Pulmonary Complications In Patients Research Articles

Outcomes of patients with COVID-19 pneumonia requiring lung resections in a third-level hospital

IntroductionCurrently, there is little evidence on the surgical management of pulmonary complications of COVID-19 pneumonia. This study aimed to give insight into common complications arising in patients with COVID-19 pneumonia that require lung resections.MethodsThis is a retrospective single-center study looking at conditions arising in patients with COVID-19 pneumonia who required lung resection for resolution between March 2020 and March 2021. Clinical presentation, indications to undergo surgery, and factors associated with increased mortality were analyzed. Analysis of nominal variables was performed using nonparametric statistical tests.ResultsTwelve men (92.3%) and one woman (7.7%) were included in the analysis; the age of included participants ranged from 27 to 72 years, with the mean age being 52. The most common presenting signs and symptoms were dyspnea and tachypnea, which were present in all patients, most common cause for surgery was pneumatocele with 6 cases, followed by lung abscess; patients who underwent surgery because of persistent air leak were more likely to require surgical reintervention (p = 0.005). The overall mortality in our sample was 23%. Increasing age (p = 0.014), myalgias (p = 0.035), elevated D-dimer (p = 0.007), and pulmonary embolism (p = 0.014) were associated with increased mortality.ConclusionsLung resections to treat pulmonary complications in patients with COVID-19 pneumonia appear to be safe, with a survival rate of 77%. Recognizing clinical characteristics such as age, myalgias, elevated D-dimer and pulmonary embolism can aid in identifying those at increased risk.

Higher fraction of inspired oxygen during anesthesia increase the risk of postoperative pulmonary complications in patients undergoing non-cardiothoracic surgery: a retrospective cohort study.

The ideal intra-operative inspired oxygen concentration remains controversial. We aimed to investigate the association between the intraoperative fraction of inspired oxygen (FiO2) and the incidence of postoperative pulmonary complications (PPCs) in patients undergoing non-cardiothoracic surgery. This was a retrospective cohort study of elderly patients who underwent non-cardiothoracic surgery between April 2020 and January 2022. According to intraoperative FiO2, patients were divided into low (≤60%) and high (>60%) FiO2 groups. The primary outcome was the incidence of a composite of pulmonary complications (PPCs) within the first seven postoperative days. Propensity score matching (PSM) and inverse probability treatment weighting (IPTW) were conducted to adjust for baseline characteristic differences between the two groups. Multivariate logistic regression analysis was used to calculate the odds ratios (OR) for FiO2 and PPCs. Among the 3,515 included patients with a median age of 70years (interquartile range: 68-74), 492 (14%) experienced PPCs within the first 7 postoperative days. Elevated FiO2 was associated with an increased risk of PPCs in all the logistic regression models. The OR of the FiO2 > 60% group was 1.252 (95%CI, 1.015-1.551, P = 0.038) in the univariate analysis. In the multivariate logistic regression models, the ORs of the FiO2 > 60% group were 1.259 (Model 2), 1.314 (Model 3), and 1.32 (model 4). A balanced covariate distribution between the two groups was created using PSM or IPTW. The correlation between elevated FiO2 and an increased risk of PPCs remained statistically significant with PSM analysis (OR, 1.393; 95% CI, 1.077-1.804; P = 0.012) and IPTW analysis (OR, 1.266; 95% CI, 1.086-1.476; P = 0.003). High intraoperative FiO2 (>60%) was associated with the postoperative occurrence of pulmonary complications, independent of predefined risk factors, in elderly non-cardiothoracic surgery patients. High intraoperative FiO2 should be applied cautiously in surgical patients vulnerable to PPCs.

High PEEP with recruitment maneuvers versus Low PEEP During General Anesthesia for Surgery - a Bayesian individual patient data meta-analysis of three randomized clinical trials.

