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

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p&lt;0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p&lt;0\ub70001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding: No funding

Cortical hyperexcitability in migraine and aversion to patterns

Background: Patients with migraine are averse to certain visual stimuli, such as flicker and striped patterns that evoke paroxysmal EEG activity in patients with photosensitive epilepsy. Migraineurs demonstrate a hyper-responsiveness to such stimuli, and there is debate as to whether the aversion and hyper-responsiveness are due to a hyperexcitability of the cortex similar to that in patients with photosensitive epilepsy. In these patients grating patterns with certain spatial characteristics can be epileptogenic, depending critically on their movement. If the contours of the grating drift continually, the grating is not epileptogenic, but if the contours are static or if their direction is repeatedly and rapidly reversed so as to vibrate, the grating then becomes highly epileptogenic.Methods: We compared aversion to vibrating, drifting and static gratings in migraineurs and controls. The contrast of each grating was gradually increased, but only until the participant felt discomfort, so as to obtain a contrast threshold for aversion with minimal exposure.Results: Migraineurs had lower thresholds than the control group, indicating greater aversion. For both groups the threshold was higher (aversion was lower) for static than for both types of moving gratings. The drifting gratings were more aversive than the vibrating gratings when both groups were combined.Conclusion: The findings suggest that the aversion shown by migraineurs is not attributable to a cortical hyperexcitability similar to that in photosensitive epilepsy. © International Headache Society 2012

Synthesis and deposition of ZnO based particles by aerosol spray pyrolysis

Spray pyrolysis was used for the deposition of well defined submicronic to nanosize particles based on ZnO. The influence of the temperature in the range from 345 to 1165 K, solution concentration (0.004 and 1.5 mol dm(-3)) and the residence time on the particle morphology is discussed. X-ray diffraction, differential scanning calorimetry and scanning electron microscopy were used in particle characterization. With the presumption that certain particle morphology is formed during the evaporation/drying stage of spray pyrolysis, the corresponding mathematical model for droplets evaporation is developed and correlated with the empirical results. (C) 1997 Elsevier Science S.A.Symposium B: Thin Film Materials for Large Area Electronics at the European-Materials-Research-Society 1996 Spring Meeting, Jun 04-07, 1996, Strasbourg, Franc

Synthesis and deposition of ZnO based particles by aerosol spray pyrolysis

Spray pyrolysis was used for the deposition of well defined submicronic to nanosize particles based on ZnO. The influence of the temperature in the range from 345 to 1165 K, solution concentration (0.004 and 1.5 mol dm(-3)) and the residence time on the particle morphology is discussed. X-ray diffraction, differential scanning calorimetry and scanning electron microscopy were used in particle characterization. With the presumption that certain particle morphology is formed during the evaporation/drying stage of spray pyrolysis, the corresponding mathematical model for droplets evaporation is developed and correlated with the empirical results. (C) 1997 Elsevier Science S.A.Symposium B: Thin Film Materials for Large Area Electronics at the European-Materials-Research-Society 1996 Spring Meeting, Jun 04-07, 1996, Strasbourg, Franc