TY - JOUR
T1 - Prevention of respiratory complications of the surgical patient
T2 - Actionable plan for continued process improvement
AU - Ruscic, Katarina J.
AU - Grabitz, Stephanie D.
AU - Rudolph, Maíra I.
AU - Eikermann, Matthias
N1 - Publisher Copyright:
Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc.
PY - 2017/6/1
Y1 - 2017/6/1
N2 - Purpose of review Postoperative respiratory complications (PRCs) increase hospitalization time, 30-day mortality and costs by up to 35000. These outcomes measures have gained prominence as bundled payments have become more common. Recent findings Results of recent quantitative effectiveness studies and clinical trials provide a framework that helps develop center-specific treatment guidelines, tailored to minimize the risk of PRCs. The implementation of those protocols should be guided by a local, respected, and visible facilitator who leads proper implementation while inviting center-specific input from surgeons, anesthesiologists, and other perioperative stakeholders. Summary Preoperatively, patients should be risk-stratified for PRCs to individualize intraoperative choices and postoperative pathways. Laparoscopic compared with open surgery improves respiratory outcomes. High-risk patients should be treated by experienced providers based on locally developed bundle-interventions to optimize intraoperative treatment and ICU bed utilization. Intraoperatively, lung-protective ventilation (procedure-specific positive end-expiratory pressure utilization, and low driving pressure) and moderately restrictive fluid therapy should be used. To achieve surgical relaxation, high-dose neuromuscular blocking agents (and reversal agents) as well as high-dose opioids should be avoided; inhaled anesthetics improve surgical conditions while protecting the lungs. Patients should be extubated in reverse Trendelenburg position. Postoperatively, continuous positive airway pressure helps prevent airway collapse and protocolized, early mobilization improves cognitive and respiratory function.
AB - Purpose of review Postoperative respiratory complications (PRCs) increase hospitalization time, 30-day mortality and costs by up to 35000. These outcomes measures have gained prominence as bundled payments have become more common. Recent findings Results of recent quantitative effectiveness studies and clinical trials provide a framework that helps develop center-specific treatment guidelines, tailored to minimize the risk of PRCs. The implementation of those protocols should be guided by a local, respected, and visible facilitator who leads proper implementation while inviting center-specific input from surgeons, anesthesiologists, and other perioperative stakeholders. Summary Preoperatively, patients should be risk-stratified for PRCs to individualize intraoperative choices and postoperative pathways. Laparoscopic compared with open surgery improves respiratory outcomes. High-risk patients should be treated by experienced providers based on locally developed bundle-interventions to optimize intraoperative treatment and ICU bed utilization. Intraoperatively, lung-protective ventilation (procedure-specific positive end-expiratory pressure utilization, and low driving pressure) and moderately restrictive fluid therapy should be used. To achieve surgical relaxation, high-dose neuromuscular blocking agents (and reversal agents) as well as high-dose opioids should be avoided; inhaled anesthetics improve surgical conditions while protecting the lungs. Patients should be extubated in reverse Trendelenburg position. Postoperatively, continuous positive airway pressure helps prevent airway collapse and protocolized, early mobilization improves cognitive and respiratory function.
KW - lung-protective ventilation
KW - postoperative respiratory complications
KW - respiratory failure
KW - score for prediction of postoperative respiratory complications (SPORC)
KW - upper airway
KW - ventilator-induced lung injury
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U2 - 10.1097/ACO.0000000000000465
DO - 10.1097/ACO.0000000000000465
M3 - Review article
C2 - 28323670
AN - SCOPUS:85015726041
SN - 0952-7907
VL - 30
SP - 399
EP - 408
JO - Current Opinion in Anaesthesiology
JF - Current Opinion in Anaesthesiology
IS - 3
ER -