Major Respiratory Complications Research Articles

The respiratory consequences of preterm birth: from infancy to adulthood.

Survival of preterm-born infants, especially at extremes of prematurity (less than 28 weeks gestation), is now common, particularly in the developed world. Despite advances in neonatal care, short-term respiratory morbidity, termed bronchopulmonary dysplasia (also called chronic lung disease of prematurity), remains an important clinical outcome. As survival during the neonatal period has improved, preterm-born individuals are now entering childhood, adolescence and adulthood in far greater numbers, and adverse longer-term respiratory outcomes following birth at an immature stage of lung development are becoming increasingly apparent. In this article, we shall review the background of the major respiratory complications in the neonatal period, bronchopulmonary dysplasia, and the current evidence regarding its prevention and management. In addition, we shall review the emerging literature on the respiratory morbidity experienced in childhood, adolescence, and adulthood by preterm-born survivors, with reduced lung function and a risk of developing chronic obstructive pulmonary disease in early adult life. As this population of preterm-born individuals increases, an understanding of the respiratory consequences of preterm birth will become increasingly important not only for neonatologists, paediatricians and paediatric pulmonologists but also for physicians and healthcare professionals involved in the care of adults who were born preterm.

The Earlier the Better: Surgical Stabilization of Rib Fractures Associated With Improved Outcomes

IntroductionSurgical stabilization of rib fractures (SSRF) has been associated with lower rates of mortality and fewer respiratory complications. This study sought to evaluate the association between SSRF timing and patient outcomes. MethodsThis retrospective analysis included patients aged ≥45 y who underwent SSRF in the Trauma Quality Improvement Program database from 2016 to 2020. Primary outcome was incidence of ventilator-assisted pneumonia (VAP). Secondary outcomes included acute respiratory distress syndrome (ARDS), unplanned endotracheal intubation, in-hospital mortality, failure to rescue (FTR) after all major complications, and FTR after severe respiratory complications. Logistic regression models of outcomes on timing to SSRF were fit while controlling for age, gender, body mass index, injury severity score, flail chest, chronic obstructive pulmonary disease, congestive heart failure, and smoking. ResultsAmong 4667 patients who received SSRF, average time to SSRF was 4.6 ± 3.2 d. Each additional day to SSRF was associated with increased odds of VAP (odds ratio [OR] 1.07, confidence interval [CI] 1.03-1.11) and intubation (OR 1.10, CI 1.08-1.13). A longer time to SSRF was associated with increased odds of ARDS (OR 1.10, CI 1.05-1.15), while no significant association was observed for in-hospital mortality (OR 0.99, CI 0.93-1.04). A longer time to SSRF was associated with decreased odds of FTR after a major complication (OR 0.90, CI 0.83-0.97) and respiratory complications (OR 0.87, CI 0.78-0.96). ConclusionsFor each day that SSRF is delayed, increased odds of VAP, intubation, and ARDS were observed. Prompt intervention is crucial for preventing these complications and improving our ability to rescue patients.

Acute type A aortic dissection features and outcomes in octogenarians: a propensity score analysis.

The clinical characteristics and early outcomes of surgical repair in octogenarians with acute type A aortic dissection were compared with those in nonoctogenarians. All patients who underwent emergency surgical repair for acute type A aortic dissection in our institution between 2003 and 2022 were included in this study. The patients were divided into an octogenarian group and a nonoctogenarian group. The patients in the 2 groups were propensity score matched at a ratio of 1:1. Before matching, the baseline characteristics were compared between 2 groups. The major complication and 30-day mortality rates were compared in the matched population. A total of 495 patients were screened, and 471 were included in the analysis, with 48 in the octogenarian group and 423 in the nonoctogenarian group. Before matching, DeBakey type II dissection was significantly more prevalent in the octogenarians (42% vs 14% in the octogenarians and nonoctogenarians, respectively, P < 0.001). Additionally, intramural haematomas (39.6% vs 14.4%, P < 0.001) were more prevalent in the octogenarians. However, severe aortic regurgitation (4.2% vs 15.4%, P = 0.046) and root enlargement (0% vs 13.7%, P = 0.009) were less prevalent in the octogenarians. After matching (36 pairs), the incidence of postoperative delirium was higher in the octogenarians (56% vs 25%, P = 0.027). However, there were no significant differences in 30-day and in-hospital mortality rates, intensive care unit stay or major complications, including stroke, paraplegia, respiratory complications, mediastinitis and haemodialysis. The octogenarians with acute type A aortic dissection had higher incidences of DeBakey type II dissection and intramural haematomas and lower incidences of severe aortic regurgitation and aortic root enlargement than the nonoctogenarians. Being an octogenarian was not associated with an increased risk of early major complications or mortality after surgery for acute type A aortic dissection.