The influence of high positive end-expiratory pressure (PEEP) with recruitment maneuvers on the occurrence of postoperative pulmonary complications after surgery is still not definitively established. Bayesian analysis can help to gain further insights from the available data and provide a probabilistic framework that is easier to interpret. Our objective was to estimate the posterior probability that the use of high PEEP with recruitment maneuvers is associated with reduced postoperative pulmonary complications in patients with intermediate-to-high risk under neutral, pessimistic, and optimistic expectations regarding the treatment effect. Multilevel Bayesian logistic regression analysis on individual patient data from three randomized clinical trials carried out on surgical patients at Intermediate-to-High Risk for postoperative pulmonary complications. The main outcome was the occurrence of postoperative pulmonary complications in the early postoperative period. We studied the effect of high PEEP with recruitment maneuvers versus Low PEEP Ventilation. Priors were chosen to reflect neutral, pessimistic, and optimistic expectations of the treatment effect. Using a neutral, pessimistic, or optimistic prior, the posterior mean odds ratio (OR) for High PEEP with recruitment maneuvers compared to Low PEEP was 0.85 (95% Credible Interval [CrI] 0.71 to 1.02), 0.87 (0.72 to 1.04), and 0.86 (0.71 to 1.02), respectively. Regardless of prior beliefs, the posterior probability of experiencing a beneficial effect exceeded 90%. Subgroup analysis indicated a more pronounced effect in patients who underwent laparoscopy (OR: 0.67 [0.50 to 0.87]) and those at high risk for PPCs (OR: 0.80 [0.53 to 1.13]). Sensitivity analysis, considering severe postoperative pulmonary complications only or applying a different heterogeneity prior, yielded consistent results. High PEEP with recruitment maneuvers demonstrated a moderate reduction in the probability of PPC occurrence, with a high posterior probability of benefit observed consistently across various prior beliefs, particularly among patients who underwent laparoscopy.

The role of prehabilitation in reducing the incidence of postoperative pulmonary complications in patients undergoing elective cardiac surgery: Results from the Pre Surgery Check Team study.

Despite its importance, prehabilitation, has only been implemented in very few cardiac surgery centers. The Pre Surgery Check Team study was designed to evaluate the impact of comprehensive interdisciplinary assessment and implementation of the prehabilitation program on the incidence of postoperative pulmonary complications after elective cardiac surgery. 725 adult patients (338 in the study group, 387 in the control group) were included in this single-center, prospective, observational study. Multimodal prehabilitation consisted of four elements: interdisciplinary medical assessment by cardiologist, anesthesiologist and cardiac surgeon, pulmonary assessment for patients at high risk of postoperative pulmonary complications, psychological assessment, and physiotherapeutic assessment and training. The primary endpoint was the occurrence of the postoperative pulmonary complications, and the secondary outcomes were: surgical site infection, rethoracotomy, ICU length of stay and hospital length of stay. Prehabilitation reduced the number of postoperative complications by 23%. Postoperative pneumonia was almost 3 times less common (5.33% vs 14.21%), and the surgical site infection - 1.4 times less common in the PreScheck group (8.28 vs 11.37%). In the logistic regression model, prehabilitation reduced the odds of postoperative pneumonia (by 0.346) and the odds of respiratory failure (by 0.479). Prehabilitation had no direct effect on ICU length of stay. Prehabilitation according to the Pre Surgery Check Team standard reduces the incidence of postoperative pulmonary complications and the total number of postoperative complications in patients undergoing elective cardiac surgery. The main benefit of attending the PreScheck Team visit is the opportunity to perform supportive preoperative interventions.

Impact of staged goal-directed fluid therapy on postoperative pulmonary complications in patients undergoing McKeown esophagectomy: a randomized controlled trial

