More than 70 years after its original report, the hypoxic pulmonary vasoconstriction (HPV) response continues to spark scientific interest on its mechanisms and clinical implications, particularly for anesthesiologists involved in thoracic surgery. Selective airway intubation and one-lung ventilation (OLV) facilitates the surgical intervention on a collapsed lung while the HPV redirects blood flow from the “upper” non-ventilated hypoxic lung to the “dependent” ventilated lung. Therefore, by limiting intrapulmonary shunting and optimizing ventilation-to-perfusion (V/Q) ratio, the fall in arterial oxygen pressure (PaO 2 ) is attenuated during OLV. The HPV involves a biphasic response mobilizing calcium within pulmonary vascular smooth muscles, which is activated within seconds after exposure to low alveolar oxygen pressure and that gradually disappears upon re-oxygenation. Many factors including acid-base balance, the degree of lung expansion, circulatory volemia as well as lung diseases and patient age affect HPV. Anesthetic agents, analgesics and cardiovascular medications may also interfer with HPV during the perioperative period. Since HPV represents the homeostatic mechanism for regional ventilation-to-perfusion matching and in turn, for optimal pulmonary oxygen uptake, a clear understanding of HPV is clinically relevant for all anesthesiologists.

No abstract

The patient empowerment movement has highlighted the importance of providing information to the patients to improve care outcome. However, relatives of patients are not yet taken into consideration. This is especially problematic during surgeries since families are often left without real-time information about the trajectory of the patient, inducing worries. Based on this observation we have developed the SMS-Chir solution that connects our surgery service management system with the automatic sending of SMS at key moments in order to inform families about the progression of the surgery. The system has been conceived thanks to the results of a focus group involving four experts. The evaluation was done by monitoring the use of the system over time and by sending questionnaires after intervention. Results analysis shows a limited use of the system but a high satisfaction of the beneficiaries. This study highlights the importance of managerial factors (resistance to change) in order to onboard the necessary stakeholders in the process.