014 València, Spain; (L.R.); (B.F.)
| | - Oscar Diaz-Cambronero
- Perioperative Medicine Research Group, Health Research Institute la Fe, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain; (P.A.-N.); (O.D.-C.)
- Department of Anesthesiology, La Fe University Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain
| |
Collapse
|
3
|
Rovira L, Kot P, Pozo S, Cano B, De Andrés J. Peri-operative Hemi-diaphragmatic Variations After Brachial Plexus Block Above the Clavicle: A Prospective Observational Study of the Contralateral Side. Ultrasound Med Biol 2023:S0301-5629(23)00175-8. [PMID: 37394374 DOI: 10.1016/j.ultrasmedbio.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/16/2023] [Accepted: 05/28/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE Hemi-diaphragm palsy after brachial plexus block above the clavicle (BPBAC) occurs frequently, but few patients develop post-operative pulmonary complications (PPC). We hypothesized that contralateral hemidiaphragm function increases after BPBAC. This contralateral function preserves global diaphragmatic function, avoiding PPC in the case of ipsilateral hemi-diaphragm palsy. METHODS This prospective observational cohort study included 64 adult patients undergoing shoulder surgery with planned BPBAC (interscalene brachial plexus block and supraclavicular block). The Thickening Fraction (TF) was measured by ultrasound in both hemi-diaphragms, ipsilateral (TF ipsilateral) and contralateral (TFcontralateral) to the BPBAC, before and after the surgery. TFglobal is the sum of TFipsilateral and TFcontralateral. PPC were defined as occurrences of dyspnea, tachypnea, SpO2 <90% or SpO2/FiO2 <315. RESULTS TFcontralateral increased significantly (an average of 40%) after BPBAC (p = 0.001), and TFipsilateral decreased (an average of 72%). After BPBAC, 86% of patients had a decreased TFipsilateral and 59% of patients an increased TFcontralateral at post-operatively. Only 17% of patients have PPC. CONCLUSION After BPBAC, global diaphragm function decreases because of ipsilateral hemi-diaphragm reduction, but less than expected because of increased contralateral hemi-diaphragm function. As a part of diaphragm function, contralateral hemi-diaphragm function must be checked.
Collapse
Affiliation(s)
- Lucas Rovira
- Department of Anesthesiology, Critical Care and Pain Medicine, Consorcio Hospital General Universitario, Valencia, Spain.
| | - Pablo Kot
- Department of Anesthesiology, Critical Care and Pain Medicine, Consorcio Hospital General Universitario, Valencia, Spain
| | - Silvia Pozo
- Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Beatriz Cano
- Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - José De Andrés
- Department of Anesthesiology, Critical Care and Pain Medicine, Consorcio Hospital General Universitario, Valencia, Spain
| |
Collapse
|
4
|
Olmedilla Arnal LE, Cambronero OD, Mazzinari G, Pérez Peña JM, Zorrilla Ortúzar J, Rodríguez Martín M, Vila Montañes M, Schultz MJ, Rovira L, Argente Navarro MP. An Individualized Low-Pneumoperitoneum-Pressure Strategy May Prevent a Reduction in Liver Perfusion during Colorectal Laparoscopic Surgery. Biomedicines 2023; 11:biomedicines11030891. [PMID: 36979870 PMCID: PMC10045598 DOI: 10.3390/biomedicines11030891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/15/2023] Open
Abstract
High intra-abdominal pressure (IAP) during laparoscopic surgery is associated with reduced splanchnic blood flow. It is uncertain whether a low IAP prevents this reduction. We assessed the effect of an individualized low-pneumoperitoneum-pressure strategy on liver perfusion. This was a single-center substudy of the multicenter ‘Individualized Pneumoperitoneum Pressure in Colorectal Laparoscopic Surgery versus Standard Therapy II study’ (IPPCollapse–II), a randomized clinical trial in which patients received an individualized low-pneumoperitoneum strategy (IPP) or a standard pneumoperitoneum strategy (SPP). Liver perfusion was indirectly assessed by the indocyanine green plasma disappearance rate (ICG–PDR) and the secondary endpoint was ICG retention rate after 15 min (R15) using pulse spectrophotometry. Multivariable beta regression was used to assess the association between group assignment and ICG–PDR and ICG–R15. All 29 patients from the participating center were included. Median IAP was 8 (25th–75th percentile: 8–10) versus 12 (12,12) mmHg, in IPP and SPP patients, respectively (p < 0.001). ICG–PDR was higher (OR 1.42, 95%-CI 1.10–1.82; p = 0.006) and PDR–R15 was lower in IPP patients compared with SPP patients (OR 0.46, 95%-CI 0.29–0.73; p = 0.001). During laparoscopic colorectal surgery, an individualized low pneumoperitoneum may prevent a reduction in liver perfusion.
Collapse
Affiliation(s)
| | - Oscar Diaz Cambronero
- Perioperative Medicine Research Group, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
- Department of Anaesthesiology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
- Spanish Clinical Research Network (SCReN), SCReN-IIS La Fe, PT17/0017/0035, 46026 Valencia, Spain
- Correspondence: or (O.D.C.); (G.M.)
| | - Guido Mazzinari
- Perioperative Medicine Research Group, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
- Department of Anaesthesiology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
- Department of Statistics and Operations Research, University of Valencia, 46100 Valencia, Spain
- Correspondence: or (O.D.C.); (G.M.)
