112 results on '"Garutti, Ignacio"'
Search Results
102. Modulation of monocyte chemoattractant protein-1 expression by ischaemic preconditioning in a lung autotransplant model †.
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Simón, Carlos, Vara, Elena, Garutti, Ignacio, González-Casaurrán, Guillermo, Azcárate, Leire, Isea, Jesús, Huerta, Luis, and González-Aragoneses, Federico
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MONOCYTES , *GENE expression , *AUTOTRANSPLANTATION , *LUNG transplantation , *REPERFUSION injury , *OXIDATIVE stress , *CYTOKINES , *ANIMAL models in research - Abstract
OBJECTIVES Monocyte chemoattractant protein-1 (MCP-1) is believed to play a crucial role in lung ischaemia-reperfusion injury (LIRI). Ischaemic preconditioning (IP) has been shown to protect several organs from ischaemia-reperfusion (IR) injury, although less is known about IP's effect on MCP-1 modulation. The objective of this study was to investigate IP's effect on MCP-1 expression in lung tissue and its relationship with oxidative stress and proinflammatory cytokine production in an experimental LIRI model. METHODS Two groups (IP and control groups) of seven large white pigs underwent a lung autotransplant (left pneumonectomy, ex situ superior lobectomy and lower lobe reimplantation). Before pneumonectomy was performed in the study group, IP was induced with two cycles of 5 min of left pulmonary artery occlusion with a 5 min interval of reperfusion between the two occlusions. Blood samples and lung biopsies were obtained at prepneumonectomy (PPn), at prereperfusion (PRp) and up to 30 min after reperfusion of the implanted lobe (Rp-10′ and Rp-30′). Haemodynamic and blood-gas measurements, evaluation of oxidative stress in lung tissue and MCP-1, tumour necrosis factor-α (TNF-α) and IL-1 protein and mRNA measurements in lung tissue were performed. Nonparametric tests were used to compare differences between groups. Data are expressed as mean ± SEM. RESULTS In control lungs, MCP-1 protein levels were found to be higher at PRp, Rp-10′ and Rp-30′ than at PPn (0.59 ± 0.1 vs. 0.21 ± 0.05, 0.47 ± 0.01 vs. 0.21 ± 0.05 and 0.56 ± 0.01 vs. 0.21 ± 0.05, respectively; P < 0.05). These differences were not evident in the IP group. MCP-1 levels at PRp, Rp-10′ and Rp-30′ were significantly higher in the control group than in the IP group (0.59 ± 0.1 vs. 0.15 ± 0.02, 0.47 ± 0.01 vs. 0.13 ± 0.01 and 0.56 ± 0.01 vs. 0.27 ± 0.01, respectively; P < 0.05). MCP-1, TNF-α and IL-1 mRNA expressions were lower at PRp, Rp-10′ and Rp-30′ (control vs. IP group, P < 0.05) when IP was carried out. Lipid peroxidation metabolites and myeloperoxidase activity increase in lung tissue were prevented by IP. CONCLUSIONS In this model, LIRI induced the expression of MCP-1 and the proinflammatory proteins TNF-α and IL-1 in control lungs. IP significantly reduced the expression of these chemokines and cytokines. These features may explain the reduction of oxidative stress observed with IP. [ABSTRACT FROM AUTHOR]
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- 2012
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103. Peri-interventional outcome study in the elderly in Europe A 30-day prospective cohort study
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Ana Sekulic, Selene Martinez Perez, Danny Feike Hoogma, GÖKHAN KILINÇ, Marc Danguy des Déserts, Evangelia Samara, AYSE HIZAL, Nicolai Goettel, Martin Scharffenberg, Sofia Fernandes, Jose Ignacio García-Sánchez, Tobias Kammerer, Marc Moritz Berger, Florian Piekarski, CEREN AYGÜN MUÇUOĞLU, PATRICIA PIÑEIRO OTERO, Angel Becerra, Aurelio Rodriguez-Perez, Ülkü Ceren Köksoy, Jakob Wittenstein, Lars Lundstrøm, Diana Zamudio Penko, Hans-Joerg Gillmann, Dianne De Korte-de Boer, Jose miguel Marcos-vidal, Sebastian Ziemann, Tournoy, Jos, Kowark, Ana, Rossaint, Rolf, Matot, Idit, Nickel, Frank, Grau Torradeflot, Laura, Coburn, Mark, Berger, Marc, Farcher, Helmut, Opperer, Mathias, Adriaensens, Ine, Saldien, Vera, Berghmans, Johan, Van Hove, Sofie, Rex, Steffen, Beran, Maud, Eerdekens, Gert-Jan, Mesotten, Dieter, Timmers, Maxim, Vandermeulen, Elly, De Bruyne, Ann, De Hert, Stefan, De Ruyter, Hendrik, Van