Effects of recruitment manoeuvre on perioperative pulmonary complications in patients undergoing robotic assisted radical prostatectomy: A randomised single-blinded trial

Choi, Eun Su; Oh, Ah Young; In, Chi Bum; Ryu, Jung Hee; Jeon, Young Tae; Kim, Hyoung Gyun

doi:10.1371/journal.pone.0183311

Cited by 35 publications

(41 citation statements)

References 36 publications

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“…Seven RCTs including a pooled total of 1609 participants investigated the effect of lung protective intraoperative ventilation strategies on PPCs 47484950515253. The definition of lung protective ventilation varied between trials, but for the purposes of analysis we used a single definition of reduced tidal volumes (≤8 mL/kg) and at least 5 cm H 2 O positive end expiratory pressure together with intermittent recruitment manoeuvres.…”

Section: Resultsmentioning

confidence: 99%

“…In total, 18 RCTs investigating different aspects of intraoperative ventilation were identified in this review,474849505152535455565758596061626364 including a pool of 2171 patients. Seven studies were of patients having open abdominal surgery,47495051545664 five were of exclusively minimally invasive surgery (laparoscopic or robotic),5255585960 three were of lung cancer resection surgery (open or thoracoscopic),485761 one was of neurosurgery,62 one was obstetric,53 and one recruited patients from a range of specialties united in having prolonged surgery 63…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis

Odor

Bampoe

Gilhooly

et al. 2020

BMJ

134

120

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OBJECTIVE To identify, appraise, and synthesise the best available evidence on the efficacy of perioperative interventions to reduce postoperative pulmonary complications (PPCs) in adult patients undergoing non-cardiac surgery. DESIGNSystematic review and meta-analysis of randomised controlled trials. DATA SOURCESMedline, Embase, CINHAL, and CENTRAL from January 1990 to December 2017. ELIGIBILITY CRITERIARandomised controlled trials investigating short term, protocolised medical interventions conducted before, during, or after non-cardiac surgery were included. Trials with clinical diagnostic criteria for PPC outcomes were included. Studies of surgical technique or physiological or biochemical outcomes were excluded. DATA EXTRACTION AND SYNTHESISReviewers independently identified studies, extracted data, and assessed the quality of evidence. Metaanalyses were conducted to calculate risk ratios with 95% confidence intervals. Quality of evidence was summarised in accordance with GRADE methods. The primary outcome was the incidence of PPCs. Secondary outcomes were respiratory infection, atelectasis, length of hospital stay, and mortality. Trial sequential analysis was used to investigate the reliability and conclusiveness of available evidence. Adverse effects of interventions were not measured or compared. RESULTS117 trials enrolled 21 940 participants, investigating 11 categories of intervention. 95 randomised controlled trials enrolling 18 062 participants were included in meta-analysis; 22 trials were excluded from meta-analysis because the interventions were not sufficiently similar to be pooled. No high quality evidence was found for interventions to reduce the primary outcome (incidence of PPCs). Seven interventions had low or moderate quality evidence with confidence intervals indicating a probable reduction in PPCs: enhanced recovery pathways (risk ratio 0.35, 95% confidence interval 0.21 to 0.58), prophylactic mucolytics (0.40, 0.23 to 0.67), postoperative continuous positive airway pressure ventilation (0.49, 0.24 to 0.99), lung protective intraoperative ventilation (0.52, 0.30 to 0.88), prophylactic respiratory physiotherapy (0.55, 0.32 to 0.93), epidural analgesia (0.77, 0.65 to 0.92), and goal directed haemodynamic therapy (0.87, 0.77 to 0.98). Moderate quality evidence showed no benefit for incentive spirometry in preventing PPCs. Trial sequential analysis adjustment confidently supported a relative risk reduction of 25% in PPCs for prophylactic respiratory physiotherapy, epidural analgesia, enhanced recovery pathways, and goal directed haemodynamic therapies. Insufficient data were available to support or refute equivalent relative risk reductions for other interventions. CONCLUSIONSPredominantly low quality evidence favours multiple perioperative PPC reduction strategies. Clinicians may choose to reassess their perioperative care pathways, but the results indicate that new trials with a low risk of bias are needed to obtain conclusive evidence of efficacy for many of these interventions. STUDY REGIS...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis

