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3. Intraoperative positive end-expiratory pressure and postoperative pulmonary complications: a patient-level meta-analysis of three randomised clinical trials

Author

Hemmes, Sabrine NT., Gama de Abreu, Marcelo, Severgnini, Paolo, Hollmann, Markus W., Binnekade, Jan M., Wrigge, Hermann, Canet, Jaume, Hiesmayr, Michael, Schmid, Werner, Tschernko, Edda, Jaber, Samir, Hedenstierna, Göran, Putensen, Christian, Pelosi, Paolo, Schultz, Marcus J., Marti, Agnes, Bacuzzi, Alessandro, Brodhun, Alexander, Molin, Alexandre, Merten, Alfred, Parera, Ana, Brunelli, Andrea, Cortegiani, Andrea, Güldner, Andreas, Reske, Andreas W., Gratarola, Angelo, Giarratano, Antonino, Bastin, Bea, Heyse, Bjorn, Mazul-Sunko, Branka, Amantea, Bruno, Barberis, Bruno, Uhlig, Christopher, Marín, Conrado Minguez, Celentano, Cristian, La Bella, Daniela, D’Antini, David, Velghe, David, Sulemanji, Demet, De Robertis, Edoardo, Hartmann, Eric, Montalto, Francesca, Tropea, Francesco, Mills, Gary H., Cinnella, Gilda, Della Rocca, Giorgio, Caggianelli, Girolamo, Pellerano, Giulia, Mollica, Giuseppina, Bugedo, Guillermo, Mulier, Jan-Paul, Vandenbrande, Jeroen, Geib, Johann, Yaqub, Jonathan, Florez, Jorge, Mayoral, Juan F., Sprung, Juraj, Van Limmen, Jurgen, Bos, Lieuwe DJ., de Baerdemaeker, Luc, Jamaer, Luc, Spagnolo, Luigi, Strys, Lydia, Gil, Manuel Granell, Vidal Melo, Marcos F., Unzueta, Maria Carmen, Moral, Maria Victoria, Ferner, Marion, Weiss, Martin, Vanoni, Massimo, Schaefer, Maximilian S., Prieto, Mercè, Grio, Michele, Spieth, Peter Markus, Simon, Philipp, Bodger, Phoebe, Sierra, Pilar, Laufenberg-Feldmann, Rita, Rusca, Roberta, Proietti, Rodolfo, Raineri, Santi Maurizio, Caroleo, Santo, Sabaté, Sergi, De Hert, Stefan, Pezzato, Stefano, Treschan, Tanja A., Goranovic, Tatjana, Koch, Thea, Bluth, Thomas, Kiss, Thomas, Perilli, Valter, Cegarra, Virginia, Ferrando, Carlos, Belda, Javier, Soro, Marina, Unzueta, Carmen, Suarez-Sipmann, Fernando, Librero, Julián, Llombart, Alicia, Rovira, Lucas, Granell, Manuel, Aldecoa, César, Diaz-Cambronero, Oscar, Balust, Jaume, Garutti, Ignacio, Gonzalez, Rafael, Gallego, Lucia, Garcia del Valle, Santiago, Redondo, Javier, Pestaña, David, Rodríguez, Aurelio, García, Javier, Matta, Manuel de la, Ibáñez, Maite, Barrios, Francisco, Hernández, Samuel, Torres, Vicente, Peiró, Salvador, Pozo, Natividad, Villena, Abigail, Carramiñana, Albert, Gallego-Casilda, Alberto, Duca, Alejandro, Alcón, Amalia, Miñana, Amanda, Asensio, Ana, Colás, Ana, Galve, Ana Isabel, Izquierdo, Ana, Jurado, Ana, Pérez, Ana María, Mugarra, Ana, Gutierrez, Andrea, De Miguel, Ángeles, Lozano, Angels, Katime, Antonio, Romero, Antonio, Garrigues, Beatriz, Ayas, Begoña, Arocas, Blanca, Delgado, Carlos, Fernández, Carmen, Romero, Carolina, Gallego, Clara, Garcés, Cristina, Lisbona, Cristina, Parrilla, Cristina, López-Herrera, Daniel, González, Domingo, Llamazares, Eduardo, Del Rio, Elena, Lozano, Elena, Pastor, Ernesto, Chamorro, Estefanía, Gracia, Estefanía, Sánchez, Ester, Romero, Esther, Díez, Fernando, Serralta, Ferran, Daviu, Francisco, Sandín, Francisco, Aguilar, Gerardo, Tusman, Gerardo, Azparren, Gonzalo, Martínez-Pallí, Graciela, Mazzinari, Guido, Benítez, Inmaculada, Hernandéz, Inmaculada, India, Inmaculada, León, Irene, Fuentes, Isabel, Ruiz, Isabel, Puig, Jaume, Román, Javie