| | - José María Pérez Peña
- Department of Anaesthesiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Jaime Zorrilla Ortúzar
- Department of Anaesthesiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Marcos Rodríguez Martín
- Department of Digestive Surgery, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Maria Vila Montañes
- Perioperative Medicine Research Group, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
- Department of Anaesthesiology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Marcus J. Schultz
- Department of Intensive Care, Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam University Medical Centers, Location ‘AMC’, 1105 AZ Amsterdam, The Netherlands
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, UK
| | - Lucas Rovira
- Department of Anaesthesiology, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain
| | - Maria Pilar Argente Navarro
- Perioperative Medicine Research Group, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
- Department of Anaesthesiology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | | |
Collapse
|
5
|
Mazzinari G, Diaz-Cambronero O, Serpa Neto A, Martínez AC, Rovira L, Argente Navarro MP, Malbrain MLNG, Pelosi P, Gama de Abreu M, Hollmann MW, Schultz MJ. Modeling intra-abdominal volume and respiratory driving pressure during pneumoperitoneum insufflation-a patient-level data meta-analysis. J Appl Physiol (1985) 2020; 130:721-728. [PMID: 33357006 DOI: 10.1152/japplphysiol.00814.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
During pneumoperitoneum, intra-abdominal pressure (IAP) is usually kept at 12-14 mmHg. There is no clinical benefit in IAP increments if they do not increase intra-abdominal volume IAV. We aimed to estimate IAV (ΔIAV) and respiratory driving pressure changes (ΔPRS) in relation to changes in IAP (ΔIAP). We carried out a patient-level meta-analysis of 204 adult patients with available data on IAV and ΔPRS during pneumoperitoneum from three trials assessing the effect of IAP on postoperative recovery and airway pressure during laparoscopic surgery under general anesthesia. The primary endpoint was ΔIAV, and the secondary endpoint was ΔPRS. The endpoints' response to ΔIAP was modeled using mixed multivariable Bayesian regression to estimate which mathematical function best fitted it. IAP values on the pressure-volume (PV) curve where the endpoint rate of change according to IAP decreased were identified. Abdomino-thoracic transmission (ATT) rate, that is, the rate ΔPRS change to ΔIAP was also estimated. The best-fitting function was sigmoid logistic and linear for IAV and ΔPRS response, respectively. Increments in IAV reached a plateau at 6.0 [95%CI 5.9-6.2] L. ΔIAV for each ΔIAP decreased at IAP ranging from 9.8 [95%CI 9.7-9.9] to 12.2 [12.0-12.3] mmHg. ATT rate was 0.65 [95%CI 0.62-0.68]. One mmHg of IAP raised ΔPRS 0.88 cmH2O. During pneumoperitoneum, IAP has a nonlinear relationship with IAV and a linear one with ΔPRS. IAP should be set below the point where IAV gains diminish.NEW & NOTEWORTHY We found that intra-abdominal volume changes related to intra-abdominal pressure increase reached a plateau with diminishing gains in commonly used pneumoperitoneum pressure ranges. We also found a linear relationship between intra-abdominal pressure and respiratory driving pressure, a known marker of postoperative pulmonary complications.
Collapse
Affiliation(s)
- Guido Mazzinari
- Research Group in Perioperative Medicine, Hospital Universitario y Politécnico la Fe, Valencia, Spain.,Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - Oscar Diaz-Cambronero
- Research Group in Perioperative Medicine, Hospital Universitario y Politécnico la Fe, Valencia, Spain.,Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain.,Spanish Clinical Research Network (SCReN), SCReN-IIS La Fe, Madrid, Spain
| | - Ary Serpa Neto
- Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam University Medical Center, location "AMC." Amsterdam, The Netherlands.,Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.,Pulmonary Division, Cardio-Pulmonary Department, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Antonio Cañada Martínez
- Data Science, Biostatistics and Bioinformatics Unit, Instituto de Investigacion Sanitaria la Fe, Valencia, Spain
| | - Lucas Rovira
- Department of Anaesthesiology, Consorcio Hospital General Universitario, Valencia, Spain
| | - María Pilar Argente Navarro
- Research Group in Perioperative Medicine, Hospital Universitario y Politécnico la Fe, Valencia, Spain.,Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - Manu L N G Malbrain
- Department of Intensive Care Medicine, University Hospital Brussels (UZB), Brussels, Belgium.,Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,International Fluid Academy, Lovenjoel, Belgium
| | - Paolo Pelosi
- San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Marcelo Gama de Abreu
- Department of Anesthesiology and Intensive Care Therapy, Pulmonary Engineering Group, Technische Universität Dresden, Dresden, Germany.,Outcomes Research Consortium, Cleveland, Ohio
| | - Markus W Hollmann
- Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam University Medical Center, location "AMC." Amsterdam, The Netherlands.,Department of Anaesthesiology, Amsterdam University Medical Center, location "AMC," Amsterdam, The Netherlands
| | - Marcus J Schultz
- Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam University Medical Center, location "AMC." Amsterdam, The Netherlands.,Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.,Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
6
|
Rovira L, Kot P, Pozo S, Cano B, de Andres J. Perioperative diaphragm point-of-care ultrasound as a prediction tool of postoperative respiratory failure in high-risk patients: A feasibility study and case series. ACTA ACUST UNITED AC 2020; 68:137-142. [PMID: 33162119 DOI: 10.1016/j.redar.2020.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/07/2020] [Accepted: 06/29/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Respiratory muscle function in the postoperative period is a key to whether a patient develops Postoperative Respiratory Failure (PRF) or not. PRF occurs when the gas exchange does not meet metabolic needs. Ipsilateral paralysis of the hemidiaphragm after interscalenic brachial plexus block (ISB) causes an acute reduction of respiratory muscle function. This reduction does not cause PRF when the contralateral hemidiaphragm generates enough gas exchange to meet metabolic demands. OBJECTIVES To study the evolution of hemidiaphragmatic muscle function during the perioperative period with diaphragmatic ultrasound (D-POCUS), and use it as an innovative tool to predict PRF, assessing the contralateral hemidiaphragm in the event of acute hemidiaphragm paralysis. METHODS Patients considered high risk, scheduled for shoulder surgery with ISB are studied. Both hemidiaphragms were evaluated by ultrasound, before and after the procedure, measuring Thickening Fraction (TF) and Diaphragmatic Excursion (DE). PACU patients with PRF were registered. RESULTS There was a significant reduction in the TF and DE of the ipsilateral hemidiaphragm in the six patients studied. Only 1/6 patients showed signs of PRF. The evaluation of the contralateral hemidiaphragm during the postoperative period showed that in the five patients without signs of PRF, there were no significant changes in the function of the contralateral hemidiaphragm. The patient, who showed a reduction in contralateral hemidiaphragm function, was the only one who suffered PRF. CONCLUSIONS In this case series, D-POCUS allows to know the perioperative function of the diaphragm in high-risk patients. All patients suffered an acute reduction of hemidiaphragm function after ISB; however, these patients did not develop PRF when the contralateral hemidiaphragm function was preserved.
