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.
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.
Objective To evaluate the association between pressure-controlled ventilation-volume guaranteed (PCV-VG) mode and volume-controlled ventilation (VCV) mode on postoperative pulmonary complications (PPCs) in patients undergoing thoracoscopic lung resection. Methods A retrospective cohort analysis of 329 patients undergoing elective thoracoscopic lung resection in West China Hospital of Sichuan University between September 2020 and March 2021 was conducted, including 213 females and 116 males, aged 53.6±11.3 years. American Society of Anesthesiologists (ASA) grade wasⅠ-Ⅲ. The patients who received lung-protective ventilation strategy during anesthesia were divided into a PCV-VG group (n=165) and a VCV group (n=164) according to intraoperative ventilation mode. Primary outcome was the incidence of PPCs during hospitalization. Results A total of 73 (22.2%) patients developed PPCs during hospitalization. The PPCs incidence of PCV-VG and VCV was 21.8% and 22.6%, respectively (RR=0.985, 95%CI 0.569-1.611, P=0.871). Multivariate logistic regression analysis showed that there was no statistical difference in the incidence of PPCs between PCV-VG and VCV mode during hospitalization (OR=0.846, 95%CI 0.487-1.470, P=0.553). Conclusion Among patients undergoing thoracoscopic lung resection, intraoperative ventilation mode (PCV-VG or VCV) is not associated with the risk of PPCs during hospitalization.
ObjectiveTo analyze the occurrence of postoperative pulmonary complications (PPC) and the risk factors in patients with spontaneous pneumothorax who underwent micro single-port video-assisted thoracoscopic surgery (VATS).MethodsA total of 158 patients with spontaneous pneumothorax who underwent micro single-port VATS in our hospital from April 2017 to December 2019 were retrospectively included, including 99 males and 59 females, with an average age of 40.53±9.97 years. The patients were divided into a PPC group (n=21) and a non-PPC group (n=137) according to whether PPC occurred after the operation, and the risk factors for the occurrence of PPC were analyzed.ResultsAll 158 patients successfully completed the micro single-port VATS, and there was no intraoperative death. The postoperative chest tightness, chest pain, and dyspnea symptoms basically disappeared. During the postoperative period, there were 3 patients of pulmonary infection, 7 patients of atelectasis, 4 patients of pulmonary leak, 6 patients of pleural effusion, 1 patient of atelectasis and pleural effusion, and the incidence of PPC was 13.29% (21/158). Multivariate logistic regression analysis showed that lung disease [OR=32.404, 95%CI (2.717, 386.452), P=0.006], preoperative albumin level≤35 g/L [OR=14.912, 95%CI (1.719, 129.353), P=0.014], severe pleural adhesions [OR=26.023, 95%CI (3.294, 205.557), P=0.002], pain grade Ⅱ-Ⅲ 24 hours after the surgery [OR=64.024, 95%CI (3.606, 1 136.677), P=0.005] , age [OR=1.195, 95%CI (1.065, 1.342), P=0.002], intraoperative blood loss [OR=1.087, 95%CI (1.018, 1.162), P=0.013] were the risk factors for PPC after micro single-port VATS.ConclusionThere is a close relationship between PPC after micro single-port VATS and perioperative indexes in patients with spontaneous pneumothorax. Clinically, targeted prevention and treatment can be implemented according to the age, pulmonary disease, preoperative albumin level, intraoperative blood loss, degree of pleural adhesion and pain grading 24 hours after surgery.
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.
ObjectiveTo investigate the morbidity of postoperative pulmonary complications (PPCs) in patients after transcatheter tricuspid valve replacement (TTVR). MethodsA prospective cohort study enrolled 19 patients who were diagnosed with severe or greater tricuspid regurgitation in West China Hospital from October 11, 2020 to March 1, 2021, and would receive TTVR using LuX-valve for valve replacement. The patients were divided into a PPCs group and a non-PPCs group according to the presence of PPCs. The incidence of PPCs after tricuspid valve intervention between the two groups was compared. ResultsOf 19 patients diagnosed with severe or greater tricuspid regurgitation registered in the database, 17 met the inclusion criteria, including 15 females and 2 males, with a mean age of 68.4±8.0 years. PPCs occurred in 9 of 17 (52.9%) patients. At discharge, compared with the non-PPCs group, the PPCs group had a longer postoperative hospital stay [11.0 (10.0, 17.0) d vs. 7.5 (7.0, 8.0) d, P=0.01], longer ICU stay [72.0 (45.5, 95.0) h vs. 20.5 (16.0, 22.8) h, P<0.01], and more hospital cost [74.3 (65.9, 98.3) thousand yuan vs. 52.6 (44.2, 57.4) thousand yuan, P<0.01]. At 30 days of follow-up, the PPCs group was found that the rate of New York Heart Association cardiac function≥class Ⅲ (66.7% vs. 12.5%, P<0.01) was higher, the six-minute walk distance (170.2±169.3 m vs. 377.9±80.5 m, P<0.01) was shorter and Kansas City Cardiomyopathy Questionnaire heart failure score (40.9±31.2 vs. 80.4±5.8, P<0.01) was less than those of the non-PPCs group. ConclusionPPCs are common in the patients undergoing TTVR and severely affect patients' cardiac function, exercise function and quality-of-life recovery. Proactive preoperative intervention as well as early postoperative rehabilitation management should be provided to those at high risk 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.
