Pursuing the Importance of Postoperative Atelectasis

Bigatello, Luca M.; Östberg, Erland

doi:10.1097/aln.0000000000004045

Cited by 4 publications

(2 citation statements)

References 9 publications

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“…We believe that it was rational to use pressure support ventilation in this category of patients with a relatively high incidence of PPCs, as this complication has a multifactorial origin and therefore, prevention might yield a better outcome than treatment [10,11]. On the other hand, the beneficial impact of postoperative physiotherapy mostly described in abdominal surgery [12], and data are sparse in major cervicofacial surgery.…”

Section: Discussionmentioning

confidence: 99%

Impact of Preemptive Postoperative Pressure Support Ventilation and Physiotherapy on Postoperative Pulmonary Complications after Major Cervicofacial Cancer Surgery: A before and after Study

et al. 2023

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Introduction: Complex cervicofacial cancer surgery with free flap reconstruction is known to have a high incidence of postoperative pulmonary complications (PPCs). We hypothesized that by implementing an optimized respiratory protocol, including preemptive postoperative pressure support ventilation, physiotherapy, and critical respiratory support and follow-up, we could decrease the incidence of PPCs. Patients and methods: We evaluated the incidence of PPCs over two periods in two groups of patients having a routine or optimized postoperative respiratory protocol: 156 adult patients undergoing major cervicofacial cancer surgery were assessed; 91 were in Group 1 (routine) and 65 were in Group 2 (optimized). In Group 1, no ventilatory support sessions were performed. The incidence of pulmonary complications in both groups was compared using a multivariate analysis. Mortality was also compared until one year postoperatively. Results: In Group 2 with an optimized protocol, the mean number of ventilatory support sessions was 3.7 ± 1 (minimum 2, maximum 6). The incidence of respiratory complications, which was 34% in Group 1 (routine), was reduced by 59% OR = 0.41 (0.16; 0.95), p = 0.043) to 21% for the optimized Group 2. No difference in mortality was found. Conclusions: The present retrospective study showed that using an optimized preemptive respiratory pressure support ventilation combined with physiotherapy after a major cervicofacial surgery could possibly help reduce the incidence of pulmonary complications. Prospective studies are needed to verify these findings.

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Section: Discussionmentioning

confidence: 99%

Impact of Preemptive Postoperative Pressure Support Ventilation and Physiotherapy on Postoperative Pulmonary Complications after Major Cervicofacial Cancer Surgery: A before and after Study

et al. 2023

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“…In addition, it occurs in critically ill patients who require mechanical ventilation, which can result in the deterioration of arterial oxygenation. [10][11][12] Moreover, atelectasis causes alveolar hypoxiainduced in ammatory responses, including NF-κB-dependent CXCL-1 secretion from the lung epithelial cells. [13] Undoubtedly, the prevention and treatment of atelectasis are bene cial for patients.…”

Section: Discussionmentioning

confidence: 99%

Prediction of hypotension during the alveolar recruitment maneuver in spine surgery: A prospective observational study

Min

Chang

Kim

et al. 2022

Preprint

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Background: Atelectasis can occur in many clinical practices. One way to prevent this complication is through the alveolar recruitment maneuver (ARM). However, hemodynamic compromise can accompany ARM. This study aims to reduce the hemodynamic effect of ARM by predicting hypotension during ARM using a non-invasive method. Methods: 94 American Society of Anesthesiologists (ASA) physical status I-II patients aged 19 to 75 with scheduled surgery were enrolled. After anesthesia, we performed a stepwise ARM by MAQUET Flow I. Data on the mean blood pressure (MBP), heart rate, pleth variability index (PVI) and perfusion index (Pi), cardiac index (CI), and stroke volume variation (SVV) were collected before induction of anesthesia (T0), just before ARM (T1), at the start of ARM(T2), 0.5 min(T3), 1 min (T4), 1.5 min (T5, end of ARM), and 2 min after the beginning of ARM (T6). Results: Hypotension was defined as when the MBP at T5 decreased by 20% or more compared to the baseline mean blood pressure; 75 patients developed hypotension during ARM. Pi was considerably higher in the hypotension group than the non-hypotension group before induction. The area under the receiver operating characteristic curve of Pi for predicting hypotension during ARM was 0.718 (95% CI 0.615~0.806; p=0.004), and the threshold value of the Pi was 2.4. Conclusion: A Higher Perfusion index value before induction of anesthesia can be used to predict the development of hypotension during ARM. Prophylactic management of the following hypotension during ARM could be considered in high baseline Pi patients.

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Atelectasias durante anestesia: fisiopatologia e tratamento: revisão

Neves,

Cardoso,

Kasburg

et al. 2024

Arch. Health

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Introdução: A atelectasia, definida como o colapso parcial ou total do parênquima pulmonar, é uma complicação comum durante a anestesia, especialmente em cirurgias de longa duração e procedimentos envolvendo ventilação mecânica. A compreensão detalhada da fisiopatologia e das estratégias de tratamento é essencial para anestesiologistas e equipes cirúrgicas, visando minimizar complicações respiratórias e otimizar a recuperação pós-operatória dos pacientes. Logo, este estudo objetiva detalhar a fisiopatologia e o tratamento desta condição. Metodologia: Para a elaboração deste estudo de revisão, foram consultados artigos científicos das principais bases de dados publicados nos últimos 20 anos, além de livros referência da medicina. Resultados e Discussão: Durante a anestesia geral, a atelectasia ocorre devido a fatores como ventilação com volumes correntes reduzidos e altas concentrações de oxigênio, que promovem o colapso alveolar, diminuição da produção de surfactante, posição supina, hipoventilação, compressão mecânica dos pulmões e redistribuição do fluxo sanguíneo. O tratamento envolve manobras de recrutamento alveolar, aplicação de PEEP, ventilação com volumes correntes adequados, ajuste da posição do paciente, monitorização contínua de oxigênio e dióxido de carbono, além de fisioterapia respiratória pós-operatória. Essas estratégias são essenciais para prevenir o colapso alveolar, melhorar a oxigenação e promover a reexpansão pulmonar. Considerações Finais: A atelectasia durante a anestesia é uma complicação frequente, mas prevenível, que requer atenção meticulosa à fisiopatologia respiratória e às técnicas de manejo ventilatório. A implementação de estratégias preventivas e terapêuticas baseadas em evidências é crucial para minimizar o risco de atelectasias e melhorar os desfechos respiratórios dos pacientes.

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Pursuing the Importance of Postoperative Atelectasis

Abstract: This editorial accompanies the article on p. 1004.

Cited by 4 publications

References 9 publications

Impact of Preemptive Postoperative Pressure Support Ventilation and Physiotherapy on Postoperative Pulmonary Complications after Major Cervicofacial Cancer Surgery: A before and after Study

Impact of Preemptive Postoperative Pressure Support Ventilation and Physiotherapy on Postoperative Pulmonary Complications after Major Cervicofacial Cancer Surgery: A before and after Study

Prediction of hypotension during the alveolar recruitment maneuver in spine surgery: A prospective observational study

Atelectasias durante anestesia: fisiopatologia e tratamento: revisão

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