Collapse
Affiliation(s)
- L Rovira
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital General Universitario de Valencia, Valencia, España.
| | - P Kot
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital General Universitario de Valencia, Valencia, España
| | - S Pozo
- Enfermería, Hospital General Universitario de Valencia, Valencia, España
| | - B Cano
- Enfermería, Hospital General Universitario de Valencia, Valencia, España
| | - J de Andres
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital General Universitario de Valencia, Valencia, España; Facultad de Medicina, Universitat de València, Valencia, España
| |
Collapse
|
7
|
Kot P, Granell M, Rovira L, Rodriguez P, Morales J, Pintado C, Cano B, Pozo S, Baldo J, De Andrés J. Study on patients undergoing thoracic surgery. Incidence of chronic pain and influence of the type of intraoperative analgesia. J Cardiothorac Vasc Anesth 2020. [DOI: 10.1053/j.jvca.2020.09.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
8
|
Mazzinari G, Rovira L, Henao L, Ortega J, Casasempere A, Fernandez Y, Acosta M, Belaouchi M, Esparza-Miñana JM. Effect of Dynamic Versus Stylet-Guided Intubation on First-Attempt Success in Difficult Airways Undergoing Glidescope Laryngoscopy: A Randomized Controlled Trial. Anesth Analg 2019; 128:1264-1271. [PMID: 31094798 DOI: 10.1213/ane.0000000000004102] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Tracheal intubation failure in patients with difficult airway is still not uncommon. While videolaryngoscopes such as the Glidescope offer better glottic vision due to an acute-angled blade, this advantage does not always lead to an increased success rate because successful insertion of the tube through the vocal cords may be the limiting factor. We hypothesize that combined use of Glidescope and fiberscope used only as a dynamic guide facilitates tracheal intubation compared to a conventional Glidescope technique with a preshaped nondynamic stylet. METHODS One hundred sixty adult patients with predicted difficult airway were randomly assigned to a conventional Glidescope (standard Glidescope group) or a combined Glidescope + fiberscope group intubation. In the Glidescope + fiberscope group under direct vision from the Glidescope, tracheal intubation was performed using the fiberscope as a guide without using fiberoptic vision, while in the standard Glidescope group, a conventional stylet-guided intubation technique was performed. We evaluated the rate of tracheal intubation success at first attempt as the primary end point (Fisher exact test). The difference between groups in airway injury, time to successful intubation, and the need for an alternative technique was also evaluated. RESULTS First-attempt intubation success was higher in the Glidescope + fiberscope group than in the standard Glidescope group (91% vs 67%; P = .0012; fragility index, 8; absolute risk reduction, 24% [95% CI, 12%-36%]). Median time to successful tracheal intubation was shorter in the Glidescope + fiberscope group (50 vs 64 seconds; P = .035). Airway injury rate was lower in the Glidescope + fiberscope group than in the standard Glidescope group (1% vs 11%; P = .035; fragility index, 1; absolute risk reduction, 10% [95% CI, 3%-18%]). Alternative rescue technique requirements to achieve tracheal intubation were higher in the standard Glidescope group (24% vs 4%; P < .001; fragility index, 7). CONCLUSIONS The use of a dynamic, flexible guide during a Glidescope laryngoscopy in patients with a predicted difficult airway compared to a standard intubation technique improves first-attempt intubation success, decreases the incidence of airway injury and time to successful intubation, as well as the need of an alternative technique to succeed.
Collapse
Affiliation(s)
- Guido Mazzinari
- From the Department of Anesthesiology and Pain Medicine, Hospital de Manises, Valencia, Spain
- Research Group in Perioperative Medicine, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Lucas Rovira
- Research Group in Perioperative Medicine, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Department of Anesthesiology, Critical Care and Pain Medicine, Consorcio Hospital General Universitario, Valencia, Spain
| | - Liliana Henao
- From the Department of Anesthesiology and Pain Medicine, Hospital de Manises, Valencia, Spain
| | - Juan Ortega
- From the Department of Anesthesiology and Pain Medicine, Hospital de Manises, Valencia, Spain
| | - Alma Casasempere
- From the Department of Anesthesiology and Pain Medicine, Hospital de Manises, Valencia, Spain
| | - Yolanda Fernandez
- Department of Anesthesiology, Critical Care and Pain Medicine, Consorcio Hospital General Universitario, Valencia, Spain
| | - Mariana Acosta
- From the Department of Anesthesiology and Pain Medicine, Hospital de Manises, Valencia, Spain
| | - Moncef Belaouchi
- From the Department of Anesthesiology and Pain Medicine, Hospital de Manises, Valencia, Spain
| | - José Miguel Esparza-Miñana
- From the Department of Anesthesiology and Pain Medicine, Hospital de Manises, Valencia, Spain
- Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir
| |
Collapse
|
9
|
Kot P, Rodriguez P, Granell M, Cano B, Rovira L, Morales J, Broseta A, Andrés JD. The erector spinae plane block: a narrative review. Korean J Anesthesiol 2019; 72:209-220. [PMID: 30886130 PMCID: PMC6547235 DOI: 10.4097/kja.d.19.00012] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 03/13/2019] [Indexed: 11/17/2022] Open
Abstract
Regional anesthesia and pain management have experienced advances in recent years, especially with the advent of fascial plane blocks. The erector spinae plane block is one of the newest techniques to be described. In the past two years, publications referring to ESP block have increased significantly. The objective of this review is to analyze the articles about ESP block that have been published to date. We performed a search in the main databases and identified 368 articles. After a selection of the relevant articles, 125 studies were found eligible and were included in the review. The ESP block is performed by depositing the local anesthetic in the fascial plane, deeper than the erector spinae muscle at the tip of the transverse process of the vertebra. Many cases of its use have been described with satisfactory results in the treatment of both acute pain and chronic pain. The applicability of the technique covers many clinical scenarios. Of the 98 case reports reviewed, 12 and 87 articles, respectively described the technique as a treatment for chronic pain and acute pain. The single-shot was the most frequently used technique. As described in the articles published to date, the technique is easy to perform and has a low rate of complications. However, despite the effectiveness of the technique, further studies are necessary to obtain more evidence of its actions.