Antibiotic therapy in pediatric outpatient ENT infections

Inflammatory diseases of the ENT organs are currently the most common pathology in children. Diseases of the nasal cavity and paranasal sinuses occupy the leading place in the structure of primary morbidity, averaging 55.5%. In the paediatric population, ENT pathology develops more often as a secondary bacterial complication of a previous viral infection of the upper respiratory tract. Bacterial otorhinolaryngological complications often require the prescription of antibacterial drugs. In outpatient practice, the choice of rational and safe therapy is of utmost importance. The article presents clinical cases of ENT diseases in children and algorithms for the choice of initial antibacterial therapy. Recommended drugs for the treatment of ENT diseases and the main indications for their administration are presented. Most national and international guidelines recommend amoxicillin as a first-line drug for the treatment of major respiratory pathogens (S. pneumoniae, H. influenzae, S. pyogenes) and bacterial complications of ENT diseases in children, taking into account its low toxicity, cost and convenient form of administration. In case of ineffective therapy or in the presence of risk factors for drug resistance of pathogens, semi-synthetic penicillins in combination with β-lactamase inhibitors are recommended.

The role of overnight pulse oximetry in risk stratification of paediatric sleep disordered breathing in a district general hospital

ObjectivesAdenoidectomy and tonsillectomy are common surgical interventions in paediatric patients with sleep disordered breathing. Post operative respiratory complications are a recognised risk, and pre-operative risk stratification of patients is important to enable safe delivery of peri-operative care. Due to easy accessibility, overnight pulse oximetry is commonly used for this purpose. However, its limitations have been widely reported and recent national guidance recommends limiting use to patients with significant risk factors. We reviewed the use of overnight pulse oximetry in our local unit to determine if local guidelines should be adapted in line with these national recommendations. MethodsRetrospective analysis of all paediatric patients referred for overnight pulse oximetry over an eighteen month period between August 2020 to February 2022. Data collection included patient age, weight, and relevant co-morbidities. The McGill score was used to risk stratify patients and determine the need for an overnight bed. This was then correlated with the occurrence of post operative respiratory complications. Results200 patients were referred for overnight pulse oximetry, with a mean age of 7.5 years. 7.5 % (15/200) had significant comorbidities. 64 % (128/200) of patients were subsequently listed for surgery. 20.3 % (26/128) were deemed at risk of post-operative complications due to McGill scores of 3 and 4 and planned for overnight ward observation. Of these, 15 % (4/26) were subsequently discharged the same day. None of our patients developed major respiratory complications in the post operative period. ConclusionOur findings support national recommendations that overnight pulse oximetry is not an accurate predictor of post-operative respiratory complications and resulted in unnecessary inpatient stays. Following discussion with the trust paediatric anaesthetist lead, our local guidance was tightened, limiting overnight pulse oximetry to children with relevant identifiable co-morbidities.

The use of ELMO helmets for the treatment of patients with COVID-19: experience report

Objective: to describe nurses' experience with the use of the ELMO helmet for the treatment of patients with COVID-19. Methods: experience report in an emergency care unit located in a metropolitan city of Ceará, Brazil, in the period from March 15 to June 22, 2021. Content Analysis was used for organization and analysis through references in the area. Results: the potentialities of care during the ELMO helmet use were observed, such as a decrease in indications for orotracheal intubation, improvement in respiratory distress, and decrease in morbidity, but also weaknesses such as diminished patient-healthcare professional communication, need for careful evaluation of the time of use and patient response, risk of psychological instability, and risk of broncho-aspiration; moreover, health teams collaborative aspects such as increased intra-team communication, effective interaction, and greater decision-making were registered. Conclusion: important results in treating COVID-19 can result from the use of this tool; however, there is a need for strict monitoring in order to avoid major respiratory complications as well as physical and psychological sequelae from the wearing of ELMO.