Ignacio, Acosta, Jesús, Rico-Feijoo, Jesús, Olmedo, Jonathan, Carbonell, Jose A., Alonso, Jose M., Pérez, Jose María, Marcos, Jose Miguel, Navarro, Jose, Valdivia, Jose, Carrizo, Juan, Piqueras, Laura, Soriano, Laura, Vaquero, Laura, Miguel, Lisset, Muñoz, Lorena, Valencia, Lucia, Olmedilla, Luis, Etulain, Mᵃ Justina, Tisner, Manuel, Barrio, María, Alonso, María Dolores, García, María, Hernández, María J., Alberola, María José, Parra, María, Argente, María Pilar, Vila, María, De Fez, Mario, Agilaga, Marta, Gine, Marta, Ayuso, Mercedes, García, Mercedes, Bejarano, Natalia, Peña, Natalia, Ojeda, Nazario, Martínez, Nilda, García, Nuria, Padrón, Oto, García, Pablo, Valls, Paola, Cruz, Patricia, Piñeiro, Patricia, Charco, Pedro, Anaya, Rafael, López, Ramiro, Rodríguez, Rayco, Martínez, Rocío, Pujol, Roger, Dosdá, Rosa, Lardies, Rosa, Díaz, Ruben, Villazala, Rubén, Zapatero, Sara, Cabrera, Sergio, Sánchez, Sergio, Martin, Silvia, Diaz, Suzana, Franco, Tania, Moreno, Tania, Socorro, Tania, Gilabert, Vicente, Balandrón, Victor, Moral, Victoria, Cegarra, Virgina, Varón, Viviana, Abelha, Fernando, Abitağaoğlu, Sühayla, Achilles, Marc, Adebesin, Afeez, Adriaensens, Ine, Ahene, Charles, Akbar, Fatima, Al Harbi, Mohammed, Al Khoury al Kallab, Rita, Albanel, Xavier, Aldenkortt, Florence, Saleh Alfouzan, Rawan Abdullah, Alruqaie, Reef, Altermatt, Fernando, Luís de Castro Araujo, Bruno, Arbesú, Genaro, Artsi, Hanna, Aurilio, Caterina, Ayanoglu, Omer Hilmi, Baig, Harris, Baird, Yolanda, Balonov, Konstantin, Banks, Samantha, Bao, Xiaodong, Baumgartner, Mélanie, Tortosa, Isabel Belda, Bergamaschi, Alice, Bergmann, Lars, Bigatello, Luca, Pérez, Elena Biosca, Birr, Katja, Bojaxhi, Elird, Bonenti, Chiara, Bonney, Iwona, Bos, Elke M.E., Bowman, Sara, Braz, Leandro Gobbo, Brugnoni, Elisa, Brull, Sorin J., Brunetti, Iole, Bruni, Andrea, Buenvenida, Shonie L., Busch, Cornelius Johannes, Camerini, Giovanni, Capatti, Beatrice, Carmona, Javiera, Carungcong, Jaime, Carvalho, Marta, Cattan, Anat, Cavaleiro, Carla, Chiumello, Davide, Ciardo, Stefano, Coburn, Mark, Colella, Umberto, Contreras, Victor, Dincer, Pelin Corman, Cotter, Elizabeth, Crovetto, Marcia, Darrah, William, Davies, Simon, Del Cojo Peces, Enrique, Delphin, Ellise, Diaper, John, Junior, Paulo do Nascimento, Donatiello, Valerio, Dong, Jing, Dourado, Maria do Socorro, Dullenkopf, Alexander, Ebner, Felix, Elgendy, Hamed, Ellenberger, Christoph, Arı, Dilek Erdoğan, Ermert, Thomas, Farah, Fadi, Fernandez-Bustamante, Ana, Ferreira, Cristina, Fiore, Marco, Fonte, Ana, Palahí, Christina Fortià, Galimberti, Andrea, Garofano, Najia, Giaccari, Luca Gregorio, Gilsanz, Fernando, Girrbach, Felix, Gobbi, Luca, Godfried, Marc Bernard, Goettel, Nicolai, Goldstein, Peter A., Goren, Or, Gorlin, Andrew, Graterol, Juan, Guyon, Pierre, Haire, Kevin, Harou, Philippe, Helf, Antonia, Hemmes, Sabrine N.T., Hempel, Gunther, Hernández Cádiz, María José, Heyse, Björn, Huercio, Ivan, Ilievska, Jasmina, Jakus, Lien, Jeganath, Vijay, Jelting, Yvonne, Jung, Minoa, Kabon, Barbara, Kacha, Aalok, Ilić, Maja