Place de la réanimation après chirurgie thoracique

Fontana, V Perez; Coureau, Michelle; Grigoriu, Bogdan; Tamburini, Nicola; Lemaı̂tre, Jean; Meert, Anne-Pascale

doi:10.1016/j.rmr.2021.12.006

Cited by 2 publications

(2 citation statements)

References 111 publications

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“…Though this reduced ICU admission rate was due to implementation of a hospital policy rather than a change in patients’ clinical condition, it is still an important finding and discussion point of this study, Thoracic ERAS protocols attempt to implement best practices in a standardized fashion. Current data supports that preventative ICU level care after thoracic surgery does not benefit patients in the absence of immediate complications ( 18 , 19 ). When we began routinely send patients to the floor instead of the PACU for observation overnight, there was no significant difference in complication rates and our overall LOS was reduced.…”

Section: Discussionmentioning

confidence: 85%

Enhanced recovery after surgery pathway leads to decreased length of stay for patients undergoing minimally invasive lung resection

Fryer,

Palleiko,

Emmerick

et al. 2024

J Thorac Dis

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Background Enhanced recovery after surgery (ERAS) protocols in thoracic surgery have been demonstrated to impact length of stay (LOS), complication rates, and postoperative opioid use. However, ERAS protocols for minimally invasive lung resections have not been well described. Given most lung resections are now performed minimally invasively, there is a gap in the literature regarding the efficacy of ERAS protocols in this setting. In this study, we analyzed patient outcomes following implementation of an ERAS protocol for minimally invasive lung resections. Methods Outcome data was retrospectively collected for 442 patients undergoing minimally invasive lung resections between January 1 st , 2015 and October 26 th , 2021. Patients were divided into either a pre-ERAS (n=193) or ERAS (n=249) group. Primary outcomes included LOS, postoperative complications, intensive care unit (ICU) admission status, 30-day hospital readmissions, and 30-day mortality. Secondary outcomes included common postoperative complications required for the Society for Thoracic Surgeons (STS) database. Results We observed an overall decrease in median LOS (4.0 vs. 3.0 days, P=0.030) and ICU admission status (15% vs. 7.6%, P=0.020) after implementation of our ERAS protocol. The difference in LOS was significantly lower for anatomic lung resections, but not non-anatomic resections. There was no difference in 30-day readmissions and a 0% mortality rate in both groups. Overall, there was a low complication rate that was similar between groups. Conclusions The implementation of an ERAS protocol led to decreased LOS and decreased ICU admission in patients undergoing minimally invasive lung resection. Process standardization optimizes performance by providers by decreasing decision fatigue and improving decision making, which may contribute to the improved outcomes observed in this study.

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Section: Discussionmentioning

confidence: 85%

Enhanced recovery after surgery pathway leads to decreased length of stay for patients undergoing minimally invasive lung resection

Fryer,

Palleiko,

Emmerick

et al. 2024

J Thorac Dis

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“…Основною причиною постторакотомічних ускладнень є респіраторні ускладнення, але оскільки виконання торакотомії можливе лише за умови проведення загальної анестезії, частота ускладнень у післяопераційний період залежить від періопераційного анестезіологічного забезпечення. Поява в пацієнтів небажаних явищ у вигляді нудоти, гіпотензії або седативного ефекту призводить до збільшення тривалості перебування у відділенні інтенсивної терапії, що підвищує ризик приєднання бактеріальної флори, розвитку пневмонії та інших ускладнень [23,24].…”

Section: обговоренняunclassified

Frequency of opioids prescribing in the postoperative period and ways to reduce their need

Poniatovska,

Dubrov

2023

Ukr. ìnterv. nejroradìol. hìr.

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Objective ‒ to explore the need for additional analgesia during surgical interventions on the respiratory organs, by evaluating the consumption of opioids in the postoperative period.Materials and methods. The data of 157 patients, who underwent open surgery for lung cancer were analyzed. Patients were divided into four groups: Multimodal analgesia group (n=39): 1000 mg of paracetamol IV 1 hour before the incision, as well as IV administration of dexketoprofen 50 mg, in the postoperative period dexketoprofen and paracetamol were administered every 8 hours with epidural analgesia using ropivacaine 2 mg/ml (3‒14 mL/h). Thoracic epidural analgesia group (n=37): epidural analgesia: in the postoperative period – ropivacaine 2 mg/ml (3‒14 mL/h). Preemptive analgesia group (n=41): according to the concept of preemptive analgesia ‒ 1000 mg of paracetamol IV 1 hour before the incision, as well as IV administration of dexketoprofen 50 mg, in the postoperative period ‒ dexketoprofen and paracetamol were administered every 8 hours. Control group (n=40): patients received dexketoprofen 50 mg and, if necessary, an opioid analgesic. Pain syndrome was assessed using a visual analog scale from 0‒100 mm.Results. The lowest average dose of morphine consumption was not statistically significantly different in the multimodal analgesia and preemptive analgesia groups (p=0.933), and was significantly lower than in the control and thoracic epidural analgesia groups.Conclusions. The use of a preventive approach to perioperative analgesia in thoracic surgery, which involves the use of paracetamol and dexketoprofen, is not statistically significantly different in terms of pain indicators and the dose and number of morphine prescriptions compared to intravenous administration of paracetamol and dexketoprofen in combination with epidural ropivacaine analgesia (p>0.05).

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Place de la réanimation après chirurgie thoracique

Cited by 2 publications

References 111 publications

Enhanced recovery after surgery pathway leads to decreased length of stay for patients undergoing minimally invasive lung resection

Enhanced recovery after surgery pathway leads to decreased length of stay for patients undergoing minimally invasive lung resection

Frequency of opioids prescribing in the postoperative period and ways to reduce their need

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