Asthma Exacerbation during the COVID-19 Pandemic

Introduction: Asthmatics, especially uncontrolled asthmatics, must be vigilant during the COVID-19 pandemic to avoid major respiratory complications. This study aimed to describe these characteristics in emergency unit patients with asthma and COVID-19 at Haji General Hospital, Surabaya, an East Java referral hospital. Methods: The study gathered medical information on 160 asthma patients from March to December 2021. The collected data were related to socioeconomics, allergy history, family allergy history, and medications. Results: 160 confirmed cases of asthma occurred during COVID-19 at Haji General Hospital, Surabaya. Most adult asthma sufferers were women (59.2%), high school graduates (31.25%), housewives (21.2%), had payment method with Social Health Insurance Administration Body (BPJS) insurance (73.8 %), had a history of drug allergies (11.5%), had no family history of allergies (50.8%), and used albuterol control drugs (10.7%). Meanwhile, the majority of children with asthma were boys (53.3%), did not attend school or did not finish elementary school (33.3%), did not work (33.3%), had payment method with BPJS (73.3%), had a history of allergies to seafood and cow's milk respectively (10%), had no family history of allergies (40%), and used albuterol control drugs (16.7%). Conclusion: The proportion of asthma in the emergency unit was dominated by women over 18 years old with a high school education. Most patients were housewives and used BPJS. Many of them had a history of allergies to medications (not asthma medication), and there was no family history of allergies. Commonly used medications were albuterol to control asthma.

The impact of residency training level on early postoperative desaturation: A retrospective multicenter cohort study

ObjectiveWe studied the primary hypothesis that the training level of anesthesiology residents (first clinical anesthesia year, CA1 vs CA2/3 residents) is associated with early postoperative desaturation (oxygen saturation < 90%). We also analyzed the change in the rate (trajectory) of desaturation during the resident's development from CA1 to CA2/3 resident, and its effects on postoperative respiratory complications. DesignRetrospective hospital registry study. SettingTwo university-affiliated hospitals networks (MA and NY, USA). Patients140,818 adults undergoing non-cardiac surgery under general anesthesia and extubation in the operating room by residents (n = 378) between 2005 and 2021. MeasurementsMultivariate logistic and quantile regression were used in the analyses. The secondary outcome was major respiratory complication within 7 days after surgery. Main resultsIn 6.5% and 1.6% of cases, early postoperative desaturation to < 90% and 80% occurred. Compared to CA2/3 residents, CA1 residents had higher odds of experiencing early postoperative desaturation to < 90% and 80% (adjusted odds ratio [ORadj], 1.07; 95%CI 1.03–1.12; p = 0.002, and ORadj 1.10; 95%CI 1.01–1.20; p = 0.037, respectively). The change in postoperative desaturation rate during the transition from CA1 to CA2/3 status varied substantially from ORadj 0.80 (decreased risk) to 1.33 (increased risk). Major respiratory complication did not differ between experience levels (p = 0.52). However, a strong decline in improvement regarding the rate of postoperative desaturation during the transition from CA1 to CA2/3, was paralleled by an increased odds of major respiratory complication for CA2/3 residents (ORadj 1.20; 95%CI 1.02–1.42; p = 0.026, p-for-interaction = 0.056). ConclusionPatients treated by CA1 residents have an increased risk of postoperative desaturation. Some residents show an improvement and others a decline in postoperative desaturation rate. Our secondary analysis suggests that there should be more focus on those residents who had a declining performance in postoperative desaturation despite becoming more experienced.

Weight loss during neoadjuvant therapy and short-term outcomes after esophagectomy: a retrospective cohort study.

Neoadjuvant therapy (NAT) has become common worldwide for resectable advanced esophageal cancer and frequently involves weight loss. Although failure to rescue (death after major complications) is known as an emerging surgical quality measure, little is known about the impact of weight loss during NAT on failure to rescue. This retrospective study aimed to investigate the association of weight loss during NAT and short-term outcomes, including failure to rescue after esophagectomy. Patients who underwent esophagectomy after NAT between July 2010 and March 2019 were identified from a Japanese nationwide inpatient database. Based on quartiles of percent weight change during NAT, patients were grouped into four categories of gain, stable, small loss, and loss (>4.5%). The primary outcomes were failure to rescue and in-hospital mortality. The secondary outcomes were major complications, respiratory complications, anastomotic leakage, and total hospitalization costs. Multivariable regression analyses were used to compare outcomes between the groups, adjusting for potential confounders, including baseline BMI. Among 15159 eligible patients, in-hospital mortality and failure to rescue occurred in 302 (2.0%) and 302/5698 (5.3%) patients, respectively. Weight loss (>4.5%) compared to gain was associated with increased failure to rescue and in-hospital mortality [odds ratios 1.55 (95% CI: 1.10-2.20) and 1.53 (1.10-2.12), respectively]. Weight loss was also associated with increased total hospitalizations costs, but not with major complications, respiratory complications, and anastomotic leakage. In subgroup analyses, regardless of baseline BMI, weight loss (>4.8% in nonunderweight or >3.1% in underweight) was a risk factor for failure to rescue and in-hospital mortality. Weight loss during NAT was associated with failure to rescue and in-hospital mortality after esophagectomy, independent of baseline BMI. This emphasizes the importance of weight loss measurement during NAT to assess the risk for a subsequent esophagectomy.

