The Acute Stress Reaction to Major Thoracic Surgery

Cagini, Lucio; Vannucci, Jacopo; Scialpi, Michele; Puma, Francesco

doi:10.5772/54667

Cited by 2 publications

(1 citation statement)

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“…Finally, patients submitted to major surgical resections had, on average, larger A/C increases, compared to those undergoing minor resections. The implications of our results in pulmonary resection settings could be that the increased systemic and pulmonary capillary permeability to plasma proteins, fluids and sodium, leads to water retention and widespread interstitial oedema, as previously suggested . Specifically, lung oedema might impair gas exchange and tissue oxygenation leading to pulmonary congestion .…”

Section: Discussionsupporting

confidence: 64%

Microalbuminuria assessment after thoracic surgery: Early identification of complication risks

Cagini

Andolfi

Potenza

et al. 2020

Clinical Respiratory J

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Introduction: Microalbuminuria (MA) is considered a reflection of systemic capillary leak and an early marker of acute stress reaction to the surgical insult, proportional to the severity of the initiating condition and predictive of the individual response to surgical stress. Objectives: We conducted a prospective study to assess for the variation of MA within 4 days after thoracic surgery. We correlated observed MA levels with both their respective PaO 2 /FiO 2 respiratory ratio and the onset of postoperative complications. Methods: This single-centre study enrolled 255 consecutive patients having an American Society of Anaesthesiologists (ASA) score ≤ 3. The mean age was 62 years with 67% male. All patients were scheduled for elective pulmonary resection. MA was measured in urine samples as the albumin-to-creatinine ratio (A/C), prior to, at and after extubation up to 96 hours. PaO 2 /FiO 2 was measured at extubation and on the first postoperative day. Results: Overall, preoperative A/C levels resulted normal, with a significant average increase at extubation which peaked 6 hours later (P < 0.001). Larger postoperative A/C increases were observed in patients who developed postoperative complications, compared to those without these complications (P < 0.019). Moreover, patients undergoing major open pulmonary resections had larger postoperative A/C increases, compared to those undergoing minor video-assisted thoracic surgery resections (P < 0.006). At the time of extubation, A/C was inversely related to the PaO 2 /FiO 2 ratio (r = −0.25; P = 0.038). Peak A/C > 61 mg/g (P = 0.0003) was associated with postoperative cardio-pulmonary complications (OR 3.85; P = 0.003). Conclusion: Within 6 hours after extubation, MA assessment may be a rapid and relatively inexpensive method for better predicting perioperative risk in an ASA score ≤ 3 population. K E Y W O R D S albuminuria, perioperative care, postoperative complications, systemic inflammatory response syndrome, thoracic surgical procedures How to cite this article: Cagini L, Andolfi M, Potenza R, et al. Microalbuminuria assessment after thoracic surgery: Early identification of complication risks. Clin Respir J. 2020;14:564-570. https://doi.

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Section: Discussionsupporting

confidence: 64%