Collapse
Affiliation(s)
- Pablo Kot
- Department of Anesthesia, Critical Care and Pain Medicine, University General Hospital Consortium of Valencia, Spain
| | - Pablo Rodriguez
- Department of Anesthesia, Critical Care and Pain Medicine, University General Hospital Consortium of Valencia, Spain
| | - Manuel Granell
- Department of Anesthesia, Critical Care and Pain Medicine, University General Hospital Consortium of Valencia, Spain
| | - Beatriz Cano
- Department of Hospital Nursing, University General Hospital Consortium of Valencia, Valencia, Spain
| | - Lucas Rovira
- Department of Anesthesia, Critical Care and Pain Medicine, University General Hospital Consortium of Valencia, Spain
| | - Javier Morales
- Department of Anesthesia, Critical Care and Pain Medicine, University General Hospital Consortium of Valencia, Spain
| | - Ana Broseta
- Department of Anesthesia, Critical Care and Pain Medicine, University General Hospital Consortium of Valencia, Spain
| | - Jose De Andrés
- Department of Anesthesia, Critical Care and Pain Medicine, University General Hospital Consortium of Valencia, Spain
| |
Collapse
|
10
|
Mazzinari G, Rovira L, Casasempere A, Ortega J, Cort L, Esparza-Miñana JM, Belaouchi M. Interfascial block at the serratus muscle plane versus conventional analgesia in breast surgery: a randomized controlled trial. Reg Anesth Pain Med 2019; 44:52-58. [DOI: 10.1136/rapm-2018-000004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/17/2018] [Accepted: 04/23/2018] [Indexed: 01/11/2023]
Abstract
Background and objectivesIn the context of opioid-sparing perioperative management, there is still little evidence from randomized controlled trials regarding the effectiveness of interfascial thoracic blocks. This study hypothesizes that receiving a serratus plane block reduces opioid requirements, pain scores, and rescue medication needs.MethodsThis double-blind, randomized controlled study was conducted on 60 adult females undergoing oncologic breast surgery. After general anesthesia, patients were randomly allocated to either conventional analgesia (control group, n=30) or single-injection serratus block with L-bupivacaine 0.25% 30mL (study group, n=30). First 24-hour total morphine consumption (primary outcome), pain scores at 1, 3, 6, 12, and 24 hours, time-to-first opioid rescue analgesia, and adverse effects were recorded.ResultsMedian 24 hours’ opioid dose was greater in the control group (median difference 9 mg (95% CI 4 to 14.5 mg); p<0.001). Proportional odds model showed that the study group has a lower probability of receiving opioid drugs (OR=0.26 (95% CI 0.10 to 0.68); p<0.001), while mastectomies have a higher probability of receiving them (OR=4.11 (95% CI 1.25 to 13.58); p=0.002). Pain scores in the study group were significantly lower throughout the follow-up period (p<0.001). Control group subjects needed earlier morphine rescue and had a higher risk of rescue dose requirement (p=0.002).ConclusionsInterfascial serratus plane block reduces opioid requirements and is associated with better pain scores and lower and later rescue analgesia needs in the first 24 hours, compared with conventional intravenous analgesia, in breast surgery.Trial registration numberNCT02905149.
Collapse
|
11
|
Folch A, Cortés MJ, Salvador-Carulla L, Vicens P, Irazábal M, Muñoz S, Rovira L, Orejuela C, Haro JM, Vilella E, Martínez-Leal R. Risk factors and topographies for self-injurious behaviour in a sample of adults with intellectual developmental disorders. J Intellect Disabil Res 2018; 62:1018-1029. [PMID: 29607562 DOI: 10.1111/jir.12487] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 11/14/2017] [Accepted: 03/04/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Self-injurious behaviour (SIB) is a prevalent form of challenging behaviour in people with intellectual developmental disorders (IDD). Existing research has yielded conflicting findings concerning the major risk factors involved, and in addition, SIB shows multiple topographies and presentations. Although presence of autism spectrum disorders (ASD) and severity of intellectual disability (ID) are known risk factors for SIB, there are no studies comparing SIB topographies by severity degrees of ID and ASD. The purpose of the present paper has been to identify risk factors and topographies for SIB in a representative, stratified and randomised sample of adults with IDD. METHOD This study was conducted on the basis of data collected by the POMONA-ESP project, in a sample of 833 adults with IDD. Data concerning demographic and health information, ASD symptoms, psychopathology and ID, have been analysed to determine the presence of risk factors for SIB among participants and to explore the occurrence and topographies of SIB across different severity levels of ID and ASD symptoms. RESULTS Self-injurious behaviour prevalence in the sample was 16.2%. Younger age, oral pain, greater severity of ID, presence of dual diagnosis, psychiatric medication intake and higher scores on Childhood Autism Rating Scale were risk factors for SIB among participants, whereas number of areas with functioning limitations, place of residence, diagnosis of epilepsy and sex were not. SIB was more frequent in participants with ASD symptoms regardless of its severity level, and they displayed a higher number of different topographies of SIB. People with profound ID without co-morbid ASD symptoms showed similar results concerning SIB prevalence and topographies. CONCLUSIONS Knowledge on risk factors and topographies of SIB might play a vital role in the development of prevention strategies and management of SIB in people with IDD. The mere presence of ASD symptoms, regardless of its severity level, can be a crucial factor to be taken into account in assessing SIB. Accordingly, the presence of SIB in people with ID, especially when presented with a varied number of topographies, might provide guidance on ASD differential diagnosis.