Comparing restrictive versus liberal oxygen strategies for trauma patients: The TRAUMOX2 trial-Statistical analysis plan.

The international advanced trauma life support guidelines recommend that all severely injured trauma patients receive supplemental oxygen based on very limited evidence. The TRAUMOX2 trial randomises adult trauma patients to a restrictive or liberal oxygen strategy for 8 h. The primary composite outcome consists of 30-day mortality and/or development of major respiratory complications (pneumonia and/or acute respiratory distress syndrome). This manuscript presents the statistical analysis plan for TRAUMOX2. Patients are randomised 1:1 in variable block sizes of four, six and eight, stratified by including centre (pre-hospital base or trauma centre) and tracheal intubation at inclusion. The trial will include 1420 patients to be able to detect a 33% relative risk reduction with the restrictive oxygen strategy of the composite primary outcome with 80% power at the 5% significance level. We will conduct modified intention-to-treat analyses on all randomised patients and per-protocol analyses for the primary composite outcome and key secondary outcomes. The primary composite outcome and two key secondary outcomes will be compared between the two allocated groups using logistic regression reported as odds ratios with 95% confidence intervals adjusted for the stratification variables as in the primary analysis. A p-value below 5% will be considered statistically significant. A Data Monitoring and Safety Committee has been established to conduct interim analyses after inclusion of 25% and 50% of the patients. This statistical analysis plan of the TRAUMOX2 trial will minimise bias and add transparency to the statistics applied in the analysis of the trial. The results will add evidence on restrictive and liberal supplemental oxygen strategies for trauma patients. EudraCT number: 2021-000556-19; ClinicalTrials.gov identifier: NCT05146700 (date of registration: 7 December 2021).

Comparing restrictive versus liberal oxygen strategies for trauma patients — the TRAUMOX2 trial: protocol for a randomised clinical trial

IntroductionSupplemental oxygen is commonly used in trauma patients, although it may lead to hyperoxaemia that has been associated with pulmonary complications and increased mortality. The primary objective of this trial,...

Outcome of neonatal hypoxemic respiratory failure: a livebirth population-based retrospective survey

BackgroundTo explore the prevalence, outcome and perinatal risks of neonatal hypoxemic respiratory failure (NRF) in a survey of all livebirths from a regional network of perinatal-neonatal care during the transition period after 5-year universal health insurance implemented in China.MethodsClinical data of all neonatal respiratory morbidities in Huai’an were retrospectively collected in the regional perinatal network database of all livebirths as vital statistics in 2015. NRF was defined as hypoxemia requiring continuous positive airway pressure (CPAP) and/or mechanical ventilation (MV) for at least 24 h. Mortality risks of antenatal and perinatal morbidities, major respiratory therapies and complications were analyzed by multivariable logistic regression model.ResultsThere were 788 NRF cases identified in 9.9% (7960) hospitalized, or 13.3‰ (59056) livebirths, in which 6.7% received intensive care and 93.0% critical care. The major underlying morbidities were respiratory distress syndrome (RDS, 36.4%) and pneumonia/sepsis (35.3%), treated mainly by CPAP, MV and surfactant. Significantly improved outcomes by surfactant in RDS were in patients with birthweight (BW) < 1500 g or gestational age (GA) < 32 weeks. The overall mortality rate in NRF was 18.4% whereas for those of BW < 1000 g and GA < 28 weeks, 70% and 54%, respectively. The multivariable regression analysis showed the highest odds for NRF death among meconium aspiration syndrome, congenital anomalies, BW < 1500 g and necrotizing enterocolitis, whereas born in level III hospitals, cesarean delivery, CPAP and MV were associated with markedly reduced death odds.ConclusionsThe salient findings with associated risk estimates reflected efficiency of respiratory support as critical care in a prefectural regional network infrastructure for annual livebirths in 5.6 million inhabitants. It implicated the representativeness of contemporaneous perinatal-neonatal care standard at medium to medium-high level, in one/fourth of the population of China, aiming at saving more life of very critical and preterm infants for better survival.