Karaman, Karuppiah, Arunthevaraja, Kavas, Ayse Duygu, Barcelos, Gleicy Keli, Kellogg, Todd A., Kemper, Johann, Kerbrat, Romain, Khodr, Suraya, Kienbaum, Peter, Kir, Bunyamin, Kivrak, Selin, Klarić, Vlasta, Köksal, Ceren, Kowark, Ana, Kranke, Peter, Kuvaki, Bahar, Kuzmanovska, Biljana, Laffey, John, Lange, Mirko, Freitas de Lemos, Marília, Licker, Marc-Joseph, López-Baamonde, Manuel, López-Hernández, Antonio, Lopez-Martinez, Mercedes, Luise, Stéphane, MacGregor, Mark, Magalhães, Danielle, Maillard, Julien, Malerbi, Patrizia, Manimekalai, Natesan, Margarson, Michael, Markstaller, Klaus, Martin, Archer K., Martin, David P., Martin, Yvette N., Martínez-Ocon, Julia, Martin-Loeches, Ignacio, Maseda, Emilio, Matot, Idit, McAuliffe, Niamh, McKenzie, Travis J., Medina, Paulina, Meersch, Melanie, Menzen, Angelika, Mertens, Els, Meurer, Bernd, Meyer-Treschan, Tanja, Miao, Changhong, Micalizzi, Camilla, Milić, Morena, Pinheiro Módolo, Norma Sueli, Moine, Pierre, Mölders, Patrick, Montero-Feijoo, Ana, Moret, Enrique, Muller, Markus K., Murphy, Zoe, Nalwaya, Pramod, Naumovski, Filip, Navalesi, Paolo, Navarro e Lima, Lais Helena, Adam, Višnja Nesek, Neumann, Claudia, Newell, Christopher, Nisnevitch, Zoulfira, Nizamuddin, Junaid, Novazzi, Cecilia, O'Connor, Michael, Oprea, Günther, Sungur, Mukadder Orhan, Özbilgin, Şule, Pace, Maria Caterina, Pacheco, Marcos, Packianathaswamy, Balaji, Gonzalez, Estefania Palma, Papaspyros, Fotios, Paredes, Sebastián, Passavanti, Maria Beatrice, Pedemonte, Juan Cristobal, Peremin, Sanja, Philipsenburg, Christoph, Pinho, Daniela, Pinho, Silvia, Posthuma, Linda M., Pota, Vincenzo, Preckel, Benedikt, Priani, Paolo, Rached, Mohamed Aymen, Radoeshki, Aleksandar, Ragazzi, Riccardo, Rajamanickam, Tamilselvan, Rajamohan, Arthi, Ramakrishna, Harish, Rangarajan, Desikan, Reiterer, Christian, Renew, J. Ross, Reynaud, Thomas, Rhys, Rhidian, Rivas, Eva, Robitzky, Luisa, Rossaint, Rolf, Rubulotta, Francesca, Machado, Humberto S., Nunes, Catarina S., Sabbatini, Giovanni, Samuels, Jon D., Sanahuja, Josep Martí, Sansone, Pasquale, Santos, Alice, Sayedalahl, Mohamed, Scharffenberg, Martin, Schiffer, Eduardo, Schliewe, Nadja, Schorer, Raoul, Schumann, Roman, Selmo, Gabriele, Sendra, Mar, Senturk, Mert, Shaw, Kate, Shosholcheva, Mirjana, Sibai, Abdulrazak, Simonassi, Francesca, Sinno, Claudia, Sivrikoz, Nukhet, Skandalou, Vasiliki, Smith, Neil, Soares, Maria, Artiles, Tania Socorro, Castro, Diogo Sousa, Sousa, Miguel, Spadaro, Savino, Stamatakis, Emmanouil, Steiner, Luzius A., Stevenazzi, Andrea, Suarez-de-la-Rica, Alejandro, Suppan, Mélanie, Teichmann, Robert, Tena Guerrero, José Maria, Thiel, Bram, Tolós, Raquel, Altun, Gulbin Tore, Tucci, Michelle, Turnbull, Zachary A., Turudić, Žana, Unterberg, Matthias, Van Nieuwenhove, Yves, Van Waesberghe, Julia, Vidal Melo, Marcos Francisco, Vitković, Bibiana, Vivona, Luigi, Vizcaychipi, Marcela, Volta, Carlo Alberto, Weber, Anne, Weingarten, Toby N., Wittenstein, Jakob, Wyffels, Piet, Yagüe, Julio, Yates, David, Yavru, Ayşen, Zac, Lilach, Zhong, Jing, Campos, Niklas S., Librero, Julian, Ball, Lorenzo, and Serpa Neto, A.