Belleghem, Vincent, Boscart, Isabelle, Steinmetz, Jacob, De Corte, Wouter, Desmet, Matthias, Missant, Carlo, Carlier, Stefaan, Castelain, Charlotte, Demeyer, Caroline, Vandenbossche, Carl, Detienne, Hans, Devroe, Sarah, Dewinter, Geertrui, Hoogma, Danny, Huygens, Christel, Meeusen, Roselien, Van de Velde, Marc, Lebrun, Christophe, Poels, Stéphanie, Soetens, Filiep, Fenger-Eriksen, Christian, Alanoglu, Zekeriyya, Draegert, Christina, Santos, Sofia Gaspar, Soelling, Christine, Andersen, Gertrud, Dalsø, Sille M., Haderslev, Pernille, Rasmussen, Vibe M., Vester-Andersen, Morten, Sommer, Tine G., Berger, Marc M., Kirkegaard, Johan, Lundstrøm, Lars H., Olesen, Christian M., Paramanathan, Sansu, Jensen, Lisbet Tokkesdal, Knudsen, Halfdan H., Schmidt, Jens C., Stehen, Nick P., Dupont, Hervé, Herbinet, Clément, Falières, Xavier, Lorne, Emmanuel, Mahjoub, Yazine, Ntouba, Alexandre, Fritsch, Marine, Garcia, Manuela, Lasocki, Sigismond, Petit Phan, Jonathan, Lieutaud, Thomas, Bonneric, Laura, Boselli, Emmanuel, Goettel, Nicolai, Gaillet, Maxime, des Déserts, Marc Danguy, Montelescaut, Etienne, Lamblin, Antoine, Muller, Violaine, Lagrange, Celine, Le Moal, Charlene, Robert, Alain, Staikowsky, Frederik, Lebas, Benoit, Kartalov, Andrijan, Lebuffe, Gilles, Garot, Matthias, Beuvelot, Johanne, Dejour, David, Deligne, Emmanuel, Desebbe, Olivier, Delannoy, Bertand, Gignoux, Benoit, Guillaud, Olivier, Nloga, Joseph, Katsanoulas, Konstantinos, Prunier-Bossion, Florence, Sibellas, Franck, Abraham, Paul, Bidon, Cyril, Rimmele, Thomas, Bruge-Ansel, Marie-Hélène, Friggeri, Arnaud, Lukaszewicz, Anne-Claire, Dziadzko, Mikhail, Leone, Marc, Rückbeil, Marcia V., Kenig, Jakub, Meresse, Zoe, Pastene, Bruno, Odin, Isabelle, Bonnal, Aurelien, Bouic, Nicolas, Trinh Duc, Pierre, Pillant, Thomas, Riboulet, Fabien, Degoul, Samuel, Saumier, Nicolas, Khoronenko, Victoria, Wasilewski, Marion, Asehnoune, Karim, Roquilly, Antoine, Glasman, Pauline, Puybasset, Louis, Garnier, Fanny, Verdonk, Franck, Samama, Charles M., Towa, Line, Blet, Alice, Barrau, Stéphanie, Boisson, Matthieu, Debaene, Bertrand, Frasca, Denis, Imzi, Nadia, Delvaux, Bernard, Huynh, Davy, Maupain, Olivier, Mercadal, Luc, Zanoun, Nabil, Macharadze, Tamar, de Baene, Armelle, Boulay-Maninovsky, Catherine, Fernandes, Olivier, Giltaire, Agathe, Gomis, Philippe, Malinovsky, Jean-Marc, Romain, François-Xavier, Calmelet, Astrid, Dupont, Ségolène, Gouraud, David, Milenovic, Miodrag, Millet, Sophie, Simonneau, Frédéric, Charret, Francoise, Couturier, Charlène, Lanoiselée, Julien, Lornage, Estelle, Mallard, Jeremy, Milati, Ryan, Passot, Sylvie, Vallier, Sylvain, Molliex, Serge, Agavriloaia, Mihaela L., Badoux, Quentin, Lewandowski, Mehdi, Mermet, Yanis, Michel, Denis, Kiskira, Olga, Adjavon, Sherifa, Dumans, Virginie, Le Guen, Morgan, Josserand, Julien, Órfão, Rosário, Ma, Sabrina, Castanera, Jeremy, Massiera, Benjamin, Petua, Philippe, Bounes-Vardon, Fanny, Bosc, Gaëlle, Bosch, Laëtitia, Clermond, Edouard, Ferre, Fabrice, Labaste, François, Soro, Marina, Martin, Charlotte, Menut, Rémi, Minville, Vincent, Srairi, Mohamed, Tarasi, Maria, Varin, Florent, Grüßer, Linda, Stefan, Mihai, Van Waesberghe, Julia, Ziemann, Sebastian, Bergmann, Lars, Nowak, Hartmuth, Oprea, Günther, Rump, Katharina, Unterberg, Matthias, Vogelsang, Heike, Klutzny, Mitja, Neumann, Claudia, Sungur, Zerrin, Soehle, Martin, Wittmann, Maria, Scharffenberg, Martin, Wittenstein, Jakob, Hinterberg, Jonas, Kienbaum, Peter, Lurati-Buse, Giovanna, Schäfer, Maximilian, Lindau, Simone, Hilgers, Ralf-Dieter, Szakmany, Tamas, Meybohm, Patrick, Gillmann, Hans-Joerg, Piekarski, Florian, Kaufhold, Theresa A., Koppert, Wolfgang, Leffler, Andreas, Reiffen, Hans-Peter, Rudolph, Diana, Starke, Henning, Stueber, Thomas, Baños, Victoria, Bischoff, Petra, Haberecht, Heinz, Plehn, Heiko, Bauer, Michael, Kortgen, Andreas, Sponholz, Christoph, Krüger, Uwe, Müller-Esch, Sabine, Otto, Mareike, Rempf, Christian, Rodriguez, Mireia, Schmidt, Christian, Schumacher, Dunja, Blazek, Juliane, Büttner, Christin, Leibeling, Andrea, Rüsch, Dirk, Wulf, Hinnerk, Burow, Karsten, El-Hilali, Eugen