BackgroundOur aim was to evaluate the influence of staged goal directed therapy (GDT) on postoperative pulmonary complications (PPCs), intraoperative hemodynamics and oxygenation in patients undergoing Mckeown esophagectomy.MethodsPatients were randomly divided into three groups, staged GDT group (group A, n = 56): stroke volume variation (SVV) was set at 8–10% during the one lung ventilation (OLV) stage and 8–12% during the two lung ventilation (TLV) stage, GDT group (group B, n = 56): received GDT with a target SVV of 8–12% During the entire surgical procedure, and control group (group C, n = 56): conventional fluid therapy was administered by mean arterial pressure (MAP), central venous pressure (CVP), and urine volume. The primary outcome was the incidence of postoperative pulmonary complications within Postoperative days (POD) 7. The secondary outcomes were postoperative lung ultrasound (LUS) B-lines artefacts (BLA) scoring, incidence of other complications, the length of hospital stay, intraoperative hemodynamic and oxygenation indicators included mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), cardiac output (CO), oxygenation index (OI), respiratory indices (RI), alveolar-arterial oxygen difference (Aa-DO2).ResultsPatients in group A and group B had a lower incidence of PPCs (7/56 vs. 17/56 and 9/56 vs. 17/56, p < 0.05), and a fewer B-lines score on postoperative ultrasound (4.61 ± 0.51 vs. 6.15 ± 0.74 and 4.75 ± 0.62 vs. 6.15 ± 0.74, p < 0.05) compared to group C. The CI, CO, MAP, and OI were higher in group A compared to group B and group C in the stage of thoracic operation. During the abdominal operation stage, patients in group A and group B had a better hemodynamic and oxygenation indicators than group C.ConclusionsIn comparison to conventional fluid therapy, intraoperative staged GDT can significantly reduce the incidence of postoperative pulmonary complications in patients undergoing McKeown esophagectomy, facilitating patient recovery. Compared to GDT, it can improve intraoperative oxygenation and stabilize intraoperative hemodynamics in patients.Trial registrationThis study was registered in the Chinese Clinical Trial Registry on 24/11/2021 (ChiCTR2100053598).

Postoperative pulmonary complications in patients with chronic obstructive pulmonary disease undergoing primary laparoscopic bariatric surgery: an MBSAQIP analysis

BackgroundRecent research has shown beneficial effects of bariatric surgery (BaS) on the risk of developing acute exacerbations of chronic obstructive pulmonary disease (COPD). However, this patient population may be at increased risk of complications, especially postoperative pulmonary complications (PPC). ObjectivesTo analyze the incidence of PPC in patients with COPD undergoing BaS. SettingAcademic Hospital, United States. MethodsWe performed a retrospective analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database for patients aged ≥18 years undergoing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass during 2015–2019. The primary outcome of the study was any PPC, defined as a composite variable including postoperative pneumonia, mechanical ventilation >48 hours and unplanned endotracheal intubation. A univariate analysis was performed to compare patients with and without COPD, and a multivariate logistic regression was performed to adjust for confounders. A subgroup analysis was performed to compare endpoints in patients with COPD with or without home oxygen requirements. ResultsA total of 752,722 patients were included in our analysis (laparoscopic sleeve gastrectomy = 73.2%, Roux-en-Y gastric bypass = 26.8%). PPC occurred in 2390 patients, 0.3% without COPD versus 1.3% with COPD (P < .001). Multivariable analysis confirmed that COPD independently increases the risk of PPC (OR = 1.7, CI = 1.4–2.1). Subgroup analysis showed that patients who are oxygen dependent had a much higher risk for PPC (2.4% versus 1.1%, P < .001). ConclusionPPC are higher among patients with obesity and concomitant COPD. Oxygen dependency confers an even higher complication rate. The risk and benefits of BaS in this population must be carefully addressed.

Effects of individualized positive end-expiratory pressure on intraoperative oxygenation and postoperative pulmonary complications in patients requiring pneumoperitoneum with Trendelenburg position: A systematic review and meta-analysis.

Whether individualized positive end-expiratory pressure (PEEP) improves intraoperative oxygenation and reduces postoperative pulmonary complications (PPCs) remains unclear. This systematic review and meta-analysis examined whether individualized PEEP is associated with improved intraoperative oxygenation and reduce PPCs for patients needing pneumoperitoneum with the Trendelenburg position during surgery. Medline, Embase, the Cochrane Library, and www.clinicaltrials.gov were searched for randomized controlled trials evaluating the effects of individualized PEEP on intraoperative oxygenation and PPCs in patients who required Trendelenburg positioning with pneumoperitoneum. The primary outcome was the oxygenation (PaO2/FiO2) during the procedure. Secondary outcomes included PPCs, intraoperative respiratory mechanics (driving pressure, compliance), and vasopressor consumption. DerSimonian-Laird random effects models were used to calculate mean differences (MDs) and log risk ratios (log RRs) with 95% confidence intervals (CIs). The Cochrane Risk-of-Bias tool 2.0 was applied to assess the risk of bias in included studies. The protocol of this meta-analysis has been registered in PROSPERO. We included 14 studies (1121 patients) that employed different individualized PEEP strategies. Compared with control groups, individualized PEEP groups exhibited a significantly improved intraoperative PaO2/FiO2 (MD=56.52mm Hg, 95% CI: [33.98, 79.06], P<0.001) and reduced incidence of PPCs (log RR=-0.50, 95% CI: [-0.84, -0.16], P=0.004). Individualized PEEP reduced driving pressure while improving respiratory compliance. Intraoperative vasopressor consumption was similar between both groups. The weighted mean PEEP in the individual PEEP groups was 13.2 [95% CI, 11.7, 14.6] cmH2O. No evidence indicated that one individualized PEEP strategy is superior to others. Individualized PEEP seems to work positively for lung protection in the Trendelenburg position and pneumoperitoneum in patients undergoing general anesthesia.

