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Anesthesiology Jan 2015
Topics: Anesthesia, General; Female; Humans; Lung; Male; Pulmonary Atelectasis; Ultrasonography
PubMed: 25611661
DOI: 10.1097/ALN.0000000000000500 -
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 -
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 -
Brazilian Journal of Otorhinolaryngology 2022General anesthesia causes pulmonary atelectasis within few minutes of induction. This can have significant impact on postoperative outcome of cancer patients undergoing... (Observational Study)
Observational Study
Lung ultrasonography as a tool to guide perioperative atelectasis treatment bundle in head and neck cancer patients undergoing free flap reconstructive surgeries: a preliminary observational study.
INTRODUCTION
General anesthesia causes pulmonary atelectasis within few minutes of induction. This can have significant impact on postoperative outcome of cancer patients undergoing prolonged reconstructive surgeries.
OBJECTIVE
The purpose of this study was to evaluate the impact of sonographically detected perioperative atelectasis on the need for postoperative oxygen supplementation, bronchodilator therapy and assisted chest physiotherapy in patients undergoing free flap surgeries for head and neck carcinoma.
METHODS
Twenty eight head and neck cancer patients underwent bilateral pulmonary ultrasonographic assessments before and after lung surgery. Lung ultrasound scores, serum lactate, and PaO/FiO ratio were measured both at the beginning and at end of the surgery. Patients were scanned in the supine position and the number of single and confluent B lines was noted. These values were correlated with the need for oxygen therapy, requirement of bronchodilators and total weaning time to predict the postoperative outcome. Other factors affecting weaning were also studied.
RESULTS
Among twenty eight patients, seven had mean lung ultrasound score of ≥10.5 which correlated with prolonged weaning time (144.56±33.5min vs. 66.7±15.7min; p=0.005). The change in lung ultrasound score significantly correlated with change in PaO/FiO ratio (r=-0.56, p=0.03). Elevated total leukocyte count >8200μL and serum lactate >2.1mmoL/L also predicted prolonged postoperative mechanical ventilation.
CONCLUSION
This preliminary study detected significant levels of perioperative atelectasis using point of care lung ultrasonography in head and neck cancer patients undergoing long duration surgical reconstructions. Higher lung ultrasound scores highlighted the need for frequent bronchodilator nebulizations as well as assisted chest physiotherapy and were associated with delayed weaning. We propose more frequent point of care lung ultrasonographic evaluations and use of recruitment maneuvers to reduce the impact of perioperative pulmonary atelectasis.
Topics: Bronchodilator Agents; Free Tissue Flaps; Head and Neck Neoplasms; Humans; Lactates; Lung; Postoperative Complications; Pulmonary Atelectasis; Plastic Surgery Procedures; Ultrasonography
PubMed: 32800584
DOI: 10.1016/j.bjorl.2020.05.030 -
Respiratory Care Dec 2016With a rising incidence of obesity in the United States, anesthesiologists are faced with a larger volume of obese patients coming to the operating room as well as obese... (Review)
Review
With a rising incidence of obesity in the United States, anesthesiologists are faced with a larger volume of obese patients coming to the operating room as well as obese patients with ever-larger body mass indices (BMIs). While there are many cardiovascular and endocrine issues that clinicians must take into account when caring for the obese patient, one of the most prominent concerns of the anesthesiologist in the perioperative setting should be the status of the lung. Because the pathophysiology of reduced lung volumes in the obese patient differs from that of the ARDS patient, the best approach to keeping the obese patient's lung open and adequately ventilated during mechanical ventilation is unique. Although strong evidence and research are lacking regarding how to best ventilate the obese surgical patient, we aim with this review to provide an assessment of the small amount of research that has been conducted and the pathophysiology we believe influences the apparent results. We will provide a basic overview of the anatomy and pathophysiology of the obese respiratory system and review studies concerning pre-, intra-, and postoperative respiratory care. Our focus in this review centers on the best approach to keeping the lung recruited through the prevention of compression atelectasis and the maintaining of physiological lung volumes. We recommend the use of PEEP via noninvasive ventilation (NIV) before induction and endotracheal intubation, the use of both PEEP and periodic recruitment maneuvers during mechanical ventilation, and the use of PEEP via NIV after extubation. It is our hope that by studying the underlying mechanisms that make ventilating obese patients so difficult, future research can be better tailored to address this increasingly important challenge to the field of anesthesia.
Topics: Adult; Body Mass Index; Humans; Lung; Noninvasive Ventilation; Obesity; Perioperative Care; Positive-Pressure Respiration; Pulmonary Atelectasis; Respiration, Artificial; Tidal Volume
PubMed: 27624632
DOI: 10.4187/respcare.04732 -
Anesthesiology Mar 2017Inspired Oxygenation in Surgical Patients During General Anesthesia With Controlled Ventilation: A Concept of Atelectasis. By Bendixen HH, Hedley-Whyte J, and Laver MB....
