Prevention Of Respiratory Complications Research Articles

Prevention of respiratory complications in patients at risk of adverse respiratory events by perioperative nitric oxide delivery during cardiac surgery under cardiopulmonary bypass: a single-center prospective randomized study

Prevention of respiratory complications in patients at risk of adverse respiratory events by perioperative nitric oxide delivery during cardiac surgery under cardiopulmonary bypass: a single-center prospective randomized study

Respiratory complications of neurological diseases

Objectives: This study aims to raise awareness toward early diagnosis, effective treatment, and prevention of respiratory complications in patients with neurological diseases. The goal is to improve patients’ overall condition and reduce mortality rates. Materials and Methods: This study is a prospective observational study conducted at Damascus Hospital, Damascus, Syria, from October 2022 to March 2023. It includes (100) patients diagnosed with neurological diseases who developed respiratory complications. Their ages ranged from 18 to 89 years, with an equal gender distribution. Data analysis was performed using SPSS statistics version 19. Results: This study revealed that cerebrovascular accidents cause aspiration pneumonia. The most frequent chest X-ray and thoracic computed tomography findings showed pulmonary densities and infiltrates. Subsequently, arterial blood gas results showed type 2 respiratory failure. Many patients experienced regression of respiratory complications, and the mortality rate was low, indicating the efficacy of treatments. Conclusion: Respiratory complications significantly contribute to mortality in patients with neurological diseases. The study emphasizes the importance of early diagnosis and preventive measures such as elevating the patient’s bed and periodic suctioning of secretions. Placing patients in specialized neurological intensive care units for tailored treatment is advised.

Role of Prophylactic Dexamethasone Administration before Elective Cesarean Section at Term in Reducing the Incidence of Neonatal Respiratory Distress Syndrome (A Randomized Controlled Trial)

Background Caesarean section rate has been increased, half of which are elective. This may be due to abnormal presentation during pregnancy, increased maternal choice about mode of delivery and due to changing practice in the management of previous caeserean sections. Aim of the Work The objective of this study is to assess the effect of prophylactic dexamethasone 48 h before elective cesarean section at term (less than 39 weeks) on decreasing the neonatal respiratory distress syndrome and NICU admission. Patients and Methods Design: A randomized controlled clinical trial. 2 groups; (Group A, Dexa) which consists of 460 pregnants who received prophylactic 4 intramuscular doses of 6mg dexamethasone 12 hours apart 48 hours before delivery. And (Groups B, Control) 460 pregnants who received No treatment before elective caesarean section at term (37-39 wks). Results Regarding the indication for the C.S, there was no significant difference between women of both groups. There was no significant statistical difference between the two groups as regarding birth weight. Neonates of dexamethasone group significantly had higher APGAR scores. Transient tachypnea of neonates (TTN) was significantly less frequent among dexamethasone group (2.8%) while in the control group was (6.5%). Respiratory distress syndrome (RDS) was significantly less frequent among dexamethasone (A) group 3/460 (0.7%) while was 15/460 (3.3%) in control (B) group. Also (RDS) grade was significantly less frequent among dexamethasone group. The intraventricular hemorrhage was non-significantly less frequent among dexamethasone group (0.2%). The need to resuscitation was significantly less frequent among dexamethasone group (6.3%) while in control group was (11.5%). NICU admission was significantly less frequent among dexamethasone group (3.5%) vs (9.1%) in control group. Also NICU admission duration was significantly shorter among dexamethasone group. The need for mechanical ventilation was significantly less frequent among dexamethasone group (0.2%) while in control group was (1.7%). Mechanical ventilation duration was significantly shorter among dexamethasone group. Neonatal mortality was nonsignificantly less frequent among dexamethasone group (0.2%) while in control group (0.4%). Conclusion Antenatal Corticosteroids are effective in prevention of respiratory complications after elective caesarean section at term including: the incidence of neonatal respiratory distress syndrome, the incidence of admission with respiratory distress to neonatal ICU and the incidence of transient tachyponea of the newborn.

Paravertebral block combined with serratus anterior plane block after video-assisted thoracic surgery: a prospective randomized controlled trial.