Published
2022
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6. Individualised perioperative open-lung approach versus standard protective ventilation in abdominal surgery (iPROVE): a randomised controlled trial

Author

Acosta, Jesús, Aguilar, Gerardo, Alberola, María José, Alcón, Amalia, Alonso, Jose M., Alonso, María Dolores, Anaya, Rafael, Argente, María Pilar, Agilaga, Marta, Arocas, Blanca, Asensio, Ana, Ayas, Begoña, Ayuso, Mercedes, Balandrón, Victor, Barrio, María, Bejarano, Natalia, Benítez, Inmaculada, Cabrera, Sergio, Carbonell, Jose A., Carramiñana, Albert, Carrizo, Juan, Cegarra, Virginia, Chamorro, Estefanía, Charco, Pedro, Cruz, Patricia, Daviu, Francisco, De Fez, Mario, De Miguel, Ángeles, Del Río, Elena, Delgado, Carlos, Díaz, Ruben, Díaz, Susana, Díez, Fernando, Dosdá, Rosa, Duca, Alejandro, Etulain, M<ce:sup loc='post">a</ce:sup> Justina, Fernández, Carmen, Franco, Tania, Fuentes, Isabel, Gallego, Clara, Gallego-Casilda, Alberto, Galve, Ana Isabel, Garcés, Cristina, García, Mercedes, García, Pablo, Garrigues, Beatriz, Gilabert, Vicente, González, Domingo, Gutiérrez, Andrea, Hernández, Inmaculada, Izquierdo, Ana, Jurado, Ana, Katime, Antonio, Llamazares, Eduardo, Lardies, Rosa, Lisbona, Cristina, López-Herrera, Daniel, López, Ramiro, Lozano, Angels, Lozano, Elena, Marcos, Jose Miguel, Martin, Silvia, Martínez, Nilda, Martínez, Rocío, Martínez-Pallí, Graciella, Mazzinari, Guido, Miñana, Amanda, Moral, Victoria, Moreno, Tania, Mugarra, Ana, Muñoz, Lorena, Navarro, Jose, Olmedilla, Luis, Olmedo, Jonathan, Ojeda, Nazario, Parera, Ana, Parra, María, Parrilla, Cristina, Pastor, Ernesto, Peña, Natalia, Pérez, Ana María, Pérez, Jose María, Piqueras, Laura, Rico-Feijoo, Jesús, Rodríguez, Rayco, Román, Javier Ignacio, Romero, Antonio, Romero, Carolina, Romero, Esther, Ruiz, Isabel, Sánchez, Ester, Sandín, Francisco, Serralta, Ferran, Socorro, Tania, Soriano, Laura, Tisner, Manuel, Valencia, Lucia, Valls, Paola, Vaquero, Laura, Varón, Viviana, Vila, María, Villazala, Rubén, Villena, Abigail, Zapatero, Sara, Ferrando, Carlos, Soro, Marina, Unzueta, Carmen, Suarez-Sipmann, Fernando, Canet, Jaume, Librero, Julián, Pozo, Natividad, Peiró, Salvador, Llombart, Alicia, León, Irene, India, Inmaculada, Aldecoa, Cesar, Díaz-Cambronero, Oscar, Pestaña, David, Redondo, Francisco J, Garutti, Ignacio, Balust, Jaume, García, Jose I, Ibáñez, Maite, Granell, Manuel, Rodríguez, Aurelio, Gallego, Lucía, de la Matta, Manuel, Gonzalez, Rafael, Brunelli, Andrea, García, Javier, Rovira, Lucas, Barrios, Francisco, Torres, Vicente, Hernández, Samuel, Gracia, Estefanía, Giné, Marta, García, María, García, Nuria, Miguel, Lisset, Sánchez, Sergio, Piñeiro, Patricia, Pujol, Roger, García-del-Valle, Santiago, Valdivia, José, Hernández, María J, Padrón, Oto, Colás, Ana, Puig, Jaume, Azparren, Gonzalo, Tusman, Gerardo, Villar, Jesús, and Belda, Javier

Published
2018
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7. Preconditioning by portal vein embolization modulates hepatic hemodynamics and improves liver function in pigs with extended hepatectomy

Author

Asencio, José M., García-Sabrido, José L., López-Baena, José A., Olmedilla, Luis, Peligros, Isabel, Lozano, Pablo, Morales-Taboada, Álvaro, Fernández-Mena, Carolina, Steiner, Miguel A., Sola, Emma, Perez-Peña, José M., Herrero, Miriam, Laso, Juan, Lisbona, Cristina, Bañares, Rafael, Casanova, Javier, and Vaquero, Javier