Intranasal Exposure to Hog Dust Extract Promotes Endotoxemia and Increases Gene Expression of TNF‐α and Secretary Epithelial Cell Markers in Mouse Intestine

Agriculture‐related dust exposures to antimicrobial‐resistant pathogens can have significant health implications for animal agricultural industry workers. In addition to major respiratory complications, air pollutants provoke intestinal diseases and altered digestive tract physiology. Hog farm dust is highly abundant in gram‐positive and gram‐negative bacteria. Lipopolysaccharides (LPS; endotoxins) excised from gram‐negative bacteria can drive increased intestinal permeability and inflammation. Therefore, we hypothesized that acute intranasal exposure to aqueous extracts of dusts collected from hog confinement facilities (HDE) ‐ containing bacterial LPS ‐ cause increased intestinal inflammation and barrier dysfunction. We previously showed that intranasal exposure of 8‐week‐old male or female C57BL/6J mice (n=12) to 12.5% HDE (containing 22.1‐91.1 EU/mL) (n=6) for 3 weeks elevated bronchoalveolar lavage total cell and neutrophil levels (indicative of chronic airway inflammation), and increased intestinal permeability, in comparison to saline controls (n=6). We now report that HDE‐treated mice have elevated serum LPS levels (unpaired t‐test, p&lt;0.0001; n=6/group) suggesting endotoxemia. To further identify intestinal epithelial responses initiated by HDE, inflammatory genes were examined in intestinal whole tissue lysates by qPCR. TNF‐α expression was increased in the ileum (unpaired t‐test, p=0.0265; n=3‐5/group) but not in the colon of HDE‐treated mice. Conversely, IL‐1B, IL‐6 and IL‐10 were not significantly altered along the intestinal tract. Following HDE treatment, mRNA expression of the goblet cell marker, Muc2, was increased in distal colon epithelial cells (unpaired t‐test, p=0.0099, n=3‐5/group). The Paneth cell‐associated marker, Lyz1 (lysozyme), was unchanged in ileum but was increased in proximal colon epithelial cells (p=0.0444, n=2‐5/group) of HDE‐treated mice. Collectively, these data indicate that agricultural dust exposure induces endotoxemia and promotes intestinal inflammation characterized by increased TNF‐α and host anti‐microbial responses.

Characteristics and outcomes of patients undergoing anesthesia while SARS-CoV-2 infected or suspected: a multicenter register of consecutive patients

BackgroundThere are limited data to detail the perioperative anesthetic management and the incidence of postoperative respiratory complications among patients requiring an anesthetic procedure while being SARS-CoV-2 positive or suspected.MethodsAn observational multicenter cohort study was performed including consecutive patients who were SARS-CoV-2 confirmed or suspected and who underwent scheduled and emergency anesthesia between March 17 and May 26, 2020.ResultsA total of 187 patients underwent anesthesia with SARS-CoV-2 confirmed or suspected, with ultimately 135 (72.2%) patients positive and 52 (27.8%) negative. The median SOFA score was 2 [0; 5], and the median ARISCAT score was 49 [36; 67]. The major respiratory complications rate was 48.7% (n = 91) with 40.4% (n = 21) and 51.9% (n = 70) in the SARS-CoV-2–negative and –positive groups, respectively (p = 0.21). Among both positive and negative groups, patients with a high ARISCAT risk score (> 44) had a higher risk of presenting major respiratory complications (p < 0.01 and p = 0.1, respectively).DiscussionWhen comparing SARS-COV-2–positive and –negative patients, no significant difference was found regarding the rate of postoperative complications, while baseline characteristics strongly impact these outcomes. This finding suggests that patients should be scheduled for anesthetic procedures based on their overall risk of postoperative complication, and not just based on their SARS-CoV-2 status.

