Postoperative pulmonary complications following adenotonsillectomy in pediatric patients with obstructive sleep apnea in a tertiary government hospital

Objective@#Our study aimed to identify and describe pulmonary complications and its associated risk factors in children with suspected or confirmed obstructive sleep apnea (OSA) who underwent tonsillectomy or adenotonsillectomy in a tertiary government hospital.@*Methods@#We conducted a retrospective cohort study. Medical charts of pediatric patients with suspected or confirmed OSA who were admitted for tonsillectomy or adenotonsillectomy from January 1, 2016 to December 31, 2020 were retrieved and reviewed. Information of the individual patients including the demographic data, clinical profile, polysomnography results, and presence of postoperative pulmonary complications were recorded. Descriptive statistics was utilized to present continuous data while frequency and percentage for categorical data. Fisher exact test was used to compare the demographic profile of patients with postoperative pulmonary complications from those without. @*Results@#A total of 90 patient records were analyzed. The mean age of the patient population was 7.87 years, 55.6% were male, 17.8% of patients were classified as obese. Thirty-four children had preoperative polysomnography and of these, 47.1% were classified as severe. Only two (2.2%) patients had postoperative pulmonary complications, which were bronchospasm and desaturation, respectively. There were no statistically significant differences noted in comparing the clinicodemographic profile of patients with postoperative pulmonary complications from those without complications. @*Conclusion@#Our results showed that most pediatric patients with suspected or confirmed OSA who underwent adenotonsillectomy did not have pulmonary complications.

The relationship between mean daily step counts and pulmonary complications after thoracoscopic lobectomy in elderly patients: A propensity score matching study / 中国胸心血管外科临床杂志

@#Objective     To investigate the relationship between preoperative mean daily step counts and pulmonary complications after thoracoscopic lobectomy in elderly patients. Methods     From 2018 to 2021, the elderly patients with pulmonary complications after thoracoscopic lobectomy were included. A 1∶1 propensity score matching was performed with patients without pulmonary complications. The clinical data were compared between the two groups. Results    Totally, 100 elderly patients with pulmonary complications were enrolled, including 78 males and 22 females, aged 66.4±4.5 years. And 100 patients without pulmonary complications were matched, including 71 males and 29 females aged 66.2±5.0 years. There was no significant difference in the preoperative data between the two groups (P>0.05). Compared to the patients with pulmonary complications, the ICU stay was shorter (8.1±4.4 h vs. 12.9±7.5 h, P<0.001), the first out-of-bed activity time was earlier (8.8±4.5 h vs. 11.2±6.1 h, P=0.002), and the tube incubation time was shorter (19.3±9.2 h vs. 22.5±9.4 h, P=0.015) in the patients wihout pulmonary complications. There was no statistical difference in other perioperative data between the two groups (P>0.05). The mean daily step counts in the pulmonary complications group were significantly less than that in the non-pulmonary complications group (4 745.5±2 190.9 steps vs. 6 821.1± 2 542.0 steps, P<0.001). The daily step counts showed an upward trend for three consecutive days in the two groups, but the difference was not significant. Conclusion     The decline of preoperative mean daily step counts is related to pulmonary complications after thoracoscopic lobectomy in elderly patients. Recording daily step counts can promote preoperative active exercise training for hospitalized patients.

Driving pressure-guided PEEP titration for intraoperative mechanical ventilation:a meta-analysis / 重庆医学

Objective To systematic evaluate the effectiveness and safety of driving pressure-guided fixed positive end-expiratory pressure(PEEP)titration in intraoperative mechanical ventilation.Methods PubMed,Web of Science,the Cochrane Library,Embase,CNKI,Wanfang and VIP databases were searched for collect randomized controlled trials(RCTs)of PEEP titration guided by driving pressure in intraoperative mechanical ventilation from inception to November 8,2023.After two researchers independently screened the literature,extracted data,and evaluated the risk of bias of the included studies,the meta-analysis was conducted by Rev-Man 5.4 software.Results Nineteen studies with a total of 2 906 patients were included.There were 1 440 patients in the study group with the lung protective ventilation strategy guided by PEEP titration,and 1 466 patients in the control group with the traditional lung protective ventilation strategy.Compared with the con-trol group,the incidence of postoperative pulmonary complications(PPCs)in the study group was lower in the non-thoracic surgery(RR=0.53,95%CI:0.43-0.65,P<0.001),but there was no statistical difference in the incidence of PPCS in the thoracic surgery(RR=0.89,95%CI:0.78-1.02,P=0.09).Compared with the control group,the intraoperative lung compliance was increased(MD= 6.90 L/cmH2O,95%CI:5.80-7.99,P<0.001),and the length of hospital stay was shortened in the study group(MD=-0.27 d,95%CI:-0.43 to-0.12,P<0.001),while there was no significant difference in intraoperative mean arterial pres-sure(MAP)between the two groups(MD=0.36 mmHg,95%CI:-1.30 to 2.01,P=0.67).Conclusion Com-pared with the traditional lung protective ventilation,driving pressure-guided PEEP titration ventilation can im-prove intraoperative lung compliance,reduce the incidence of PPCs in non-thoracic surgery,shorten the length of hospital stay,and does not increase the risk of hemodynamic disturbances in patients undergoing surgery.