Published
2017
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9. Effect of intraoperative paravertebral or intravenous lidocaine versus control during lung resection surgery on postoperative complications: A randomized controlled trial

Author

De la Gala, Francisco, Piñeiro, Patricia, Reyes, Almudena, Simón, Carlos, Vara, Elena, Rancan, Lisa, Huerta, Luis Javier, Gonzalez, Guillermo, Benito, Carmen, Muñoz, Marta, Grande, Pilar, Paredes, Sergio D., Aznar, Pablo Tomas, Perez, Alvaro, Martinez, David, Higuero, Fernando, Sanz, David, De Miguel, Juan Pedro, Cruz, Patricia, Olmedilla, Luis, Lopez Gil, Elena, Duque, Patricia, Sanchez-Pedrosa, Guillermo, Valle, Mayte, and Garutti, Ignacio

Published
2019
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18. Mechanisms of regenerative preconditioning in pigs with subtotal hepatectomies.

Author

Orue-Echebarria, Maitane I., Vaquero, Javier, Vara, Elena, Rancan, Lisa, Lozano, Pablo, Lisbona, Cristina J., Laso, Juan, Fernández-Mena, Carolina, Olmedilla, Luis, Peligros, Isabel, García-Sabrido, José L., and Asencio, José M.

Subjects
REGENERATIVE medicine, PORTAL vein, HEPATECTOMY, SWINE anatomy, ENERGY metabolism
Abstract

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Published
2022
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27. "Small-for-Flow" Syndrome: Concept Evolution.

Author

Orue-Echebarria, Maitane I., Lozano, Pablo, Olmedilla, Luis, García Sabrido, J L., Asencio, JM., and Asencio, J M

Subjects
VENOUS pressure, LIVER failure, SYNDROMES, LIVER transplantation, HEMODYNAMICS, LIVER surgery, PORTAL vein surgery, LIVER blood-vessels, PORTAL vein, HEPATECTOMY
Abstract

Background: The "Small-for-Size" syndrome is defined as a liver failure after a liver transplant with a reduced graft or after a major hepatectomy. The later coined "Small-for-Flow" syndrome describes the same situation in liver resections but based on hemodynamic intraoperative parameters (portal pressure > 20 mmHg and/or portal flow > 250 ml/min/100 g). This focuses on the damage caused by the portal hyperafflux related to the volume of the remnant.Methods: Relevant studies were reviewed using Medline, PubMed, and Springer databases.Results: Portal hypertension after partial hepatectomies also leads to a higher morbidity and mortality. There are plenty of experimental studies focusing on flow rather than size. Some of them also perform different techniques to modulate the portal inflow. The deleterious effect of high posthepatectomy portal venous pressure is known, and that is why the idea of portal flow modulation during major hepatectomies in humans is increasing in everyday clinical practice.Conclusions: Considering the extensive knowledge obtained with the experimental models and good results in clinical studies that analyze the "Small-for-Flow" syndrome, we believe that measuring portal flow and portal pressure during major liver resections should be performed routinely in extended liver resections. Applying these techniques, the knowledge of hepatic hemodynamics would be improved in order to advance against posthepatectomy liver failure. [ABSTRACT FROM AUTHOR]

Published
2020
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30. Comportamento da variação do volume sistólico em pacientes hemodinamicamente estáveis durante cirurgia torácica com períodos de ventilação monopulmonar.

Author

Lema Tome, María, De la Gala, Francisco Andrés, Piñeiro, Patricia, Olmedilla, Luis, and Garutti, Ignacio