Predictors of Major Respiratory Complications after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Analysis of the NSQIP Database

Predictors of Major Respiratory Complications after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Analysis of the NSQIP Database

Outcomes of Endovascular Aneurysm Repair with Adjunctive Stenting

Endovascular aneurysm repair is the standard of care for abdominal aortic aneurysm repair, however data regarding adjunctive stenting at the time of endovascular aneurysm repair (EVAR) are limited. The study aims to evaluate outcomes of patients undergoing EVAR with and without adjunctive stenting. Patients undergoing EVAR with stenting (EVAR-S) and without stenting (EVAR) (2008 - 2017) were selected from Cerner HealthFacts database using ICD-9 diagnosis and procedure codes. Chi-square analysis and multivariable logistic regression were used to evaluate the association of patient characteristics with medical and vascular outcomes. 4,957 patients undergoing EVAR procedures were identified (3,816 EVAR and 1,141 EVAR-S). Demographic analysis revealed that patients who underwent EVAR-S had higher Charlson comorbidity scores (2.35 vs. 2.13, P=0.0001). EVAR-S was associated with a greater frequency of vascular complications such as thrombolysis/percutaneous thrombectomy (0.9% vs. 0.2%; P < 0.0004). There were no differences seen in access complications between EVAR and EVAR-S. Multivariable analysis revealed that EVAR-S was associated with prolonged length of stay (OR 1.37, 95% CI 1.03-1.82), readmission < 30 days (OR 1.36, 95% CI 1.11-1.68), major adverse cardiac events (OR 1.59, 95% CI 1.09-2.32), respiratory complications (OR 1.47, 95% CI 1.16-1.88) and renal failure (OR 1.57, 95% CI 1.16-2.11). Endovascular aneurysm repair with adjunctive stenting (EVAR-S) was associated with vascular complications requiring reintervention, although the overall rate was very low. As well, readmission within 30 days, cardiac complications, respiratory problems and renal failure were more likely when compared to standard EVAR. The need for adjunctive stenting acts as a marker for an overall sicker and more complex population, not just in terms of vascular complications but across all medical complications as well. Staging the procedure may be helpful in terms of spreading out the operative risk into smaller portions. Furthermore, consideration of a non-operative strategy should be discussed with the patient if the risk of the procedure outweighs the risk of aneurysm rupture in high-risk groups.

Safety of elective paediatric surgery during the coronavirus disease 2019 pandemic

IntroductionCorona-virus Disease 2019 (COVID-19) has had a huge impact on the delivery of healthcare worldwide, particularly elective surgery. There is a lack of data regarding risk of postoperative COVID-19 infection in children undergoing elective surgery, and regarding the utility of pre-operative COVID-19 testing, and preoperative “cocooning” or restriction of movements. The purpose of this present study was to examine the safety of elective paediatric Otolaryngology surgery during the COVID-19 pandemic with respect to incidence of postoperative symptomatic COVID-19 infection or major respiratory complications. Materials and methodsProspective cohort study of paediatric patients undergoing elective Otolaryngology surgery between September and December 2020. Primary outcome measure was incidence of symptomatic COVID-19 or major respiratory complications within the 14 days after surgery. Parents of prospectively enrolled patients were contacted 14 days after surgery and enquiry made regarding development of postoperative symptoms, COVID-19 testing, or diagnosis of COVID-19. Results302 patients were recruited. 125 (41.4%) underwent preoperative COVID-19 RT-PCR testing. 66 (21.8%) restricted movements prior to surgery. The peak 14-day COVID-19 incidence during the study was 302.9 cases per 100,000 population. No COVID-19 infections or major respiratory complications were reported in the 14 day follow-up period. ConclusionThe results of our study support the safety of elective paediatric Otolaryngology surgery during the pandemic, in the setting of community incidence not exceeding that observed during the study period.

Safe Elective Surgical Practice During COVID-19 Pandemic - A Prospective Observational Study of 303 Elective Surgeries in the UK.