Adequate pain management after thoracoscopic surgery is a major issue in the prevention of respiratory complications. The combination of the paravertebral block (PVB) with the serratus anterior plane block (SAPB) may decrease postoperative pain. The objective of this study was to evaluate the impact of the combination of PVB and SAPB on the consumption of morphine and pain after video- or robot-assisted thoracic surgery. The main objective of this randomized controlled trial was to compare the cumulative postoperative morphine consumption at 24 h between a group having PVB (PVB group) and a group having PVB and SAPB (PV-SAPB group). Postoperative pain at 6 and 24 h and morphine-related complications were also assessed. A total of 112 patients were included with 56 in each group. There was no difference in median cumulative morphine consumption at 24 h between the 2 groups (P = 0.1640). At 6 h, the median postoperative pain was higher in the PVB group compared to the PV-SAPB group (3 [0; 4] vs 2 [0; 3], P = 0.0231). There were no differences between the 2 groups for pain at 24 h and morphine-related complications. We did not find any difference in morphine consumption between the 2 groups. Our results suggest that the combination of PVB and SAPB for video-assisted thoracic surgery or robot-assisted thoracic surgery is safe effective and reliable and could be an alternative to PVB alone in certain indications.

Erector Spinae Plane Block versus Paravertebral Block after Thoracic Surgery for Lung Cancer: A Propensity Score Study.

The prevention of respiratory complications is a major issue after thoracic surgery for lung cancer, and requires adequate post-operative pain management. The erector spinae plane block (ESPB) may decrease post-operative pain. The objective of this study was to evaluate the impact of ESPB on pain after video or robot-assisted thoracic surgery (VATS or RATS). The main outcome of this retrospective study with a propensity score analysis (PSA) was to compare the post-operative pain at 24 h at rest and at cough between a group that received ESPB and a group that received paravertebral block (PVB). Post-operative morphine consumption at 24 h and complications were also assessed. One hundred and seven patients were included: 54 in the ESPB group and 53 in the PVB group. The post-operative median pain score at rest and cough was lower in the ESPB group compared to the PVB group at 24 h (respectively, at rest 2 [1; 3.5] vs. 2 [0; 4], p = 0.0181, with PSA; ESPB -0.80 [-1.50; -0.10], p = 0.0255, and at cough (4 [3; 6] vs. 5 [4; 6], p = 0.0261, with PSA; ESPB -1.48 [-2.65; -0.31], p = 0.0135). There were no differences between groups concerning post-operative morphine consumption at 24 h and respiratory complications. Our results suggest that ESPB is associated with less post-operative pain at 24 h than PVB after VATS or RATS for lung cancer. Furthermore, ESPB is an acceptable and safe alternative compared to PVB.

Mechanical insufflation-exsufflation for the prevention and treatment of respiratory complications in acute cervical spinal cord injury: A retrospective service evaluation

Background A cervical spinal cord injury (CSCI) is a life-changing event resulting in neurological weakness. Acutely, respiratory complications are the leading cause of mortality. Mechanical insufflation-exsufflation (MI-E) is used to augment cough and promote airway clearance in the prevention and treatment of respiratory complications in this population. The incidence of respiratory complications in subjects with CSCI who receive MI-E is not widely reported. Objectives To report on the incidence of respiratory complications and to evaluate the clinical application of MI-E in subjects with acute traumatic CSCI. Methods This was a retrospective case note review. Data was collected for subjects with a traumatic CSCI admitted to a U.K. major trauma centre between January 2017 and September 2018. The incidence of respiratory complications on admission and 3 weeks post-admission were collected. Where used, detail relating to MI-E clinical application was recorded. Results 33 subjects were eligible for inclusion. The overall incidence of respiratory complications was 21% (7/33). There was no significant difference in occurrence of respiratory complications between those who received MI-E and those who did not. There was a significant difference in the clinical application of therapeutic MI-E compared to prophylactic MI-E. The ‘number of cycles’ and ‘exhale pressure’ settings were found to be significantly greater in those receiving therapeutic treatment (p = <0.001; p = 0.002 respectively). Reporting of other MI-E parameters and treatment detail was poor. Conclusion Whilst the findings of this review may suggest that MI-E provides no additional benefit in the prevention of respiratory complications following acute traumatic CSCI, firm conclusions cannot be drawn due the small sample and poor treatment detail reporting. Further incidence reporting in a multi-site study, including those with thoracic injuries is warranted.

