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Anesthesiology Aug 1972
Review
Topics: Adrenal Glands; Animals; Brain; Carbon Dioxide; Humans; Lung; Nitrogen; Oxygen; Pituitary Gland; Positive-Pressure Respiration; Pulmonary Alveoli; Pulmonary Atelectasis; Pulmonary Surfactants; Respiration; Thyroid Gland
PubMed: 4559456
DOI: 10.1097/00000542-197208000-00010 -
The Cochrane Database of Systematic... Sep 2012Incentive spirometry (IS) is a treatment technique that uses a mechanical device to reduce pulmonary complications during postoperative care. This is an update of a... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Incentive spirometry (IS) is a treatment technique that uses a mechanical device to reduce pulmonary complications during postoperative care. This is an update of a Cochrane review first published in 2007.
OBJECTIVES
Update the previously published systematic review to compare the effects of IS for preventing postoperative pulmonary complications in adults undergoing coronary artery bypass graft (CABG).
SEARCH METHODS
We searched CENTRAL and DARE on The Cochrane Library (Issue 2 of 4 2011), MEDLINE OVID (1948 to May 2011), EMBASE (1980 to Week 20 2011), LILACS (1982 to July 2011) , the Physiotherapy Evidence Database (PEDro) (1980 to July 2011), Allied & Complementary Medicine (AMED) (1985 to May 2011), CINAHL (1982 to May 2011).
SELECTION CRITERIA
Randomised controlled trials comparing IS with any type of prophylactic physiotherapy for prevention of postoperative pulmonary complications in adults undergoing CABG.
DATA COLLECTION AND ANALYSIS
Two reviewers independently evaluated trial quality using the guidelines of the Cochrane Handbook for Systematic Reviews and extracted data from included trials. For continuous outcomes, we used the generic inverse variance method for meta-analysis and for dichotomous data we used the Peto Odds Ratio.
MAIN RESULTS
This update included 592 participants from seven studies (two new and one that had been excluded in the previous review in 2007. There was no evidence of a difference between groups in the incidence of any pulmonary complications and functional capacity between treatment with IS and treatment with physical therapy, positive pressure breathing techniques (including continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP) and intermittent positive pressure breathing (IPPB), active cycle of breathing techniques (ACBT) or preoperative patient education. Patients treated with IS had worse pulmonary function and arterial oxygenation compared with positive pressure breathing. Based on these studies there was no improvement in the muscle strength between groups who received IS demonstrated by maximal inspiratory pressure and maximal expiratory pressure .
AUTHORS' CONCLUSIONS
Our update review suggests there is no evidence of benefit from IS in reducing pulmonary complications and in decreasing the negative effects on pulmonary function in patients undergoing CABG. In view of the modest number of patients studied, methodological shortcomings and poor reporting of the included trials, these results should still be interpreted cautiously. An appropriately powered trial of high methodological rigour is needed to determine if there are patients who may derive benefit from IS following CABG.
Topics: Coronary Artery Bypass; Forced Expiratory Volume; Humans; Lung Diseases; Pneumonia; Positive-Pressure Respiration; Pulmonary Atelectasis; Randomized Controlled Trials as Topic; Respiration; Spirometry; Vital Capacity
PubMed: 22972072
DOI: 10.1002/14651858.CD004466.pub3 -
British Journal of Anaesthesia Mar 2020General anaesthesia is increasingly common in elderly and obese patients. Greater age and body mass index (BMI) worsen gas exchange. We assessed whether this is related... (Meta-Analysis)
Meta-Analysis
BACKGROUND
General anaesthesia is increasingly common in elderly and obese patients. Greater age and body mass index (BMI) worsen gas exchange. We assessed whether this is related to increasing atelectasis during general anaesthesia.
METHODS
This primary analysis included pooled data from previously published studies of 243 subjects aged 18-78 yr, with BMI of 18-52 kg m. The subjects had no clinical signs of cardiopulmonary disease, and they underwent computed tomography (CT) awake and during anaesthesia before surgery after preoxygenation with an inspired oxygen fraction (FIO) of >0.8, followed by mechanical ventilation with FIO of 0.3 or higher with no PEEP. Atelectasis was assessed by CT.
RESULTS
Atelectasis area of up to 39 cm in a transverse scan near the diaphragm was seen in 90% of the subjects during anaesthesia. The log of atelectasis area was related to a quadratic function of (age+age) with the most atelectasis at ∼50 yr (r=0.08; P<0.001). Log atelectasis area was also related to a broken-line function of the BMI with the knee at 30 kg m (r=0.06; P<0.001). Greater atelectasis was seen in the subjects receiving FIO of 1.0 than FIO of 0.3-0.5 (12.8 vs 8.1 cm; P<0.001). A multiple regression analysis, including a quadratic function of age, a broken-line function of the BMI, and dichotomised FIO (0.3-0.5/1.0) adjusting for ventilatory frequency, strengthened the association (r=0.23; P<0.001). PaO decreased with both age and BMI.
