-
Journal of Thoracic Oncology : Official... Feb 2017Impairment in aerobic fitness is a potential modifiable risk factor for postoperative complications. In this randomized controlled trial, we hypothesized that a... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Impairment in aerobic fitness is a potential modifiable risk factor for postoperative complications. In this randomized controlled trial, we hypothesized that a high-intensity interval training (HIIT) program enhances cardiorespiratory fitness before lung cancer surgery and therefore reduces the risk of postoperative complications.
METHODS
Patients with operable lung cancer were randomly assigned to usual care (UC) (n = 77) or preoperative rehabilitation based on HIIT (Rehab) (n = 74). Maximal cardiopulmonary exercise testing and the 6-minute walk test were performed twice before surgery. The primary outcome measure was a composite of death and in-hospital postoperative complications.
RESULTS
The groups were well balanced in terms of patient characteristics. During the preoperative waiting period (median 25 days), the peak oxygen consumption and the 6-minute walking distance increased (median +15%, interquartile range, 25th to 75 percentile [IQR25%-75%, %] = +9% to +22%, p = 0.003 and +15%, IQR25%-75% = +8% to +28%, p < 0.001, respectively) in the Rehab group, whereas peak oxygen consumption declined in the UC group (median -8%, IQR25%-75% = -16% to 0%], p = 0.005). The primary end point did not differ significantly between the two groups: at least one postoperative complication developed in 27 of the 74 patients (35.5%) in the Rehab group and 39 of 77 patients (50.6%) in the UC group (p = 0.080). Notably, the incidence of pulmonary complications was lower in the Rehab compared with in the UC group (23% versus 44%, p = 0.018), owing to a significant reduction in atelectasis (12.2% versus 36.4%, p < 0.001), and this decrease was accompanied by a shorter length of stay in the postanesthesia care unit (median -7 hours, IQR25%-75% = -4 to -10).
CONCLUSIONS
In this randomized controlled trial, preoperative HIIT resulted in significant improvement in aerobic performances but failed to reduce early complications after lung cancer resection.
Topics: Exercise Therapy; Female; Follow-Up Studies; High-Intensity Interval Training; Humans; Lung Neoplasms; Male; Middle Aged; Neoplasm Staging; Postoperative Complications; Preoperative Care; Prognosis; Prospective Studies; Pulmonary Atelectasis
PubMed: 27771425
DOI: 10.1016/j.jtho.2016.09.125 -
Anesthesiology Sep 2023Individualized positive end-expiratory pressure (PEEP) guided by dynamic compliance improves oxygenation and reduces postoperative atelectasis in nonobese patients. The... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Individualized positive end-expiratory pressure (PEEP) guided by dynamic compliance improves oxygenation and reduces postoperative atelectasis in nonobese patients. The authors hypothesized that dynamic compliance-guided PEEP could also reduce postoperative atelectasis in patients undergoing bariatric surgery.
METHODS
Patients scheduled to undergo laparoscopic bariatric surgery were eligible. Dynamic compliance-guided PEEP titration was conducted in all patients using a downward approach. A recruitment maneuver (PEEP from 10 to 25 cm H2O at 5-cm H2O step every 30 s, with 15-cm H2O driving pressure) was conducted both before and after the titration. Patients were then randomized (1:1) to undergo surgery under dynamic compliance-guided PEEP (PEEP with highest dynamic compliance plus 2 cm H2O) or PEEP of 8 cm H2O. The primary outcome was postoperative atelectasis, as assessed with computed tomography at 60 to 90 min after extubation, and expressed as percentage to total lung tissue volume. Secondary outcomes included Pao2/inspiratory oxygen fraction (Fio2) and postoperative pulmonary complications.
RESULTS
Forty patients (mean ± SD; 28 ± 7 yr of age; 25 females; average body mass index, 41.0 ± 4.7 kg/m2) were enrolled. Median PEEP with highest dynamic compliance during titration was 15 cm H2O (interquartile range, 13 to 17; range, 8 to 19) in the entire sample of 40 patients. The primary outcome of postoperative atelectasis (available in 19 patients in each group) was 13.1 ± 5.3% and 9.5 ± 4.3% in the PEEP of 8 cm H2O and dynamic compliance-guided PEEP groups, respectively (intergroup difference, 3.7%; 95% CI, 0.5 to 6.8%; P = 0.025). Pao2/Fio2 at 1 h after pneumoperitoneum was higher in the dynamic compliance-guided PEEP group (397 vs. 337 mmHg; group difference, 60; 95% CI, 9 to 111; P = 0.017) but did not differ between the two groups 30 min after extubation (359 vs. 375 mmHg; group difference, -17; 95% CI, -53 to 21; P = 0.183). The incidence of postoperative pulmonary complications was 4 of 20 in both groups.
