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

La simpatectomía española de René Leriche

Introducción. La simpatectomía lumbar fue una técnica hiperemiante utilizada para mejorar la perfusión sanguínea de las extremidades inferiores de los pacientes isquémicos, que marca los inicios de la Cirugía Vascular en el primer tercio del siglo xx. Surge como único tratamiento revascularizador indirecto antes del desarrollo de la cirugía arterial reconstructiva. René Leriche, cirujano francés del último tercio del siglo xix y mitad del xx, es considerado uno de los pioneros en el estudio de las enfermedades vasculares por las aportaciones a su diagnóstico y tratamiento. Objetivo. Relatar un caso clínico curioso desde el punto de vista histórico, tratado por René Leriche en Barcelona (España) mediante simpatectomía lumbar, y se cuenta con la colaboración en la anestesia de Robert Macintosh, padre de la Anestesiología científica actual. Desarrollo. Se considera una curiosidad histórica y se comentan los valores no sólo científicos, sino personales de los personajes; también se considera que el hecho médico ocurre a petición de un compañero y amigo de ambos

Neumotórax espontáneo: sínfisis pleural con solución hidroalcohólica de povidona yodada

Objetivo: Analizar la eficacia de una solución hidroalcohólica de povidona yodada como agente químico sinfisante, en el tratamiento del neumotórax espontáneo. Material y método: Estudio descriptivo y retrospectivo de 81 pacientes con diagnóstico de neumotórax espontáneo, tratados mediante videotoracoscopia y pleurodesis química con una solución hidroalcohólica de povidona yodada, en el Servicio de Cirugía Torácica del Hospital de la Santa Creu i Sant Pau de Barcelona, desde enero de 1993 a diciembre de 1999. Resultados: Se trata de 81 pacientes, 59 varones (73%) y 22 mujeres (27%) con edades comprendidas entre los 14 y los 82 años (media de 33 años). El hemitórax afectado con mayor frecuencia fue el derecho, en 43 casos (53%). Las principales indicaciones de tratamiento quirúrgico fueron: recidivas en 52 casos (64%) y fugas aéreas persistentes en 25 (31%). Todos fueron tratados por videotoracoscopia, se realizó resección del parénquima pulmonar en 30 casos (37%) e instilación pleural de solución hidroalcohólica de povidona yodada como agente químico sinfisante en todos los casos. Durante el postoperatorio inmediato presentaron fugas aéreas 10 pacientes (12,3%), fiebre autolimitada 5 pacientes (6,1%) y hubo dos infecciones en los orificios de los drenajes (2,4%). Durante un período de seguimiento postoperatorio de 6 a 67 meses (media de 24 meses) hemos constatado 5 recidivas (6,1%). Conclusiones: La solución hidroalcohólica de povidona yodada es un agente químico sinfisante de fácil aplicación por videotoracoscopia y de gran eficacia en el tratamiento del neumotórax espontáneo