CONCLUSIONS
Atelectasis during general anaesthesia increased with age up to 50 yr and decreased beyond that. Atelectasis increased with BMI in normal and overweight patients, but showed no further increase in obese subjects (BMI ≥30 kg m). Therefore, greater age and obesity appear to limit atelectasis formation during general anaesthesia.
Topics: Adolescent; Adult; Age Distribution; Age Factors; Aged; Anesthesia, General; Body Mass Index; Female; Humans; Male; Middle Aged; Obesity; Postoperative Complications; Pulmonary Atelectasis; Pulmonary Gas Exchange; Respiration, Artificial; Smoking; Tidal Volume; Tomography, X-Ray Computed; Young Adult
PubMed: 31918847
DOI: 10.1016/j.bja.2019.11.026 -
BMC Anesthesiology Aug 2023There is the ongoing debate over the effect of inspired oxygen fraction (FiO) during mechanical ventilation on postoperative atelectasis. We aimed to compare the effects... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
There is the ongoing debate over the effect of inspired oxygen fraction (FiO) during mechanical ventilation on postoperative atelectasis. We aimed to compare the effects of low (30%) and moderate (60%) FiO on postoperative atelectasis. The hypothesis of the study was that 30% FiO during mechanical ventilation could reduce postoperative atelectasis volume compared with 60% FiO.
METHODS
We performed a randomized controlled trial with 120 patients. Subjects were randomly assigned to receive 30% or 60% FiO during mechanical ventilation in a 1:1 ratio. The primary outcome was the percentage of postoperative atelectasis volume in the total lung measured using chest CT within 30 min after extubation. The secondary outcomes included different aeration region volumes, incidence of clinically significant atelectasis, and oxygenation index.
RESULTS
In total, 113 subjects completed the trial, including 55 and 58 subjects in the 30% and 60% FiO groups, respectively. The percentage of the postoperative atelectasis volume in the 30% FiO group did not differ from that in the 60% FiO group. Furthermore, there was no significant difference in the atelectasis volume between the two groups after the missing data were imputed by multiple imputation. Additionally, there were no significant differences in the volumes of the over-aeration, normal-aeration, and poor-aeration regions between the groups. No significant differences in the incidence of clinically significant atelectasis or oxygenation index at the end of surgery were observed between the groups.
CONCLUSIONS
Compared with 60% FiO, the use of 30% FiO during mechanical ventilation does not reduce the postoperative atelectasis volume.
TRIAL REGISTRATION
Chinese Clinical Trial Registry ( http://www.chictr.org.cn ). Identifier: ChiCTR1900021635. Date: 2 March 2019. Principal invetigator: Weidong Gu.
Topics: Humans; Respiration, Artificial; Oxygen; Pulmonary Atelectasis; Lung; Postoperative Complications
PubMed: 37550648
DOI: 10.1186/s12871-023-02226-6 -
The Journal of Thoracic and... Sep 2015
Topics: Female; Humans; Lung Transplantation; Pneumonectomy; Pulmonary Atelectasis; Transplantation, Autologous
PubMed: 26254748
DOI: 10.1016/j.jtcvs.2015.07.005 -
Zhongguo Yi Xue Ke Xue Yuan Xue Bao.... Oct 2022Objective To investigate the clinical characteristics of 30-day unplanned reoperations after thoracic surgery. Methods We retrospectively analyzed the clinical data of...
Objective To investigate the clinical characteristics of 30-day unplanned reoperations after thoracic surgery. Methods We retrospectively analyzed the clinical data of patients with unplanned reoperations within 30 days after thoracic surgery in Peking Union Medical College Hospital from May 2016 to May 2021. Results The 30-day unplanned reoperations showed the incidence of 0.75%(79/10 543),the median hospital stay of 19(12,37) days,and the median hospitalization cost of 109 929.11(80 549.46,173 491.87) yuan.Twenty-two(27.85%) patients received blood transfusion and 26(32.91%) underwent intensive care.The period between May 2016 and May 2017 witnessed the most unplanned reoperations.The main causes of unplanned reoperations after thoracic surgery were bleeding(21.52%),chylothorax(17.72%),pulmonary air leakage(16.46%),atelectasis(13.92%),and gastroesophageal fistula(11.39%).Specifically,the main causes of unplanned reoperations in the patients of non-esophagus/cardia group were bleeding,pulmonary air leakage,atelectasis,and chylothorax,and those in the patients of esophagus/cardia group were gastroesophageal fistula,incision infection and poor healing,bleeding,and chylothorax.Among all the patients with unplanned reoperations,4 patients died,17 improved,and 58 recovered. Conclusions The patients who underwent unplanned reoperations after thoracic surgery had a long hospital stay and high hospitalization costs. Bleeding,chylothorax,pulmonary air leakage,atelectasis,and gastroesophageal fistula were the main reasons for the unplanned reoperations.