Abstract

Resumo Introdução Nos últimos anos, a importância da terapia alvo‐dirigida foi enfatizada para aprimorar o estado hemodinâmico do paciente e melhorar seu prognóstico. Os parâmetros baseados na interação entre o coração e os pulmões foram questionados em situações como baixo volume corrente e cirurgia aberta do tórax. O objetivo do estudo foi analisar as alterações que a ventilação monopulmonar pode produzir na variação do volume sistólico e avaliar o possível impacto das pressões da via aérea e da complacência pulmonar sobre a variação do volume sistólico. Métodos Estudo observacional prospectivo, no qual 112 pacientes submetidos à cirurgia de ressecção pulmonar com períodos de ventilação monopulmonar foram incluídos. A terapia de fluídos intravenosos com cristaloides foi ajustada a 2 mL.kg −1 .h −1 . Os episódios de hipotensão foram tratados com vasoconstritores. A ventilação dos dois pulmões (VDP) foi implantada com volume corrente de 8 mL.kg −1 e a ventilação monopulmonar foi controlada com volume corrente de 6 mL.kg −1 . Foi monitorada a pressão arterial invasiva. Registramos os seguintes valores cardiorrespiratórios: frequência cardíaca, pressão arterial média, índice cardíaco, índice de volume sistólico, pressão de pico das vias aéreas, pressão de platô das vias aéreas e complacência pulmonar estática em três tempos durante a cirurgia: imediatamente após o colapso do pulmão, 30 minutos após o início da ventilação monopulmonar e após a restauração da ventilação dos dois pulmões. Resultados Os valores de variação do volume sistólico foram influenciados pelo colapso pulmonar (antes do colapso pulmonar 14,6 [DS] vs. ventilação monopulmonar 9,9% [DS], p < 0,0001), ou após o restabelecimento da ventilação dos dois pulmões (11,01 [DS], p < 0,0001). Durante a ventilação dos dois pulmões houve uma correlação significativa entre as pressões das vias aéreas e a variação do volume sistólico, porém, essa correlação não existe durante a ventilação monopulmonar. Conclusão A diminuição dos valores da variação do volume sistólico durante a ventilação monopulmonar com estratégias ventilatórias protetoras sugere não usar os mesmos valores de limiar para determinar a responsividade aos fluídos. Introduction In last few years, emphasis was placed in goal‐directed therapy in order to optimize patient's hemodynamic status and improve their prognosis. Parameters based on the interaction between heart and lungs have been questioned in situations like low tidal volume and open chest surgery. The goal of the study was to analyze the changes that one‐lung ventilation can produce over stroke volume variation and to assess the possible impact of airway pressures and lung compliance over stroke volume variation. Methods Prospective observational study, 112 patients undergoing lung resection surgery with one‐lung ventilation periods were included. Intravenous fluid therapy with crystalloids was set at 2 mL.kg −1 .h −1 . Hypotension episodes were treated with vasoconstrictive drugs. Two‐lung ventilation was implemented with a TV of 8 mL.kg −1 and one‐lung ventilation was managed with a TV of 6 mL.kg −1 . Invasive blood pressure was monitored. We recorded the following cardiorespiratory values: heart rate, mean arterial pressure, cardiac index, stroke volume index, airway peak pressure, airway plateau pressure and static lung compliance at 3 different times during surgery: immediately after lung collapse, 30 minutes after initiating one‐lung ventilation and after restoration of two‐lung ventilation. Results Stroke volume variation values were influenced by lung collapse (before lung collapse14.6 (DS) vs. OLV 9.9% (DS), p < 0.0001); or after restoring two‐lung ventilation (11.01 (DS), p < 0.0001). During two‐lung ventilation there was a significant correlation between airwaypressures and stroke volume variation, however this correlation lacks during one‐lung ventilation. Conclusion The decrease of stroke volume variation values during one‐lung ventilation with protective ventilatory strategies advices not to use the same threshold values to determine fluid responsiveness. [ABSTRACT FROM AUTHOR]

Published
2018
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31. Bloqueio neuromuscular profundo versus moderado durante a ventilação monopulmonar em cirurgia de ressecção pulmonar.

Author

Casanova, Javier, Piñeiro, Patricia, De La Gala, Francisco, Olmedilla, Luis, Cruz, Patricia, Duque, Patricia, and Garutti, Ignacio

Abstract

Resumo Justificativa e objetivos Os relaxantes neuromusculares são essenciais durante a anestesia geral para vários procedimentos. A literatura clássica de anestesiologia indica que o uso de bloqueio neuromuscular em cirurgia torácica pode ser prejudicial em pacientes posicionados em decúbito lateral com ventilação seletiva. O objetivo primário deste estudo foi comparar a função respiratória de acordo com o grau de relaxamento neuromuscular do paciente. O objetivo secundário foi verificar que o bloqueio neuromuscular durante a ventilação seletiva não é prejudicial. Métodos Estudo observacional, prospectivo e longitudinal no qual cada paciente serviu como próprio controle. Foram incluídos 76 pacientes consecutivos, agendados para cirurgia de ressecção do pulmão no Hospital Gregorio Marañon ao longo de 2013, submetidos à ventilação seletiva em decúbito lateral. Os dados do ventilador e os parâmetros hemodinâmicos foram registrados em diferentes momentos de acordo com a resposta por sequência de quatro estímulos (bloqueio intenso, profundo e moderado) durante a ventilação seletiva. Resultados As pressões de pico, platô e média foram significativamente menores durante os bloqueios intenso e profundo. Além disso, complacência e saturação periférica de oxigênio foram significativamente maiores nesses momentos. A frequência cardíaca foi significativamente maior durante o bloqueio profundo. Não houve alteração dos parâmetros da ventilação mecânica durante as mensurações. Conclusões O bloqueio neuromuscular profundo atenua a mecânica pulmonar deficiente observada durante a ventilação seletiva. Background and objectives Neuromuscular relaxants are essential during general anesthesia for several procedures. Classical anesthesiology literature indicates that the use of neuromuscular blockade in thoracic surgery may be deleterious in patients in lateral decubitus position in one‐lung ventilation. The primary objective of our study was to compare respiratory function according to the degree of patient neuromuscular relaxation. Secondary, we wanted to check that neuromuscular blockade during one‐lung ventilation is not deleterious. Methods A prospective, longitudinal observational study was made in which each patient served as both treated subject and control. 76 consecutive patients programmed for lung resection surgery in Gregorio Marañon Hospital along the year of 2013 who required one‐lung ventilation in lateral decubitus were included. Ventilator data, hemodynamic parameters were registered in different moments according to train‐of‐four response (intense, deep and moderate blockade) during one‐lung ventilation. Results Peak, plateau and mean pressures were significantly lower during the intense and deep blockade. Besides, compliance and peripheral oxygen saturation were significantly higher in those moments. Heart rate was significantly higher during deep blockade. No mechanical ventilation parameters were modified during measurements. Conclusions Deep neuromuscular blockade attenuates the poor lung mechanics observed during one‐lung ventilation. [ABSTRACT FROM AUTHOR]

