Current challenges in the recognition, prevention and treatment of perioperative pulmonary atelectasis

Restrepo, Ruben D; Braverman, J

doi:10.1586/17476348.2015.996134

Cited by 40 publications

(44 citation statements)

References 73 publications

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“…Reported incidence varies from 2% to 40%. 6 In 2015, a European Perioperative Clinical Outcome task force recommended a definition of PPC including respiratory infection, respiratory failure, pleural effusion, atelectasis, pneumothorax, bronchospasm, aspiration pneumonitis, acute respiratory distress syndrome, pulmonary edema, and pulmonary embolism. 36 In the current study, PPCs consisted of the following clinically relevant parameters: prolonged invasive mechanical ventilation, prolonged high-level respiratory support, requirement for noninvasive ventilation or CPAP above patient's baseline, diagnosis of pneumonia, and readmission to the ICU (or transfer to higher level of care) for pulmonary complications.…”

Section: This Multicenter Prospective Trial Evaluated Integration Of mentioning

confidence: 99%

“…[1][2][3][4][5] Although PPCs are an incompletely understood multifactorial occurrence, atelectasis is recognized as a critical component. 6 Evidence suggests that atelectasis is a common precursor of PPCs. Nearly all patients undergoing major operations experience some degree of transitory, clinically unimportant atelectasis.…”

mentioning

confidence: 99%

“…In patients at higher risk for complications, secretion mobilization techniques and lung expansion therapies might be indicated. [6][7][8][9] Lung expansion devices that provide either oscillating airflow or positive expiratory pressure therapy have been used for more than 25 years. Those using continuous positive airway pressure (CPAP) have shown therapeutic benefits in high-risk hypoxemic patients.…”

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confidence: 99%

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Efficacy of Oscillation and Lung Expansion in Reducing Postoperative Pulmonary Complication

Huynh

Liesching

Cereda

et al. 2019

Journal of the American College of Surgeons

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BACKGROUND: Postoperative pulmonary complications (PPCs) cause high morbidity and mortality. Targeted treatment for patients at risk for PPCs can improve outcomes. This multicenter prospective trial examined the impact of oscillation and lung expansion (OLE) therapy, using continuous high-frequency oscillation and continuous positive expiratory pressure on PPCs in high-risk patients. METHODS:In stage I, CPT and ICD codes were queried for patients (n ¼ 210) undergoing thoracic, upper abdominal, or aortic open procedures at 3 institutions from December 2014 to April 2016. Patients were selected randomly. Age, comorbidities, American Society of Anesthesiologists physical status classification scores, and PPC rates were determined. In stage II, 209 subjects were enrolled prospectively from October 2016 to July 2017 using the same criteria. Stage II subjects received OLE treatment and standard respiratory care. The PPCs rate (prolonged ventilation, high-level respiratory support, pneumonia, ICU readmission) were compared. We also compared ICU length of stay (LOS), hospital LOS, and mortality using t-tests and analysis of covariance. Data are mean AE SD. RESULTS: There were 419 subjects. Stage II patients were older (61.1 AE 13.7 years vs 57.4 AE 15.5 years; p < 0.05) and had higher American Society of Anesthesiologists scores. Treatment with OLE decreased PPCs from 22.9% (stage I) to 15.8% (stage II) (p < 0.01 adjusted for age, American Society of Anesthesiologists score, and operation time). Similarly, OLE treatment reduced ventilator time (23.7 AE 107.5 hours to 8.5 AE 27.5 hours; p < 0.05) and hospital LOS (8.4 AE 7.9 days to 6.8 AE 5.0 days; p < 0.05). No differences in ICU LOS, pneumonia, or mortality were observed. CONCLUSIONS: Aggressive treatment with OLE reduces PPCs and resource use in high-risk surgical patients. (J Am Coll Surg 2019;229:458e466. Ó 2019 by the American College of Surgeons. Published by Elsevier Inc. on behalf of the American College of Surgeons. This is an open access article under the CC BY-NC-ND license [http://creativecommons.org/licenses/by-nc-nd/4.0/].)Postoperative pulmonary complications (PPCs) result in significant morbidity, mortality, and healthcare costs. The incidence of "important" PPCs is 2% to 5% in the general surgical population. These consist of respiratory infection, respiratory failure, atelectasis, prolonged invasive mechanical ventilation, prolonged high-level