Collapse
Affiliation(s)
- A Folch
- Intellectual Disability and Developmental Disorders Research Unit (UNIVIDD), Fundació Villablanca, IISPV, Universitat Rovira i Virgili, Reus, Spain
- Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain
| | - M J Cortés
- Intellectual Disability and Developmental Disorders Research Unit (UNIVIDD), Fundació Villablanca, IISPV, Universitat Rovira i Virgili, Reus, Spain
- Centre of Biomedical Research Network on Mental Health (CIBERSAM), Spain
| | - L Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - P Vicens
- Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain
- Research Center in Behavioral Assessment (CRAMC), Universitat Rovira i Virgili, Tarragona, Spain
- Laboratory of Toxicology and Environmental Health, Universitat Rovira i Virgili, Tarragona, Spain
| | - M Irazábal
- Parc Sanitari Sant Joan de Déu, Spain
- Faculty of Education, Universitat de Barcelona, Barcelona, Spain
| | - S Muñoz
- Plena Inclusión España, Madrid, Spain
| | - L Rovira
- Intellectual Disability and Developmental Disorders Research Unit (UNIVIDD), Fundació Villablanca, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - C Orejuela
- Intellectual Disability and Developmental Disorders Research Unit (UNIVIDD), Fundació Villablanca, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - J M Haro
- Centre of Biomedical Research Network on Mental Health (CIBERSAM), Spain
- Parc Sanitari Sant Joan de Déu, Spain
- Department of Psychiatry and Clinical Psychobiology, Universitat de Barcelona, Barcelona, Spain
| | - E Vilella
- Centre of Biomedical Research Network on Mental Health (CIBERSAM), Spain
- Institut Pere Mata, University Psychiatric Hospital, Reus, Spain
| | - R Martínez-Leal
- Intellectual Disability and Developmental Disorders Research Unit (UNIVIDD), Fundació Villablanca, IISPV, Universitat Rovira i Virgili, Reus, Spain
- Centre of Biomedical Research Network on Mental Health (CIBERSAM), Spain
- Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain
| |
Collapse
|
12
|
Kot P, Granell M, Rodriguez P, Rovira L, De Andrés J. Diaphragmatic Ultrasound: Early Diagnosis When Phrenic Injury in Thoracic Surgery Is Suspected. J Cardiothorac Vasc Anesth 2018; 32:e7-e8. [PMID: 30072267 DOI: 10.1053/j.jvca.2018.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Pablo Kot
- Servicio de Anestesia Reanimación y Terapia del Dolor Consorci Hospital General Universitari de Valencia Valencia, Spain
| | - Manuel Granell
- Servicio de Anestesia Reanimación y Terapia del Dolor Consorci Hospital General Universitari de Valencia Valencia, Spain
| | - Pablo Rodriguez
- Servicio de Anestesia Reanimación y Terapia del Dolor Consorci Hospital General Universitari de Valencia Valencia, Spain
| | - Lucas Rovira
- Servicio de Anestesia Reanimación y Terapia del Dolor Consorci Hospital General Universitari de Valencia Valencia, Spain
| | - Jose De Andrés
- Servicio de Anestesia Reanimación y Terapia del Dolor Consorci Hospital General Universitari de Valencia Valencia, Spain
| |
Collapse
|
13
|
Ferrando C, Soro M, Unzueta C, Suarez-Sipmann F, Canet J, Librero J, Pozo N, Peiró S, Llombart A, León I, India I, Aldecoa C, Díaz-Cambronero O, Pestaña D, Redondo FJ, Garutti I, Balust J, García JI, Ibáñez M, Granell M, Rodríguez A, Gallego L, de la Matta M, Gonzalez R, Brunelli A, García J, Rovira L, Barrios F, Torres V, Hernández S, Gracia E, Giné M, García M, García N, Miguel L, Sánchez S, Piñeiro P, Pujol R, García-Del-Valle S, Valdivia J, Hernández MJ, Padrón O, Colás A, Puig J, Azparren G, Tusman G, Villar J, Belda J. Individualised perioperative open-lung approach versus standard protective ventilation in abdominal surgery (iPROVE): a randomised controlled trial. Lancet Respir Med 2018; 6:193-203. [PMID: 29371130 DOI: 10.1016/s2213-2600(18)30024-9] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/08/2017] [Accepted: 11/13/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND The effects of individualised perioperative lung-protective ventilation (based on the open-lung approach [OLA]) on postoperative complications is unknown. We aimed to investigate the effects of intraoperative and postoperative ventilatory management in patients scheduled for abdominal surgery, compared with standard protective ventilation. METHODS We did this prospective, multicentre, randomised controlled trial in 21 teaching hospitals in Spain. We enrolled patients who were aged 18 years or older, were scheduled to have abdominal surgery with an expected time of longer than 2 h, had intermediate-to-high-risk of developing postoperative pulmonary complications, and who had a body-mass index less than 35 kg/m2. Patients were randomly assigned (1:1:1:1) online to receive one of four lung-protective ventilation strategies using low tidal volume plus positive end-expiratory pressure (PEEP): open-lung approach (OLA)-iCPAP (individualised intraoperative ventilation [individualised PEEP after a lung recruitment manoeuvre] plus individualised postoperative continuous positive airway pressure [CPAP]), OLA-CPAP (intraoperative individualised ventilation plus postoperative CPAP), STD-CPAP (standard intraoperative ventilation plus postoperative CPAP), or STD-O2 (standard intraoperative ventilation plus standard postoperative oxygen therapy). Patients were masked to treatment allocation. Investigators were not masked in the operating and postoperative rooms; after 24 h, data were given to a second investigator who was masked to allocations. The primary outcome was a composite of pulmonary and systemic complications during the first 7 postoperative days. We did the primary analysis using the modified intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT02158923. FINDINGS Between Jan 2, 2015, and May 18, 2016, we enrolled 1012 eligible patients. Data were available for 967 patients, whom we included in the final analysis. Risk of pulmonary and systemic complications did not differ for patients in OLA-iCPAP (110 [46%] of 241, relative risk 0·89 [95% CI 0·74-1·07; p=0·25]), OLA-CPAP (111 [47%] of 238, 0·91 [0·76-1·09; p=0·35]), or STD-CPAP groups (118 [48%] of 244, 0·95 [0·80-1·14; p=0·65]) when compared with patients in the STD-O2 group (125 [51%] of 244). Intraoperatively, PEEP was increased in 69 (14%) of patients in the standard perioperative ventilation groups because of hypoxaemia, and no patients from either of the OLA groups required rescue manoeuvres. INTERPRETATION In patients who have major abdominal surgery, the different perioperative open lung approaches tested in this study did not reduce the risk of postoperative complications when compared with standard lung-protective mechanical ventilation. FUNDING Instituto de Salud Carlos III of the Spanish Ministry of Economy and Competitiveness, and Grants Programme of the European Society of Anaesthesiology.
