Objective To evaluate the effect of perioperative fluid management on postoperative pulmonary complications (PPCs) of esophagectomy, and to find out the optimal scheme for perioperative fluid administration. Methods This retrospective cohort study enrolled 75 patients with esophageal squamous cell cancer who have received esophagectomy in West China Hospital from June to December 2014. We used the Kroenke's postoperative pulmonary complications classification system to define the PPCs. Patients with PPCs of grade Ⅱ-Ⅳ were considered as PPCs group (n=13, 12 males, 1 female, age of 64.62±8.64 years), and others were considered as non-complication group (n=62, 50 males, 12 females, age of 60.55±8.73 years). Intraoperative and postoperative fluid inputs and outputs as well as clinical characteristics between groups were compared. Results Between two groups, there was a great difference in postoperative albumin infusion, intraoperative fluid administration [net input, total input, net input/kg, total input/kg, net input/(kg·h) and total input/(kg·h)] and fluid input on the first postoerative 1–3 days (total input and total input/kg). The cutoff value for total input/(kg·h) in operation and total input on the first 1–3 postoerative days was 12.07 ml/(kg·h) and 178.57 ml/kg, respectively. Conclusion The speed of fluid infusion in operation and total input on postoperative 1-3 days are most important influence factors of PPCs. The speed in operation should not exceed 12.07 ml/(kg·h) and the total input on postoperative 1-3 days should not exceed 178.57 ml/kg. Within this range, an appropriate increase in fluid volume can make patients feel better.
Tricuspid valve, also known as "forgotten valve" because of the high natural and surgical mortality. Transcatheter tricuspid valve replacement is an innovative surgical method to treat tricuspid regurgitation, which improves the prognosis of patients and is gradually being popularized in clinics. However, postoperative pulmonary complications are still the main causes affecting the rapid recovery and death. More and more medical experts begin to use preoperative inspiratory muscle training to reduce postoperative pulmonary complications and improve the quality of life of patients after cardiac surgery. However, there was no report on the effect of preoperative inspiratory muscle training on pulmonary complications after transcatheter tricuspid valve replacement. Therefore, for the first time, we boldly speculate that inspiratory muscle training can reduce pulmonary complications after transcatheter tricuspid valve replacement, and put forward suggestions for its treatment mechanism and strategy. But this rehabilitation intervention lacks practical clinical research. Unknown challenges may also be encountered, which may be a new research direction.
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.
ObjectiveTo 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. MethodsDuring 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. ConclusionThis 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.
ObjectiveTo compare the effects of flow-controlled ventilation (FCV) and conventional pressure-controlled ventilation (PCV) on postoperative pulmonary complications (PPCs) within 7 days after elective thoracic surgery. Methods Patients scheduled for elective thoracic surgery at Langzhong People's Hospital between August 2024 and June 2025 were enrolled and randomly assigned in a 1:1 ratio to either the FCV group or PCV group. The primary outcome was the incidence of PPCs within 7 days postoperatively. Secondary outcomes included systemic inflammatory factor levels at 24 hours postoperatively, numerical rating scale (NRS) pain scores at 3 days postoperatively, post-anesthesia care unit (PACU) stay duration, and length of postoperative hospitalization. Mechanical power (MP), oxygenation index, partial pressure of arterial carbon dioxide (PaCO2), peak pressure (Ppeak), positive end-expiratory pressure (PEEP), tidal volume (VT), respiratory rate (RR), and minute ventilation (MV) were compared between groups at 30 and 60 minutes after one-lung ventilation (OLV). Differences in MP between patients with and without PPCs were analyzed, and receiver operating characteristic (ROC) curves were constructed to evaluate the predictive value of MP for PPCs using area under the curve (AUC). Results A total of 60 patients were included: 30 in the FCV group [17 males, 13 females, mean age (57.4±10.0) years] and 30 in the PCV group [18 males, 12 females; mean age (58.7±11.2) years]. The FCV group demonstrated a significantly lower incidence of PPCs compared to the PCV group (16.7% vs. 40.0%, P=0.045) and reduced systemic pro-inflammatory factor levels at 24 hours postoperatively. No statistically significant difference was observed in NRS pain scores between groups at 3 days postoperatively. Additionally, the FCV group showed shorter PACU stay duration [(51.8±11.5) min vs. (66.2±24.5) min, P=0.008] and reduced postoperative hospitalization time [(7.8±1.2) d vs. (8.9±2.5) d, P=0.034]. At both 30 and 60 minutes after OLV initiation, the FCV group exhibited lower MP, MV, and RR values alongside higher oxygenation indices and VT compared to the PCV group, while PaCO2 and PEEP showed no significant differences. Although Ppeak did not differ significantly between groups at 30 minutes after OLV, it was lower in the PCV group at 60 minutes. Patients who developed PPCs consistently demonstrated higher MP values than those without PPCs at both time points. ROC curve analysis revealed excellent predictive performance of MP for PPCs occurrence within 7 days postoperatively (30-minute OLV: AUC=0.97, P<0.001; 60-minute OLV: AUC=0.93, P<0.001). Conclusion Compared with PCV, implementing FCV during OLV significantly reduces PPCs incidence. This protective effect may be attributed to reduced MP, improved oxygenation, enhanced ventilatory efficiency, and attenuated inflammatory responses. As a lung-protective ventilatory strategy, FCV effectively promotes postoperative recovery in patients undergoing elective thoracic surgery with American Society of Anesthesiologists physical status classification Ⅰ-Ⅲ.