Odor

Bampoe

Gilhooly

et al. 2020

BMJ

134

120

View full text Add to dashboard Cite

show abstract

“…Compared with the use of zero PEEP or PEEP alone, recruitment maneuvers have been shown to increase end expiratory lung volume, improve compliance, and reduce chest wall elastance during laparoscopic surgery 67686970. Investigators have shown that recruitment maneuvers lead to improved intraoperative oxygenation in abdominal surgery, thoracic surgery with OLV, post-cardiopulmonary bypass, and procedures requiring Trendelenberg positioning 71727374757677. These benefits are unfortunately short lived, as atelectasis is thought to recur within 40 minutes 78…”

Section: Evidence Based Strategies For Perioperative Lung Protective mentioning

confidence: 99%

Perioperative lung protective ventilation

O’Gara

Talmor

2018

BMJ

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Perioperative lung injury is a major source of postoperative morbidity, excess healthcare use, and avoidable mortality. Many potential inciting factors can lead to this condition, including intraoperative ventilator induced lung injury. Questions exist as to whether protective ventilation strategies used in the intensive care unit for patients with acute respiratory distress syndrome are equally beneficial for surgical patients, most of whom do not present with any pre-existing lung pathology. Studied both individually and in combination as a package of intraoperative lung protective ventilation, the use of low tidal volumes, moderate positive end expiratory pressure, and recruitment maneuvers have been shown to improve oxygenation and pulmonary physiology and to reduce postoperative pulmonary complications in at risk patient groups. Further work is needed to define the potential contributions of alternative ventilator strategies, limiting excessive intraoperative oxygen supplementation, use of non-invasive techniques in the postoperative period, and personalized mechanical ventilation. Although the weight of evidence strongly suggests a role for lung protective ventilation in moderate risk patient groups, definitive evidence of its benefit for the general surgical population does not exist. However, given the shift in understanding of what is needed for adequate oxygenation and ventilation under anesthesia, the largely historical arguments against the use of intraoperative lung protective ventilation may soon be outdated, on the basis of its expanding track record of safety and efficacy in multiple settings.

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“…These include raised airway pressure with atelectasis, cerebral and facial oedema, raised intra-ocular pressure, and traction on lower limbs with neuropraxia. 10,11 No documented cases of these complications were noted in this cohort of patients.…”

Section: Surgical Techniquementioning

confidence: 71%

The first series of laparoscopic radical cystectomies done in South Africa

et al. 2018

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Background: Radical cystectomy (RC) with extended lymphadenectomy and urinary diversion remains the standard of care for muscle-invasive urothelial carcinoma. Laparoscopic radical cystectomies (LRC) have been performed at Groote Schuur Hospital (GSH) since 2009. We aimed to audit our data regarding complications and oncological outcome and compare it to data obtained from patients undergoing open radical cystectomy (ORC) by the same surgeon since 2007. Methods: All adult patients who underwent open and laparoscopic RC from 2007 to 2013 have been included in the study. Data on demographics, operative time, intraoperative blood loss, postoperative complications, margin positivity, and lymph nodes was obtained retrospectively by means of folder review. Results: Thirty (30) patients who underwent LRC and 32 who underwent ORC were included in the study. Participants undergoing ORC experienced shorter operative duration (301 minutes versus 382 minutes; p-value < 0.0001), increased blood loss (1376 ml versus 779ml; p-value = 0.0023) and transfusion requirement (2 units versus 0; p-value = 0.071) in contrast to LRC. Postoperative complications were more prevalent in the ORC arm compared to the LRC arm (61% versus 43%). Patients with a past medical history were at higher risk of experiencing postoperative complications (p-value = 0.04; Risk Ratio: 1.6). Margin positivity was comparable between the two arms. A higher number of nodes was sampled by the laparoscopic technique in this study (overall p-value = 0.07). Conclusion: Laparoscopic RC is associated with longer operative times, decreased blood loss, and equivalent oncological outcomes when compared to ORC. Laparoscopic RC is a feasible option in our setting.

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Effects of recruitment manoeuvre on perioperative pulmonary complications in patients undergoing robotic assisted radical prostatectomy: A randomised single-blinded trial

Cited by 35 publications

References 36 publications

Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis

Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis

Perioperative lung protective ventilation

The first series of laparoscopic radical cystectomies done in South Africa

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