Ventilator-Associated Events

Weinberger, Jeremy; Cocoros, Noelle M

doi:10.1016/j.idc.2021.07.005

Cited by 19 publications

(10 citation statements)

References 125 publications

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“…In the present study, we noted significant alterations in respiratory mechanics among patients undergoing robot-assisted procedures, specifically increased airway pressures and diminished lung compliance. These changes coincide with the established high-risk factors for ventilator-associated lung injury (VALI) such as elevated airway pressures and high tidal volumes [ 13 ]. We observed notable impairments in diaphragmatic movement after surgery, a failure to return to baseline levels in a short term, and a significant rise in serum markers of lung injury.…”

Section: Discussionmentioning

confidence: 70%

The effects of robot-assisted laparoscopic surgery with Trendelenburg position on short-term postoperative respiratory diaphragmatic function

Xue,

Wang,

et al. 2024

BMC Anesthesiol

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Objective To study how Pneumoperitoneum under Trendelenburg position for robot-assisted laparoscopic surgery impact the perioperative respiratory parameters, diagrammatic function, etc. Methods Patients undergoing robot-assisted laparoscopic surgery in the Trendelenburg position and patients undergoing general surgery in the supine position were selected. The subjects were divided into two groups according to the type of surgery: robot-assisted surgery group and general surgery group. ① Respiratory parameters such as lung compliance, oxygenation index, and airway pressure were recorded at 5 min after intubation, 1 and 2 h after pneumoperitoneum. ② Diaphragm excursion (DE) and diaphragm thickening fraction (DTF) were recorded before entering the operating room (T1), immediately after extubation (T2), 10 min after extubation (T3), and upon leaving the postanesthesia care unit (T4). ③ Peripheral venous blood (5 ml) was collected before surgery and 30 min after extubation and was analyzed by enzyme-linked immunosorbent assay to determine the serum concentration of Clara cell secretory protein 16 (CC16) and surfactant protein D (SP-D). Result ① Compared with the general surgery group (N = 42), the robot-assisted surgery group (N = 46) presented a significantly higher airway pressure and lower lung compliance during the surgery(P < 0.001). ② In the robot-assisted surgery group, the DE significantly decreased after surgery (P < 0.001), which persisted until patients were discharged from the PACU (P < 0.001), whereas the DTF only showed a transient decrease postoperatively (P < 0.001) and returned to its preoperative levels at discharge (P = 0.115). In the general surgery group, the DE showed a transient decrease after surgery(P = 0.011) which recovered to the preoperative levels at discharge (P = 1). No significant difference in the DTF was observed among T1, T2, T3, and T4. ③ Both the general and robot-assisted surgery reduced the postoperative serum levels of SP-D (P < 0.05), while the robot-assisted surgery increased the postoperative levels of CC16 (P < 0.001). Conclusion Robot-assisted laparoscopic surgery significantly impairs postoperative diaphragm function, which does not recover to preoperative levels at PACU discharge. Elevated levels of serum CC16 after surgery suggest potential lung injury. The adverse effects may be attributed to the prolonged Trendelenburg position and pneumoperitoneum during laparoscopic surgery.

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Section: Discussionmentioning

confidence: 70%

The effects of robot-assisted laparoscopic surgery with Trendelenburg position on short-term postoperative respiratory diaphragmatic function

Xue,

Wang,

et al. 2024

BMC Anesthesiol

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“…Die Wirksamkeit der Einführung von VAP-Bündeln wurde in einem systemischen Review bestätigt. Teilweise konnten die VAP-Raten signifikant um mehr als 65% nach Interventionsbeginn gesenkt werden [1,2,3].…”

Section: Einführung Von Infektionspräventiven "Bündeln"unclassified

“…Profunde Kenntnisse über die einzelnen Präventionsbestandteile eines Bündels können dazu beitragen, die Compliance bei der Umsetzung zu verbessern [1,2]. Die Rückmeldung der Surveillance-Ergebnisse kann die Motivation steigern und erhält das Bewusstsein für die Wichtigkeit des Themas.…”

Section: Personalschulungen Und Regelmäßige Fortbildungunclassified

Nosokomiale Pneumonien – Teil 2: Präventionsmaßnahmen

Großmann,

Schulz-Stübner

2024

Krankenhaushygiene up2date

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“…Deep sedation prolongs mechanical ventilation (and inevitably patient immobilization) as well as ICU stay [10–12]. Prolonged ventilation could increase complications such as ventilator-associated pneumonia and ICU-acquired weakness [13,14]. Several recent studies found links between adverse brain states (burst suppression, coma) and mortality [15 ▪ ,16 ▪ ].…”

Section: Introductionmentioning

confidence: 99%

Monitoring of sedation in mechanically ventilated patients using remote technology

Hanidziar

Westover

2022

Current Opinion in Critical Care

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Purpose of reviewTwo years of coronavirus disease 2019 (COVID-19) pandemic highlighted that excessive sedation in the ICU leading to coma and other adverse outcomes remains pervasive. There is a need to improve monitoring and management of sedation in mechanically ventilated patients. Remote technologies that are based on automated analysis of electroencephalogram (EEG) could enhance standard care and alert clinicians real-time when severe EEG suppression or other abnormal brain states are detected.Recent findingsHigh rates of drug-induced coma as well as delirium were found in several large cohorts of mechanically ventilated patients with COVID-19 pneumonia. In patients with acute respiratory distress syndrome, high doses of sedatives comparable to general anesthesia have been commonly administered without defined EEG endpoints. Continuous limited-channel EEG can reveal pathologic brain states such as burst suppression, that cannot be diagnosed by neurological examination alone. Recent studies documented that machine learning-based analysis of continuous EEG signal is feasible and that this approach can identify burst suppression as well as delirium with high specificity.SummaryPreventing oversedation in the ICU remains a challenge. Continuous monitoring of EEG activity, automated EEG analysis, and generation of alerts to clinicians may reduce drug-induced coma and potentially improve patient outcomes.

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Ventilator-Associated Events

Cited by 19 publications

References 125 publications

The effects of robot-assisted laparoscopic surgery with Trendelenburg position on short-term postoperative respiratory diaphragmatic function

The effects of robot-assisted laparoscopic surgery with Trendelenburg position on short-term postoperative respiratory diaphragmatic function

Nosokomiale Pneumonien – Teil 2: Präventionsmaßnahmen

Monitoring of sedation in mechanically ventilated patients using remote technology

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