Atelectasis and perioperative pulmonary complications in high-risk patients

Tusman, Gerardo; Böhm, Stephan H.; Warner, David O.; Šprung, Juraj

doi:10.1097/aco.0b013e32834dd1eb

Cited by 179 publications

(134 citation statements)

References 119 publications

Supporting

Mentioning

111

Contrasting

Unclassified

Order By: Relevance

“…These interventions are especially beneficial for preventing atelectasis (80.5% of all PPCs in the present study) progressing to more severe forms of PPCs. 15 In addition, LAG is associated with lower rates of postoperative pain than open gastrectomy, which can improve patients' compliance with chest physical therapy. Thus, such a beneficial effect may be accelerated.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] Surgery involving incision sites near the diaphragm causes a reduction in the vital capacity and limits diaphragmatic motion, thereby resulting in alveolar collapse, early airway closure, ventilation/ perfusion abnormalities, decreased mucus clearance and increased bacterial colonization. 15 All of these mechanisms contribute to the development of PPCs.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Is routine preoperative spirometry necessary in elderly patients undergoing laparoscopy-assisted gastrectomy?

et al. 2013

View full text Add to dashboard Cite

Objectives: To identify predictors of postoperative pulmonary complications (PPCs) in patients aged !60 years who underwent laparoscopy-assisted gastrectomy (LAG), and to examine the value of preoperative spirometry to predict PPCs. Methods: Patients with preoperative spirometric results who underwent LAG were retrospectively studied. Spirometry included four parameters: forced expiratory volume in 1 s; functional vital capacity; mean forced expiratory flow during middle of functional vital capacity; peak expiratory flow rate. Results: Of 213 patients, overall incidence of PPCs was 19.2%. Abnormal spirometry findings were not identified as an independent predictor of PPCs using multivariate logistic regression analysis. Age was found to be the only independent predictor of PPCs out of all variables evaluated. Separate assessment of individual spirometric parameters using receiver-operating curve analyses indicated poor diagnostic accuracy. Conclusions: Preoperative spirometry was not reliably predictive of PPCs, either as combined or individual parameters, in patients aged !60 years who underwent LAG. These results do not support routine use of spirometry to stratify risk of PPCs in this surgical population.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Is routine preoperative spirometry necessary in elderly patients undergoing laparoscopy-assisted gastrectomy?

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Th e presence of atelectasis is an important factor in the pathogenesis of postoperative pulmonary complications, such as hypoxemia, pulmonary infections and local infl ammatory response [18]. Postoperative pulmonary complications in the fi rst hours after surgery are mainly due to atelectasis in the dependent regions of the lungs.…”

Section: Rationale For Lung-protective Ventilation During General Anementioning

confidence: 99%

Protective Lung Ventilation During General Anesthesia: Is There Any Evidence?