A., Greke, Christian, Martinez, Selene, Großmann, Paul, Kluth, Mario, Schulz, Regina, Dridi, Sofiane, Popovska, Ivana, Brenes, Andrés, Ranft, Andreas, Feddersen, Pia, Gerstmeyer, Dominik, Fthenakis, Philippe, Saller, Thomas, Schneider, Gerhard, Miketta, Dirk, von Dossow, Vera, Groene, Philipp, Höchter, Dominik, Hofmann-Kiefer, Klaus, Kammerer, Tobias, Kamrath, Malte, Schaefer, Simon T., Schäfer, Simon T., Tomasi, Roland, Wiedemann, Tobias, Zeuzem-Lampert, Catharina, Zwissler, Bernhard, Braune, Stephan, Brune, Mona, Gurlit, Simone, Hemping-Bovenkerk, André, Möllmann, Michael, Santamaria, Mario, Schirwitz, Leonie M., Meersch, Melanie, Zarbock, Alexander, Guenther, Ulf, Decker, Stefanie, Drexler, Berthold, Hipp, Silvia, Hofmann, Pascal, Müller, Markus, Roth, Judith, Seiß, Miriam, Adam, Christian, Schwartges, Ingo, Kranke, Peter, Chloropoulou, Pelagia, Andreeva, Antonia, Dimakopoulou, Antonia, Douma, Amalia, Gregoriadou, Iphigeneia, Koutsouli, Evelina, Mendrinou, Konstantina, Mavrommati, Eirini, Stathopoulos, Anastasios, Batistaki, Chrysanthi, Matsota, Paraskevi, Kalopita, Konstantina, Skandalou, Vasiliki, Balanika, Marina, Papathanakos, Georgios, Tzimas, Petros, Ketikidou, Evgenia, Vachlioti, Anastasia, Kiamiloglou, Bioulent, Nikouli, Evangelia, Arnaoutoglou, Eleni, Kolonia, Konstantina, Laou, Eleni, Stamoulis, Konstantinos, Vlachakis, Epaminondas, Bilotta, Federico, Karpetas, Georgios, Lianou, Ioanna, Spyraki, Maria, Tatani, Irini, Panagiotou, Eleni, Samara, Evangelia, Kolesnikova, Anna, Sifaki, Freideriki, Zarzava, Eirini, Bampzelis, Athanasios, Georgopoulou, Eleni, Christidou, Eleni, Tsaousi, Georgia, Nastou, Maria, Ioannidis, Orestis, Dolzenko, Eugene, Geleve, Georgia, Logotheti, Eleni, Yfantidis, Fotios, Lee, Peter, Rajamanickam, Senbagam, Ramaswamy, Shanmuga, Switzer, Timothy, Das Punshi, Gurmukh, Srinivasan, Karthikeyan, Gilmartin, Michael, Morris, Osmond, Buchman, Immanuel, Gozal, Yaacov, Merissat, Amar, Peled, Reut, Willner, Dafna, Chariski, Hila A., Eidelman, Leonid A., Livne, Michal Y., Mangoubi, Eitan, Berkenstadt, Haim, Orlcin, Dina, Yahav-Shafir, Dana, Aharonov, Rita, Cattan, Anat, Felman, Lior, Refaeli-Awin, Einat, Steinberg, Yohai, Zabeeda, Wisam, Kuzmanovska, Biljana, Naumovski, Filip, Toleska, Marija, Sivevski, Atanas, Andriessen, Anouk, Kortekaas, Minke, Buhre, Wolfgang, Van Gorp, Roos, de Korte-de Boer, Dianne, Smit-Fun, Valerie, Theunissen, Maurice, Droger, Mirjam, van den Enden, Toine, Koopman, Seppe, Marsman, Marije, van Schaik, Eva, Azenha, Marta, Lanzaro, Camile, Borrego, Andreia, Branquinho, Pedro, Fernandes, Sofia, Laires, Miguel, de Noronha, Denise, Ferraz, Inês, Pires, Ana, Silva, Joana, Corneci, Dan, Oprea, Oana, Zahiu, Stefan-Vladimir, Tomescu, Dana R., Grintescu, Ioana M., Filipescu, Daniela, Stefanescu, Elena, Vazenin, Andrey, Baskakov, Danil, Tipisev, Dmitry, Kozlova, Ksenia, Marinkovic, Olivera, Sekulic, Ana, Rajkovic, Marija, Djukanovic, Marija, Nikolic, Jovanka, Sreckovic, Svetlana, Stojanovic, Marina, Ladjevic, Nebojsa, Jovicic, Jelena, Unic-Stojanovic, Dragana, Bollheimer, Leo C., Stosic, Biljana, Bulasevic, Aleksandra, Espinosa-Moreno, Alma M., García-Sánchez, Jose I., Martín-Vaquerizo, Beatriz, Morandeira-Rivas, Clara, Zamudio, Diana, Guadalupe, Nerea, Herranz, Gracia, Baute, Javier, Madrona, Vanesa, de Jose, Roser, Miralles, Jordi, Merten, Alfred, Muñoz, Rolando, Delgado, Anabel, Cruz, Patricia, Moral, Victoria, Blesa, Aleix Carmona, Espejo, Sara, Grau Torredeflot, Laura, Fernández, Alejandro Romero, Sanabra, Maria, Pujol, Pere Serra, Alvira Uribe, Maria J., Perez, Astrid Alvarez, Brunetto, Espedito, Fernández, Carmen, Castelli, Federica, Aguirre, Jorge Gonzalez, Villar, Adriana Herivas, Rojas, Guido Munoz, Montero, Natalia, González, Víctor Baladrón, Becerra-Bolaños, Ángel, Rodríguez-Pérez, Aurelio, Santana-Ortega, Luis, Suárez-Romero, Vanessa, Torres-Machí, María L., Ferrero de Paz, Javier, Marcos-Vidal, Jose M., Garcia, Ana Martín, García, María Merino, Diaz, Consuelo Rego, Santiago, Ana Crespo, Laso, Lourdes Ferreira, Solores, Felix Lobato, Burgos, Alba, Calvo, Alberto, Fernández, Ignacio, Garutti, Ignacio, Higuero, Fernando, Martinez, David, Piñeiro, Patricia, Carazo, Sonia Expósito, Hernández, Rosa Méndez, Rodríguez, Mar Orts, Rueda, Fernando Ramasco, Abad-Motos, Ane, Ripollés-Melchor, Javier, López, Carmen