Topics: Humans; Reoperation; Retrospective Studies; Thoracic Surgery; Chylothorax; Hemorrhage; Pulmonary Atelectasis; Postoperative Complications
PubMed: 36325778
DOI: 10.3881/j.issn.1000-503X.14642 -
Minerva Anestesiologica Apr 2004Flail chest occurs when a series of adjacent ribs are fractured in at least 2 places, anteriorly and posteriorly. This section of the chest wall becomes unstable and it... (Review)
Review
Flail chest occurs when a series of adjacent ribs are fractured in at least 2 places, anteriorly and posteriorly. This section of the chest wall becomes unstable and it moves inwards during spontaneous inspiration. The physiological impact of a flail chest depends on multiple factors, including the size of the flail segment, the intrathoracic pressure generated during spontaneous ventilation, and the associated damage to the lung and chest wall. Treatment varies with the severity of the physiologic impairment attributable to the flail segment itself. Immediate surgical fixation may decrease morbidity, but conservative treatment with positive pressure ventilation is preferred when multiple injuries to the intrathoracic organs are present.
Topics: Contusions; Flail Chest; Humans; Hypoventilation; Pulmonary Atelectasis; Respiratory Mechanics
PubMed: 15173695
DOI: No ID Found -
Allergology International : Official... Jul 2016Although right middle lobe (RML)-atelectasis of the lungs is a common complication of asthma, the relevant data is limited. The aim of this study is to define the...
BACKGROUND
Although right middle lobe (RML)-atelectasis of the lungs is a common complication of asthma, the relevant data is limited. The aim of this study is to define the characteristics of RML atelectasis in asthma during childhood.
METHODS
Children with asthma who had recently developed RML atelectasis were included; anti-inflammatory medications, clarithromycin, and inhaled salbutamol were prescribed, chest-physiotherapy (starting on the sixth day) was applied. Patients were reevaluated on the sixth, fourteenth, thirtieth, and ninetieth days, chest X-rays were taken if the atelectasis had not resolved at the time of the previous visit.
RESULTS
Twenty-seven patients (6.8 (4.8-8.3) years, 48.1% male) with RML atelectasis were included. Symptoms started 15 (7-30) days before admission. The thickness of the atelectasis was 11.8 ± 5.8 mm; FEV1% was 75.9 ± 14.2 and Childhood Asthma Control Test scores were 11.8 ± 5.6 at the time of admission. The atelectasis had been resolved by the sixth (n = 3), fourteenth (n = 9), thirtieth (n = 10), and ninetieth days (n = 3). The treatment response of the patients whose atelectasis resolved in fourteen days was better on the sixth-day (atelectasis thickness: 4.7 ± 1.7 vs. 11.9 ± 7.3 mm, p = 0.021) compared to those whose atelectasis resolved later. Nearly half (54.5%) of the patients whose atelectasis had resolved by fourteen days were using controller medications at the time of admission. However, only two patients (13.3%) were on controller treatment in the latter group (p = 0.032). Regression analysis didn't reveal any prognostic factors for the early resolution of atelectasis.
CONCLUSIONS
Early diagnosis and treatment of RML atelectasis prevents complications. Patients who had early resolution of atelectasis had already been on anti-inflammatory medications, and responded better to aggressive treatment within the first week.
Topics: Asthma; Child; Child, Preschool; Female; Humans; Immunoglobulin E; Leukocyte Count; Male; Prognosis; Prospective Studies; Pulmonary Atelectasis; Radiography, Thoracic; Respiratory Function Tests; Risk Factors
PubMed: 26806056
DOI: 10.1016/j.alit.2015.12.002 -
Anesthesiology Apr 2023Nitrous oxide promotes absorption atelectasis in poorly ventilated lung segments at high inspired concentrations. The Evaluation of Nitrous oxide In the Gas Mixture for... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Nitrous oxide promotes absorption atelectasis in poorly ventilated lung segments at high inspired concentrations. The Evaluation of Nitrous oxide In the Gas Mixture for Anesthesia (ENIGMA) trial found a higher incidence of postoperative pulmonary complications and wound sepsis with nitrous oxide anesthesia in major surgery compared to a fraction of inspired oxygen of 0.8 without nitrous oxide. The larger ENIGMA II trial randomized patients to nitrous oxide or air at a fraction of inspired oxygen of 0.3 but found no effect on wound infection or sepsis. However, postoperative pulmonary complications were not measured. In the current study, post hoc data were collected to determine whether atelectasis and pneumonia incidences were higher with nitrous oxide in patients who were recruited to the Australian cohort of ENIGMA II.
