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Intraoperative Ventilation/Perfusion Mismatch and Postoperative Pulmonary Complications after Major Noncardiac Surgery: A Prospective Cohort Study.
Scaramuzzo, Gaetano; Karbing, Dan Stieper; Ball, Lorenzo; Vigolo, Federico; Frizziero, Martina; Scomparin, Francesca; Ragazzi, Riccardo; Verri, Marco; Rees, Stephen Edward; Volta, Carlo Alberto; Spadaro, Savino.
Afiliación
  • Scaramuzzo G; Department of Translational Medicine, University of Ferrara, Ferrara, Italy; and Department of Emergency, Azienda Ospedaliera Universitaria Sant'Anna, Ferrara, Italy.
  • Karbing DS; Respiratory and Critical Care Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
  • Ball L; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.
  • Vigolo F; Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
  • Frizziero M; Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
  • Scomparin F; Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
  • Ragazzi R; Department of Translational Medicine, University of Ferrara, Ferrara, Italy; and Department of Emergency, Azienda Ospedaliera Universitaria Sant'Anna, Ferrara, Italy.
  • Verri M; Department of Emergency, Azienda Ospedaliera Universitaria Sant'Anna, Ferrara, Italy.
  • Rees SE; Respiratory and Critical Care Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
  • Volta CA; Department of Translational Medicine, University of Ferrara, Ferrara, Italy; and Department of Emergency, Azienda Ospedaliera Universitaria Sant'Anna, Ferrara, Italy.
  • Spadaro S; Department of Translational Medicine, University of Ferrara, Ferrara, Italy; and Department of Emergency, Azienda Ospedaliera Universitaria Sant'Anna, Ferrara, Italy.
Anesthesiology ; 141(4): 693-706, 2024 Oct 01.
Article en En | MEDLINE | ID: mdl-38768389
ABSTRACT

BACKGROUND:

Postoperative pulmonary complications can increase hospital length of stay, postoperative morbidity, and mortality. Although many factors can increase the risk of postoperative pulmonary complications, it is not known whether intraoperative ventilation/perfusion (V/Q) mismatch can be associated with an increased risk of postoperative pulmonary complications after major noncardiac surgery.

METHODS:

This study enrolled patients undergoing general anesthesia for noncardiac surgery and evaluated intraoperative V/Q distribution using the automatic lung parameter estimator technique. The assessment was done after anesthesia induction, after 1 h from surgery start, and at the end of surgery. Demographic and procedural information were collected, and intraoperative ventilatory and hemodynamic parameters were measured at each timepoint. Patients were followed up for 7 days after surgery and assessed daily for postoperative pulmonary complication occurrence.

RESULTS:

The study enrolled 101 patients with a median age of 71 [62 to 77] years, a body mass index of 25 [22.4 to 27.9] kg/m2, and a preoperative Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score of 41 [34 to 47]. Of these patients, 29 (29%) developed postoperative pulmonary complications, mainly acute respiratory failure (23%) and pleural effusion (11%). Patients with and without postoperative pulmonary complications did not differ in levels of shunt at T1 (postoperative pulmonary complications 22.4% [10.4 to 35.9%] vs. no postoperative pulmonary complications19.3% [9.4 to 24.1%]; P = 0.18) or during the protocol, whereas significantly different levels of high V/Q ratio were found during surgery (postoperative pulmonary complications 13 [11 to 15] mmHg vs. no postoperative pulmonary complications 10 [8 to 13.5] mmHg; P = 0.007) and before extubation (postoperative pulmonary complications 13 [11 to 14] mmHg vs. no postoperative pulmonary complications 10 [8 to 12] mmHg; P = 0.006). After adjusting for age, ARISCAT, body mass index, smoking, fluid balance, anesthesia type, laparoscopic procedure and surgery duration, high V/Q ratio before extubation was independently associated with the development of postoperative pulmonary complications (odds ratio, 1.147; 95% CI, 1.021 to 1.289; P = 0.02). The sensitivity analysis showed an E-value of 1.35 (CI, 1.11).

CONCLUSIONS:

In patients with intermediate or high risk of postoperative pulmonary complications undergoing major noncardiac surgery, intraoperative V/Q mismatch is associated with the development of postoperative pulmonary complications. Increased high V/Q ratio before extubation is independently associated with the occurrence of postoperative pulmonary complications in the first 7 days after surgery.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Enfermedades Pulmonares Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Anesthesiology Año: 2024 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Enfermedades Pulmonares Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Anesthesiology Año: 2024 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Estados Unidos