Efficacy of respiratory physiotherapy preceding to heart surgery with extracorporeal circulation

Introduction and objectivesHeart surgery is one of the most important tools for the treatment of cardiovascular diseases. Postoperative pulmonary complications in patients undergoing heart surgery represent a meaningful clinical problem.Respiratory physiotherapy is essential in the management of patients during postoperative period, contributing to a better prognosis.Our objective is to evaluate the efficacy of respiratory physiotherapy prior to cardiac surgery in reducing postoperative complications and hospital stay. MethodsRandomized, controlled and observational study. A group of 92 patients who underwent heart surgery with extracorporeal circulation were analyzed in the Hospital Puerta del Mar (Spain), divided into 2 groups (control group and experimental group with previous respiratory physiotherapy). We study different postoperative complications and hospital stay. ResultsAtelectasis, pleural effusion, and sternal dehiscence were altered between both groups. An improvement in the intubation time and the reintubation rate was reported in the experimental group, in addition, lower oxygen consumption, an improvement in the fulfillment of respiratory physiotherapy following surgery and a shorter overall hospital stay and in the post-operative care unit was also observed. ConclusionFulfillment of respiratory physiotherapy preceding to heart surgery decreases pulmonary complications and hospital stay, as well as accelerates the recovery of the breathing capacity.

Effect of preoperative natural killer cell on postoperative pulmonary complications in patients of lung cancer − A single-center retrospective cohort study

BackgroundThe effect of preoperative natural killer (NK) cell abnormalities on postoperative pulmonary complications (PPCs) after thoracoscopic radical resection of lung cancer is still unclear. The main purpose of this study was to investigate the relationship between the preoperative NK cell ratio and PPCs. MethodsThe patients who underwent thoracoscopic radical resection for lung cancer were divided into a normal group and an abnormal group according to whether the proportion of preoperative NK cells was within the reference range. The main outcome was the incidence of PPCs during postoperative hospitalization. The demographic and perioperative data were collected. Propensity score matching was used to exclude systematic bias. Univariate logistic regression was used to test the relationship between the preoperative NK cell ratio and the incidence of PPCs. The restrictive cubic spline curve was used to analyze the dose–effect relationship between the preoperative NK cell ratio and the incidence of PPCs. ResultsA total of 4161 patients were included. After establishing a matching cohort, 910 patients were included in the statistical analysis. The incidence of PPCs in the abnormal group was greater than that in the normal group (55.2% vs. 31.6%). The incidence of PPCs first decreased and then increased with increasing NK cell ratio. The proportion of patients with Grade 3 or higher PPCs in the normal group was lower than that in the abnormal group [108 (23.7%) vs. 223 (49%)]. The indwelling time of the thoracic drainage tube in the abnormal group was longer than that in the normal group [3 (3, 4) vs. 3 (3, 5)]. A preoperative abnormal NK cell ratio constituted a risk factor for PPCs in each subgroup. ConclusionLung cancer patients with an abnormal proportion of peripheral blood NK cells before surgery were more likely to develop PPCs, their disease degree was more severe, and they had a prolonged duration of chest tube indwelling. Compared with those with abnormally high NK cell ratios, those with abnormally low NK cell ratios had more pronounced PPCs.

