Respiratory complications after major surgery

Ferreyra, Gabriela; Long, Yun; Ranieri, V. Marco

doi:10.1097/mcc.0b013e32832e0669

Cited by 95 publications

(68 citation statements)

References 70 publications

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“…Despite technical improvements and advances in perioperative care, major abdominal operations are still associated with a high rate of severe complications, long‐term disability, and health and social costs3, 4, 5, 6, 7. Moreover, the likelihood of successfully rescuing patients from surgery‐related morbidity is still unpredictable.…”

Section: Introductionmentioning

confidence: 99%

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

et al. 2017

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BackgroundFrailty is associated with poor prognosis, but the multitude of definitions and scales of assessment makes the impact on outcomes difficult to assess. The aim of this study was to quantify the effect of frailty on postoperative morbidity and mortality, and long‐term mortality after major abdominal surgery, and to evaluate the performance of different frailty metrics.MethodsAn extended literature search was performed to retrieve all original articles investigating whether frailty could affect outcomes after elective major abdominal surgery in adult populations. All possible definitions of frailty were considered. A random‐effects meta‐analysis was carried out for all outcomes of interest. For postoperative morbidity and mortality, overall effect sizes were estimated as odds ratios (OR), whereas the hazard ratio (HR) was calculated for long‐term mortality. The potential effect of the number of domains of the frailty indices was explored through meta‐regression at moderator analysis.ResultsA total of 35 studies with 1 153 684 patients were analysed. Frailty was associated with a significantly increased risk of postoperative major morbidity (OR 2·56, 95 per cent c.i. 2·08 to 3·16), short‐term mortality (OR 5·77, 4·41 to 7·55) and long‐term mortality (HR 2·71, 1·63 to 4·49). All domains were significantly associated with the occurrence of postoperative major morbidity, with ORs ranging from 1·09 (1·00 to 1·18) for co‐morbidity to 2·52 (1·32 to 4·80) for sarcopenia. No moderator effect was observed according to the number of frailty components.ConclusionRegardless of the definition and combination of domains, frailty was significantly associated with an increased risk of postoperative morbidity and mortality after major abdominal surgery.

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Section: Introductionmentioning

confidence: 99%

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

et al. 2017

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“…Patients on NHF had significantly fewer desaturations and succeeded more in their allocated therapy, with less need for NIV or intubation, although respiratory (SpO 2 , respiratory rate and forced expiratory volume in 1 s) and cardiovascular (systolic and diastolic arterial pressure and heart rate) variables did not differ between groups. Positive airway pressure, enabling the recruitment of atelectatic lung areas, along with facilitation of mucociliary clearance by the heated and humidified gas administered by NHF, were the possible key features that improved overall treatment effectiveness in both studies [25,45], given that atelectasis is the more common respiratory complication after surgery, presenting in 90% of patients undergoing general anaesthesia [42]. The specific mechanisms of benefits of NHF on post-surgical respiratory complications were studied further by CORLEY et al [5] and it was found that NHF compared to low-flow oxygen on post-cardiac surgery patients significantly increased mean airway pressure by 3.0 cmH 2 O, tidal volume by 10.5% and EELV by 25.6%, regardless of whether they breathed with the mouth open or closed.…”

Section: No Benefitmentioning

confidence: 99%

“…Post-extubation following surgery Benefit Respiratory complications play a significant role after major surgery, and can determine morbidity and mortality and substantially increase healthcare cost [42,43]. Traditionally, low-and high-flow oxygen systems have been used to reverse post-surgical respiratory complications.…”

Section: No Benefitmentioning

confidence: 99%

Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

2017

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Nasal high flow is a promising novel oxygen delivery device, whose mechanisms of action offer some beneficial effects over conventional oxygen systems. The administration of a high flow of heated and humidified gas mixture promotes higher and more stable inspiratory oxygen fraction values, decreases anatomical dead space and generates a positive airway pressure that can reduce the work of breathing and enhance patient comfort and tolerance. Nasal high flow has been used as a prophylactic tool or as a treatment device mostly in patients with acute hypoxaemic respiratory failure, with the majority of studies showing positive results. Recently, its clinical indications have been expanded to post-extubated patients in intensive care or following surgery, for pre-and peri-oxygenation during intubation, during bronchoscopy, in immunocompromised patients and in patients with "do not intubate" status. In the present review, we differentiate studies that suggest an advantage (benefit) from other studies that do not suggest an advantage (no benefit) compared to conventional oxygen devices or noninvasive ventilation, and propose an algorithm in cases of nasal high flow application in patients with acute hypoxaemic respiratory failure of almost any cause.

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“…Atelektazi gelişimi akciğer kompliyansında azalmayla birlikte ventilasyon-perfüzyon bozukluğu, şantlar, gaz değişi-minde bozulma ve pulmoner vasküler dirençte artma sonucu ciddi hipoksemilere neden olur. Ayrıca, oksijenizasyonda bozulma ve akciğer permeabilitesinde artma sonucu akut akciğer hasarına neden olabilir (13 na geçişte artış sonucu infeksiyonlara zemin hazırlar (14). Atelektazi dışında koroner arter by-pass cerrahisi veya akciğer rezeksiyonları sonucu doğrudan akciğer hasarına bağlı oluşan akut akciğer hasarı ve akut solunum sıkıntısı sendromu (ARDS), pulmoner emboli, çe-şitli ilaçlar veya inflamatuvar mediyatörler sonucu oluşan bronkospazm, aspirasyon pnömonisi, pnömoto-raks, akciğer ödemi ve frenik sinir zedelenmesine bağ-lı gelişen diyafram disfonksiyonu, POSY'nin diğer nedenleri arasında sayılabilir (11,13) (Şekil 1).…”

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The effect of non-invasive mechanical ventilation in postoperative respiratory failure

Özyılmaz

Kaya²

2012

Tuberk Toraks

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Respiratory complications after major surgery

Cited by 95 publications

References 70 publications

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

The effect of non-invasive mechanical ventilation in postoperative respiratory failure

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