Risk factors of postoperative pulmonary complications in children after video-assisted thoracoscopic lung resection / 临床麻醉学杂志

Objective To investigate risk factors of postoperative pulmonary complications(PPCs)in children after video-assisted thoracoscopic lung resection.Methods Retrospective analysis of clinical data of 566 children,334 males and 232 females,aged≤6 years,ASA physical statusⅠorⅡ,enrolled for video-assisted thoracoscopic lung resection.The children were divided into two groups based on whether they developed PPCs within 7 days after surgery:the PPCs group and the non-PPCs group.Factors with P≤0.2 and perceived as potentially clinically meaningful,were included in the binary logistic regression model.The receiver operating characteristic(ROC)curve was drawn and the area under the curve(AUC)was calculated.Results A total of 123 children(21.7%)developed postoperative pulmonary compli-cations(PPCs).Multivariate logistic regression analysis showed longer duration of one-lung ventilation(OLV),faster respiratory rate during OLV and inexperienced surgeon were found to be independently risk factors of PPCs.Higher PEEP level was protective factors of PPCs(The maximum PEEP was 7 cmH2 O).The prediction model was Logit(P)=-4.41+0.006×OLV duration+0.063×OLV respiratory rate+0.569×inexperienced surgeon(yes = 1)-0.16×maximum PEEP value.The ROC curve showed a good accuracy with an area under the curve of 0.682(95%CI 0.631-0.734),and sensitivity was76.4%,and specificity was 69.6%.Conclusion Longer OLV duration,faster repiratory rate and less surgeon experience are found to be independently risk factors of PPCs.Higher PEEP level is protective factor of PPCs.

The association of intraoperative positive end-expiratory pressure with pulmonary complications after thoracoscopic lung surgery: A propensity score-matching study / 中国胸心血管外科临床杂志

@#Objective To evaluate the correlation between positive end-expiratory pressure (PEEP) level and postoperative pulmonary complications (PPCs) in patients undergoing thoracoscopic lung surgery. Methods The clinical data of patients who underwent elective thoracoscopic lung surgery at West China Hospital of Sichuan University from January 2022 to June 2023 were retrospectively analyzed. Patients were divided into 2 groups according to intraoperative PEEP levels: a PEEP 5 cm H2O group and a PEEP 10 cm H2O group. The incidence of PPCs in the two groups after matching was compared using a nearest neighbor matching method with a ratio of 1∶1, setting the clamp value as 0.02. Results A total of 538 patients were screened, and after propensity score-matching, a total of 229 pairs (458 patients) were matched, with an average age of 53.9 years and 69.4% (318/458) females. A total of 118 (25.8%) patients had PPCs during hospitalization after surgery, including 60 (26.2%) patients in the PEEP 5 cm H2O group and 58 (25.3%) patients in the PEEP 10 cm H2O group, with no statistically significant difference between the two groups [OR=0.997, 95%CI (0.495, 1.926), P=0.915]. Multivariate logistic regression analysis showed that PEEP was not an independent risk factor for PPCs [OR=0.920, 95%CI (0.587, 1.441), P=0.715]. Conclusion For patients undergoing thoracoscopic lung surgery, intraoperative PEEP (5 cm H2O or 10 cm H2O) is not associated with the risk of PPCs during hospitalization after surgery, which needs to be further verified by prospective, large-sample randomized controlled studies.