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Section: This Multicenter Prospective Trial Evaluated Integration Of mentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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Efficacy of Oscillation and Lung Expansion in Reducing Postoperative Pulmonary Complication

Huynh

Liesching

Cereda

et al. 2019

Journal of the American College of Surgeons

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“…12 Lung expansion therapy and pulmonary hygiene are important aspects of respiratory care for hospitalized patients, with the ultimate aim of preventing respiratory complications rather than responding reactively after complications occur. 12,[23][24][25][26] However, support for prophylactic lung expansion therapy is mixed 8,10,23,25,27,28 and is often specific to certain patient populations, such as patients with cystic fibrosis 29,30 or COPD 31 and postoperative patients. 21,[32][33][34] There are 2 studies in the trauma literature that address prevention of pulmonary complications utilizing prophylactic respiratory therapy methods.…”

Section: Introductionmentioning

confidence: 99%

A Preventative Respiratory Protocol to Identify Trauma Subjects at Risk for Respiratory Compromise on a General In-Patient Ward

et al. 2016

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“…Development of atelectasis in perioperative patients is associated with decreased lung compliance and increased pulmonary vascular resistance leading to lung injury and impairment of oxygenation [23]. Even though most patients with atelectasis recovered with conservative treatment in this study, persistent prolonged atelectasis after anesthesia is known to increase perioperative respiratory complications leading to signi cant consequence, especially in patients with underlying lung disease or cardiopulmonary dysfunction [23][24][25][26]. Therefore, early detection of atelectasis and effort for reversal of atelectasis in those patients may prevent signi cant periprocedural respiratory complication and improve clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Association Between Charlson Comorbidity Index and Complications of Endoscopic Resection of Gastric Neoplasms in Elderly Patients

Kim

Park

et al. 2020

Preprint

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Background: Although endoscopic resection is safe and effective for gastric epithelial neoplasms, information is limited on its efficacy and safety in extremely elderly patients who have various comorbidities. Further, the relationship between comorbidities and complications of endoscopic resection is not well established. Therefore, we aimed to evaluate the efficacy and safety of endoscopic resection of gastric epithelial neoplasms in extremely elderly patients. Methods: From October 2008 to December 2017, 4475 consecutive patients underwent endoscopic resection of gastric epithelial neoplasms. Among them, 242 were 75 years or older. We assessed Charlson comorbidity index (CCI) scores, procedural outcomes, and procedure- and sedation-related complications related to endoscopic resection. Results: Mean patient age was 78.7 ± 3.2 years. Of the 242 patients, 124 (51.2%) had low-grade dysplasia and 112 (46.3%) had adenocarcinoma. The most common comorbidity was hypertension (55.4%), followed by diabetes (23.1%). The mean CCI score was 1.67 ± 1.43. Sixty patients (24.8%) had a CCI score ≥ 3. During the procedure, 10 (4.1%) patients had desaturation that recovered by flumazenil use with mask (n=2) or Ambu bag (n=3) ventilation. During subsequent admission, atelectasis or pneumonia occurred in 45 (18.6%) patients, post-procedural bleeding in 12 (5.0%), and perforation in 3 (1.2%). Respiratory complications were more common in patients with a CCI score ≥ 3 (20/60, 33.3%) than in those with a CCI score < 3 (25/182, 13.7%, P=0.002). Conclusions: CCI score is related to respiratory complications of endoscopic resection in extremely elderly patients. Endoscopic resection must be performed cautiously, particularly in elderly patients with a high CCI score, to prevent respiratory complications.

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Current challenges in the recognition, prevention and treatment of perioperative pulmonary atelectasis

Cited by 40 publications

References 73 publications

Efficacy of Oscillation and Lung Expansion in Reducing Postoperative Pulmonary Complication

Efficacy of Oscillation and Lung Expansion in Reducing Postoperative Pulmonary Complication

A Preventative Respiratory Protocol to Identify Trauma Subjects at Risk for Respiratory Compromise on a General In-Patient Ward

Association Between Charlson Comorbidity Index and Complications of Endoscopic Resection of Gastric Neoplasms in Elderly Patients

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