Adoption of Lung Protective ventilation IN patients undergoing Emergency laparotomy: the ALPINE study. A prospective multicentre observational study
| Autor: | X. Watson, M. Chereshneva, P.M. Odor, I. Chis Ster, M. Cecconi, C. Johnston, S. Huddart, J. Woods, N. Hadi, S. Ali, G. Thorning, P. Gill, O. Boomers, T. Rope, R. Bartlett, A. Kuttler, B. O'Carroll-Kuehn, M. Dickinson, C. Lyness, R. Jha, S. Patel, A. Raj, T. Tanqueray, M. Cox, A. Khader, S. Vashisht, S. Liyanage, K. Ahmed, J. Whitehead, N. Patel, S. Liu, C. Patel, L. Hayward, S. Leonard, S. Hare, R. Saha, J. de Bois, T. Winterbottom, Y. Choo, C.M. Oliver, D. Timbrell, M. Sinnott, E. Yip, N. Trask, S. Sothisrihar, M. Shaw, P. Thorat, D. Shah, S. Leir, M. Farag, A. Duffen, T. McCretton, T. Wojcikiewicz, C. King, J. Pennington, M. Patel, W. Kok, D. Gunarathna, L. Carter, E. Spence, K. Chambers, E. Cervi, J. Cummins, N. Shah, A. Eeles, A. Chu, C. Webb, L. Nolan, B. McHugh, A. Walls, R. Lakhani, S. Matthews, Z. Hussein, S. Wang, R. Weisskopf, H. Talbot, C. Verney, E. Nurmi, K. Henderson, O.R. Beesley, J. Hunter, L. Nicholls, A. Robles, S. Lee, R. Hawkins, K. Patel, A. Kwok, J. Han, A. Allana, S. Kestner, A. Roopra, L. Edwards, T. O'Dell, J. Selby, E. Bickmore, P. Remeta, E. Karsten, P. Daum, A. Loughnan, A. Heggarty, H. Bowes, D. Gunaratna, J. Cronin, B. Post, N. Blunt, E. Gilbert-Kawai, M. Gray, D. Highton, C. Finlay, O. Clancy, S. Bampoe, J. O'Carroll, A. Wickham, H. Wordsworth, F. Williams, J. Hackney, V. Marsh, O. Davies, R. Bird, R. Patel, S. Philips, H. Laycock, C. Morkane, K. Grailey, K. El-Boghdadly, T.P. Hansen |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male Emergency Medical Services Ventilator-Induced Lung Injury medicine.medical_treatment Peak inspiratory pressure Positive-Pressure Respiration Inspiratory Capacity 03 medical and health sciences Postoperative Complications 0302 clinical medicine 030202 anesthesiology Laparotomy London Tidal Volume medicine Humans Prospective Studies 030212 general & internal medicine Prospective cohort study Tidal volume Aged business.industry Hazard ratio Perioperative Middle Aged Respiration Artificial Oxygen Anesthesiology and Pain Medicine Anesthesia Female business Abdominal surgery |
| Zdroj: | British Journal of Anaesthesia. 121:909-917 |
| ISSN: | 0007-0912 |
| DOI: | 10.1016/j.bja.2018.04.048 |
| Popis: | Background Emergency abdominal surgery is associated with a high risk of postoperative pulmonary complications (PPCs). The primary aim of this study was to determine whether patients undergoing emergency laparotomy are ventilated using a lung-protective ventilation strategy employing tidal volume ≤8 ml kg−1 ideal body weight−1, PEEP >5 cm H2O, and recruitment manoeuvres. The secondary aim was to investigate the association between ventilation factors (lung-protective ventilation strategy, intraoperative FiO2, and peak inspiratory pressure) and the occurrence of PPCs. Methods Data were collected prospectively in 28 hospitals across London as part of routine National Emergency Laparotomy Audit (NELA). Patients were followed for 7 days. Complications were defined according to the European Perioperative Clinical Outcome definition. Results Data were collected from 568 patients. The median [inter-quartile range (IQR)] tidal volume observed was 500 ml (450–540 ml), corresponding to a median tidal volume of 8 ml kg−1 ideal body weight−1 (IQR: 7.2–9.1 ml). A lung-protective ventilation strategy was employed in 4.9% (28/568) of patients, and was not protective against the occurrence of PPCs in the multivariable analysis (hazard ratio=1.06; P=0.69). Peak inspiratory pressure of Conclusions Both intraoperative peak inspiratory pressure and FiO2 are independent factors significantly associated with development of a postoperative pulmonary complication in emergency laparotomy patients. Further studies are required to identify causality and to demonstrate if their manipulation could lead to better clinical outcomes. |
| Databáze: | OpenAIRE |
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