Pastor, Charco, Pedro, Perez-Palao, Sara, Sancho-Iñigo, Laura, Segura, Nasara, Utrera, Esther, Albinarrate, Ania, Fondarella, Ana M., Gallego-Ligorit, Lucia, Torrijos, Luisa Lacosta, Bandschapp, Oliver, Blum, Andrea A., Seeberger, Esther, Steiner, Luzius A., Thomann, Alessandra E., Frei, Seraina, Hoehn, Susan, Baenziger, Bertram, Capaldo, Giuliana, Christ, Daniel, Doerig, Ramon, Hodel, Daniel, Weiss, Andreas, Witt, Lukas, Schumacher, Philippe, Siebing, Dirk A., Akbuz, Seyma Orcan, Bengisun, Zuleyha Kazak, Kazbek, Baturay K., Koksoy, Ulku C., Terzi, Engin Z., Yilmaz, Hakan, Alkis, Neslihan, Turhan, Sanem Cakar, Meco, Basak C., Hajiyeva, Konul, Guclu, Cigdem Yildirim, Ergil, Jülide, Ceran, Emine Unal, Ozcelik, Menekse, Bülent, Atik, Gökhan, Kilinc, Saracoglu, Kemal T., Kir, Bunyamin, Koltka, Kemalettin, Sivrikoz, Nükhet, Dincer, Pelin Corman, Canbolat, Nur, Kudsioglu, Turkan, Aydin, Gaye, Mucuoglu, Ceren Aygün, Inal, Duriye G., Kucukguclu, Semih, Egilmez, Ayse I., Kozanhan, Betul, Yildiz, Munise, Pinar, Hüseyin U., Erdivanlı, Başar, Hızal, Ayşe, Karagöz, Emre, Kazdal, Hızır, Özdemir, Abdullah, Tas Tuna, Ayca, Gulgun, Gamze, Oleg, Dolya, Hoeft, Andreas, MUMC+: MA Anesthesiologie (3), RS: MHeNs - R3 - Neuroscience, and MUMC+: MA Anesthesiologie (9)
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Aged, 80 and over ,Male ,Patient ,Frailty ,Preoperative assessment ,Surgical outcomes ,Europe ,Hospitalization ,Older ,Anesthesiology and Pain Medicine ,Outcome Assessment, Health Care ,Humans ,Female ,Surgery ,Prospective Studies ,Derivation ,Mortality ,Aged - Abstract
OBJECTIVES The aim of this study was to describe the 30-day mortality rate of patients aged 80 years and older undergoing surgical and nonsurgical procedures under anaesthesia in Europe and to identify risk factors associated with mortality. DESIGN A prospective cohort study. SETTING European multicentre study, performed from October 2017 to December 2018. Centres committed to a 30-day recruitment period within the study period. PATIENTS Nine thousand four hundred and ninety-seven consecutively recruited patients aged 80 years and older undergoing any kind of surgical or nonsurgical procedures under anaesthesia. MAIN OUTCOME MEASURES The primary outcome was all-cause mortality within 30 days after procedure described by Kaplan–Meier curves with 95% CI. Risk factors for 30-day mortality were analysed using a Cox regression model with 14 fixed effects and a random centre effect. RESULTS Data for 9497 patients (median age, 83.0 years; 52.8% women) from 177 academic and nonacademic hospitals in 20 countries were analysed. Patients presented with multimorbidity (77%), frailty (14%) and at least partial functional dependence (38%). The estimated 30-day mortality rate was 4.2% (95% CI 3.8 to 4.7). Among others, independent risk factors for 30-day mortality were multimorbidity, hazard ratio 1.87 (95% CI 1.26 to 2.78), frailty, hazard ratio 2.63 (95% CI 2.10 to 3.30), and limited mobility, hazard ratio 2.19 (95% CI 1.24 to 3.86). The majority of deaths (76%) occurred in hospital. Mortality risk for unplanned ICU admission was higher, hazard ratio 3.57 (95% CI 2.38 to 5.26) than for planned ICU admission, hazard ratio 1.92 (95% CI 1.47 to 2.50). Compared with other studies, the in-hospital complication rates of 17.4 and 3.9% after discharge were low. Admission to a unit with geriatric care within 30 days after the intervention was associated with a better survival within the first 10 days. CONCLUSIONS The estimated 30-day mortality rate of 4.2% was lower than expected in this vulnerable population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03152734, https://clinicaltrials.gov. ispartof: European Journal Of Anaesthesiology vol:39 issue:3 pages:198-209 ispartof: location:England status: published
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- 2022
104. Efecto de la lidocaína en la modulación del daño pulmonar en un modelo experimental de cirugía de resección pulmonar en cerdos
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Cusati, Gabriel, Garutti, Ignacio, Vara, Elena, and Simon, Carlos
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Anestesiología y reanimación ,Veterinaria - Published