Published
2017
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33. Systemic and alveolar inflammatory response in the dependent and nondependent lung in patients undergoing lung resection surgery: A prospective observational study.

Author

de la Gala, Francisco, Piñeiro, Patricia, Garutti, Ignacio, Reyes, Almudena, Olmedilla, Luis, Cruz, Patricia, Duque, Patricia, Casanova, Javier, Rancan, Lisa, Benito, Pilar, and Vara, Elena

Abstract

Background: Measurement of inflammatory mediators in bronchoalveolar lavage (BAL) during lung resection surgery with periods of one-lung ventilation (OLV) has revealed an intense local pulmonary response. The role of each lung in the inflammation that occurs during this procedure has never been investigated.Objective(s): The primary objective of our study was to compare the inflammatory response in the dependent lung with that of the nondependent lung by measuring inflammatory markers in BAL. Our secondary objective was to assess the behaviour of these inflammatory mediators in patients with and without postoperative pulmonary complications (PPCs).Design: A prospective, observational study.Setting: Department of Anaesthesiology in a university hospital.Patients: Forty-six consecutive patients undergoing lung resection surgery.Intervention(s): BAL samples were taken from dependent and nondependent lung 10 min before initiating OLV and at the end of OLV (once two-lung ventilation was established). All patients were followed up until 30 days after surgery.Main Outcome Measures: The concentration of cytokines [interleukin (IL)-1, IL-2, IL-6, IL-10, tumour necrosis factor-alpha (TNF-α)], nitric oxide, carbon monoxide and matrix metalloproteinase 2 (MMP-2) was analysed in both lungs before and after OLV. PPCs were recorded.Results: In BAL fluid, all measured biomarkers, apart from IL-10, were significantly greater (P < 0.05) at the end of OLV than those obtained before OLV, both for the dependent and nondependent lung. The increase in measured biomarkers was similar in both lungs. Eight patients developed PPC. Patients who developed PPC had higher levels of TNF-α (P < 0.05) in BAL from the nondependent lung before and after OLV than patients who did not have PPC. Patients who developed PPC had a smaller increase in MMP-2 levels (P < 0.05) in the dependent lung than patients who did not have PPC.Conclusion: In lung resection surgery, the inflammatory response is similar in both lungs. However, the greater increase in TNF-α levels in the nondependent lung and the smaller increase of MMP-2 concentration in the dependent lung may increase the susceptibility to develop PPC. [ABSTRACT FROM AUTHOR]

Published
2015
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38. Hepatic flow is an intraoperative predictor of early allograft dysfunction in whole-graft deceased donor liver transplantation: An observational cohort study.

Author

Lominchar PL, Orue-Echebarria MI, Martín L, Lisbona CJ, Salcedo MM, Olmedilla L, Sharma H, Asencio JM, and López-Baena JÁ

