Prevention of respiratory complications of the surgical patient: actionable plan for continued process improvement
View/ Open
Published Version
https://doi.org/10.1097/ACO.0000000000000465Metadata
Show full item recordCitation
Ruscic, Katarina J., Stephanie D. Grabitz, Maíra I. Rudolph, and Matthias Eikermann. 2017. “Prevention of respiratory complications of the surgical patient: actionable plan for continued process improvement.” Current Opinion in Anaesthesiology 30 (3): 399-408. doi:10.1097/ACO.0000000000000465. http://dx.doi.org/10.1097/ACO.0000000000000465.Abstract
Purpose of review Postoperative respiratory complications (PRCs) increase hospitalization time, 30-day mortality and costs by up to $35 000. 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.Other Sources
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5434965/pdf/Terms of Use
This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAACitable link to this page
http://nrs.harvard.edu/urn-3:HUL.InstRepos:33029712
Collections
- HMS Scholarly Articles [17918]
Contact administrator regarding this item (to report mistakes or request changes)