Collapse
Affiliation(s)
- Carlos Ferrando
- Department of Anesthesiology & Critical Care, Hospital Clínico Universitario, Valencia, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
| | - Marina Soro
- Department of Anesthesiology & Critical Care, Hospital Clínico Universitario, Valencia, Spain
| | - Carmen Unzueta
- Department of Anesthesiology & Critical Care, Hospital Universitario Sant Pau, Barcelona, Spain
| | - Fernando Suarez-Sipmann
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Jaume Canet
- Department of Anesthesiology & Critical Care, Hospital Universitario Germans Tries i Pujol, Badalona, Spain
| | - Julián Librero
- Navarrabiomed-Fundación Miguel Servet. Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Spain
| | - Natividad Pozo
- INCLIVA Clinical Research Institute, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - Salvador Peiró
- Centro Superior de Investigación en Salud Publica (CSISP-FISABIO), REDISSEC, Valencia, Spain
| | - Alicia Llombart
- IISLAFE Clinical Research Institute, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Irene León
- Department of Anesthesiology & Critical Care, Hospital Clínico Universitario, Valencia, Spain
| | - Inmaculada India
- Department of Anesthesiology & Critical Care, Hospital Universitario Sant Pau, Barcelona, Spain
| | - Cesar Aldecoa
- Department of Anesthesiology & Critical Care, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Oscar Díaz-Cambronero
- Department of Anesthesiology & Critical Care, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - David Pestaña
- Department of Anesthesiology & Critical Care, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Francisco J Redondo
- Department of Anesthesiology & Critical Care, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Ignacio Garutti
- Department of Anesthesiology & Critical Care, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jaume Balust
- Department of Anesthesiology & Critical Care, Hospital Clínic i Provincial Universitario, Barcelona, Spain
| | - Jose I García
- Department of Anesthesiology & Critical Care, Hospital Fundación de Alcorcón, Alcorcón, Spain
| | - Maite Ibáñez
- Department of Anesthesiology, Hospital de la Marina Baixa de la Vila Joiosa, Alicante, Spain
| | - Manuel Granell
- Department of Anesthesiology & Critical Care, Hospital General Universitario, Valencia, Spain
| | - Aurelio Rodríguez
- Department of Anesthesiology, Hospital Universitario Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Lucía Gallego
- Department of Anesthesiology & Critical Care, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Manuel de la Matta
- Department of Anesthesiology & Critical Care, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Rafael Gonzalez
- Department of Anesthesiology, Hospital Universitario de León, León, Spain
| | - Andrea Brunelli
- Department of Anesthesiology & Critical Care, Hospital Universitario Germans Tries i Pujol, Badalona, Spain
| | - Javier García
- Department of Anesthesiology & Critical Care, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Lucas Rovira
- Department of Anesthesiology, Hospital de Manises, Valencia, Spain
| | - Francisco Barrios
- Department of Anesthesiology & Critical Care, Hospital Principe de Asturias, Madrid, Spain
| | - Vicente Torres
- Department of Anesthesiology & Critical Care, Hospital Son Espases, Palma de Mallorca, Spain
| | - Samuel Hernández
- Department of Anesthesiology, Hospital NS de Candelaria, Santa Cruz de Tenerife, Spain
| | - Estefanía Gracia
- Department of Anesthesiology & Critical Care, Hospital Clínico Universitario, Valencia, Spain
| | - Marta Giné
- Department of Anesthesiology & Critical Care, Hospital Universitario Sant Pau, Barcelona, Spain
| | - María García
- Department of Anesthesiology & Critical Care, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Nuria García
- Department of Anesthesiology & Critical Care, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Lisset Miguel
- Department of Anesthesiology & Critical Care, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Sergio Sánchez
- Department of Anesthesiology & Critical Care, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Patricia Piñeiro
- Department of Anesthesiology & Critical Care, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Roger Pujol
- Department of Anesthesiology & Critical Care, Hospital Clínic i Provincial Universitario, Barcelona, Spain
| | | | - José Valdivia
- Department of Anesthesiology, Hospital de la Marina Baixa de la Vila Joiosa, Alicante, Spain
| | - María J Hernández
- Department of Anesthesiology & Critical Care, Hospital General Universitario, Valencia, Spain
| | - Oto Padrón
- Department of Anesthesiology, Hospital Universitario Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Ana Colás
- Department of Anesthesiology & Critical Care, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Jaume Puig
- Department of Anesthesiology & Critical Care, Hospital Clínico Universitario, Valencia, Spain
| | - Gonzalo Azparren
- Department of Anesthesiology & Critical Care, Hospital Universitario Sant Pau, Barcelona, Spain
| | - Gerardo Tusman
- Department of Anesthesiology, Hospital Privado de Comunidad Mar de Plata, Mar de Plata, Argentina
| | - Jesús Villar
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Multidisciplinary Organ Dysfunction Evaluation Research Network, Hospital Universitario Doctor Negrin, Las Palmas, Spain
| | - Javier Belda
- Department of Anesthesiology & Critical Care, Hospital Clínico Universitario, Valencia, Spain; Department of Surgery, Universidad de Valencia, Valencia, Spain
| | | |
Collapse
|
14
|
Ferrando C, Soro M, Canet J, Unzueta MC, Suárez F, Librero J, Peiró S, Llombart A, Delgado C, León I, Rovira L, Ramasco F, Granell M, Aldecoa C, Diaz O, Balust J, Garutti I, de la Matta M, Pensado A, Gonzalez R, Durán ME, Gallego L, Del Valle SG, Redondo FJ, Diaz P, Pestaña D, Rodríguez A, Aguirre J, García JM, García J, Espinosa E, Charco P, Navarro J, Rodríguez C, Tusman G, Belda FJ. Rationale and study design for an individualized perioperative open lung ventilatory strategy (iPROVE): study protocol for a randomized controlled trial. Trials 2015; 16:193. [PMID: 25927183 PMCID: PMC4425893 DOI: 10.1186/s13063-015-0694-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 03/30/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Postoperative pulmonary and non-pulmonary complications are common problems that increase morbidity and mortality in surgical patients, even though the incidence has decreased with the increased use of protective lung ventilation strategies. Previous trials have focused on standard strategies in the intraoperative or postoperative period, but without personalizing these strategies to suit the needs of each individual patient and without considering both these periods as a global perioperative lung-protective approach. The trial presented here aims at comparing postoperative complications when using an individualized ventilatory management strategy in the intraoperative and immediate postoperative periods with those when using a standard protective ventilation strategy in patients scheduled for major abdominal surgery. METHODS This is a comparative, prospective, multicenter, randomized, and controlled, four-arm trial that will include 1012 patients with an intermediate or high risk for postoperative pulmonary complications. The patients will be divided into four groups: (1) individualized perioperative group: intra- and postoperative individualized strategy; (2) intraoperative individualized strategy + postoperative continuous positive airway pressure (CPAP); (3) intraoperative standard ventilation + postoperative CPAP; (4) intra- and postoperative standard strategy (conventional strategy). The primary outcome is a composite analysis of postoperative complications. DISCUSSION The Individualized Perioperative Open-lung Ventilatory Strategy (iPROVE) is the first multicenter, randomized, and controlled trial to investigate whether an individualized perioperative approach prevents postoperative pulmonary complications. TRIAL REGISTRATION Registered on 5 June 2014 with identification no. NCT02158923 .