- 2016
105. Cost-effectiveness of preoperative pharmaceutical care consultations: a 5-year analysis.
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Gómez Costas D, Ribed A, Gimenez-Manzorro A, Garutti I, Sanz FJ, Taladriz-Sender I, Herrero S, Rioja Y, Carrillo A, Herranz A, and Sanjurjo-Saez M
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Objectives: Preoperative medication errors can be prevented by screening patients through a preoperative pharmaceutical care consultation. The aim of this study was to analyse the cost-effectiveness of implementing such a consultation and to determine which patients would benefit most., Methods: A retrospective study was conducted that included all patients who underwent a preoperative pharmacy consultation between 2016 and 2020. During this consultation, two part-time pharmacists reviewed patients' appropriate preoperative chronic medication management. All prevented errors were collected and classified by therapeutic group and type of error. A team of pharmacists and anaesthetists assigned to each prevented medication error a probability of causing an adverse event 'p', following the methodology of Nesbit et al by establishing five different 'p' values: 0, 0.01, 0.1, 0.4, and 0.6. 'p' = 1 was not considered. The cost of an adverse event was determined to be between €4124 and €6946 according to current literature, and a sensitivity analysis was performed by increasing the interval by 20% above and below. The cost of employing two part-time specialist pharmacists was estimated to be €59 142. Savings per medication error prevented were calculated as (€4124 OR €6946) × 'p'. Total savings were the sum of all costs associated with prevented medication errors. Patients on chronic medications who were in therapeutic groups with a 0.6 probability of an adverse event or who were in therapeutic groups responsible for 50% of the prevented adverse events were considered prioritisable., Results: 3105 patients attended the consultation and 1179 medication errors were prevented, corresponding to 300 adverse events. 42.2% of the errors had a 'p' of 0.4. The costs avoided by this consultation ranged from €1 237 200 to €2 083 800, while the cost of its implementation was €295 710. The cost-effectiveness ratio was between €4.2 and €7.0 saved per euro invested. In the sensitivity analysis, the ratios ranged from €3.3 to €8.5 per euro invested. Fifteen different therapeutic groups accounted for 90% of the medication errors prevented. The therapeutic groups 'Agents acting on the renin-angiotensin system', 'Antidiabetics, non-insulin (excluding SGLT2)' and 'Antithrombotics: low molecular weight heparins' were responsible for 56% of the prevented adverse events. The therapeutic groups 'Antidiabetics: rapid-acting insulin' and 'Antithrombotic agents: vitamin K antagonists, low-molecular-weight heparins, or direct oral anticoagulants' had a 'p' of 0.6. Therefore, patients in six therapeutic groups should be prioritised for preoperative pharmacy counselling., Conclusions: The implementation of preoperative pharmaceutical care consultations in Spain has proven to be cost-effective. Incorporating the probability of a medication error causing an adverse event allowed the prioritisation of patients for these consultations. Patients taking anticoagulants, oral antidiabetics, rapid-acting insulins, and agents acting on the renin-angiotensin system benefited the most. This study could serve as a basis for implementing such consultations in other hospitals, as they are effective in reducing the cost of medication errors in surgical patients., Competing Interests: Competing interests: None declared., (© European Association of Hospital Pharmacists 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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106. A noninvasive postoperative clinical score to identify patients at risk for postoperative pulmonary complications: the Air-Test Score.
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Ferrando C, Suárez-Sipmann F, Librero J, Pozo N, Soro M, Unzueta C, Brunelli A, Peiró S, Llombart A, Balust J, Aldecoa C, Díaz-Cambronero O, Franco T, Redondo FJ, Garutti I, García JI, Ibáñez M, Granell M, Rodríguez A, Gallego L, de la Matta M, Marcos JM, García J, Mazzinari G, Tusman G, Villar J, and Belda J
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- Cohort Studies, Humans, Lung, Risk Assessment, Risk Factors, Postoperative Complications epidemiology, Pulmonary Atelectasis epidemiology, Respiratory Function Tests
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Background: Postoperative pulmonary complications (PPCs) negatively affect morbidity, healthcare costs and postsurgical survival. Preoperative and intraoperative peripheral oxyhemoglobin saturation (SpO2) levels are independent risk factors for postoperative pulmonary complications (PPCs). The air-test assesses the value of SpO2 while breathing room-air. We aimed at building a clinical score that includes the air-test for predicting the risk for PPCs., Methods: This is a development and validation study in patients -randomly divided into two cohorts- from a large randomized clinical trial (iPROVE) that enrolled 964 intermediate-to-high risk patients scheduled for abdominal surgery. Arterial oxygenation was assessed on room-air in the preoperative period (preoperative air-test) and 3h after admission to the postoperative care unit (postoperative air-test). The air-test was defined as positive or negative if SpO2 was ≤96% or >96%, respectively. Positive air-tests were stratified into weak (93-96%) or strong (<93%). The primary outcome was a composite of moderate-to-severe PPCs during the first seven postoperative days., Results: A total of 902 patients were included in the final analysis (542 in the development cohort and 360 in the validation cohort). Regression analysis identified five independent risk factors for PPC: age, type of surgery, pre- and postoperative air-test, and atelectasis. The area under the receiver operating characteristic curve (AUC) was 0.79 (95% CI: 0.75-0.82) when including these five independent predictors. We built a simplified score termed "air-test score" by using only the pre- and postoperative SpO2, resulting in an AUC of 0.72 (95% CI: 0.67-0.76) for the derivation and 0.72 (95% CI: 0.66-0.78) for the validation cohort, respectively. The air-test score stratified patients into four levels of risk, with PPCs ranging from <15% to >75%., Conclusions: The simple, non-invasive and inexpensive bedside air-test score, evaluating pre- and postoperatively SpO2 measured on room-air, helps to predict the risk for PPCs.
