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

Farmacocinética plasmática, concentraciones tisulares y urinarias de cefuroxima en gatos luego de su administración parenteral

Cefuroxime is a second generation cephalosporin active against gram-positive cocci, gramnegative rods and anaerobes. The aim of the present study is to characterize cefuroxime plasma pharmacokinetics after intravenous, intramuscular and subcutaneous administration to cats; and, to determine cefuroxime concentrations in some tissues and in urine of the animals. After antibiotic administration (20 mg/kg), blood and urine samples were taken during 8 hours and, tissue samples at 1-1.5 hours. After intravenous administration, main pharmacokinetic parameters (mean±SD) were: initial plasma concentration (µg/mL): 135.46±81.42; half-life (h): 0.21±0.15. After intramuscular and subcutaneous administration, main pharmacokinetic parameters were, respectively: maximum plasma concentrations (µg/mL): 48.65±6.71 and 28.17±8.44; time of maximum plasma concentration were 0.18±0.06 h and 0.82±0.30 h; and, elimination half-life (h): 1.04±0.10 and 1.59±0.18. Tissue concentrations (µg/g) ranged between 3,35±0,65 and 23.02±8.77. After 8 hours, 78,09±24,59% of the administered cefuroxime was recovered from urine. The present results showed that cefuroxime, administered at a dosage of 20 mg/kg by intravenous, intramuscular or subcutaneous route, would be a useful tool for the infection treatment in cats when produced by susceptible microorganisms.Fil: Lorenzini, P.M. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Cátedra de Farmacología. Buenos Aires, ArgentinaFil: Passini, S.M. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Cátedra de Farmacología. Buenos Aires, ArgentinaFil: Lupi, M.P. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Cátedra de Farmacología. Buenos Aires, ArgentinaFil: Montoya, L. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Cátedra de Farmacología. Buenos Aires, ArgentinaFil: Landoni, M.F. Universidad Nacional de La Plata. Facultad de Ciencias Veterinarias. Cátedra de Farmacología. La Plata, ArgentinaFil: Albarellos, G.A. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Cátedra de Farmacología. Buenos Aires, ArgentinaCefuroxima es una cefalosporina de segunda generación que incluye en su espectro antibiótico a cocos gram-positivos, bacilos gram-negativos y anaerobios. El objetivo de este trabajo es caracterizar la farmacocinética plasmática de cefuroxima en gatos luego de su administración por vía intravenosa, intramuscular y subcutánea, y determinar la concentración de cefuroxima en algunos tejidos y en la orina de los animales. Luego de la administración del antibiótico (20 mg/kg), se tomaron muestras sanguíneas y de orina durante 8 horas y muestras de tejidos entre las 1-1,5 horas. Los principales parámetros farmacocinéticos (media±desvío estándar) para la administración intravenosa fueron: concentración inicial (µg/mL): 135,46±81,42; vida media de eliminación (h): 0,21±0,15. Para las administraciones intramuscular y subcutánea los principales parámetros farmacocinéticos fueron respectivamente: concentración máxima (µg/mL): 48,65±6,71 y 28,17±8,44, tiempo de la concentración máxima (h): 0,18±0,06 y 0,82±0,30, y vida media de eliminación (h): 1,04±0,10 y 1,59±0,18. Las concentraciones (µg/g) en tejidos estuvieron entre 3, 35±0,65 y 23.02±8.77. Al cabo de 8 horas se recuperó en la orina el 78,09±24,59% de la dosis administrada. Estos resultados indicarían que cefuroxima administrada a una dosis de 20 mg/kg por las vías estudiadas sería de utilidad para el tratamiento de infecciones producidas por microorganismos susceptibles en gatos

Pharmacokinetic studies of flunixin meglumine and phenylbutazone in plasma, exudate and transudate in sheep

Flunixin meglumine (FM, 1.1 mg/kg) and phenylbutazone (PBZ, 4.4 mg/kg) were administered intravenously (i.v.) as a single dose to eight sheep prepared with subcutaneous (s.c.) tissue-cages in which an acute inflammatory reaction was stimulated with carrageenan. Pharmacokinetics of FM, PBZ and its active metabolite oxyphenbutazone (OPBZ) in plasma, exudate and transudate were investigated. Plasma kinetics showed that FM had an elimination half-life (t(1/2 beta)) of 2.48 +/- 0.12 h and an area under the concentration - time curve (AUC) of 30.61 +/- 3.41 mu g/mL.h. Elimination of PBZ from plasma was slow (t(1/2 beta) = 17.92 +/- 1.74 h, AUC = 968.04 +/- mu g/mL.h.). Both FM and PBZ distributed well into exudate and transudate although penetration was slow, indicated by maximal drug concentration (C-max) for FM of 1.82 +/- 0.22 mu g/mL at 5.50 +/- 0.73 h (exudate) and 1.58 +/- 0.39 mu g/mL at 8.00 h (transudate), and C-max for PBZ of 22.32 +/- 1.29 mu g/mL at 9.50 +/- 0.73 h (exudate) and 22.07 +/- 1.57 mu g/mL at 11.50 +/- 1.92 h (transudate), and a high mean tissue-cage fluids:plasma AUC(last) ratio obtained in the FM and PBZ groups (80-98%). These values are higher than previous reports in horses and calves using the same or higher dose rates. Elimination of FM and PBZ from exudate and transudate was slower than from plasma. Consequently the drug concentrations in plasma were initially higher and subsequently lower than in exudate and transudate.Peer reviewe