Effects of an innovative inspiratory muscle training program on postoperative pulmonary complications in patients with valvular heart disease with limited resources / 中国康复医学杂志

Objective:To explore the effectiveness and feasibility of strengthening inspiratory muscle training program matching the preoperative waiting time for patients with valvular heart disease in China with limited resources in preventing postoperative pulmonary complications(PPCs). Method:Patients undergoing elective heart valve surgery were randomly divided into control group and inter-vention group,with 65 patients in each group.All the enrolled patients received a routine physical therapy pro-gram before surgery,and the intervention group received an additional 3 days of enhanced inspiratory muscle training program before surgery.The incidence of postoperative complications was recorded for all patients with-in 14 days after surgery,respiratory function and motor capacity(6-minute walking test)were tested for all patients on the day of admission and discharge,and the length of postoperative hospital stay was counted. Result:Compared with the control group,the incidence of PPCs was lower in the intervention group(OR 2.18,95％CI 1.07-4.47,P-0.03),and the walking distance was longer(P=0.01).There was no statistical difference in lung function and length of hospital stay(P＞0.05),and no adverse events occurred during train-ing.There was no significant difference in general demographic characteristics between the two groups before treatment.The incidence of PPCs in the intervention group was lower than that in the control group(P＜0.05),and the 6-minute walking distance at discharge was higher than that in the control group(P＜0.05).There were no statistically significant differences in lung function and postoperative hospital stay between the intervention group and the control group(P＞0.05),and no adverse events occurred during training. Conclusion:Enhanced inspiratory muscle training 3 days before surgery is safe and feasible in patients with elective heart valves and can reduce postoperative pulmonary complications and improve the level of motor function at discharge.

Risk factors analysis of pulmonary complications after video-assisted thoracoscopic surgery in elderly patients / 基础医学与临床

Objective To analyze the incidence and risk factors of postoperative pulmonary complications(PPCs)in elderly patients undergoing video-assisted thoracoscopic surgery(VATS).Methods Elderly patients aged≥65 years who underwent VATS in Peking Union Medical College Hospital from January 2013 to December 2017,were reviewed retrospectively and divided into non-PPCs group and PPCs group.General information,past medi-cal history,and postoperative complications were recorded in a uniform case report form.The clinical factors with statistical significance in univariate analysis and important clinical significance according to experience were ana-lyzed with Logistic regression to evaluate the independent risk factors for PPCs.Results A total of 900 patients were included,and 48(5.3%)of them suffered PPCs.Multivariate logistic regression showed that pre-operative smoking history,history of stroke,chronic obstructive pulmonary disease(COPD)and pulmonary lobectomy were independent risk factors for PPCs in elderly patients after VATS.Conclusions Elderly patient is a high-risk group for PPCs after VATS.The risk factors include smoking history,stroke,COPD and scope of surgery.Therefore,perioperative management needs to optimize,and monitoring should be strengthened for these high-risk patients.

Predictive value of preoperative frailty for pulmonary complications after cardiac surgery in elderly patients / 临床麻醉学杂志

Objective To investigate the predictive value of preoperative frailty for pulmonary com-plications(PPCs)after cardiac surgery in elderly patients.Methods A total of 162 elderly patients,109 males and 53 females,aged 65-83 years,BMI 18-36 kg/m2,ASA physical status Ⅱ-Ⅳ,underwent elec-tive open heart surgery from July 2022 to January 2023 were collected.The patients were divided into two groups according to the occurrence of PPCs:the PPCs group(n=57)and the non-PPCs group(n=105).General information,smoking history,alcohol consumption history,EuroSCORE Ⅱ,frailty,chronic comorbidities(hypertension,diabetes mellitus,myocardial infarction,pulmonary hypertension,chronic ob-structive pulmonary disease,sleep apnea syndrome,etc.),Hb,creatinine,albumin,pulmonary function indices,left ventricular ejection fraction,type of surgery,duration of surgery,aortic clamping time,and cardiopulmonary bypass time were collected.Factors with P＜0.2 and clinically significant in the univariate regression analysis were included in the multivariate logistic regression analysis,and the predictive efficacy of the Fried frailty scale and EuroSCORE Ⅱ for PPCs were compared by the area under the ROC curve(AUC).Results PPCs occurred in 57 patients(35.2％).Multifactorial Logistic regression analysis showed that frailty(OR=3.14,95％CI 1.05-9.37,P＜0.05)and EuroSCORE Ⅱ(OR=2.16,95％CI 1.01-4.60,P＜0.05)were risk factors for the development of PPCs.The predictive power of Fried frailty scale(AUC=0.76,95％CI 0.68-0.82)was significantly higher than that of EuroSCORE Ⅱ(AUC=0.65,95％CI 0.57-0.72)(P＜0.05).Conclusion Preoperative frailty is the independent risk factors for pulmonary complications after cardiac surgery in elderly patients,and the Fried frailty scale has a better predictive efficacy compared to EuroSCORE Ⅱ,a traditional risk predictor.

