Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery

Fernandez-Bustamante, Ana; Frendl, György; Šprung, Juraj; Kor, Daryl J.; Subramaniam, Bala; Ruiz, Ricardo Martinez; Lee, Jae Woo; Henderson, William G.; Moss, Angela; Mehdiratta, Nitin; Colwell, Megan M.; Bartels, Karsten; Kolodzie, Kerstin; Giquel, Jadelis; Melo, Marcos F. Vidal

doi:10.1001/jamasurg.2016.4065

Cited by 398 publications

(361 citation statements)

References 34 publications

Supporting

Mentioning

326

Contrasting

Unclassified

Order By: Relevance

“…Thus, the S1 peak position tended to be over-estimated. Given Equations (7) and (8), it then became plausible that PEP would exhibit more positive and LVET more negative outliers. Compared to the same position and for healthy subjects, the performances reported by Paiva et al were in the same range, whilst slightly higher [30].…”

Section: Discussionmentioning

confidence: 99%

“…Respiratory parameters also play an important role in the clinical, postanesthetic routine. It has been shown that respiratory complications are major causes of prolonged hospital stay, poor overall outcomes, and increased mortality [5][6][7]. Outbreaks of respiratory syndromes such as severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and the currently ongoing COVID-19 pandemic [8] further emphasize the importance of tools for an early diagnosis [9].…”

Section: Clinical Background and State-of-the-artmentioning

confidence: 99%

“…When more than two candidates were found in the window, the peak closest to the R-peak was defined as S1, and the peak closest to the T-wave was defined as S2. After peak detection and classification, the PEP was calculated from the ECG and stethoscope as: PEP(n) = t S1 peak (n) − t Q (n), (7) and the LVET as: LVET(n) = t S2 peak (n) − t S1 peak (n),…”

Section: Pep and Lvet Estimationmentioning

confidence: 99%

See 2 more Smart Citations

Wearable Cardiorespiratory Monitoring Employing a Multimodal Digital Patch Stethoscope: Estimation of ECG, PEP, LVET and Respiration Using a 55 mm Single-Lead ECG and Phonocardiogram

Klum

Tigges

Pielmuş

et al. 2020

Sensors

View full text Add to dashboard Cite

Cardiovascular diseases are the main cause of death worldwide, with sleep disordered breathing being a further aggravating factor. Respiratory illnesses are the third leading cause of death amongst the noncommunicable diseases. The current COVID-19 pandemic, however, also highlights the impact of communicable respiratory syndromes. In the clinical routine, prolonged postanesthetic respiratory instability worsens the patient outcome. Even though early and continuous, long-term cardiorespiratory monitoring has been proposed or even proven to be beneficial in several situations, implementations thereof are sparse. We employed our recently presented, multimodal patch stethoscope to estimate Einthoven electrocardiogram (ECG) Lead I and II from a single 55 mm ECG lead. Using the stethoscope and ECG subsystems, the pre-ejection period (PEP) and left ventricular ejection time (LVET) were estimated. ECG-derived respiration techniques were used in conjunction with a novel, phonocardiogram-derived respiration approach to extract respiratory parameters. Medical-grade references were the SOMNOmedics SOMNO HD TM and Osypka ICON-Core TM . In a study including 10 healthy subjects, we analyzed the performances in the supine, lateral, and prone position. Einthoven I and II estimations yielded correlations exceeding 0.97. LVET and PEP estimation errors were 10% and 21%, respectively. Respiratory rates were estimated with mean absolute errors below 1.2 bpm, and the respiratory signal yielded a correlation of 0.66. We conclude that the estimation of ECG, PEP, LVET, and respiratory parameters is feasible using a wearable, multimodal acquisition device and encourage further research in multimodal signal fusion for respiratory signal estimation.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Clinical Background and State-of-the-artmentioning

confidence: 99%

Section: Pep and Lvet Estimationmentioning

confidence: 99%

See 1 more Smart Citation

Wearable Cardiorespiratory Monitoring Employing a Multimodal Digital Patch Stethoscope: Estimation of ECG, PEP, LVET and Respiration Using a 55 mm Single-Lead ECG and Phonocardiogram

Klum

Tigges

Pielmuş

et al. 2020

Sensors

View full text Add to dashboard Cite

show abstract

“…All have been used as surrogate endpoints to describe lung injury; however, consensus efforts have been made recently to consolidate the most clinically relevant sequelae into a composite outcome of postoperative pulmonary complications (see box 1). 251718…”