Abstract

Background: Early allograft dysfunction (EAD) after liver transplantation (LT) is an important cause of morbidity and mortality. To ensure adequate graft function, a critical hepatocellular mass is required in addition to an appropriate blood supply. We hypothesized that intraoperative measurement of portal venous and hepatic arterial flow may serve as a predictor in the diagnosis of EAD., Aim: To study whether hepatic flow is an independent predictor of EAD following LT., Methods: This is an observational cohort study in a single institution. Hepatic arterial blood flow and portal venous blood flow were measured intraoperatively by transit flow. EAD was defined using the Olthoff criteria. Univariate and multivariate analyses were used to determine the intraoperative predictors of EAD. Survival analysis and prognostic factor analysis were performed using the Kaplan-Meier and Cox regression models., Results: A total of 195 liver transplant procedures were performed between January 2008 and December 2014 in 188 patients. A total of 54 (27.7%) patients developed EAD. The median follow-up was 39 mo. Portal venous flow, hepatic arterial flow (HAF) and total hepatic arterial flow were associated with EAD in both the univariate and multivariate analyses. HAF is an independent prognostic factor for 30-d patient mortality., Conclusion: Intraoperative measurement of blood flow after reperfusion appears to be a predictor of EAD; Moreover, HAF should be considered a predictor of 30-d patient mortality., Competing Interests: Conflict-of-interest statement: The authors have no conflicts of interest to declare., (©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.)

Published
2019
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39. [Deep versus moderate neuromuscular block during one-lung ventilation in lung resection surgery].

Author

Casanova J, Piñeiro P, De La Gala F, Olmedilla L, Cruz P, Duque P, and Garutti I

Subjects
Female, Humans, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Respiratory Function Tests, Lung physiopathology, Neuromuscular Blockade methods, One-Lung Ventilation, Pneumonectomy
Abstract

Background and Objectives: Neuromuscular relaxants are essential during general anesthesia for several procedures. Classical anesthesiology literature indicates that the use of neuromuscular blockade in thoracic surgery may be deleterious in patients in lateral decubitus position in one-lung ventilation. The primary objective of our study was to compare respiratory function according to the degree of patient neuromuscular relaxation. Secondary, we wanted to check that neuromuscular blockade during one-lung ventilation is not deleterious., Methods: A prospective, longitudinal observational study was made in which each patient served as both treated subject and control. 76 consecutive patients programmed for lung resection surgery in Gregorio Marañon Hospital along the year of 2013 who required one-lung ventilation in lateral decubitus were included. Ventilator data, hemodynamic parameters were registered in different moments according to train-of-four response (intense, deep and moderate blockade) during one-lung ventilation., Results: Peak, plateau and mean pressures were significantly lower during the intense and deep blockade. Besides, compliance and peripheral oxygen saturation were significantly higher in those moments. Heart rate was significantly higher during deep blockade. No mechanical ventilation parameters were modified during measurements., Conclusions: Deep neuromuscular blockade attenuates the poor lung mechanics observed during one-lung ventilation., (Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Published
2017
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40. Effects of ventilatory mode during one-lung ventilation on intraoperative and postoperative arterial oxygenation in thoracic surgery.

Author

Pardos PC, Garutti I, Piñeiro P, Olmedilla L, and de la Gala F

Subjects
Female, Humans, Male, Middle Aged, Monitoring, Intraoperative methods, Postoperative Complications, Prospective Studies, Respiration, Artificial adverse effects, Respiratory Function Tests, Treatment Outcome, Anesthesia, Inhalation methods, Lung surgery, Oxygen blood, Respiration, Artificial methods, Thoracic Surgical Procedures methods
Abstract

Objective: The purpose of this study was to investigate the relationship between the ventilatory mode used during one-lung ventilation (OLV) and intraoperative and early postoperative arterial oxygenation in patients undergoing thoracic surgery., Methods: A prospective, randomized clinical trial., Setting: A tertiary care university hospital single institution., Participants: One hundred ten patients scheduled for thoracic surgery with at least 1 hour of OLV., Interventions: Patients were prospectively randomized into 2 groups depending on the ventilatory mode used during OLV: volume-controlled ventilation (VCV) or pressure-controlled ventilation (PCV). In VCV, the authors used a tidal volume (Vt) of 8 mL/kg and in the PCV group an inspiratory pressure to provide a tidal volume of 8 mL/kg., Measurements and Main Results: Airway pressures and arterial blood gases were obtained at 20, 30, and 40 minutes after OLV. The authors recorded the ratio of arterial oxygen tension to inspired oxygen fraction (PaO(2)/F(I)O(2)) at 4 hours (RU1) and 24 hours (RU2) after surgery. During OLV, there were no differences in arterial oxygenation, airway plateau pressure, and mean pressure between groups, although peak pressure was higher in the VCV group (p < 0.01). The PaO(2)/F(I)O(2) ratio at RU1 was 312.6 +/- 106 in the VCV group and 322.1 +/- 104. In the PCV group at RU2, it was 402.4 +/- 105 and 389.6 +/- 114, respectively, and there were no significant differences between the groups., Conclusions: In patients undergoing thoracic surgery, the use of PCV compared with VCV during OLV with the same Vt of 8 mL/kg does not affect arterial oxygenation during OLV or early postoperative oxygenation.

Published
2009
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