Risk factors of postoperative pulmonary complications in patients undergoing thoracic surgery in Day Care Unit / 实用医学杂志

Objective To determine risk factors of postoperative pulmonary complications within 1 month in patients undergoing thoracic surgery in Day Care Unit.Methods The total of 200 patients routinely scheduled for VATS under centralized management were enrolled in this study.On the postoperative day 1,lung ultrasound(LUS)was conducted by one physician in the ward.The patients received at least once Chest X-ray or CT in outpatient department within 30 days after discharge.The composite of out-of-hospital PPCs,and the value of LUSS in predicting the PPCs was appraised.Furthermore,we identified the perioperative risk factors associated with PPCs in VATS patients.Results Of 200 recruited VATS patients eligible in the Nanjing Drum Tower Hospital,188 participants received LUS examination and finally completed the 30 days follow-up.Of whom,68 patients developed the varied types of PPCs.Multivariable Logistic regression analysis indicated that comorbidity of immune system disease(P = 0.021),lobar resection(P = 0.031)and the postoperative 24 hours LUSS(P = 0.002)were independent risk factors for PPCs within 30 days after VATS.Conclusion Comorbidity of immune system disease,lobar resection and the postoperative 24 h LUSS were independent risk factors for PPCs within 30 days after VATS.

Research progress on preoperative inspiratory muscle training for prevention of postoperative pulmonary complications in adult cardiac surgery / 中国胸心血管外科临床杂志

@#In the past two decades, adult cardiac surgery has developed by leaps and bounds in both anesthetic techniques and surgical methods, whereas the incidence of postoperative pulmonary complications (PPCs) has not changed. Until now PPCs are still the most common complications after cardiac surgery, resulting in poor prognosis, significantly prolonged hospital stays and increased medical costs. With the promotion of the concept of enhanced recovery after surgery (ERAS), pre-rehabilitation has been becoming a basic therapy to prevent postoperative complications. Among them, preoperative inspiratory muscle training as a very potential intervention method has been widely and deeply studied. However, there is still no consensus about the definition and diagnostic criteria of PPCs around the world; and there is significant heterogeneity in preoperative inspiratory muscle training in the prevention of pulmonary complications after cardiac surgery in adults, which impedes its clinical application. This paper reviewed the definition, mechanism, and evaluation tools of PPCs, as well as the role, implementation plan and challenges of preoperative inspiratory muscle training in the prevention of PPCs in patients undergoing cardiac surgery, to provide reference for clinical application.

elationship between preoperative fasting plasma glucose and postoperative pulmonary complications after lung resection in type 2 diabetic patients / 中国胸心血管外科临床杂志

@#Objective     To explore the relationship between preoperative fasting plasma glucose (FPG) and postoperative pulmonary complications (PPCs) in type 2 diabetic patients undergoing elective thoracoscopic lung resection, and provide a reference for prediction and prevention of PPCs in the clinic. Methods     A retrospective analysis was performed on the type 2 diabetic patients who underwent elective thoracoscopic lung resection for the first time in our hospital from January 2017 to March 2021. According to the level of FPG one day before the operation, the patients were divided into three groups: a hypoglycemia group (<6.1 mmol/L), a medium level blood glucose group (≥6.1 mmol/L and <8.0 mmol/L) and a high blood glucose group (≥8.0 mmol/L). Besides, the patients were divided into a PPCs group and a non-PPCs group according to whether PPCs occurred. The risk factors for PPCs were analyzed by logistic regression analysis, and the predictive value of preoperative FPG level on PPCs was estimated by the area under the receiver operating characteristic curve (AUC). Results     A total of 130 patients were included, including 75 (57.7%) males and 55 (42.3%) females with an average age of 63.5±9.0 years. Logistic regression analysis showed that compared to non-PPCs patients, the level of preoperative FPG (P=0.023) and smoking history ratio (P=0.036) were higher and the operation time was longer (P=0.004) in the PPCs patients. High FPG level on preoperative day 1 and longer operation time were associated with PPCs risk. Besides, the preoperative FPG of 6.79 mmol/L was the threshold value to predict the occurrence of PPCs [AUC=0.653, 95%CI (0.559, 0.747), P=0.003]. Conclusion     There is a certain correlation between preoperative FPG level and postoperative PPCs, which may be used as an index to predict the occurrence of PPCs.

