Who Needs to Be Allocated in ICU after Thoracic Surgery? An Observational Study

Pinheiro, Liana; Santoro, Ilka Lopes; Faresin, Sônia Maria

doi:10.1155/2016/3981506

Cited by 18 publications

(13 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Second, because this study was performed retrospectively by reviewing electronic medical records, there may be inherent selection biases. Third, this study was conducted using a relatively small number of patients; however, 340 patients is not a small number compared to the number of patients in previous studies on ICU admission or postoperative complications after lung resection [2,3,5,6].…”

Section: Discussionmentioning

confidence: 99%

“…General anesthesia was induced with propofol, and maintained with inhalation agents and remifentanil in all patients. According to previous studies [5,6,10], mandatory ICU admission was defined as the presence of one or more of the following characteristics: maintenance of controlled ventilation, reintubation, acute respiratory failure, hemodynamic instability, shock, use of multiple vasoactive drugs, and cardiac arrhythmia. The patients who were admitted to the ICU immediately postoperatively were classified into two groups: (1) ineffective use group: patients who were admitted to the ICU immediately postoperatively only for surveillance purposes and then transferred to the general ward the day after the surgery and (2) effective use group: those who met the criteria of mandatory ICU admission.…”

Section: Methodsmentioning

confidence: 99%

“…[5]. Numerous factors, including age, pneumonectomy (versus [vs.] other types of lung resection), male sex, smoking, severe chronic obstructive pulmonary disease, severe restrictive lung disease (predicted forced vital capacity <50%), predicted postoperative forced expiratory volume 1 (ppo FEV 1 ) <40%, predicted postoperative diffusion capacity of the lung for carbon monoxide (ppo DLCO) <40%, American Society of Anesthesiologists (ASA) classification ≥3, open thoracotomy (vs. video-assisted thoracotomy), and inhalation anesthesia (vs. total intravenous anesthesia) have been suggested as independent risk factors for mandatory ICU admission after lung resection [1,4,5,6,7,8].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Perioperative Factors for Predicting the Need for Postoperative Intensive Care after Major Lung Resection

Kim

Park

et al. 2019

JCM

View full text Add to dashboard Cite

Postoperative management after major lung surgery is critical. This study evaluates risk factors for predicting mandatory intensive care unit (ICU) admission immediately after major lung resection. We retrospectively reviewed patients for whom the surgeon requested an ICU bed before major lung resection surgery. Patients were classified into three groups. Univariable and multivariable logistic regression analyses were performed, and a clinical nomogram was constructed. Among 340 patients, 269, 50, and 21 were classified into the no need for ICU, mandatory ICU admission, and late-onset complication groups, respectively. Predictive postoperative diffusion capacity of the lung for carbon monoxide (47.2 (interquartile range (IQR) 43.3–65.7)% versus vs. 67.8 (57.1–79.7)%; p = 0.003, odds ratio (OR) 0.969, 95% confidence interval (CI) 0.95–0.99), intraoperative blood loss (400.00 (250.00–775.00) mL vs. 100.00 (50.00–250.00) mL; p = 0.040, OR 1.001, 95% CI 1.000–1.002), and open thoracotomy (p = 0.030, OR 2.794, 95% CI 1.11–7.07) were significant predictors for mandatory ICU admission. The risk estimation nomogram demonstrated good accuracy in estimating the risk of mandatory ICU admission (concordance index 83.53%). In order to predict the need for intensive care after major lung resection, preoperative and intraoperative factors need to be considered.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Perioperative Factors for Predicting the Need for Postoperative Intensive Care after Major Lung Resection

Kim

Park

et al. 2019

JCM

View full text Add to dashboard Cite

show abstract

“…[ 20 ] Similarly, another study concluded that the presence of more than two or three pulmonary risk predictors also lead to postoperative ICU requirements. [ 21 ]…”