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- 2020
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107. Association between complications and death within 30 days after noncardiac surgery.
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Spence J, LeManach Y, Chan MTV, Wang CY, Sigamani A, Xavier D, Pearse R, Alonso-Coello P, Garutti I, Srinathan SK, Duceppe E, Walsh M, Borges FK, Malaga G, Abraham V, Faruqui A, Berwanger O, Biccard BM, Villar JC, Sessler DI, Kurz A, Chow CK, Polanczyk CA, Szczeklik W, Ackland G, X GA, Jacka M, Guyatt GH, Sapsford RJ, Williams C, Cortes OL, Coriat P, Patel A, Tiboni M, Belley-Côté EP, Yang S, Heels-Ansdell D, McGillion M, Parlow S, Patel M, Pettit S, Yusuf S, and Devereaux PJ
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- Aged, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Postoperative Hemorrhage mortality, Prospective Studies, Sepsis mortality, Postoperative Complications mortality, Surgical Procedures, Operative mortality
- Abstract
Background: Among adults undergoing contemporary noncardiac surgery, little is known about the frequency and timing of death and the associations between perioperative complications and mortality. We aimed to establish the frequency and timing of death and its association with perioperative complications., Methods: We conducted a prospective cohort study of patients aged 45 years and older who underwent inpatient noncardiac surgery at 28 centres in 14 countries. We monitored patients for complications until 30 days after surgery and determined the relation between these complications and 30-day mortality using a Cox proportional hazards model., Results: We included 40 004 patients. Of those, 715 patients (1.8%) died within 30 days of surgery. Five deaths (0.7%) occurred in the operating room, 500 deaths (69.9%) occurred after surgery during the index admission to hospital and 210 deaths (29.4%) occurred after discharge from the hospital. Eight complications were independently associated with 30-day mortality. The 3 complications with the largest attributable fractions (AF; i.e., potential proportion of deaths attributable to these complications) were major bleeding (6238 patients, 15.6%; adjusted hazard ratio [HR] 2.6, 95% confidence interval [CI] 2.2-3.1; AF 17.0%); myocardial injury after noncardiac surgery [MINS] (5191 patients, 13.0%; adjusted HR 2.2, 95% CI 1.9-2.6; AF 15.9%); and sepsis (1783 patients, 4.5%; adjusted HR 5.6, 95% CI 4.6-6.8; AF 12.0%)., Interpretation: Among adults undergoing noncardiac surgery, 99.3% of deaths occurred after the procedure and 44.9% of deaths were associated with 3 complications: major bleeding, MINS and sepsis. Given these findings, focusing on the prevention, early identification and management of these 3 complications holds promise for reducing perioperative mortality. Study registration: ClinicalTrials.gov, no. NCT00512109., Competing Interests: Competing interests: Clara Chow received support from the National Health and Medical Research Council of Australia and The Heart Foundation (Australia) for a career development fellowship. Robert Sapsford received nonfinancial support in the form of a research nurse funded by the National Institutes of Health Research, and lecture fees from Eli Lilly, MSD and Novo Nordisk. Denis Xavier received grants from Cadila Pharmaceuticals, Boehringer Ingelheim, Astra Zeneca India, Sanofi Aventis, Pfizer, Bristol–Myers Squibb, Medical Research Council (United Kingdom) and Wellcome Trust outside the submitted work. Emmanuelle Duceppe received a grant as a coapplicant on an investigator-initiated study and lecture fees from Roche Diagnostics. Philip J. Devereaux is a member of a research group with a policy of not accepting honorariums or other payments from industry for their own personal financial gain. They do accept honorariums or payments from industry to support research endeavours and costs to participate in meetings. Based on study questions Dr. Devereaux has originated and grants he has written, he has received grants from Abbott Diagnostics, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers-Squibb, Coviden, Octapharma, Philips Healthcare, Roche Diagnostics, Siemens and Stryker. Dr Devereaux has participated in advisory board meetings for GlaxoSmithKline and Boehringer Ingelheim. He also attended an expert panel meeting with AstraZeneca and Boehringer Ingelheim. Roche Diagnostics provided Troponin T assays and financial support for the Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) Study. No other competing interests were declared., (© 2019 Joule Inc. or its licensors.)
- Published
- 2019
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108. [Deep versus moderate neuromuscular block during one-lung ventilation in lung resection surgery].
- Author
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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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109. Residual neuromuscular blockade in the postanesthesia care unit: observational cross-sectional study of a multicenter cohort.