Impact of Opioid-free Anesthesia After Video-assisted Thoracic Surgery: A Propensity Score Study

BackgroundAdequate postoperative morphine consumption and pain management after thoracic surgery are major issues in the prevention of respiratory complications. Opioid-free anesthesia (OFA) may decrease morphine consumption and postoperative pain. The objective of this study was to evaluate the impact of OFA on the consumption of morphine and pain after video-assisted thoracic surgery or robotic-assisted thoracic surgery. MethodsThe main objective of this retrospective study with propensity score analysis (PSA) was to compare the cumulative postoperative morphine consumption at 48 hours between an OFA group receiving dexmedetomidine, lidocaine, and ketamine; and an opioid anesthesia (OA) group receiving remifentanil plus morphine. Postoperative pain at 24 and 48 hours and respiratory and hemodynamics complications were also assessed. ResultsEighty-one patients were included, 48 in the OFA group and 33 in the OA group. The cumulative postoperative morphine consumption at 48 hours was lower in the OFA group than in the OA group (28.5 mg [0 to 62.25 mg] vs 55 mg [34 to 79.5 mg], P = .002, with PSA; OFA −27.67 mg [−46 mg to −11.5 mg], P = .002). The postoperative pain score was significantly lower in the OFA group compared with the OA group at 24 hours (2 [0 to 4] vs 3 [2 to 5], P = .064, with PSA; OFA −1.40 [−2.47 to −0.33], P = .0088) and 48 hours (0 [0 to 3] vs 2.5 [0 to 5], P = .034, with PSA; OFA −1.87 [−3.45 to −0.28], P = .021). There were no differences between groups concerning respiratory or hemodynamic complications. ConclusionsOur results suggest that OFA after video-assisted thoracic surgery or robotic-assisted thoracic surgery is safe and is associated with less postoperative morphine cumulative consumption and pain at 48 hours.

Management of Multiple Rib Fractures-Results from a Major Trauma Centre with Review of the Existing Literature

The mainstay management of rib fracture is provision of adequate analgesia and the prevention of respiratory complications that can all stem from poor ventilatory function amongst other patient factors and injury patterns. Through the decades, surgical stabilisation has gained pace and has found its niche in the management of rib fractures.

Management of multiple rib fractures-results from a Major Trauma Centre with the review of the existing literature

Introduction: Rib fractures are amongst the most common fractures following major traumapresenting to the Emergency Department. The impact of rib fractures is even more significant in thepatient with underlying chronic respiratory conditions. Aim: To assess our current management ofrib fractures at our trauma center. Method: The current study collected our data from the TARNRegistry primarily focussing on patients with multiple rib fractures. The main components were theanalgesic requirement of our patients. The number of rib fracture stabilization procedures and theaverage number of ribs fixed were also studied. Results: The data were collected retrospectivelyover 12 months. There were 313 patients identified as having chest wall injuries. From the data,41.9% (131) of patients were over the age of 65 years. A significant proportion of our patients34.5% (108) were noted to have multiple rib fractures (>3 Ribs). It was noted that 3% (9) of the313 patients required operations. The average of the patients included in the study was noted to be61 years with an age range of 17-92 years. Conclusion: The mainstay management of rib fractureis a provision of adequate analgesia and the prevention of respiratory complications that can allstem from poor ventilatory function amongst other patient factors and injury patterns. Through thedecades, surgical stabilization has gained pace and has found its niche in the management of ribfractures.