Objective To explore the relationship between preoperative fasting plasma glucose (FPG) and postoperative pulmonary complications (PPCs) in type 2 diabetic patients undergoing elective thoracoscopic lung resection, and provide a reference for prediction and prevention of PPCs in the clinic. Methods A retrospective analysis was performed on the type 2 diabetic patients who underwent elective thoracoscopic lung resection for the first time in our hospital from January 2017 to March 2021. According to the level of FPG one day before the operation, the patients were divided into three groups: a hypoglycemia group (<6.1 mmol/L), a medium level blood glucose group (≥6.1 mmol/L and <8.0 mmol/L) and a high blood glucose group (≥8.0 mmol/L). Besides, the patients were divided into a PPCs group and a non-PPCs group according to whether PPCs occurred. The risk factors for PPCs were analyzed by logistic regression analysis, and the predictive value of preoperative FPG level on PPCs was estimated by the area under the receiver operating characteristic curve (AUC). Results A total of 130 patients were included, including 75 (57.7%) males and 55 (42.3%) females with an average age of 63.5±9.0 years. Logistic regression analysis showed that compared to non-PPCs patients, the level of preoperative FPG (P=0.023) and smoking history ratio (P=0.036) were higher and the operation time was longer (P=0.004) in the PPCs patients. High FPG level on preoperative day 1 and longer operation time were associated with PPCs risk. Besides, the preoperative FPG of 6.79 mmol/L was the threshold value to predict the occurrence of PPCs [AUC=0.653, 95%CI (0.559, 0.747), P=0.003]. Conclusion There is a certain correlation between preoperative FPG level and postoperative PPCs, which may be used as an index to predict the occurrence of PPCs.
Objective To evaluate the effect of intraoperative fluid infusion volume on postoperative pulmonary complications (PPCs) in patients after minimally invasive endoscopic esophageal carcinoma resection. Methods From June 2019 to August 2021, 486 patients undergoing elective minimally invasive endoscopic esophagectomy for esophageal cancer were retrospectively screened from the electronic medical record information management system and anesthesia surgery clinical information system of West China Hospital of Sichuan University. There were 381 males and 105 females, with a median age of 64.0 years. Taking the incidence of pulmonary complications within 7 days after operation as the primary outcome, the correlation between intraoperative fluid infusion volume and the occurrence of PPCs within 7 days was clearly analyzed by regression analysis. ResultsThe incidence of pulmonary complications within 7 days after surgery was 33.5% (163/486). Regression analysis showed that intraoperative fluid infusion volume was correlated with the occurrence of PPCs [adjusted OR=1.089, 95%CI (1.012, 1.172), P=0.023], especially pulmonary infection [adjusted OR=1.093, 95%CI (1.014, 1.178), P=0.020], and pleural effusion [adjusted OR=1.147, 95%CI (1.007, 1.306), P=0.039]. Pulmonary infection was significantly less in the low intraoperative fluid infusion group [<6.49 mL/(kg·h), n=115] compared with the high intraoperative fluid infusion group [≥6.49 mL/(kg·h), n=371] (18.3% vs. 34.5%, P=0.023). Intraoperative fluid infusion volume was positively associated with death within 30 days after surgery [adjusted OR=1.442, 95%CI (1.056, 1.968), P=0.021]. Conclusion Among patients undergoing elective minimally invasive endoscopic esophageal cancer resection, intraoperative fluid infusion volume is related with the occurrence of PPCs within 7 days after the surgery, especially pulmonary infection and pleural effusion, and may affect death within 30 days after the surgery.
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.