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. ResultsTotally, 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.
ObjectiveTo investigate the correlation between the postoperative day 1 (POD1) drainage volume and postoperative pulmonary complications (PPCs). MethodsThe 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±7.3 years) and a non-PPCs group (203 patients, 110 males and 93 females, aged 62.4±8.2 years). The correlation between POD1 drainage volume and PPCs was analyzed. ResultsThe POD1 drainage volume in the PPCs group was significantly more than that in the non-PPCs group (337.5±127.4 ml vs. 208.7±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). ConclusionThe POD1 drainage volume is closely related to the occurrence of PPCs, which can be used to predict the occurrence of PPCs.
Objective To investigate the effects of different ventilation modes on postoperative pulmonary complications in elderly patients undergoing abdominal surgery. Methods The patients who underwent upper abdominal surgery under general anesthesia in Chengdu Office Hospital of the People’s Government of Tibet Autonomous Region between February 2020 and February 2021 were selected. Patients were randomly divided into volume controlled ventilation (VCV) group, pressure controlled ventilation (PCV) group, and pressure controlled ventilation-volume guarantee (PCV-VG) group according to the random number table method. All the three groups adopted the internationally recognized lung protective ventilation strategy. The transcutaneous arterial oxygen saturation and respiratory mechanics indicators of three different time periods, as well as pulmonary symptoms and signs and laboratory imaging examinations 7 days after surgery were recorded. The incidence of postoperative pulmonary complications in the three groups of patients were evaluated using the Melbourne Group Scale Version 2. Results A total of 120 patients were included, with 40 in each group. There was no statistically significant difference in the general situation of the three groups of patients (P>0.05). The platform pressure and compliance of three different time periods all changed over time (P<0.05). There were statistically significant differences in the occurrence of pulmonary complications and hospital stay among the three groups 7 days after surgery (P<0.05). Conclusion Under the internationally recognized lung protective ventilation strategy, PCV-VG mode can significantly reduce the incidence of pulmonary complications 7 days after abdominal surgery, shorten the length of hospital stay, and improve the quality of life in elderly patients.
ObjectiveTo evaluate the association of intraoperative ventilation modes with postoperative pulmonary complications (PPCs) in adult patients undergoing selective cardiac surgery under cardiopulmonary bypass (CPB).MethodsThe 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. ResultsThe 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. ConclusionAmong adults receiving selective cardiac surgery, PPCs risk does not differ significantly by using different intraoperative ventilation modes.
Aortic dissection is a serious cardiovascular disease characterized by acute onset and high mortality rates. Although advancements in surgical techniques and anesthesia methods have significantly reduced surgical mortality, postoperative complications, particularly pulmonary complications, remain a challenge for the recovery of patients with aortic dissection. Existing studies indicate that respiratory rehabilitation plays a crucial role in preventing and alleviating postoperative pulmonary complications, and its application is gradually expanding. However, current understanding of respiratory rehabilitation treatment for patients with aortic dissection is still insufficient, and there is a lack of standardized protocols in clinical practice. This article aims to review the existing research evidence, comprehensively analyze common pulmonary complications after aortic dissection surgery, their pathogenesis, the latest advancements in perioperative respiratory rehabilitation, and the main challenges faced, in order to provide references for clinical practice and future research.