Coppola¹,

Froio²,

Chiumello³

2014

Annual Update in Intensive Care and Emergency Medicine 2014

View full text Add to dashboard Cite

IntroductionIn acute respiratory distress syndrome (ARDS) several studies have shown that mechanical ventilation with high tidal volume (V T ) and low levels of positive endexpiratory pressure (PEEP) can promote ventilatorinduced lung injury (VILI), thus increasing morbidity and mortality [1]. An open lung strategy, combining the use of low V T with adequate PEEP levels and recruitment maneuvers, has thus been recommended in ARDS patients [2]-[4]. In patients without ARDS admitted to intensive care units (ICUs), who required mechanical ventilation for at least 12 hours, the use of a high V T signifi cantly increased the infl ammatory response [5], [6]. In contrast to critically ill patients, during general anesthesia, mechanical ventilation is required only for a few hours, thus the benefi cial eff ects of lung-protective ventilation remain questionable. Moreover, there are limited data from few randomized controlled trials with only small cohorts of enrolled patients.Two recent meta-analyses that enrolled patients from ICUs and the operating room (OR) showed that lungprotective ventilation was associated with lower mortality and postoperative complications [2], [7]. However, there are no recommendations regarding optimal ventilatory strategies in patients without lung injury during general anesthesia.In the present article, we provide a comprehensive picture of the current literature on lung-protective ventilation during general anesthesia in patients without ARDS, focusing on the applications of this strategy in patients undergoing abdominal, thoracic and cardiac surgery. How mechanical ventilation is applied in the operating roomAlthough the protective ventilation approach may be benefi cial in a broader population with and without ARDS, the use of high V T without PEEP is still common during general anesthesia. A large French multicenter observational study, in which more than 2,900 patients undergoing general anesthesia were enrolled, showed that 18 % of patients were ventilated with a V T greater than 10 ml/kg body weight and 81 % without PEEP [8]. Moreover, a recruitment maneuver was applied in only 7 % of patients.Similarly a 5-year observational study, in which 45,575 patients were enrolled, reported that although use of a V T less than 10 ml/kg and PEEP levels greater than 5 cmH 2 O increased progressively over time, 16-18 % of patients continued to receive a V T greater than 10 ml/kg without application of PEEP [9]. Th e presence of obesity and a short height were the main risk factors for receiving a large V T during prolonged anesthesia [10]. Rationale for lung-protective ventilation during general anesthesiaGeneral anesthesia aff ects lung function primarily because of the loss of muscle tone, which promotes a reduction in lung volume, an alteration in ventilationperfusion ratio and the onset of lung atelectasis. Th e development of atelectasis is very common and occurs in more than 90 % of subjects undergoing general anesthesia [11], [12]. Atelectasis is mainly due to three basic mechanisms [13], ...

show abstract

“…Physiotherapy aims to address well-known pathophysiological effects of abdominal surgery on the respiratory system including atelectasis (Duggan and Kavanagh 2005, Hedenstierna and Edmark 2010, Tusman et al 2012, reduced muco-ciliary clearance (Bilgi et al 2011, Gamsu et al 1976, Konrad et al 1993, diaphragm dysfunction (Blaney and Sawyer 1997, Ford et al 1983, Kim et al 2010, reduced lung volumes (Cheifetz et al 2010, Fagevik Olsén et al 2009, Stock et al 1985 and reduced respiratory muscle and cough strength (Barbalho-Moulim et al 2011, Bellinetti andThomson 2006, Kulkarni et al 2010). It is hypothesised that combinations of these factors can lead to bacterial proliferation in the airways and/or severe atelectasis (Smith and Ellis 2000), increasing the risk of infection and PPCs.…”

Section: Physiotherapy Management For Patients Undergoing Abdominal Smentioning

confidence: 99%

The physiotherapy management of patients undergoing abdominal surgery

Reeve¹,

Boden²

2016

NZJP

View full text Add to dashboard Cite

Abdominal surgery is performed to remove cancerous tissue, to resolve visceral tissue perforations or to remove inflammatory bowel segments, benign growths or vascular aneurysms. Postoperative complications, including pulmonary complications, are common following abdominal surgery and physiotherapy aims to prevent and treat many of these complications. Much of the literature investigating physiotherapy interventions is over a decade old and advances in surgery, including minimally invasive surgery and fast track pathways, require physiotherapists to re-evaluate their practices. This narrative review aims to examine the evidence investigating the effectiveness of physiotherapy interventions and apply this to contemporary surgical practices. Recommendations for practice and research are outlined.

show abstract

Atelectasis and perioperative pulmonary complications in high-risk patients

Abstract: A goal-directed ventilatory approach keeping an 'open lung' condition during the perioperative period may reduce the incidence of PPCs.

Cited by 179 publications

References 119 publications

Is routine preoperative spirometry necessary in elderly patients undergoing laparoscopy-assisted gastrectomy?

Is routine preoperative spirometry necessary in elderly patients undergoing laparoscopy-assisted gastrectomy?

Protective Lung Ventilation During General Anesthesia: Is There Any Evidence?

The physiotherapy management of patients undergoing abdominal surgery

Contact Info

Product

Resources

About