Breathing reserve as a predictor of postoperative pulmonary complications in patients with lung cancer

The objective was to assess the possibility of using breathing reserve (BR) to evaluate the individual risk of postoperative pulmonary complications (PPC) in patients who underwent open surgery for lung cancer.Materials and methods. The study involved 185 patients who underwent open surgery for lung cancer in the clinic of the Pavlov University in 2018–2020. All patients underwent cardiopulmonary exercise testing (CPET) in the preoperative period to determine the BR. All patients were retrospectively divided into 2 groups depending on the presence of PPC during 7 days after the surgery. To assess the information content of BR for predicting PPC and their outcome, the data were statistically processed: the Mann–Whitney U-test, Fisher’s exact test, Youden index and linear regression method were used.Results. PPC developed in 7 patients (3.8%), in 3 of them (42.9% of the group with PC and 1.6% of the total group) they were accompanied by acute respiratory failure (ARF), requiring reintubation and mechanical ventilation; these patients died. At the anaerobic threshold (AT), there were significant differences in BR (p = 0.003). A direct correlation was found between BR at the AT not only at the peak load but also during the unloaded cycling (UC) (closeness of connection on the Chaddock scale BR (AT) – BR (peak) ρ = 0.724, BR (AT) – BR (UC) ρ = 0.734, p &lt; 0.001). The chances to develop PC changed as follows: in the group of patients with BR (UC) &lt; 72.025% were 21.4 times higher (95% CI: 2.499 – 182.958); with BR (AT) &lt; 44.136% were 27.2 times higher (95% CI: 4.850 – 152.167); with BR (peak) &lt; 36.677% were 7.6 times higher (95% CI: 1.426 – 40.640).Conclusions. Dynamic measurement of the BR is informative at all stages of CPET. The risk of PPC and their unfavorable outcome increases when the BR is below 72.025% at the unloaded cycling, below 44.136% at the anaerobic threshold and below 36.377% at the peak load. BR can be used as a marker of the development of PPC in patients undergoing lung cancer surgery.

Does coronavirus disease 2019 history alone increase the risk of postoperative pulmonary complications after surgery? Prospective observational study using serology assessment.

Concern exists about the increasing risk of postoperative pulmonary complications in patients with a history of coronavirus disease 2019 (COVID-19). We conducted a prospective observational study that compared the incidence of postoperative pulmonary complications in patients with and without a history of COVID-19. From August 2022 to November 2022, 244 adult patients undergoing major non-cardiac surgery were enrolled and allocated either to history or no history of COVID-19 groups. For patients without a history of confirming COVID-19 diagnosis, we tested immunoglobulin G to nucleocapsid antigen of SARS-CoV-2 for serology assessment to identify undetected infection. We compared the incidence of postoperative pulmonary complications, defined as a composite of atelectasis, pleural effusion, pulmonary edema, pneumonia, aspiration pneumonitis, and the need for additional oxygen therapy according to a COVID-19 history. After excluding 44 patients without a COVID-19 history who were detected as seropositive, 200 patients were finally enrolled in this study, 100 in each group. All subjects with a COVID-19 history experienced no or mild symptoms during infection. The risk of postoperative pulmonary complications was not significantly different between the groups according to the history of COVID-19 (24.0% vs. 26.0%; odds ratio, 0.99; 95% confidence interval, 0.71-1.37; P-value, 0.92). The incidence of postoperative pulmonary complications was also similar (27.3%) in excluded patients owing to being seropositive. Our study showed patients with a history of no or mild symptomatic COVID-19 did not show an increased risk of PPCs compared to those without a COVID-19 history. Additional precautions may not be needed to prevent PPCs in those patients.

Association between mechanical power during one-lung ventilation and pulmonary complications after thoracoscopic lung resection surgery: a prospective observational study

BackgroundThe role of mechanical power on pulmonary outcomes after thoracic surgery with one-lung ventilation was unclear. We investigated the association between mechanical power and postoperative pulmonary complications in patients undergoing thoracoscopic lung resection surgery.MethodsIn this single-center, prospective observational study, 622 patients scheduled for thoracoscopic lung resection surgery were included. Volume control mode with lung protective ventilation strategies were implemented in all participants. The primary endpoint was a composite of postoperative pulmonary complications during hospital stay. Multivariable logistic regression models were used to evaluate the association between mechanical power and outcomes.ResultsThe incidence of pulmonary complications after surgery during hospital stay was 24.6% (150 of 609 patients). The multivariable analysis showed that there was no link between mechanical power and postoperative pulmonary complications.ConclusionsIn patients undergoing thoracoscopic lung resection with standardized lung-protective ventilation, no association was found between mechanical power and postoperative pulmonary complications.Trial registrationTrial registration number: ChiCTR2200058528, date of registration: April 10, 2022.