Collapse
Affiliation(s)
- Carlos Ferrando
- Anesthesiology and Critical Care Department, Hospital Clínico of Valencia, Av. Blasco Ibañez, 17, Valencia, CP: 46010, Spain.
| | - Marina Soro
- Anesthesiology and Critical Care Department, Hospital Clínico of Valencia, Av. Blasco Ibañez, 17, Valencia, CP: 46010, Spain.
| | - Jaume Canet
- Anesthesiology and Critical Care Department, Hospital Germans Tries i Pujol, Carretera de Canyet s/n, 08916, Badalona, Spain.
| | - Ma Carmen Unzueta
- Anesthesiology and Critical Care Department, Hospital San Pau, Carrer de Sant Quintí, 89, CP: 08026, Barcelona, Spain.
| | - Fernando Suárez
- Intensive Care Department, Uppsala University Hospital, Suecia Akademiska Sjukhuset Uppsala University, CP: 75185, Uppsala, Sweden.
| | - Julián Librero
- FISABIO salud Pública, Av. Cataluña, 21, CP: 46020, Valencia, Spain.
| | - Salvador Peiró
- FISABIO salud Pública, Av. Cataluña, 21, CP: 46020, Valencia, Spain.
| | - Alicia Llombart
- Anesthesiology and Critical Care Department, Hospital Clínico of Valencia, Av. Blasco Ibañez, 17, Valencia, CP: 46010, Spain.
| | - Carlos Delgado
- Anesthesiology and Critical Care Department, Hospital Clínico of Valencia, Av. Blasco Ibañez, 17, Valencia, CP: 46010, Spain.
| | - Irene León
- Anesthesiology and Critical Care Department, Hospital Clínico of Valencia, Av. Blasco Ibañez, 17, Valencia, CP: 46010, Spain.
| | - Lucas Rovira
- Anesthesiology and Critical Care Department, Hospital de Manises, Av. De la Generalitat Valenciana, Manises, CP: 46940, Spain.
| | - Fernando Ramasco
- Anesthesiology and Critical Care Department, Hospital La Princesa of Madrid, Calle de Diego León, 62, CP: 28006, Madrid, Spain.
| | - Manuel Granell
- Anesthesiology and Critical Care Department, Hospital General of Valencia, Av. De les Tres Creus, 2, Valencia, CP: 46014, Spain.
| | - César Aldecoa
- Anesthesiology and Critical Care Department, Hospital Río Hortega of Valladolid, Calle Dulzaina, 2, Valladolid, CP 47012, Spain.
| | - Oscar Diaz
- Anesthesiology and Critical Care Department, Hospital La Fe of Valencia, Av. De Fernando Abril Martorell, 106, Valencia, CP: 46026, Spain.
| | - Jaume Balust
- Anesthesiology and Critical Care Department, Hospital Clínic i Provincial of Barcelona, Carrer Villarroel 170, Barcelona, CP: 08036, Spain.
| | - Ignacio Garutti
- Anesthesiology and Critical Care Department, Hospital General Gregorio Marañon of Madrid, Calle del Doctor Esquerdo, 46, Madrid, CP: 28007, Spain.
| | - Manuel de la Matta
- Anesthesiology and Critical Care Department, Hospital Vírgen del Rocio of Sevilla, Av. Manuel Siurot s/n, Sevilla, CP: 41013, Spain.
| | - Alberto Pensado
- Anesthesiology and Critical Care Department, Complejo Hospitalario Juan Canalejo of La Coruña, Xubias, 84, La Coruña, CP: 15006, Spain.
| | - Rafael Gonzalez
- Anesthesiology and Critical Care Department, Hospital of León, C/ Altos de Nava s/n, Leon, CP: 24701, Spain.
| | - M Eugenia Durán
- Anesthesiology and Critical Care Department, Hospital Vírgen de la Arraixaca of Murcia, Carretera de Madrid-Cartagena s/n, Madrird, CP: 30120, Spain.
| | - Lucia Gallego
- Anesthesiology and Critical Care Department, Hospital Miguel Servet of Zaragoza, Paseo Isabel la Católica, 1-3, Zaragoza, CP: 50009, Spain.
| | - Santiago García Del Valle
- Anesthesiology and Critical Care Department, Hospital Fundación of Alcorcón, Calle de Valdelaguna, 1, Alcorcón, CP: 28922, Spain.
| | - Francisco J Redondo
- Anesthesiology and Critical Care Department, Hospital General of Ciudad Real, C/ Alisos, 19, Ciudad Real, CP: 13002, Spain.
| | - Pedro Diaz
- Anesthesiology and Critical Care Department, Hospital de Valme of Sevilla, Av. Bellavista s/n, Sevilla, CP: 41014, Spain.
| | - David Pestaña
- Anesthesiology and Critical Care Department, Hospital Ramón y Cajal of Madrid, Carretera de Colmenar Viejo Km 9, Madrid, CP: 28034, Spain.
| | - Aurelio Rodríguez
- Anesthesiology and Critical Care Department, Hospital de Gran Canaria Dr. Negrín, c/ Barranco de la Ballena s/n, Negrin, CP: 35010, Spain.