A wearable six-minute walk-based system to predict postoperative pulmonary complications after cardiac valve surgery: an exploratory study / 生物医学工程学杂志

In recent years, wearable devices have seen a booming development, and the integration of wearable devices with clinical settings is an important direction in the development of wearable devices. The purpose of this study is to establish a prediction model for postoperative pulmonary complications (PPCs) by continuously monitoring respiratory physiological parameters of cardiac valve surgery patients during the preoperative 6-Minute Walk Test (6MWT) with a wearable device. By enrolling 53 patients with cardiac valve diseases in the Department of Cardiovascular Surgery, West China Hospital, Sichuan University, the grouping was based on the presence or absence of PPCs in the postoperative period. The 6MWT continuous respiratory physiological parameters collected by the SensEcho wearable device were analyzed, and the group differences in respiratory parameters and oxygen saturation parameters were calculated, and a prediction model was constructed. The results showed that continuous monitoring of respiratory physiological parameters in 6MWT using a wearable device had a better predictive trend for PPCs in cardiac valve surgery patients, providing a novel reference model for integrating wearable devices with the clinic.

Application of cardiopulmonary exercise test in the establishment of a nomogram prognostic prediction model for postoperative pulmonary complications in patients with lung cancer / 中国康复医学杂志

Objective:To predict the influencing factors of postoperative pulmonary complications(PPCs)in patients with lung cancer after video-assisted thoracic surgery by using the cardiopulmonary exercise test(CPET)combined with clini-cal indicators,and to draw a nomogram model to make the prediction results more intuitive and visualized. Method:The relevant data in patients with lung cancer who underwent video-assisted thoracic surgery in the thoracic surgery department of our hospital was retrospectively collected.Single factor analysis and multivariate logistic stepwise analysis were used to find out the independent influencing factors of PPCs.The nomograph model of PPCs risk was drawn and internal verification was done to get the calibration curve.Finally,the ar-ea under the curve(AUC)and 95％confidence interval(CI)were calculated by the receiver operating charac-teristic(ROC)curve. Result:There were 168 patients in total,including 45 patients in the complication group(26.8％)and 123 pa-tients in the non-complication group(73.2％).Unifactor analysis results showed that the occurrence of PPCs was significantly correlated with age,stage,smoking history,intraoperative blood loss,coronary heart dis-ease,VO2peak,VENCO2 slope,AT and PetCO2(P＜0.05),but not with other factors(P＞0.05),and the length of postoperative hospital stay in the complication group was significantly higher than that in the non-complica-tion group(P＜0.05).Multivariate analysis results showed that age(OR=6.51,95％CI:1.89-22.45,P＜0.05),intraoperative blood loss(OR=5.16,95％CI:0.93-1.00,P＜0.05)and VENCO2 slope(OR=0.96,95％CI:1.64-16.25,P＜0.05)were independent influencing factors for PPCs occurrence in VATS pneumonectomy.Af-ter constructing the nomogram model topredict the occurrence of PPCs,the ROC curve was used to analyze the discrimination of the nomogram prediction model.The results of the nomogram model with the ROC curve showed that AUC was 0.792(95％CI:0.71-0.87),and the sensitivity and specificity of PPCs prediction were 76.4％and 77.8％.Hosmer-lemesho x2=11.595,P=0.170,indicating that the difference between the predicted value of the model and the actual observed value was not statistically significant,and the prediction model had good calibration ability. Conclusion:The CPET combined with clinical indicators to make the prediction of PPCs more comprehensive and reliable.The nomogram model can be more intuitive,objective and individual to assess the risk of PPCs in lung cancer patients.

Complicaciones respiratorias en el posoperatorio inmediato en pacientes sometidos a cirugías de hemiabdomen superior