Kinesitherapy application features in patients after pectus excavatum repair

Surgical treatment of “pectus excavatum” by Nuss technique is a safe procedure that is successfully used in young people. However, after surgery, these patients face complications that limit their ability to engage in physical labor or sports.
 Aim. Develop a rehabilitation program for patients who underwent surgical correction of pectus excavatum using Nuss technique.
 Material and methods. 85 patients with pectus excavatum deformity were examined and underwent minimally invasive correction according to Nuss technique.
 Results. In 82 (96,47 %) patients we managed to achieve the perfect cosmetic result. In 78 (91,76 %) patients we used one fixator, in 5 (5,88 %) – 2 fixators, and in 2 (2,35 %) patients – 3 fixators. Among the complications, 17 (20 %) patients had pneumothorax, 3 (3,53 %) – hemothorax followed by pleural puncture, pneumonia was diagnosed in 2 (2,35 %) patients, pleural effusion – in 2 (2,35 %), empyema – in 1 (1,18 %), sulfur – in 1 (1,18 %), deep infection – in 1 (1,18 %). One patient (1,18 %) underwent a second operation due to the dislocation of the fixator.
 Conclusions. In the postoperative period, it is recommended to avoid bending or rotating the body, limit participation in sports activities during the first 3 months after the operation. During the first 8 weeks, patients were recommended to perform breathing exercises with a small amplitude (for the prevention of respiratory complications), and 3 months after surgery – exercises to strengthen postural and abdominal muscles, to improve the amplitude of movements in the shoulder joints. The use of exercises helps to reduce the risk of post operative complications and improve the functional capabilities of patients with pectus excavatum in a shorter time.

Comparative Study between Betamethasone and Dexamethasone as a Prophylactic Corticosteroids Therapy on Neonatal Outcome in Elective Cesarean Section at 37 Weeks

Background: preterm birth is the most costly complication of pregnancy and the leading cause of neonatal morbidity and mortality. There are multiple strategies to minimize the risk and the impact of prematurity, such as administration of antenatal corticosteroids (ACS), in association with tocolysis, neuroprotection with magnesium sulphate, and neonatal life-saving therapies. Aim of the Work: this study aimed to assess the comparison between betamethasone and dexamethasone before elective cesarean section at (37-37+6) weeks, in reducing neonatal respiratory morbidity and admission to neonatal intensive care unit (NICU) with respiratory complications. Patients and Methods: this clinical observational prospective study had been conducted at El Hussein University Hospitals Obstetrics and Gynecology Department from December 2017 to July 2018 to assess the comparison between betamethasone and dexamethasone as a prophylactic corticosteriodes before elective cesarean section at (37-37+6) weeks. Five hundred pregnant women attended to out-patient clinic, the patient were at risk of preterm labour before 37 weeks. Results: the rate of neonatal admission to primary care baby unit (PCBU) and TTN was significantly lower in group I [Betamethasone Group] when compared to group II [Dexamethasone Group]. There was a statistically significant difference between both groups regarding need for mechanical ventilation (1 to 9) respectively with p value of 0.011.Conclusion:antenatal corticosteroids (ecpecially betamethasone) were effective in prevention of respiratory complications after elective caesarean section at term.

Comparative Study between Betamethasone and Dexamethasone as a Prophylactic Corticosteroids Therapy on Neonatal Outcome in Elective Cesarean Section at 37 Weeks

Background: preterm birth is the most costly complication of pregnancy and the leading cause of neonatal morbidity and mortality. There are multiple strategies to minimize the risk and the impact of prematurity, such as administration of antenatal corticosteroids (ACS), in association with tocolysis, neuroprotection with magnesium sulphate, and neonatal life-saving therapies. Aim of the Work: this study aimed to assess the comparison between betamethasone and dexamethasone before elective cesarean section at (37-37+6) weeks, in reducing neonatal respiratory morbidity and admission to neonatal intensive care unit (NICU) with respiratory complications. Patients and Methods: this clinical observational prospective study had been conducted at El Hussein University Hospitals Obstetrics and Gynecology Department from December 2017 to July 2018 to assess the comparison between betamethasone and dexamethasone as a prophylactic corticosteriodes before elective cesarean section at (37-37+6) weeks. Five hundred pregnant women attended to out-patient clinic, the patient were at risk of preterm labour before 37 weeks. Results: the rate of neonatal admission to primary care baby unit (PCBU) and TTN was significantly lower in group I [Betamethasone Group] when compared to group II [Dexamethasone Group]. There was a statistically significant difference between both groups regarding need for mechanical ventilation (1 to 9) respectively with p value of 0.011.Conclusion:antenatal corticosteroids (ecpecially betamethasone) were effective in prevention of respiratory complications after elective caesarean section at term.

Development of a Dysphagia Screening Test for Preterm Infants (DST-PI).