Preoperative three-dimensional lung volumetry predicts respiratory complications in patients undergoing major liver resection for colorectal metastases

Colorectal liver metastases (CRLM) are the predominant factor limiting survival in patients with colorectal cancer and liver resection with complete tumor removal is the best treatment option for these patients. This study examines the predictive ability of three-dimensional lung volumetry (3DLV) based on preoperative computerized tomography (CT), to predict postoperative pulmonary complications in patients undergoing major liver resection for CRLM. Patients undergoing major curative liver resection for CRLM between 2010 and 2021 with a preoperative CT scan of the thorax within 6 weeks of surgery, were included. Total lung volume (TLV) was calculated using volumetry software 3D-Slicer version 4.11.20210226 including Chest Imaging Platform extension (http://www.slicer.org). The area under the curve (AUC) of a receiver-operating characteristic analysis was used to define a cut-off value of TLV, for predicting the occurrence of postoperative respiratory complications. Differences between patients with TLV below and above the cut-off were examined with Chi-square or Fisher’s exact test and Mann–Whitney U tests and logistic regression was used to determine independent risk factors for the development of respiratory complications. A total of 123 patients were included, of which 35 (29%) developed respiratory complications. A predictive ability of TLV regarding respiratory complications was shown (AUC 0.62, p = 0.036) and a cut-off value of 4500 cm3 was defined. Patients with TLV < 4500 cm3 were shown to suffer from significantly higher rates of respiratory complications (44% vs. 21%, p = 0.007) compared to the rest. Logistic regression analysis identified TLV < 4500 cm3 as an independent predictor for the occurrence of respiratory complications (odds ratio 3.777, 95% confidence intervals 1.488–9.588, p = 0.005). Preoperative 3DLV is a viable technique for prediction of postoperative pulmonary complications in patients undergoing major liver resection for CRLM. More studies in larger cohorts are necessary to further evaluate this technique.

Rationale and study design for an Individualized PeriopeRative Open lung VEntilatory approach in Emergency Abdominal Laparotomy/scopy: study protocol for a prospective international randomized controlled trial

BackgroundPostoperative pulmonary complications (PPC) are the most frequent postoperative complications, with an estimated prevalence in elective surgery ranging from 20% in observational cohort studies to 40% in randomized clinical trials. However, the prevalence of PPCs in patients undergoing emergency abdominal surgery is not well defined. Lung-protective ventilation aims to minimize ventilator-induced lung injury and reduce PPCs. The open lung approach (OLA), which combines recruitment manoeuvres (RM) and positive end-expiratory pressure (PEEP) titration, aims to minimize areas of atelectasis and the development of PPCs; however, there is no conclusive evidence in the literature that OLA can prevent PPCs. The purpose of this study is to compare an individualized perioperative OLA with conventional standardized lung-protective ventilation in patients undergoing emergency abdominal surgery with clinical signs of intraoperative lung collapse. MethodsRandomized international clinical trial to compare an individualized perioperative OLA (RM plus individualized PEEP and individualized postoperative respiratory support) with conventional lung-protective ventilation (standard PEEP of 5 cmH2O and conventional postoperative oxygen therapy) in patients undergoing emergency abdominal surgery with clinical signs of lung collapse. Patients will be randomised to open-label parallel groups. The primary outcome is any severe PPC during the first 7 postoperative days, including: acute respiratory failure, pneumothorax, weaning failure, acute respiratory distress syndrome, and pulmonary infection. The estimated sample size is 732 patients (366 per group). The final sample size will be readjusted during the interim analysis. DiscussionThe Individualized Perioperative Open-lung Ventilatory Strategy in emergency abdominal laparotomy (iPROVE-EAL) is the first multicentre, randomized, controlled trial to investigate whether an individualized perioperative approach prevents PPCs in patients undergoing emergency surgery.

Positive end-expiratory pressure and the incidence of postoperative pulmonary complications in patients undergoing general anaesthesia.

