Factors Associated with an Increased Risk of Mechanical Ventilation Lasting over 48 Hours after Abdominal Surgery
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Abstract
Introduction: Postoperative respiratory failure, necessitating mechanical ventilation for more than 48 h or resulting in unplanned intubation following surgery, ranks among the foremost serious postoperative pulmonary complications. It is closely linked with high mortality rates. The objective of the study is to identify peri-operative factors associated with an increased risk of postoperative mechanical ventilation lasting beyond 48 hours Methods: A retrospective, observational cohort study involving adult patients who underwent abdominal surgery in the fields of gynecology, urology and general surgery from October 1, 2017 to September 30, 2021. The study specifically focused on patients who remained an endotracheal tube and required post-operative mechanical ventilation. Results: Out of 674 patients, 334 (49.6%) required postoperative mechanical ventilation more than 48 hours. The study revealed several contributing factors, encompassing chronic obstructive pulmonary disease, coronary artery disease, sepsis, hypoalbuminemia, preoperative transfusion of 2 units or more, intraoperative oliguria, open aortic surgery, and intestinal surgery. Conclusion: Several factors including chronic obstructive pulmonary disease, coronary artery disease, sepsis, hypoalbuminemia, preoperative transfusion of 2 units or more, intraoperative oliguria, open aortic surgery, and intestinal surgery associate with an increased risk of mechanical ventilation lasting over 48 hours after abdominal surgery.
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References
Yang CK, Teng A, Lee DY, Rose K. Pulmonary complications after major abdominal surgery: National Surgical Quality Improvement Program analysis. J Surg Res. 2015;198:441-9.
Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth. 2017;118:317-34.
Canet J, Sabaté S, Mazo V, Gallart L, et al. Development and validation of a score to predict postoperative respiratory failure in a multicentre European cohort: a prospective, observational study. Eur J Anaesthesiol. 2015;32:458-70.
Mazo V, Sabaté S, Canet J, et al. Prospective external validation of a predictive score for postoperative pulmonary complications. Anesthesiology. 2014;121:219-31.
Kotloff RM. Acute respiratory failure in the surgical patient. In: Grippi MA, Antin-Ozerkis DE, Dela Cruz CS, Kotloff RM, Kotton CN, Pack AI, eds. Fishman’s Pulmonary Diseases and Disorders, 6e. New York, NY: McGraw-Hill Education; 2023 [cited 2023 May 31]. Available from:https://accessmedicine.mhmedical.com/content.aspx?aid=1195012215
Johnson RG, Arozullah AM, Neumayer L, Henderson WG, Hosokawa P, Khuri SF. Multi-variable predictors of postoperative respiratory failure after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg. 2007;204:1188-98.
Ferreyra G, Squadrone V, Ranieri VM. Acute respiratory failure after abdominal surgery. In: Vincent JL, ed. Yearbook of Intensive Care and Emergency Medicine 2005. New York, NY: Springer. 2005;p10-8.
Arozullah AM, Daley J, Henderson WG, Khuri SF. Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. The National Veterans Administration Surgical Quality Improvement Program. Ann Surg. 2000;232:242-53.
Gupta H, Gupta PK, Fang X, et al. Development and validation of a risk calculator predicting postoperative respiratory failure. Chest. 2011;140:1207-15.
Rothaar RC, Epstein SK. Extubation failure: magnitude of the problem, impact on outcomes, and prevention. Curr Opin Crit Care. 2003;9:59-66.
Gupta H, Ramanan B, Gupta PK, et al. Impact of COPD on postoperative outcomes: results from a national database. Chest. 2013;143:1599-606.
Hausman MSJ, Jewell ES, Engoren M. Regional versus general anesthesia in surgical patients with chronic obstructive pulmonary disease: does avoiding general anesthesia reduce the risk of postoperative complications? Anesth Analg. 2015;120:1405-12.
Hedge J, Balajibabu PR, Sivaraman T. The patient with ischaemic heart disease undergoing non cardiac surgery. Indian J Anaesth. 2017;61:705-11.
Stocking JC, Drake C, Aldrich JM, et al. Risk factors associated with early postoperative respiratory failure: a matched case-control study. J Surg Res. 2021;261:310-9.
Mauri T, Spinelli E, Pavlovsky B, et al. Respiratory drive in patients with sepsis and septic shock: modulation by high-flow nasal cannula. Anesthesiology. 2021;135:1066-75.
Hu WH, Eisenstein S, Parry L, Ramamoorthy S. Preoperative malnutrition with mild hypo-albuminemia associated with postoperative mortality and morbidity of colorectal cancer: a propensity score matching study. Nutr J. 2019;18:33.
Hans G, Jones N. Preoperative anaemia. Cont Educ Anaesth Crit Care Pain. 2013;13:71-4.
Voelker MT, Spieth P. Blood transfusion associated lung injury. J Thorac Dis. 2019;11:3609-15.
Zilberberg MD, Carter C, Lefebvre P, et al. Red blood cell transfusions and the risk of acute respiratory distress syndrome among the critically ill: a cohort study. Crit Care. 2007;11:R63.
Darmon M, Legrand M, Terzi N. Understanding the kidney during acute respiratory failure. Intensive Care Med. 2017;43:1144-7.
Klein CL, Hoke TS, Fang WF, Altmann CJ, Douglas IS, Faubel S. Interleukin-6 mediates lung injury following ischemic acute kidney injury or bilateral nephrectomy. Kidney Int. 2008;74:901-9.
Pasin L, Nardelli P, Belletti A, et al. Pulmonary complications after open abdominal aortic surgery: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth. 2017;31:5620-8.
Patel S, Lutz JM, Panchagnula U, Bansal S. Anesthesia and perioperative management of colorectal surgical patients-specific issues (part 2). J Anaesthesiol Clin Pharmacol. 2012;28:304-13.