Section: Discussionmentioning

confidence: 99%

Factors affecting reintubations after cardiac and thoracic surgeries in cardiac intensive care unit of a tertiary care hospital

et al. 2018

View full text Add to dashboard Cite

Background:Reintubation and readmission after cardiothoracic surgeries are not uncommon, and its reasons are multifactorial. The study goal was to identify the factors that contribute reintubation after cardiac and thoracic surgery in tertiary care hospital and to compare the outcome with international benchmark.Methodology:A prospective, observational study was planned in Cardiac Intensive Care Unit (CICU). The study included all those patients who required readmission in CICU due to endotracheal intubation following cardiac and thoracic surgeries. The study was conducted from January to December 2016. The primary focus was to identify the reasons for reintubation within 72 h of extubation after CICU discharge and its association with outcome.Results:Out of 750 patients who shifted out from CICU following successful extubation, only 32 were readmitted and among them in 25 patients (3.33%) were reintubated and their reasons reintubation were noted. Patients underwent a coronary artery bypass grafting (CABG) with valve replacement had a higher incidence of reintubation 3/39 (7.69%) when compared with CABG 13/517 (2.51%) and 4/135 (2.96%) valve procedure alone. Single cause of endotracheal reintubation was observed in 7 patients (28%), in which 5 patients (20%) had respiratory and 2 patients had (8%) cardiac reason while 18 patients (72%) were observed with multisystem involvement, in which 7 patients (28%) had both respiratory and cardiovascular causes, and 2 (8%) had both respiratory and neurological causes. More than 70% cause of endotracheal reintubation was both respiratory and cardiovascular. The CICU stay after reintubations was 12.88 ± 16.88 days and the hospital stay prolonged to 23.84 ± 21.61 days.Conclusion:Reasons of reintubation were mainly respiratory and cardiac. The rate of reintubations is high when multisystem involvement is there. CICU, hospital stay, and mortality are increases after reintubation.

show abstract

“…The clinical practice guidelines of the European Respiratory Society/European Society of Thoracic Surgeons 10 and recent studies 11 provide data on criteria that may be a guide on what the best destination of these patients may be depending on the risks, benefits, and resources available. ICU admission is especially recommended in patients with comorbidities, a low cardiopulmonary reserve, extensive lung resections, and those who require support due to organ failure with life-threatening risk for the patient (Table 2).…”

Section: Admission Criteria In Intensive Care Unitsmentioning

confidence: 99%

Perioperative management in thoracic surgery

Cabo

Alarza

Rodríguez

et al. 2020

Medicina Intensiva (English Edition)

View full text Add to dashboard Cite

Thoracic surgery has undergone significant advances in recent years related to anesthetic and surgical techniques and the prevention and management of complications related to the procedure. This has allowed improvements in patient clinical outcomes in surgeries of this kind. Despite the above, thoracic surgery, especially related to pulmonary resection, is not without risk, and is associated to considerable morbidity and mortality. Fast track or enhanced recovery after anesthesia protocols, minimally invasive surgery, and intraoperative anesthetic management improve the prognosis and safety of thoracic surgery. Patients in the postoperative period of major thoracic surgery require intensive surveillance, especially the first 24-72 h after surgery. Admission to the ICU is especially recommended in those patients with comorbidities, a reduced cardiopulmonary reserve, extensive lung resections, and those requiring support due to life-threatening organ failure. During the postoperative period, intensive cardiorespiratory monitoring, proper management of thoracic drainage, aggressive pain control (multimodal analgesia and regional anesthetic techniques), nausea and multimodal rehabilitation are key elements for avoiding adverse events. Medical complications include respiratory failure, arrhythmias, respiratory infections, atelectasis and thromboembolic lung disease. The most frequent surgical complications are hemothorax, chylothorax, bronchopleural fistula and prolonged air leakage. The multidisciplinary management of these patients throughout the perioperative period is essential in order to ensure the best surgical outcomes.

show abstract

Who Needs to Be Allocated in ICU after Thoracic Surgery? An Observational Study

Cited by 18 publications

References 20 publications

Perioperative Factors for Predicting the Need for Postoperative Intensive Care after Major Lung Resection

Perioperative Factors for Predicting the Need for Postoperative Intensive Care after Major Lung Resection

Factors affecting reintubations after cardiac and thoracic surgeries in cardiac intensive care unit of a tertiary care hospital

Perioperative management in thoracic surgery

Contact Info

Product

Resources

About