AimDuring the COVID-19 pandemic, there has been worldwide cancellation of elective surgeries to protect patients from nosocomial viral transmission and peri-operative complications. With the unfolding situation, there is a definite need for an exit strategy to reinstate elective services. Therefore, more literature evidence supporting exit plans for elective surgical services is imperative to adopt a safe working principle. This study aims to provide evidence for safe elective surgical practice during the pandemic.MethodologyThis single centre, prospective, observational study included adult patients who were admitted and underwent elective surgical procedures in the trust’s COVID-free environment at the Birmingham Treatment Centre between May 19 and July 14, 2020. Data were collected on demographic parameters, peri-operative variables, surgical specialities, COVID-19 reverse transcription polymerase chain reaction (RT-PCR) testing results, post-operative complications and mortality. The study also highlighted the protocols it followed for the elective services during the pandemic.ResultsA total of 303 patients were included with mean age of 49.9 years (SD 16.5) comprising of 59% (178) female and 41% (125) male. They were classified according to the American Society of Anaesthesiologist Grade, different surgical specialities and types of anaesthesia used. Ninety-six percent (96%) of patients were discharged on the same day. Hundred percent (100%) compliance with pre-operative COVID-19 RT-PCR testing was maintained. There was no 30-day mortality or major respiratory complications.ConclusionCareful patient selection, simultaneous involvement of the pre-assessment and anaesthetic team, strict adherence to peri-operative protocols and delivering vigilant post-operative care for COVID-19 infection can help provide safe elective surgical services if the community transmission is under reasonable control. However, it is particularly important to maintain COVID-free safe environment for such procedures.

Incidence of post-anesthetic respiratory complications in pediatrics. Observational, single-center study in Medellin, Colombia

Introduction: Post-anesthetic complications, particularly respiratory complications, continue to be a source of concern due to their high frequency, particularly in pediatrics.&#x0D; Objective: To describe the incidence of respiratory complications in the post-anesthesia care unit of an intermediate complexity center during a six-month period, and to explore the variables associated with major respiratory complications.&#x0D; Materials and Methods: Retrospective cohort study based on clinical record reviews. The records of the post-anesthesia care unit of an intermediate complexity pediatric institution located in Medellin, Colombia, were reviewed. This center uses a nursing-based care model that includes patient extubation in the post-anesthesia care unit.&#x0D; Results: The records of 1181 patients were analyzed. The cumulative incidences of major complications were bronchospasm 1.44%, laryngospasm 0.68% and respiratory depression 0.59%. There were no cases of cardiac arrest or acute pulmonary edema. A history of respiratory infection less than 15 days before the procedure, rhinitis and female sex were associated with major respiratory complications.&#x0D; Conclusions: A low frequency of respiratory complications was found during care provided by nursing staff trained in anesthesia recovery and pediatric airway in the post-anesthesia care unit.

Perioperative blood transfusion decreases long-term survival in pediatric living donor liver transplantation

BACKGROUNDThe impact of perioperative blood transfusion on short- and long-term outcomes in pediatric living donor liver transplantation (PLDLT) must still be ascertained, mainly among young children. Clinical and surgical postoperative complications related to perioperative blood transfusion are well described up to three months after adult liver transplantation.AIMTo determine whether transfusion is associated with early and late postoperative complications and mortality in small patients undergoing PLDLT.METHODSWe evaluated the effects of perioperative transfusion on postoperative complications in recipients up to 20 kg of body weight, submitted to PLDLT. A total of 240 patients were retrospectively allocated into two groups according to postoperative complications: Minor complications (n = 109) and major complications (n = 131). Multiple logistic regression analysis identified the volume of perioperative packed red blood cells (RBC) transfusion as the only independent risk factor for major postoperative complications. The receiver operating characteristic curve was drawn to identify the optimal volume of the perioperative RBC transfusion related to the presence of major postoperative complications, defining a cutoff point of 27.5 mL/kg. Subsequently, patients were reallocated to a low-volume transfusion group (LTr; n = 103, RBC ≤ 27.5 mL/kg) and a high-volume transfusion group (HTr; n = 137, RBC > 27.5 mL/kg) so that the outcome could be analyzed.RESULTSHigh-volume transfusion was associated with an increased number of major complications and mortality during hospitalization up to a 10-year follow-up period. During a short-term period, the HTr showed an increase in major infectious, cardiovascular, respiratory, and bleeding complications, with a decrease in rejection complications compared to the LTr. Over a long-term period, the HTr showed an increase in major infectious, cardiovascular, respiratory, and minor neoplastic complications, with a decrease in rejection complications. Additionally, Cox hazard regression found that high-volume RBC transfusion increased the mortality risk by 3.031-fold compared to low-volume transfusion. The Kaplan-Meier survival curves of the studied groups were compared using log-rank tests and the analysis showed significantly decreased graft survival, but with no impact in patient survival related to major complications. On the other hand, there was a significant decrease in both graft and patient survival, with high-volume RBC transfusion.CONCLUSIONTransfusion of RBC volume higher than 27.5 mL/kg during the perioperative period is associated with a significant increase in short- and long-term postoperative morbidity and mortality after PLDLT.