UNLABELLED
Inspired Oxygenation in Surgical Patients During General Anesthesia With Controlled Ventilation: A Concept of Atelectasis. By Bendixen HH, Hedley-Whyte J, and Laver MB. New Engl J Med 1963; 269:991-996. Reprinted with permission.
ABSTRACT
The purpose of this study was to determine if the pattern of ventilation, by itself, influences oxygenation during anesthesia and surgery and examine the hypothesis that progressive pulmonary atelectasis may occur during constant ventilation whenever periodic hyperventilation is lacking, but is reversible by passive hyperinflation of the lungs. Eighteen surgical patients, ranging in age from 24 to 87 yr, without known pulmonary disease, were studied during intraabdominal procedures and one radical mastectomy. Although ventilation remained constant, changes occurred in arterial oxygen tension and in total pulmonary compliance, with an average fall of 22% in oxygen tension and 15% in total pulmonary compliance. This fall in oxygen tension supports the hypothesis that progressive mechanical atelectasis may lead to increased venous admixture to arterial blood. The influence of the ventilator pattern on atelectasis and shunting is further illustrated by the reversibility of the fall in oxygen tension that follows hyperinflation. A relation between the degree of ventilation and the magnitude of fall in arterial oxygen tension was found, where large tidal volumes appear to protect against falls in oxygen tension, while shallow tidal volumes lead to atelectasis and increased shunting with impaired oxygenation.
Topics: Abdomen; Anesthesia; Female; History, 20th Century; Humans; Male; Oxygen; Pulmonary Atelectasis; Respiration, Artificial
PubMed: 28199243
DOI: 10.1097/ALN.0000000000001413 -
BMJ Case Reports Nov 2019
Topics: Aged; Bronchoscopy; Carcinoma, Squamous Cell; Diagnosis, Differential; Female; Humans; Lung Neoplasms; Pleural Effusion, Malignant; Pulmonary Atelectasis; Tomography, X-Ray Computed
PubMed: 31780607
DOI: 10.1136/bcr-2019-232405 -
Respiratory Care Oct 2011We searched the MEDLINE, CINAHL, and Cochrane Library databases for articles published between January 1995 and April 2011. The update of this clinical practice...
We searched the MEDLINE, CINAHL, and Cochrane Library databases for articles published between January 1995 and April 2011. The update of this clinical practice guideline is the result of reviewing a total of 54 clinical trials and systematic reviews on incentive spirometry. The following recommendations are made following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) scoring system. 1: Incentive spirometry alone is not recommended for routine use in the preoperative and postoperative setting to prevent postoperative pulmonary complications. 2: It is recommended that incentive spirometry be used with deep breathing techniques, directed coughing, early mobilization, and optimal analgesia to prevent postoperative pulmonary complications. 3: It is suggested that deep breathing exercises provide the same benefit as incentive spirometry in the preoperative and postoperative setting to prevent postoperative pulmonary complications. 4: Routine use of incentive spirometry to prevent atelectasis in patients after upper-abdominal surgery is not recommended. 5: Routine use of incentive spirometry to prevent atelectasis after coronary artery bypass graft surgery is not recommended. 6: It is suggested that a volume-oriented device be selected as an incentive spirometry device.
Topics: Contraindications; Equipment Design; Humans; Monitoring, Physiologic; Pulmonary Atelectasis; Spirometry; Work of Breathing
PubMed: 22008401
DOI: 10.4187/respcare.01471 -
Respiratory Care Mar 2012The bedside chest x-ray (CXR) is an indispensible diagnostic tool for monitoring seriously ill patients in the intensive care unit. The CXR often reveals abnormalities... (Review)
Review
The bedside chest x-ray (CXR) is an indispensible diagnostic tool for monitoring seriously ill patients in the intensive care unit. The CXR often reveals abnormalities that may not be detected clinically. In addition, bedside CXRs are an irreplaceable tool with which to detect the malposition of tubes and lines and to identify associated complications. Although the image quality is often limited, bedside CXRs still provide valuable diagnostic information. The interpretation of the bedside CXRs is often challenging, and requires extensive radiologic experience to avoid misinterpretation of the wide spectrum of pleural and pulmonary disease. The clinical information is of substantial value for the interpretation of the frequently nonspecific findings.
Topics: Catheterization, Central Venous; Chest Tubes; Critical Care; Humans; Intra-Aortic Balloon Pumping; Intubation, Intratracheal; Lung; Pneumonia; Pneumothorax; Point-of-Care Systems; Pulmonary Atelectasis; Pulmonary Edema; Radiography, Thoracic; Respiratory Distress Syndrome; Respiratory Tract Diseases
PubMed: 22391269
DOI: 10.4187/respcare.01712