To evaluate the effect of intraoperative positive end-expiratory pressure and driving pressure on the development of postoperative pulmonary complications. The prospective study included 83 patients undergoing abdominal surgery and receiving general anaesthesia. Patients were divided into two groups: with low intraoperative positive end-expiratory pressure (0-2cm H2O) and with high intraoperative positive end-expiratory pressure (8-10cm H2O). The primary endpoint is the development of postoperative pulmonary complications during follow-up. The incidence of postoperative pulmonary complications in the group of low intraoperative positive end-expiratory pressure was 9.8%, while in the group of high positive end-expiratory pressure was 7.1% (p = 0.6), demonstrating that high positive end-expiratory pressure used during general anaesthesia does not affect the frequency of complications (odds ratio = 0.71, p = 0.6). In the multivariate analysis that controls for all confounders, driving pressure resulted in a significant and independent risk factor for complications. High intraoperative positive end-expiratory pressure does not affect the frequency of postoperative pulmonary complications. The increase in driving pressure is a risk factor for complications. Positive end-expiratory pressure is easily implemented, and its use does not result in significant economic costs.

Time to Mobility Is Associated With Pulmonary Complications in Patients With Spine Fractures.

Treatment of spine fractures may require periods of prolonged immobilization which prevents effective pulmonary toileting. We hypothesized that patients with longer time to mobilization, as measured by time to first physical therapy (PT) session, would have higher pulmonary complications. We performed a retrospective review of all trauma patients with cervical and thoracolumbar spinal fractures admitted to a level 1 trauma center over a 12-month period. Demographic data collection included age, gender, BMI, pulmonary comorbidities, concomitant rib fractures, admission GCS, Injury Severity Score (ISS), GCS at 24h, treatment with cervical or thoracolumbar immobilization, and time to first PT evaluation. The primary outcome was the presence of any one of the following complications: unplanned intubation, pneumonia, or mortality at 30days. Multivariable logistic regression analysis was used to assess significant predictors of pulmonary complication. In total, 491 patients were identified. In terms of overall pulmonary complications, 10% developed pneumonia, 13% had unplanned intubation, and 6% died within 30days. In total, 19% developed one or more complication. Overall, 25% of patients were seen by PT <48h, 33% between 48 and 96h, 19% at 96h to 1week, and 7% > 1week. Multivariable logistic regression analysis showed that time to PT session (OR 1.010, 95% CI 1.005-1.016) and ISS (OR 1.063, 95% CI 1.026-1.102) were independently associated with pulmonary complication. Time to mobility is independently associated with pulmonary complications in patients with spine fractures.

Postoperative pulmonary complications in patients undergoing upper abdominal surgery: risk factors and predictive models.

Postoperative pulmonary complications (PPCs) are unexpected disorders that occur up to 30 days after surgery, affecting the patient's clinical status and requiring therapeutic intervention. Therefore, it becomes important to assess the patient preoperatively, as many of these complications can be minimized with proper perioperative strategies following a thorough preoperative checkup. Herein, we describe the PPCs and risk factors associated with developing PPCs in patients undergoing upper abdominal surgery. Additionally, we compared the accuracy of the American Society of Anaesthesiologists (ASA) score, the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score, the 6-Minute Walk Test (6MWT), and spirometry in predicting PPCs. Consenting patients (>18 years) undergoing elective upper abdominal surgery were recruited from November 2021 to April 2023. Clinical history was noted. Spirometry and 6MWT were both performed. Pre-operative ASA and ARISCAT scores were recorded. Postoperative follow-up was conducted to assess respiratory symptoms and the occurrence of PPC. PPC was defined as per EPCO guidelines. A total of 133 patients were recruited, predominantly male. A total of 27 (20.3%) patients developed PPCs. A total of 14 (10.5%) patients had more than one PPC. The most common PPCs developed were pleural effusion (11.3%), respiratory failure (7.5%), and pneumonia (4.5%). We obtained ten statistically significant associated variables on univariable analysis, viz obstructive airway disease (p=0.002), airflow limitation (p=0.043), chest radiography (p<0.001), albumin (p=0.30), blood urea nitrogen (BUN) (p=0.029), aspartate aminotransferase (p=0.019), alanine aminotransferase (p=0.009), forced expiratory volume in one second/forced vital capacity ratio (p=0.006), duration of surgery (p<0.001), and ASA score (p=0.012). On multivariable regression analysis, abnormal chest radiograph [odds ratio: 8.26; (95% confidence interval: 2.58-25.43), p<0.001], BUN [1.05; (1.00-1.09), p=0.033], and duration of surgery [1.44; (1.18-1.76), p<0.001] were found to be independently associated with PPC. The ASA score was found to have better predictive power for the development of PPCs compared to the ARISCAT score but is of poor clinical significance. Additionally, 6MWD and spirometry results were found to lack any meaningful predictive power for PPC. To conclude, preoperative evaluation of the chest radiograph, BUN, and duration of surgery are independently associated with developing PPCs. The ASA score performs better than the ARISCAT score in identifying patients at a higher risk of developing PPCs and implementing preventive measures.

