How to identify a high-risk surgical patient?

Schmidt, André; Stefani, Luciana Cadore

doi:10.1016/j.bjane.2022.04.002

Cited by 5 publications

(4 citation statements)

References 24 publications

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“…In the realm of high-risk surgeries, where extended operative durations, significant fluid shifts [18], and heightened inflammatory responses prevail [19], meticulous attention is warranted. High-risk surgeries encompass complex procedures such as major abdominal surgeries, cardiac surgeries, and thoracic surgeries [20]. Candidates for these procedures, due to the physiological stress imposed by such surgeries, are more susceptible to lung injuries, making meticulous ventilation strategies particularly vital [21 ▪ ].…”

Section: Patients Subgroupsmentioning

confidence: 99%

Intraoperative lung protection: strategies and their impact on outcomes

Simonte,

Cammarota,

De Robertis

2024

Current Opinion in Anaesthesiology

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Purpose of review The present review summarizes the current knowledge and the barriers encountered when implementing tailoring lung-protective ventilation strategies to individual patients based on advanced monitoring systems. Recent findings Lung-protective ventilation has become a pivotal component of perioperative care, aiming to enhance patient outcomes and reduce the incidence of postoperative pulmonary complications (PPCs). High-quality research has established the benefits of strategies such as low tidal volume ventilation and low driving pressures. Debate is still ongoing on the most suitable levels of positive end-expiratory pressure (PEEP) and the role of recruitment maneuvers. Adapting PEEP according to patient-specific factors offers potential benefits in maintaining ventilation distribution uniformity, especially in challenging scenarios like pneumoperitoneum and steep Trendelenburg positions. Advanced monitoring systems, which continuously assess patient responses and enable the fine-tuning of ventilation parameters, offer real-time data analytics to predict and prevent impending lung complications. However, their impact on postoperative outcomes, particularly PPCs, is an ongoing area of research. Summary Refining protective lung ventilation is crucial to provide patients with the best possible care during surgery, reduce the incidence of PPCs, and improve their overall surgical journey.

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Section: Patients Subgroupsmentioning

confidence: 99%

Intraoperative lung protection: strategies and their impact on outcomes

Simonte,

Cammarota,

De Robertis

2024

Current Opinion in Anaesthesiology

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“…In patients being considered for surgical removal of their invasive breast tumours, preoperative risk stratification is essential. Various tools such as the American Society of Anaesthesiologists' Physical Status Classification (ASA-PS), Physiological and Operative Severity Score for the enumeration of mortality and morbidity (POSSUM) score, and Revised Cardiac Risk Index (RCRI) [7], among others, are available to assess patients' preoperative risk. In general, high-risk surgical patients are those with an individual mortality risk of greater than 5% [8]; these may include patients with a variety of comorbidities.…”

Section: Introductionmentioning

confidence: 99%

Treatment Options for Early Stage Inoperable Breast Cancer: Cryoablation or Radiotherapy?

Chua,

2024

Breast Care

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Background: Surgical removal of the tumour is the gold standard treatment for early stage invasive breast cancer. However, with a global ageing population, a larger number of diagnoses are occurring in women with comorbidities that render them unsuitable for surgery. Hence, it is of interest to explore alternative treatment strategies for this group of women. Summary: Our narrative review aims to explore two such techniques, cryoablation and external beam radiotherapy, providing a brief summary of the evidence behind each technique. Following this, we discuss which groups of patients would gain the most benefit from each technique. Factors favouring the use of radiotherapy include patients with larger tumours, more superficial tumours, and those with less well-demarcated tumours where there is uncertainty regarding tumour extent. Meanwhile, patients who may benefit more from cryoablation include those who desire a smaller number of treatment sessions, have concerns regarding cosmesis and skin pigmentation, or who have relative contraindications to radiotherapy such as scleroderma, systemic lupus erythematosus, reduced lung function, or cardiac comorbidities. Key Messages: Continued advancements in both cryoablation and radiotherapy technologies are taking place, in tandem with imaging technologies enabling greater certainty in tumour detection and delineation. These factors will help increase local control rates in this group of non-operable early stage breast cancer patients. Through this review, we hope to aid in the clinical decision-making process regarding the selection and referral of patients for each treatment.

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“…Various perioperative risk scoring systems that incorporate patient and surgical factors have been used to aid in the assessment. However, some pitfalls to using them have been identified in the literature [ 5 ]. Most risk scores, for example, are developed for specific target populations and types of surgery and, as a result, have been found to be less predictive and have limited applicability in all settings.…”

Section: Introductionmentioning

confidence: 99%