Postoperative respiratory failure

Canet, Jaume; Gallart, Lluís

doi:10.1097/mcc.0000000000000045

Cited by 76 publications

(17 citation statements)

References 53 publications

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“…The use of colloids (albumin in milliliters per kilogram per hour) was a modifiable variable independently associated with PPC development. This is consistent with previous literature suggesting an effect of large fluid administration in worsening surgical outcomes, 25,27,28 and our observed lower administration of fluids (in milliliters per kilogram per hour) to patients without PPCs. Interestingly, recent studies have shown an increased PPC risk in surgical patients with hypoalbuminemia.…”

Section: Discussionsupporting

confidence: 94%

Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery

et al. 2017

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IMPORTANCE Postoperative pulmonary complications (PPCs), a leading cause of poor surgical outcomes, are heterogeneous in their pathophysiology, severity, and reporting accuracy. OBJECTIVE To prospectively study clinical and radiological PPCs and respiratory insufficiency therapies in a high-risk surgical population. DESIGN, SETTING, AND PARTICIPANTS We performed a multicenter prospective observational study in 7 US academic institutions. American Society of Anesthesiologists physical status 3 patients who presented for noncardiothoracic surgery requiring 2 hours or more of general anesthesia with mechanical ventilation from May to November 2014 were included in the study. We hypothesized that PPCs, even mild, would be associated with early postoperative mortality and use of hospital resources. We analyzed their association with modifiable perioperative variables. EXPOSURE Noncardiothoracic surgery. MAIN OUTCOMES AND MEASURES Predefined PPCs occurring within the first 7 postoperative days were prospectively identified. We used bivariable and logistic regression analyses to study the association of PPCs with ventilatory and other perioperative variables. RESULTS This study included 1202 patients who underwent predominantly abdominal, orthopedic, and neurological procedures. The mean (SD) age of patients was 62.1 (13.8) years, and 636 (52.9%) were men. At least 1 PPC occurred in 401 patients (33.4%), mainly the need for prolonged oxygen therapy by nasal cannula (n = 235; 19.6%) and atelectasis (n = 206; 17.1%). Patients with 1 or more PPCs, even mild, had significantly increased early postoperative mortality, intensive care unit (ICU) admission, and ICU/hospital length of stay. Significant PPC risk factors included nonmodifiable (emergency [yes vs no]: odds ratio [OR], 4.47, 95% CI, 1.59–12.56; surgical site [abdominal/pelvic vs nonabdominal/pelvic]: OR, 2.54, 95% CI, 1.67–3.89; and age [in years]: OR, 1.03, 95% CI, 1.02–1.05) and potentially modifiable (colloid administration [yes vs no]: OR, 1.75, 95% CI, 1.03–2.97; preoperative oxygenation: OR, 0.86, 95% CI, 0.80–0.93; blood loss [in milliliters]: OR, 1.17, 95% CI, 1.05–1.30; anesthesia duration [in minutes]: OR, 1.14, 95% CI, 1.05–1.24; and tidal volume [in milliliters per kilogram of predicted body weight]: OR, 1.12, 95% CI, 1.01–1.24) factors. CONCLUSIONS AND RELEVANCE Postoperative pulmonary complications are common in patients with American Society of Anesthesiologists physical status 3, despite current protective ventilation practices. Even mild PPCs are associated with increased early postoperative mortality, ICU admission, and length of stay (ICU and hospital). Mild frequent PPCs (eg, atelectasis and prolonged oxygen therapy need) deserve increased attention and intervention for improving perioperative outcomes.

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Section: Discussionsupporting

confidence: 94%

Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery

et al. 2017

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“…According to the literature data atelectasis in the pulmonary tissue are formed mainly during intraoperative and in the early postoperative period (14,15). Resolving atelectasis in the lungs after cardiac surgery often takes several weeks.…”

Section: Discussionmentioning

confidence: 99%

Recovery of Respiratory Function After Coronary Artery Bypass Graft Surgery Using Pep-Therapy

Мамалыга

Лобачева

Alshibaya

2018

Multidiscip Cardio Annal

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Background: Bronchopulmonary complications after CABG remain one of the main reasons for the increase in hospital mortality. A number of works showed the effectiveness of using PEEP-therapy and oPEEP-therapy in pulmonary pathology. However there was no direct comparison of the effectiveness of these methodic approaches in cardiac surgery patients. Objective: Due to this, the study objective was to study the effectiveness of recovery of respiratory parameters after coronary artery bypass graft using different device methods: PEEP-therapy and vibration PEEP-therapy. Methods: We studied 45 patients who underwent CABG. Patients were divided into 3 groups: Group I (control) -incentive spirometry was not performed after surgery, group II -PEEP-therapy was performed with EzPAP (USA), group III -oPEEP-therapy was performed with Acapella device (USA). Spirometry test was performed using device SMP-2101-RD (Russia). Results: Studies showed, that on the second day post-surgery in groups I, II and III vital capacity decreases by 42%, 35%, 34% (P < 0.01), and forced vital capacity -by 46%, 32%, 35% (P < 0.01) respectively. In patients of all studied groups there is detected statistically significant decrease of PFER, AFER 25 -75, MFER 25, MFER 50, MFER 75. On day five after surgery in the patients of second group vital capacity and forced vital capacity reached pre-surgery level, while in the group I these parameters decreased by 31% and 34%, and in group III -by 25% and 26% respectively. On the ninth day after surgery vital capacity and forced vital capacity in groups II and III reached pre-surgery level, while in group I these values remained decreased by 28%, 32%, respectively. Conclusions: Carrying out PEEP therapy after coronary artery bypass surgery with EzPAP incentive spirometer allows the restoration of volumetric and velocity respiratory values at the moment of patient discharge from the hospital, whereas after vibrational PEEP therapy the Acapella device restores only volumetric values, and in the patients of the control group, recovery does not occur.

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“…For example, ARISCAT (Assess Respiratory Risk in Surgical Patients in Catalonia) uses age, preoperative O 2 saturation, surgical incision (upper abdomen or thoracic), duration of surgery, and other clinical risks (eg, anemia, recent respiratory infection, or emergency surgery). 12 There are no prospective studies on the utilization of preoperative risk scores to direct the application of enhanced monitoring.…”

Section: Risk Factors For Respiratory Compromisementioning

confidence: 99%

Respiratory Monitoring in General Care Units

Lamberti

2020

Respir Care

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Respiratory compromise is a common and potentially dangerous complication of patients admitted to general care units of hospitals. There are several distinct and disparate pathophysiologic trajectories of respiratory deterioration that hospitalized patients may suffer. Obstructive sleep apnea and preexisting cardiopulmonary disease increase the risk of respiratory failure after major surgery. Patients in general care units of hospitals currently receive only intermittent monitoring of vital signs. Early warning systems that utilize analysis of intermittently collected vital signs may result in earlier recognition of clinical deterioration. Continuous monitoring of oximetry and capnography may allow the detection of pathophysiologic abnormalities earlier in patients in general care units, but the evidence for improved clinical outcomes remains weak. Increased monitoring may lead to increased monitor alarms that can have negative effects on patient care.

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Postoperative respiratory failure

Cited by 76 publications

References 53 publications

Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery

Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery

Recovery of Respiratory Function After Coronary Artery Bypass Graft Surgery Using Pep-Therapy

Respiratory Monitoring in General Care Units

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