Preoperative DLco and FEV1 are correlated with postoperative pulmonary complications in patients after esophagectomy

Limited information is available regarding the association between preoperative lung function and postoperative pulmonary complications (PPCs) in patients with esophageal cancer who undergo esophagectomy. This is a retrospective cohort study. Patients were classified into low and high lung function groups by the cutoff of the lowest fifth quintile of forced expiratory volume in 1 s (FEV1) %predicted (%pred) and diffusing capacity of the carbon monoxide (DLco) %pred. The PPCs compromised of atelectasis requiring bronchoscopic intervention, pneumonia, and acute lung injury/acute respiratory distress syndrome. Modified multivariable-adjusted Poisson regression model using robust error variances and inverse probability treatment weighting (IPTW) were used to assess the relative risk (RR) for the PPCs. A joint effect model considered FEV1%pred and DLco %pred together for the estimation of RR for the PPCs. Of 810 patients with esophageal cancer who underwent esophagectomy, 159 (19.6%) developed PPCs. The adjusted RR for PPCs in the low FEV1 group relative to high FEV1 group was 1.48 (95% confidence interval [CI] = 1.09–2.00) and 1.98 (95% CI = 1.46–2.68) in the low DLco group relative to the high DLco group. A joint effect model showed adjusted RR of PPCs was highest in patients with low DLco and low FEV1 followed by low DLco and high FEV1, high DLco and low FEV1, and high DLco and high FEV1 (Reference). Results were consistent with the IPTW. Reduced preoperative lung function (FEV1 and DLco) is associated with post-esophagectomy PPCs. The risk was further strengthened when both values decreased together.

Risk Factors of Pulmonary Complications in Patients with COVID-19: A Case-Control Study

Background: Pneumothorax (PTX), pneumomediastinum (PM), and subcutaneous emphysema (SE) are complications associated with COVID-19. It is crucial to study these risk factors, complications, and their prognosis for early diagnosis amidst the rising number of cases today. Methods: We conducted a case-control study involving 81 pairs of patients diagnosed with SARS-CoV-2 pneumonia complicated by Pneumothorax and pneumomediastinum, comparing them with patients who did not have these complications to assess the risk factors for and prognosis of pulmonary complications in COVID-19. Results: The demographic data and medical history of comorbid diseases did not show an association with PTX, PM, and SE in COVID-19 pneumonia (all P-values &gt; 0.05). However, laboratory data such as white blood cell count, lymphocyte count, C-reactive protein, lactate dehydrogenase, troponin, and D-dimer levels were significantly higher in the group with complications (P &lt; 0.05). Additionally, the length of hospital stay was significantly longer in the group with complications, and intubation further extended this duration. The mortality rate was significantly higher in the case group (70% vs. 14%, P &lt; 0.0001), with a significant odds ratio in comparison to patients without complications in the regression model (B = 2.61, Exp(B) = 13.65 with a 95% CI of 6.28 - 29.69). Conclusions: Pulmonary complications worsen the prognosis of COVID-19. The pathophysiology of COVID-19 pneumonia can lead to mechanical barotrauma, regardless of intubation status. Ventilator settings should be adjusted below the confidence level. Acute phase reactants and certain inflammatory markers, except for the erythrocyte sedimentation rate (ESR), are elevated in patients with complications, though they do not significantly predict outcomes.

Inhaled Nitric Oxide ReDuce postoperatIve pulmoNAry complicaTions in patiEnts with recent COVID-19 infection (INORDINATE): protocol for a randomised controlled trial

BackgroundA history of SARS-CoV-2 infection has been reported to be associated with an increased risk of postoperative pulmonary complications (PPCs). Even mild PPCs can elevate the rates of early postoperative...