| | - Javier Aguirre
- Anesthesiology and Critical Care Department, Hospital of Galdakano, Barrio Labeaga s/n, Galdakano, CP: 48960, Spain.
| | - Jose M García
- Anesthesiology and Critical Care Department, Complejo Hospitalario Juan Ramón Jimenez of Huelva, Ronda exterior norte, s/n, Huelva, CP: 21005, Spain.
| | - Javier García
- Anesthesiology and Critical Care Department, Hospital Puerta de Hierro of Majadahonda, C/ Manuel de Falla, 1, Majadahonda, CP: 28222, Spain.
| | - Elena Espinosa
- Anesthesiology and Critical Care Department, Hospital Nuestra Señora de la Candelaria of Santa Cruz de Tenerife, Carretera del Rosario, 145, Santa Cruz de Tenerife, CP: 38010, Spain.
| | - Pedro Charco
- Anesthesiology and Critical Care Department, Hospital Son Espases of Mallorca, Carretera de la Valldemosa, 79, Mallorca, CP: 07120, Spain.
| | - Jose Navarro
- Anesthesiology and Critical Care Department, Hospital General of Alicante, Pintor Baeza, 12, Alicante, CP: 03010, Spain.
| | - Clara Rodríguez
- FISABIO salud Pública, Av. Cataluña, 21, CP: 46020, Valencia, Spain.
| | - Gerardo Tusman
- Anesthesiology Department, Hospital Privado de Comunidad Mar de Plata, Mar de Plata, Argentina.
| | - Francisco Javier Belda
- Anesthesiology and Critical Care Department, Hospital Clínico of Valencia, Av. Blasco Ibañez, 17, Valencia, CP: 46010, Spain.
| |
Collapse
|
15
|
Rovira L, Aguilar G, Cuñat A, Belda FJ. Late evaluation of upper limb arterial flow in patients after long radial (PiCCO™) catheter placement. Ann Intensive Care 2015; 5:1. [PMID: 25852961 PMCID: PMC4384993 DOI: 10.1186/s13613-014-0041-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 12/18/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The purpose of the study was to assess blood flow in the upper limb arteries after prolonged catheterization with long radial artery catheters (LRC) which reach the subclavian artery compared to catheterization with standard short radial artery catheters (SRC) and a group of upper limb flow without any catheter placement (NOCATH), with both SRC and NOCATH as control groups. METHODS Prospective observational study with 20 patients admitted to ICU (40 upper limbs) with LRC and/or SRC inserted >48 h for hemodynamic monitoring. More than 45 days after catheter withdrawal, patients underwent a Doppler ultrasound study of both upper limbs. Arterial flows of arms with LRC (FlowLRC) were compared with arterial flows of arms with SRC (FlowSRC) and those without any catheter (FlowNOCATH). RESULTS Flow in the ulnar, brachial, and subclavian arteries did not show any significant difference between the two types of catheters. The only significant difference was in the radial arteries, showing a lower mean flow in the arms with LRC than in the arms with SRC (2.2 vs. 8.5 cc/min; p = 0.041). Flow reduction in the radial artery (74%) in the arms with LRC compared to the SRC arms showed a tendency to increase ulnar flow as a compensatory mechanism. None of the patients with LRC included in our study had any ischemic events, in spite of observing complete flow occlusion in three radial arteries (18%) from the Doppler study. CONCLUSIONS In this sample, the use of PiCCO long radial catheters reaching the subclavian artery did not produce chronic significant changes in brachial or subclavian flows. However, LRC produces a significant reduction in radial flow and a tendency to increase ulnar flow. When comparing these blood flow changes with those produced by SRC use, only the radial flow reduction was significantly lower, whereas the other arterial flow changes did not significantly differ.
Collapse
Affiliation(s)
- Lucas Rovira
- />Anesthesiology and Critical Care Department, Hospital Clínico Universitario, Avd. Blasco Ibañez n°17, Valencia, 46010 Spain
| | - Gerardo Aguilar
- />Anesthesiology and Critical Care Department, Hospital Clínico Universitario, Avd. Blasco Ibañez n°17, Valencia, 46010 Spain
| | - Alberto Cuñat
- />Radiology Department, Hospital Clínico Universitario, Avd. Blasco Ibañez n°17, Valencia, 46010 Spain
| | - Francisco J Belda
- />Anesthesiology and Critical Care Department, Hospital Clínico Universitario, Avd. Blasco Ibañez n°17, Valencia, 46010 Spain
| |
Collapse
|
16
|
Rovira L, Trobajo R, Ibáñez C. The use of diatom assemblages as ecological indicators in highly stratified estuaries and evaluation of existing diatom indices. Mar Pollut Bull 2012; 64:500-511. [PMID: 22305410 DOI: 10.1016/j.marpolbul.2012.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 12/30/2011] [Accepted: 01/05/2012] [Indexed: 05/31/2023]
Abstract
Diatom indices are used to evaluate the ecological status of rivers but they have been rarely applied in estuaries. This study aimed to identify the diatom species indicating the main environmental gradients and pressures in a highly stratified estuary; and to evaluate the applicability of existing freshwater diatom indices. Marine influence due to salt-wedge intrusion and sea water mixing appeared as the main factor affecting diatom community. Three diatom assemblages were identified: indicators of riverine conditions (without marine influence), indicators of estuarine conditions (heterogeneous conditions with higher conductivities due to marine influence) and those specifically indicating well-established salt-wedge situations. Nowadays, the main human pressure affecting diatom community in the Ebro Estuary is the hydrological alteration resulting from flow regulation and abstraction. Several limitations were encountered in the application of diatom indices (e.g. inverse response with nutrients; ecologically important species not considered). Therefore, their use in estuaries should be done cautiously.
Collapse
Affiliation(s)
- L Rovira
- IRTA-Aquatic Ecosystems, Carretera Poble Nou Km. 5.5, St. Carles de la Ràpita, Catalonia, Spain.
| | | | | |
Collapse
|
17
|
Tort L, Rotllant J, Rovira L. Immunological suppression in gilthead sea bream Sparus aurata of the North-West Mediterranean at low temperatures. Comp Biochem Physiol A Mol Integr Physiol 1998. [DOI: 10.1016/s1095-6433(98)10027-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|