Las complicaciones respiratorias durante el posoperatorio inmediato justifica el interés del anestesiólogo por el conocimiento actualizado con el fin de disminuir la morbimortalidad. Con el objetivo de caracterizar las complicaciones respiratorias más frecuentes que se presentan en el posoperatorio inmediato de cirugía de hemiabdomen superior se realizó estudioobservacional, descriptivo de serie de casos, en 146 pacientes sometidos a cirugía de hemiabdomen superior atendidos en la unidad de cuidados posanestésicos del Hospital Provincial Clínico Quirúrgico Docente "Saturnino Lora", de Santiago de Cuba, duranteenero a diciembre de 2020; los datos se obtuvieron a partir de la historia clínica hospitalaria y examen clínico general realizado, los que fueron plasmados en una planilla confeccionada para el efecto. Fueron utilizados el test del Xi-cuadrado (X2), y la prueba de diferencias de proporciones, con un valor de p = 0,05durante el procesamiento estadístico. Los pacientes con edades mayores de 60 años, del sexo masculino y que presentaban como hábitos tóxicos el tabaquismo, la hipertensión arterial seguida de las neuropatías son las más frecuentes; mientras que los diagnósticos operatorios fueron la colecistitis aguda convencional y el trauma hepático. La intervención quirúrgica urgente, los pacientes ASA II, y los procedimientos que duraron más de 2 horas fueron los más frecuentes. Las complicaciones respiratorias más frecuentes encontradas fue la hipoxia; seguida de la ventilación mecánica prolongada y la atelectasia. Las complicaciones respiratorias encontradas en el posoperatorio inmediato de cirugía de hemiabdomen superior se asociaron desde el punto de vista estadístico con la clasificación ASA.

Respiratory complications during the immediate postoperative period justify the anesthesiologist's interest in updated knowledge in order to reduce morbidity and mortality. In order to characterize the most frequent respiratory complications that occur in the immediate postoperative period of upper hemiabdomen surgery, an observational, descriptive case series study was conducted in 146 patients undergoing upper hemiabdomen surgery attended at the post-anesthetic care unit of the "Saturnino Lora" Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba. during January to December 2020; The data were obtained from the hospital clinical history and general clinical examination performed, which were reflected in a form prepared for this purpose. The Xi-square test (X2) and the proportions differences test were used, with a p value = 0.05 during statistical processing. Patients over 60 years of age, male and who presented smoking as toxic habits, hypertension followed by neuropathies are the most frequent; while the operative diagnoses were conventional acute cholecystitis and liver trauma. Urgent surgery, ASA II patients, and procedures lasting more than 2 hours were the most frequent. The most frequent respiratory complications found were hypoxia; followed by prolonged mechanical ventilation and atelectasis. The respiratory complications found in the immediate postoperative period of upper hemiabdomen surgery were statistically associated with the ASA classification.

As complicações respiratórias no pós-operatório imediato justificam o interesse do anestesiologista em atualizar o conhecimento para reduzir a morbimortalidade. Com o objetivo de caracterizar as complicações respiratórias mais frequentes que ocorrem no pós-operatório imediato de cirurgia de hemiabdome alto, foi realizado um estudo observacional descritivo de série de casos em 146 pacientes submetidos à cirurgia de hemiabdome superior atendidos na unidade de recuperação pós-anestésica do Hospital Provincial Clínico Cirúrgico Universitário "Saturnino Lora" em Santiago de Cuba de janeiro a dezembro de 2020; Os dados foram obtidos da história clínica hospitalar e do exame clínico geral realizados, os quais foram refletidos em um formulário elaborado para esse fim.Utilizou-se o teste do xi-quadrado (X2) e o teste de diferenças de proporções, com valor de p = 0,05 durante o processamento estatístico. Pacientes acima de 60 anos, do sexo masculino e que apresentavam o tabagismo como hábitos tóxicos, sendo a hipertensão arterial seguida de neuropatias os mais frequentes; enquanto os diagnósticos operatórios foram colecistite aguda convencional e trauma hepático. Cirurgias de urgência, pacientes ASA II e procedimentos com duração superior a 2 horas foram os mais frequentes. As complicações respiratórias mais frequentes encontradas foram hipóxia; seguido de ventilação mecânica prolongada e atelectasia. As complicações respiratórias encontradas no pós-operatório imediato de cirurgia de hemiabdome alto foram estatisticamente associadas à classificação ASA.

Analysis of risk factors for pulmonary complications in patients with spontaneous pneumothorax after micro single-port video-assisted thoracoscopic surgery / 中国胸心血管外科临床杂志