ObjectiveTo explore both the early prediction and diagnosis of dysphagia in preterm infants as an important developmental aspect as well as the prevention of respiratory complications, we developed the simple and-easy-to-apply Dysphagia Screening Test for Preterm Infants (DST-PI) to predict supraglottic penetration and subglottic aspiration.MethodsFifty-two infants were enrolled in a videofluoroscopic swallowing study (VFSS) due to clinical suspicions of dysphagia. Thirteen items related to supraglottic penetration or subglottic aspiration were initially selected from previous studies for the DST-PI. Finally, 7 items were determined by linear logistic regression analysis. Cutoff values, sensitivity, specificity, and the area under the ROC curve (AUC) of the DST-PI for predicting supraglottic penetration or subglottic aspiration were calculated using a ROC curve. For inter-rater reliability, the kappa coefficient was calculated.ResultsSeven items were selected: ‘gestational age,’ ‘history of apnea,’ ‘history of cyanosis during feeding,’ ‘swallowing pattern,’ ‘coughs during or after feeding,’ ‘decreased oxygen saturation within 3 minutes of feeding,’ and ‘voice change after feeding.’ The Spearman correlation coefficient between the DST-PI and the penetration-aspiration scale (PAS) was 0.807 (p<0.001). The sensitivity and specificity at different cutoff values for detecting supraglottic penetration and subglottic aspiration were 96.6% and 76.9% at 3.25, and 88.9% and 75.8% at 6.25, respectively.ConclusionThe DST-PI is a valid and reliable dysphagia screening test for supraglottic penetration or subglottic aspiration in preterm infants that is easy to apply in a clinical context.

Aspects respiratoires et réanimatoires des dystrophies musculaires

Among the various myopathies, Duchenne muscular dystrophy represents the myopathy with the most stereotypical respiratory evolution. This progressive respiratory failure is going to develop in a parallel way of motor deficit, conducting patients to mechanical ventilation at the end of their second decade. In the absence of curative therapeutics, respiratory cares like home ventilation and prevention of respiratory complications, in a systematic and organized way, allowed to decrease the morbidity and the mortality of these patients. It is not exceptional to meet patients with life expectancy of which overtakes about forty. Besides axial stabilization, cough assistance techniques and swallowing disorders management need to be associated to mechanical ventilation. Invasive techniques of ventilation as tracheostomy keep their place in this pathology even if alternative techniques allowing full day non-invasive ventilation were generalized these last years.

How Not to ‘Go Blue'

Background Information: The first 24 hours after surgery is a high risk period for respiratory depression secondary to opioid administration. Hypoventilation and collapse of alveolar tissue is common in the PACU setting. Pulse oximetry is commonly used to assess oxygenation, but not ventilation. It does not measure the build-up of CO2. Pulse oximetry is not a good tool to detect hypoventilation in patients receiving supplemental oxygen. Oxygen therapy can mask hypoventilation. Objectives of Project: To identify patients with respiratory depression in the PACU so as to allow reduction in opioid dosing, addition of non-opioid adjunct analgesia or the use of regional analgesia Process of implementation: At least every hour, PACU nurse will perform a 5 minute room air PaO2 test. The patient is removed from supplemental oxygen for 5 minutes to determine PaO2 on room air. At any point during those 5 minutes, the oxygen will be re-applied if PaO2 falls below 90%. This is a simple test to identify patients with hypoventilation. Statement of successful practice: Hypoventilation is identified in the PACUbefore thepatient is transferred to the in-patient unit. Nurses are promoting use of stir-up regime and inspirometer therapy. Several adjunct therapies are utilized in the PACU to alleviate pain including the use of Acetaminophen, Ketorolac, Ibuprofen, and peripheral nerve blocks. Implications for Advancing Perianesthesia Nursing: PACU nurses are able to provide safer patient care by early identification of patients with respiratory depression. Patients and families can be taught the importance of inspirometer therapy and deep breathing/coughing in the prevention of respiratory complications.