- Author
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Errando CL, Garutti I, Mazzinari G, Díaz-Cambronero Ó, and Bebawy JF
- Subjects
- Androstanols, Anesthesia Recovery Period, Cross-Sectional Studies, Delayed Emergence from Anesthesia etiology, Female, Humans, Male, Neostigmine therapeutic use, Neuromuscular Nondepolarizing Agents, Prospective Studies, Sex Factors, Spain epidemiology, Young Adult, gamma-Cyclodextrins therapeutic use, Delayed Emergence from Anesthesia epidemiology
- Abstract
Background: Residual neuromuscular blockade after general anesthesia using nondepolarizing neuromuscular blocking agents has pathophysiological, clinical, and economic consequences. A significant number of patients under muscle relaxation sustain residual curarization., Methods: Observational, prospective, multicenter study of a cohort of patients (Residual Curarization in Spain Study, ReCuSS). Residual blockade was defined as TOFr<0.9. Patients >18 years-old under general anesthesia, including at least one dose of non-depolarizing neuromuscular blocking agents, and transferred extubated and spontaneously ventilating to the postanesthesia care unit were included. Pre- and intraoperative data were recorded, including, patient characteristics, ASA physical status, experience of the anesthesiologist, type of surgery, temperature monitoring, surgery duration, neuromuscular blockade-related parameters, type of anesthesia (halogenated-balanced, intravenous propofol-based, other), and use of neuromuscular monitoring., Results: A total of 763 patients from 26 hospitals were included, 190 patients (26.7%) showing residual paralysis. Female patients were more prone to residual neuromuscular blockade. Length of surgery, type of relaxant used (benzylisoquinolines), halogenated anesthesia, absence of intraoperative specific monitoring, avoidance of drug reversal, and neostigmine reversal (vs. sugammadex), were significantly related to residual blockade. In the postanesthesia care unit, patients with residual neuromuscular blockade had an increased incidence of respiratory events and tracheal reintubation., Conclusions: The incidence of residual blockade in Spain is similar to that published in other settings and countries. Female gender, longer duration of surgery, and halogenated drugs for anesthesia maintenance were related to residual paralysis, as were NMBA specific items, such as the use of benzylisoquinoline drugs, and the absence of reversal or reversal with neostigmine.
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- 2016
110. Rationale and study design for an individualized perioperative open lung ventilatory strategy (iPROVE): study protocol for a randomized controlled trial.
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Ferrando C, Soro M, Canet J, Unzueta MC, Suárez F, Librero J, Peiró S, Llombart A, Delgado C, León I, Rovira L, Ramasco F, Granell M, Aldecoa C, Diaz O, Balust J, Garutti I, de la Matta M, Pensado A, Gonzalez R, Durán ME, Gallego L, Del Valle SG, Redondo FJ, Diaz P, Pestaña D, Rodríguez A, Aguirre J, García JM, García J, Espinosa E, Charco P, Navarro J, Rodríguez C, Tusman G, and Belda FJ
- Subjects
- Clinical Protocols, Female, Humans, Lung Diseases diagnosis, Lung Diseases etiology, Lung Diseases physiopathology, Male, Perioperative Care, Postoperative Complications diagnosis, Postoperative Complications physiopathology, Prospective Studies, Research Design, Respiration, Artificial adverse effects, Spain, Time Factors, Treatment Outcome, Abdomen surgery, Continuous Positive Airway Pressure adverse effects, Lung physiopathology, Lung Diseases prevention & control, Postoperative Complications prevention & control, Respiration, Artificial methods
- Abstract
Background: Postoperative pulmonary and non-pulmonary complications are common problems that increase morbidity and mortality in surgical patients, even though the incidence has decreased with the increased use of protective lung ventilation strategies. Previous trials have focused on standard strategies in the intraoperative or postoperative period, but without personalizing these strategies to suit the needs of each individual patient and without considering both these periods as a global perioperative lung-protective approach. The trial presented here aims at comparing postoperative complications when using an individualized ventilatory management strategy in the intraoperative and immediate postoperative periods with those when using a standard protective ventilation strategy in patients scheduled for major abdominal surgery., Methods: This is a comparative, prospective, multicenter, randomized, and controlled, four-arm trial that will include 1012 patients with an intermediate or high risk for postoperative pulmonary complications. The patients will be divided into four groups: (1) individualized perioperative group: intra- and postoperative individualized strategy; (2) intraoperative individualized strategy + postoperative continuous positive airway pressure (CPAP); (3) intraoperative standard ventilation + postoperative CPAP; (4) intra- and postoperative standard strategy (conventional strategy). The primary outcome is a composite analysis of postoperative complications., Discussion: The Individualized Perioperative Open-lung Ventilatory Strategy (iPROVE) is the first multicenter, randomized, and controlled trial to investigate whether an individualized perioperative approach prevents postoperative pulmonary complications., Trial Registration: Registered on 5 June 2014 with identification no. NCT02158923 .
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- 2015
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111. Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes.