@#Objective    To analyze the occurrence of postoperative pulmonary complications (PPC) and the risk factors in patients with spontaneous pneumothorax who underwent micro single-port video-assisted thoracoscopic surgery (VATS). Methods    A total of 158 patients with spontaneous pneumothorax who underwent micro single-port VATS in our hospital from April 2017 to December 2019 were retrospectively included, including 99 males and 59 females, with an average age of 40.53±9.97 years. The patients were divided into a PPC group (n=21) and a non-PPC group (n=137) according to whether PPC occurred after the operation, and the risk factors for the occurrence of PPC were analyzed. Results    All 158 patients successfully completed the micro single-port VATS, and there was no intraoperative death. The postoperative chest tightness, chest pain, and dyspnea symptoms basically disappeared. During the postoperative period, there were 3 patients of pulmonary infection, 7 patients of atelectasis, 4 patients of pulmonary leak, 6 patients of pleural effusion, 1 patient of atelectasis and pleural effusion, and the incidence of PPC was 13.29% (21/158). Multivariate logistic regression analysis showed that lung disease [OR=32.404, 95%CI (2.717, 386.452), P=0.006], preoperative albumin level≤35 g/L [OR=14.912, 95%CI (1.719, 129.353), P=0.014], severe pleural adhesions [OR=26.023, 95%CI (3.294, 205.557), P=0.002], pain grade Ⅱ-Ⅲ 24 hours after the surgery [OR=64.024, 95%CI (3.606, 1 136.677), P=0.005] , age [OR=1.195, 95%CI (1.065, 1.342), P=0.002], intraoperative blood loss [OR=1.087, 95%CI (1.018, 1.162), P=0.013] were the risk factors for PPC after micro single-port VATS. Conclusion    There is a close relationship between PPC after micro single-port VATS and perioperative indexes in patients with spontaneous pneumothorax. Clinically, targeted prevention and treatment can be implemented according to the age, pulmonary disease, preoperative albumin level, intraoperative blood loss, degree of pleural adhesion and pain grading 24 hours after surgery.

Effect of ventilation mode on pulmonary complications after thoracoscopic lung resection: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective     To evaluate the association between pressure-controlled ventilation-volume guaranteed (PCV-VG) mode and volume-controlled ventilation (VCV) mode on postoperative pulmonary complications (PPCs) in patients undergoing thoracoscopic lung resection. Methods     A retrospective cohort analysis of 329 patients undergoing elective thoracoscopic lung resection in West China Hospital of Sichuan University between September 2020 and March 2021 was conducted, including 213 females and 116 males, aged 53.6±11.3 years. American Society of Anesthesiologists (ASA) grade wasⅠ-Ⅲ. The patients who received lung-protective ventilation strategy during anesthesia were divided into a PCV-VG group (n=165) and a VCV group (n=164) according to intraoperative ventilation mode. Primary outcome was the incidence of PPCs during hospitalization. Results     A total of 73 (22.2%) patients developed PPCs during hospitalization. The PPCs incidence of PCV-VG and VCV was 21.8% and 22.6%, respectively (RR=0.985, 95%CI 0.569-1.611, P=0.871). Multivariate logistic regression analysis showed that there was no statistical difference in the incidence of PPCs between PCV-VG and VCV mode during hospitalization (OR=0.846, 95%CI 0.487-1.470, P=0.553). Conclusion     Among patients undergoing thoracoscopic lung resection, intraoperative ventilation mode (PCV-VG or VCV) is not associated with the risk of PPCs during hospitalization.

Effect of intraoperative ventilation modes on postoperative pulmonary complications after cardiac surgery under cardiopulmonary bypass: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To evaluate the association of intraoperative ventilation modes with postoperative pulmonary complications (PPCs) in adult patients undergoing selective cardiac surgery under cardiopulmonary bypass (CPB). Methods    The clinical data of 604 patients who underwent selective cardiac surgical procedures under CPB in the West China Hospital, Sichuan University from June to December 2020 were retrospectively analyzed. There were 293 males and 311 females with an average age of 52.0±13.0 years. The patients were divided into 3 groups according to the ventilation modes, including a pressure-controlled ventilation-volume guarantee (PCV-VG) group (n=201), a pressure-controlled ventilation (PCV) group (n=200) and a volume-controlled ventilation (VCV) group (n=203). The association between intraoperative ventilation modes and PPCs (defined as composite of pneumonia, respiratory failure, atelectasis, pleural effusion and pneumothorax within 7 days after surgery) was analyzed using modified poisson regression. Results    The PPCs were found in a total of 246 (40.7%) patients, including 86 (42.8%) in the PCV-VG group, 75 (37.5%) in the PCV group and 85 (41.9%) in the VCV group. In the multivariable analysis, there was no statistical difference in PPCs risk associated with the use of either PCV-VG mode (aRR=0.951, 95%CI 0.749-1.209, P=0.683) or PCV mode (aRR= 0.827, 95%CI 0.645-1.060, P=0.133) compared with VCV mode. Conclusion    Among adults receiving selective cardiac surgery, PPCs risk does not differ significantly by using different intraoperative ventilation modes.