Respiratoriske komplikasjoner ved ryggmargsskader

Respiratory complications are the most common cause of acute and long-term morbidity and mortality in patients with spinal cord injury. The article is based on a non-systematic search in PubMed and the authors' clinical experience in treatment and follow-up of respiratory complications in patients with spinal cord injury. The extent of respiratory complications is dependent on the level of spinal cord injury and the degree of motor completeness. In acute spinal cord injury, 80 % of patients may suffer from respiratory complications. Long-term follow-up indicates that respiratory complications are the most common cause of death in these patients. The most common respiratory complications are atelectasis, pneumonia and respiratory failure. Prevention of respiratory complications must be initiated immediately, independent of the level of spinal cord injury. The question of mechanical ventilation in the acute setting, and also during long-term follow-up must be addressed, along with aggressive secretion management. Patients with spinal cord injury have a high prevalence of sleep apnea that may influence their quality of life and rehabilitation. Respiratory complications are common in patients with spinal cord injury. These patients need a multidisciplinary approach. All disciplines involved must obtain knowledge of respiratory complications in the acute phase and in the longer term, to ensure patients are referred for necessary pulmonary review and follow-up.

Respiratory complications after major surgery

To discuss the recent literature concerning the significance of respiratory complications as a determining factor in postoperative complications after major surgery. Although many studies have identified risk factors focusing on the prevention of respiratory complications, these complications continue to be a significant cause of morbidity and mortality. Here, we will examine the diagnosis, contributing factors, consequences, and early treatment of respiratory complications. General anesthesia and surgery are the main causes of postoperative respiratory complications. Atelectasis, a common respiratory complication, may contribute to pneumonia and acute respiratory failure. Recently, it has been shown that activation of abdominal muscles during the induction of anesthesia contributes to a reduction of lung capacity, leading to a higher degree of atelectasis. Additionally, long-term mortality at 5 and 10 years has recently been shown to remain significantly increased in patients with respiratory complications. Prevention or early therapy of respiratory complications may, therefore, be beneficial in improving outcome in postoperative patients. Postoperative respiratory complications may have significant deleterious consequences. Increasing the understanding of the underlying causes of respiratory complications and developing early treatment strategies will likely provide improved benefits. To date, early treatment with prophylactic or therapeutic continuous positive airway pressure has proved beneficial in an abdominal surgical patient population; however, the efficacy in a general population remains unclear.

Possible Risk Factors for respiratory Complications after Thyroidectomy: An Observational Study

It is widely accepted that thyroid surgery is not without morbidity. One well-known postoperative complication is respiratory distress. The aim of this prospective observational study was to determine the incidence of post-thyroidectomy respiratory complications and to identify possible predictive factors. The study population was made up of 262 patients who had undergone thyroidectomy for goiter at the University of Ilorin Teaching Hospital in Nigeria from January 1989 through December 2003. Information was collected on 8 possible predictive factors for respiratory complications: (1) the duration of the goiter, (2) the preoperative status of the recurrent laryngeal nerve, (3) the presence or absence of tracheal narrowing or deviation, (4) the presence or absence of retrosternal extension, (5) the ease or difficulty of endotracheal intubation, (6) the presence or absence of thyroid cancer, (7) the presence or absence of giant goiter, and (8) whether or not the goiter represented a recurrence. Respiratory complications occurred in 20 of the 262 patients (7.6%). Of these 20 patients, 16 (80%) had a goiter of at least 5 years' duration, 12 (60%) had a giant goiter, 5 (25%) had tracheal narrowing, 4 (20%) had a malignant goiter, 3 (15%) had palsy of the recurrent laryngeal nerve preoperatively, and 2 patients each (10%) had retrosternal extension, a difficult intubation, or a recurrent goiter. Twelve patients (60%) had at least 4 of the 8 possible risk factors, and 6 others (30%) had 3 factors. Postoperative tracheotomy was necessary for 4 patients. No deaths occurred. While the findings of this observational study can only suggest the possibility of causation, preoperative factors such as long-standing goiter and giant goiter should be taken into consideration in postoperative management and the prevention of respiratory complications. In addition, the presence of at least 4 of the 8 factors studied should likewise alert the management team.

Technique of Open Ivor Lewis Esophagectomy

Technique of Open Ivor Lewis Esophagectomy

小児神経筋疾患 (脊髄性筋萎縮症と筋ジストロフィー) における呼吸器合併症予防と長期予後

小児神経筋疾患 (脊髄性筋萎縮症と筋ジストロフィー) における呼吸器合併症予防と長期予後