METHODS
Digital health records of patients who participated in the trial at 10 Australian hospitals were examined blinded to trial treatment allocation. The primary endpoint was the incidence of atelectasis, defined as lung atelectasis or collapse reported on chest radiology. Pneumonia, as a secondary endpoint, required a diagnostic chest radiology report with fever, leukocytosis, or positive sputum culture. Comparison of the nitrous oxide and nitrous oxide-free groups was done according to intention to treat using chi-square tests.
RESULTS
Data from 2,328 randomized patients were included in the final data set. The two treatment groups were similar in surgical type and duration, risk factors, and perioperative management recorded for ENIGMA II. There was a 19.3% lower incidence of atelectasis with nitrous oxide (171 of 1,169 [14.6%] vs. 210 of 1,159 [18.1%]; odds ratio, 0.77; 95% CI, 0.62 to 0.97; P = 0.023). There was no difference in pneumonia incidence (60 of 1,169 [5.1%] vs. 52 of 1159 [4.5%]; odds ratio, 1.15; 95% CI, 0.77 to 1.72; P = 0.467) or combined pulmonary complications (odds ratio, 0.84; 95% CI, 0.69 to 1.03; P = 0.093).
CONCLUSIONS
In contrast to the earlier ENIGMA trial, nitrous oxide anesthesia in the ENIGMA II trial was associated with a lower incidence of lung atelectasis, but not pneumonia, after major surgery.
Topics: Humans; Australia; Nitrous Oxide; Postoperative Complications; Lung; Pulmonary Atelectasis; Pneumonia; Oxygen; Anesthesia, General
PubMed: 36645804
DOI: 10.1097/ALN.0000000000004497 -
Journal of Clinical Anesthesia May 2024Dexmedetomidine improves intrapulmonary shunt in thoracic surgery and minimizes inflammatory response during one-lung ventilation (OLV). However, it is unclear whether... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Dexmedetomidine improves intrapulmonary shunt in thoracic surgery and minimizes inflammatory response during one-lung ventilation (OLV). However, it is unclear whether such benefits translate into less postoperative pulmonary complications (PPCs). Our objective was to determine the impact of dexmedetomidine on the incidence of PPCs after thoracic surgery.
METHODS
Major databases were used to identify randomized trials that compared dexmedetomidine versus placebo during thoracic surgery in terms of PPCs. Our primary outcome was atelectasis within 7 days after surgery. Other specific PPCs included hypoxemia, pneumonia, and acute respiratory distress syndrome (ARDS). Secondary outcome included intraoperative respiratory mechanics (respiratory compliance [Cdyn]) and postoperative lung function (forced expiratory volume [FEV1]). Random effects models were used to estimate odds ratios (OR).
RESULTS
Twelve randomized trials, including 365 patients in the dexmedetomidine group and 359 in the placebo group, were analyzed in this meta-analysis. Patients in the dexmedetomidine group were less likely to develop postoperative atelectasis (2.3% vs 6.8%, OR 0.42, 95%CI 0.18-0.95, P = 0.04; low certainty) and hypoxemia (3.4% vs 11.7%, OR 0.26, 95%CI 0.10-0.68, P = 0.01; moderate certainty) compared to the placebo group. The incidence of postoperative pneumonia (3.2% vs 5.8%, OR 0.57, 95%CI 0.25-1.26, P = 0.17; moderate certainty) or ARDS (0.9% vs 3.5%, OR 0.39, 95%CI 0.07-2.08, P = 0.27; moderate certainty) was comparable between groups. Both intraoperative Cdyn and postoperative FEV1 were higher among patients that received dexmedetomidine with a mean difference of 4.42 mL/cmHO (95%CI 3.13-5.72) and 0.27 L (95%CI 0.12-0.41), respectively.
CONCLUSION
Dexmedetomidine administration during thoracic surgery may potentially reduce the risk of postoperative atelectasis and hypoxemia. However, current evidence is insufficient to demonstrate an effect on pneumonia or ARDS.
Topics: Humans; Dexmedetomidine; One-Lung Ventilation; Thoracic Surgery; Lung; Pulmonary Atelectasis; Pneumonia; Respiratory Distress Syndrome; Postoperative Complications; Hypoxia
PubMed: 37988813
DOI: 10.1016/j.jclinane.2023.111345