CONCLUSIONS
Postoperative atelectasis was lower in patients undergoing laparoscopic bariatric surgery under dynamic compliance-guided PEEP versus PEEP of 8 cm H2O. Postoperative Pao2/Fio2 did not differ between the two groups.
Topics: Female; Humans; Positive-Pressure Respiration; Pulmonary Atelectasis; Obesity; Lung; Respiratory Distress Syndrome
PubMed: 37440205
DOI: 10.1097/ALN.0000000000004603 -
Current Opinion in Anaesthesiology Jun 2022Apneic oxygenation is increasingly used in pediatric anesthesia. Its benefit for specific applications depends on the effect of apneic oxygenation on safe apnea time and... (Review)
Review
PURPOSE OF REVIEW
Apneic oxygenation is increasingly used in pediatric anesthesia. Its benefit for specific applications depends on the effect of apneic oxygenation on safe apnea time and carbon dioxide (CO2) elimination, on differences between low and high flow oxygen delivery, and on possible adverse effects. The present review summarizes current evidence on these pathophysiological aspects of apneic oxygenation as well as its applications in pediatric anesthesia.
RECENT FINDINGS
Apneic oxygenation with both low flow and high flow nasal oxygen increases the safe apnea time, but does not lead to increased CO2 elimination. Airway pressures and adverse effects like atelectasis formation, oxidative stress and aerosol generation under apneic oxygenation are not well studied in pediatric anesthesia. Data from adults suggest no important effect on airway pressures when the mouth is open, and no significant formation of atelectasis, oxidative stress or aerosol generation with high flow nasal oxygen.
SUMMARY
Apneic oxygenation in pediatric anesthesia is mainly used during standard and difficult airway management. It is sometimes used for airway interventions, but CO2 accumulation remains a major limiting factor in this setting. Reports highlight the use of high flow nasal oxygen in spontaneously breathing rather than in apneic children for airway interventions.
Topics: Adult; Anesthesia; Apnea; Carbon Dioxide; Child; Humans; Oxygen; Oxygen Inhalation Therapy; Pulmonary Atelectasis
PubMed: 35671025
DOI: 10.1097/ACO.0000000000001127 -
Anesthesiology Oct 2019
Topics: Humans; Lung; Positive-Pressure Respiration; Postoperative Complications; Pulmonary Atelectasis
PubMed: 31283741
DOI: 10.1097/ALN.0000000000002875 -
Anesthesiology Jan 2015
Topics: Anesthesia, General; Female; Humans; Lung; Male; Pulmonary Atelectasis; Ultrasonography
PubMed: 25611661
DOI: 10.1097/ALN.0000000000000500 -
Anesthesiology Jun 2022
Topics: Humans; Lung; Positive-Pressure Respiration; Pulmonary Atelectasis; Respiration
PubMed: 35362084
DOI: 10.1097/ALN.0000000000004193 -
Critical Care (London, England) Oct 2018
Topics: Animals; Barotrauma; Disease Models, Animal; Humans; Pulmonary Atelectasis; Ventilator-Induced Lung Injury
PubMed: 30360756
DOI: 10.1186/s13054-018-2199-2 -
Journal of Anaesthesiology, Clinical... 2016In the era of evidence-based medicine, ultrasonography has emerged as an important and indispensable tool in clinical practice in various specialties including critical... (Review)
Review
In the era of evidence-based medicine, ultrasonography has emerged as an important and indispensable tool in clinical practice in various specialties including critical care. Lung ultrasound (LUS) has a wide potential in various surgical and clinical situations for timely and easy detection of an impending crisis such as pulmonary edema, endobronchial tube migration, pneumothorax, atelectasis, pleural effusion, and various other causes of desaturation before it clinically ensues to critical level. Although ultrasonography is frequently used in nerve blocks, airway handling, and vascular access, LUS for routine intraoperative monitoring and in crisis management still necessitates recognition. After reviewing the various articles regarding the use of LUS in critical care, we found, that LUS can be used in various intraoperative circumstances similar to Intensive Care Unit with some limitations. Except for few attempts in the intraoperative detection of pneumothorax, LUS is hardly used but has wider perspective for routine and crisis management in real-time. If anesthesiologists add LUS in their routine monitoring armamentarium, it can assist to move a step ahead in the dynamic management of critically ill and high-risk patients.
PubMed: 27625474
DOI: 10.4103/0970-9185.188824 -
Anesthesiology Dec 2021
Topics: Humans; Postoperative Complications; Pulmonary Atelectasis
PubMed: 34731243
DOI: 10.1097/ALN.0000000000004045 -
Jornal Brasileiro de Pneumologia :... 2017
Topics: Aged; Diagnosis, Differential; Humans; Lung Neoplasms; Male; Pulmonary Atelectasis; Radiography, Thoracic
PubMed: 28746524
DOI: 10.1590/S1806-37562017000000024