Perioperative nebulization of ipratropium bromide in patients with chronic obstructive pulmonary disease under thoracic surgery: A randomized, double-blind, placebo-controlled, parallel-group, multi-centre trial / 中国胸心血管外科临床杂志

@#Objective    To evaluate the effect of perioperative nebulization of ipratropium bromide on preoperative pulmonary function and incidence of postoperative pulmonary complications as well as safety in chronic obstructive pulmonary disease (COPD) patients who underwent lung resection in thoracic surgery. Methods    During November 18, 2013 to August 12, 2015, 192 COPD patients with a necessity of selective surgical procedures of lobectomy or right bilobectomy or segmentectomy under general anaesthesia in 10 centers were 1 : 1 randomized to an ipratropium bromide group (96 patients) and a placebo group (96 patients), to compare the effect on preoperative pulmonary function and incidence of postoperative pulmonary complications. The average age of treated patients was 62.90±6.50 years, with 168 male patients and 22 female patients. Results     The demographic and baseline characteristics were well-balanced between the two groups. The adjusted mean increase of forced expiratory volume in one second (FEV1) in the ipratropium bromide group was significantly higher than that in the placebo group (169.90±29.07 mL vs. 15.00±29.35 mL, P<0.05). The perioperative use of ipratropium bromide significantly decreased incidence of postoperative pneumonia (2.6% vs. 14.1%, P<0.05). There was no ipratropium bromide related adverse event (AE) observed in this trial. Conclusion    This trial indicates that perioperative nebulization of ipratropium bromide significantly improves preoperative lung function and reduces postoperative pneumonia in COPD patients undergoing lung resection in thoracic surgery, and has good safety profile.

Effects of anesthetics on postoperative pulmonary complications in patients undergoing cardiac surgery / 中国胸心血管外科临床杂志

@#Objective    To evaluate the association of anesthesia regime (volatile or intravenous anesthetics) with the occurrence of postoperative pulmonary complications (PPCs) in adult patients undergoing elective cardiac surgery under cardiopulmonary bypass (CPB). Methods    The electronic medical records of 194 patients undergoing elective cardiac surgery under CPB at West China Hospital, Sichuan University between September 2018 and February 2019 were reviewed, including 92 males and 102 females with an average age of 53 years. The patients were classified into a volatile group (n=94) or a total intravenous anesthesia (TIVA) group (n=100) according to anesthesia regimen during surgery (including CPB). The primary outcome was the incidence of PPCs within first 7 d after surgery. Secondary outcomes included incidence of reintubation, duration of mechanical ventilation, ICU stay and hospital stay. Results    There was no significant difference in the incidence of PPCs between the two groups (RR=1.020, 95%CI 0.763-1.363, P=0.896), with an incidence of 48.9% in the volatile group and 48.0% in the TIVA group. Secondary outcomes were also found no significant difference between the two groups (P>0.05). Conclusion    No association of anesthesia regimen with the incidence of PPCs is found in adult patients undergoing elective cardiac surgery under CPB.

Relationship between drainage volume on the first postoperative day and complications after video-assisted thoracoscopic surgery lobectomy / 中国胸心血管外科临床杂志

@#Objective 聽 聽To investigate the correlation between the postoperative day 1 (POD1) drainage volume and postoperative pulmonary complications (PPCs). Methods 聽 聽The clinical data of 254 non-small cell lung cancer (NSCLC) patients undergoing thoracoscopic lobectomy at our department from January 2014 to June 2018 were retrospectively reviewed. According to whether there were PPCs after operation, patients were divided into a PPCs group (51 patients, 33 males and 18 females, aged 65.2卤7.3 years) and a non-PPCs group (203 patients, 110 males and 93 females, aged 62.4卤8.2 years). The correlation between POD1 drainage volume and PPCs was analyzed. Results 聽 聽The POD1 drainage volume in the PPCs group was significantly more than that in the non-PPCs group (337.5卤127.4 ml vs. 208.7卤122.9 ml, P=0.000). The result of regression analysis showed that POD1 drainage volume was an independent risk factor for the occurrence of PPCs. Receiver operating characteristic curve (ROC curve) analysis showed that POD1 drainage volume of 265 ml was the cut-off point to predict PPCs. The rate of PPCs in the group of POD1 drainage volume less than 265 ml was significantly lower than that in the group of drainage volume more than 265 ml (8.3% vs. 43.0%, P=0.000). Conclusion 聽 聽The POD1 drainage volume is closely related to the occurrence of PPCs, which can be used to predict the occurrence of PPCs.