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Botto F, Alonso-Coello P, Chan MT, Villar JC, Xavier D, Srinathan S, Guyatt G, Cruz P, Graham M, Wang CY, Berwanger O, Pearse RM, Biccard BM, Abraham V, Malaga G, Hillis GS, Rodseth RN, Cook D, Polanczyk CA, Szczeklik W, Sessler DI, Sheth T, Ackland GL, Leuwer M, Garg AX, Lemanach Y, Pettit S, Heels-Ansdell D, Luratibuse G, Walsh M, Sapsford R, Schünemann HJ, Kurz A, Thomas S, Mrkobrada M, Thabane L, Gerstein H, Paniagua P, Nagele P, Raina P, Yusuf S, Devereaux PJ, Devereaux PJ, Sessler DI, Walsh M, Guyatt G, McQueen MJ, Bhandari M, Cook D, Bosch J, Buckley N, Yusuf S, Chow CK, Hillis GS, Halliwell R, Li S, Lee VW, Mooney J, Polanczyk CA, Furtado MV, Berwanger O, Suzumura E, Santucci E, Leite K, Santo JA, Jardim CA, Cavalcanti AB, Guimaraes HP, Jacka MJ, Graham M, McAlister F, McMurtry S, Townsend D, Pannu N, Bagshaw S, Bessissow A, Bhandari M, Duceppe E, Eikelboom J, Ganame J, Hankinson J, Hill S, Jolly S, Lamy A, Ling E, Magloire P, Pare G, Reddy D, Szalay D, Tittley J, Weitz J, Whitlock R, Darvish-Kazim S, Debeer J, Kavsak P, Kearon C, Mizera R, O'Donnell M, McQueen M, Pinthus J, Ribas S, Simunovic M, Tandon V, Vanhelder T, Winemaker M, Gerstein H, McDonald S, O'Bryne P, Patel A, Paul J, Punthakee Z, Raymer K, Salehian O, Spencer F, Walter S, Worster A, Adili A, Clase C, Cook D, Crowther M, Douketis J, Gangji A, Jackson P, Lim W, Lovrics P, Mazzadi S, Orovan W, Rudkowski J, Soth M, Tiboni M, Acedillo R, Garg A, Hildebrand A, Lam N, Macneil D, Mrkobrada M, Roshanov PS, Srinathan SK, Ramsey C, John PS, Thorlacius L, Siddiqui FS, Grocott HP, McKay A, Lee TW, Amadeo R, Funk D, McDonald H, Zacharias J, Villar JC, Cortés OL, Chaparro MS, Vásquez S, Castañeda A, Ferreira S, Coriat P, Monneret D, Goarin JP, Esteve CI, Royer C, Daas G, Chan MT, Choi GY, Gin T, Lit LC, Xavier D, Sigamani A, Faruqui A, Dhanpal R, Almeida S, Cherian J, Furruqh S, Abraham V, Afzal L, George P, Mala S, Schünemann H, Muti P, Vizza E, Wang CY, Ong GS, Mansor M, Tan AS, Shariffuddin II, Vasanthan V, Hashim NH, Undok AW, Ki U, Lai HY, Ahmad WA, Razack AH, Malaga G, Valderrama-Victoria V, Loza-Herrera JD, De Los Angeles Lazo M, Rotta-Rotta A, Szczeklik W, Sokolowska B, Musial J, Gorka J, Iwaszczuk P, Kozka M, Chwala M, Raczek M, Mrowiecki T, Kaczmarek B, Biccard B, Cassimjee H, Gopalan D, Kisten T, Mugabi A, Naidoo P, Naidoo R, Rodseth R, Skinner D, Torborg A, Paniagua P, Urrutia G, Maestre ML, Santaló M, Gonzalez R, Font A, Martínez C, Pelaez X, De Antonio M, Villamor JM, García JA, Ferré MJ, Popova E, Alonso-Coello P, Garutti I, Cruz P, Fernández C, Palencia M, Díaz S, Del Castillo T, Varela A, de Miguel A, Muñoz M, Piñeiro P, Cusati G, Del Barrio M, Membrillo MJ, Orozco D, Reyes F, Sapsford RJ, Barth J, Scott J, Hall A, Howell S, Lobley M, Woods J, Howard S, Fletcher J, Dewhirst N, Williams C, Rushton A, Welters I, Leuwer M, Pearse R, Ackland G, Khan A, Niebrzegowska E, Benton S, Wragg A, Archbold A, Smith A, McAlees E, Ramballi C, Macdonald N, Januszewska M, Stephens R, Reyes A, Paredes LG, Sultan P, Cain D, Whittle J, Del Arroyo AG, Sessler DI, Kurz A, Sun Z, Finnegan PS, Egan C, Honar H, Shahinyan A, Panjasawatwong K, Fu AY, Wang S, Reineks E, Nagele P, Blood J, Kalin M, Gibson D, and Wildes T
- Subjects
- Age Distribution, Aged, Cohort Studies, Humans, Male, Middle Aged, Myocardial Ischemia blood, Postoperative Complications blood, Prognosis, Prospective Studies, Troponin T blood, Myocardial Ischemia diagnosis, Myocardial Ischemia epidemiology, Patient Outcome Assessment, Postoperative Complications diagnosis, Postoperative Complications epidemiology, Surgical Procedures, Operative
- Abstract
Background: Myocardial injury after noncardiac surgery (MINS) was defined as prognostically relevant myocardial injury due to ischemia that occurs during or within 30 days after noncardiac surgery. The study's four objectives were to determine the diagnostic criteria, characteristics, predictors, and 30-day outcomes of MINS., Methods: In this international, prospective cohort study of 15,065 patients aged 45 yr or older who underwent in-patient noncardiac surgery, troponin T was measured during the first 3 postoperative days. Patients with a troponin T level of 0.04 ng/ml or greater (elevated "abnormal" laboratory threshold) were assessed for ischemic features (i.e., ischemic symptoms and electrocardiography findings). Patients adjudicated as having a nonischemic troponin elevation (e.g., sepsis) were excluded. To establish diagnostic criteria for MINS, the authors used Cox regression analyses in which the dependent variable was 30-day mortality (260 deaths) and independent variables included preoperative variables, perioperative complications, and potential MINS diagnostic criteria., Results: An elevated troponin after noncardiac surgery, irrespective of the presence of an ischemic feature, independently predicted 30-day mortality. Therefore, the authors' diagnostic criterion for MINS was a peak troponin T level of 0.03 ng/ml or greater judged due to myocardial ischemia. MINS was an independent predictor of 30-day mortality (adjusted hazard ratio, 3.87; 95% CI, 2.96-5.08) and had the highest population-attributable risk (34.0%, 95% CI, 26.6-41.5) of the perioperative complications. Twelve hundred patients (8.0%) suffered MINS, and 58.2% of these patients would not have fulfilled the universal definition of myocardial infarction. Only 15.8% of patients with MINS experienced an ischemic symptom., Conclusion: Among adults undergoing noncardiac surgery, MINS is common and associated with substantial mortality.
- Published
- 2014
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112. Effects of ventilatory mode during one-lung ventilation on intraoperative and postoperative arterial oxygenation in thoracic surgery.
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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
- Full Text
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