Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (VT) size was 500 ml, or 7 to 9 ml kg1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P < 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P < 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high VT and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome

Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS - An observational study in 29 countries

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (V T) size was 500 ml, or 7 to 9 ml kg−1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P ˂ 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P ˂ 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high V T and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome.</p

XMM-Newton first-light observations of the Hickson galaxy group 16

This paper presents the XMM-Newton first-light observations of the Hickson-16 compact group of galaxies. Groups are possibly the oldest large-scale structures in the Universe, pre-dating clusters of galaxies, and are highly evolved. This group of small galaxies, at a redshift of 0.0132 (or 80 Mpc) is exceptional in the having the highest concentration of starburst or AGN activity in the nearby Universe. So it is a veritable laboratory for the study of the relationship between galaxy interactions and nuclear activity. Previous optical emission line studies indicated a strong ionising continuum in the galaxies, but its origin, whether from starbursts, or AGN, was unclear. Combined imaging and spectroscopy with the EPIC X-ray CCDs unequivocally reveals a heavily obscured AGN and a separately identified thermal (starburst) plasma, in NGC 835, NGC 833, & NGC 839. NGC 838 shows only starburst thermal emission. Starbursts and AGN can evidently coexist in members of this highly evolved system of merged and merging galaxies, implying a high probability for the formation of AGN as well as starbursts in post-merger galaxies

The ROSAT Wide Field Camera all-sky survey of extreme-ultraviolet sources. I - The Bright Source Catalogue

The first all-sky survey for cosmic sources of extreme-ultraviolet radiation has been carried out with the UK Wide Field Camera on ROSAT. A first reduction of the survey data has yielded a catalogue of 383 relatively bright EUV sources, forming the WFC Bright Source Catalogue. This represents a 30-fold increase in the number of astrophysical objects detected in the ~ 60–200 eV energy band and covers a flux range, in each of the two survey bands, of more than 2000. A search of the (typically ~ 1-arcmin) error circles of the WFC sources, using a variety of catalogues and the SIMBAD data base, has identified probable optical counterparts of ~ 73 per cent, including many active stars, white dwarf stars and a variety of other galactic and extragalactic objects. A follow-up programme of optical spectroscopy has since added further identifications, but some 13 per cent of the EUV sources remain unidentified