Section: Perioperative Lung Injurymentioning

confidence: 99%

“…For many patients, postoperative recovery will unfortunately be complicated by perioperative lung injury. Between 11% and 59% of patients have a postoperative pulmonary complication (PPC), leading to a significantly higher likelihood of serious morbidity, mortality, and increased use of hospital resources 23456. The most severe form of perioperative lung injury, acute respiratory distress syndrome (ARDS), has been historically reported in 0.4-3% of surgical patients at high risk, leading to a significantly greater risk of postoperative mortality 78.…”

Section: Introductionmentioning

confidence: 99%

Perioperative lung protective ventilation

O’Gara

Talmor

2018

BMJ

View full text Add to dashboard Cite

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.

show abstract

Effect of Intraoperative High Positive End-Expiratory Pressure (PEEP) With Recruitment Maneuvers vs Low PEEP on Postoperative Pulmonary Complications in Obese Patients

Bluth¹,

Neto²,

Schultz³

et al. 2019

JAMA

223

134

View full text Add to dashboard Cite

IMPORTANCE An intraoperative higher level of positive end-expiratory positive pressure (PEEP) with alveolar recruitment maneuvers improves respiratory function in obese patients undergoing surgery, but the effect on clinical outcomes is uncertain. OBJECTIVE To determine whether a higher level of PEEP with alveolar recruitment maneuvers decreases postoperative pulmonary complications in obese patients undergoing surgery compared with a lower level of PEEP. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial of 2013 adults with body mass indices of 35 or greater and substantial risk for postoperative pulmonary complications who were undergoing noncardiac, nonneurological surgery under general anesthesia. The trial was conducted at 77 sites in 23 countries from July 2014-February 2018; final follow-up: May 2018. INTERVENTIONS Patients were randomized to the high level of PEEP group (n = 989), consisting of a PEEP level of 12 cm H 2 O with alveolar recruitment maneuvers (a stepwise increase of tidal volume and eventually PEEP) or to the low level of PEEP group (n = 987), consisting of a PEEP level of 4 cm H 2 O. All patients received volume-controlled ventilation with a tidal volume of 7 mL/kg of predicted body weight. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of pulmonary complications within the first 5 postoperative days, including respiratory failure, acute respiratory distress syndrome, bronchospasm, new pulmonary infiltrates, pulmonary infection, aspiration pneumonitis, pleural effusion, atelectasis, cardiopulmonary edema, and pneumothorax. Among the 9 prespecified secondary outcomes, 3 were intraoperative complications, including hypoxemia (oxygen desaturation with SpO 2 Յ92% for >1 minute). RESULTS Among 2013 adults who were randomized, 1976 (98.2%) completed the trial (mean age, 48.8 years; 1381 [69.9%] women; 1778 [90.1%] underwent abdominal operations). In the intention-to-treat analysis, the primary outcome occurred in 211 of 989 patients (21.3%) in the high level of PEEP group compared with 233 of 987 patients (23.6%) in the low level of PEEP group (difference, −2.3% [95% CI, −5.9% to 1.4%]; risk ratio, 0.93 [95% CI, 0.83 to 1.04]; P = .23). Among the 9 prespecified secondary outcomes, 6 were not significantly different between the high and low level of PEEP groups, and 3 were significantly different, including fewer patients with hypoxemia (5.0% in the high level of PEEP group vs 13.6% in the low level of PEEP group; difference, −8.6% [95% CI, −11.1% to 6.1%]; P < .001). CONCLUSIONS AND RELEVANCE Among obese patients undergoing surgery under general anesthesia, an intraoperative mechanical ventilation strategy with a higher level of PEEP and alveolar recruitment maneuvers, compared with a strategy with a lower level of PEEP, did not reduce postoperative pulmonary complications.

show abstract

Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery

Cited by 398 publications

References 34 publications

Wearable Cardiorespiratory Monitoring Employing a Multimodal Digital Patch Stethoscope: Estimation of ECG, PEP, LVET and Respiration Using a 55 mm Single-Lead ECG and Phonocardiogram

Wearable Cardiorespiratory Monitoring Employing a Multimodal Digital Patch Stethoscope: Estimation of ECG, PEP, LVET and Respiration Using a 55 mm Single-Lead ECG and Phonocardiogram

Perioperative lung protective ventilation

Effect of Intraoperative High Positive End-Expiratory Pressure (PEEP) With Recruitment Maneuvers vs Low PEEP on Postoperative Pulmonary Complications in Obese Patients

Contact Info

Product

Resources

About