1. A multicentre observational study on management of general anaesthesia in elderly patients at high-risk of postoperative adverse outcomes
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Matthias Garot, K. Xu, Hélène Beloeil, Benoit Plaud, C. Lambert, Pascal Incagnoli, S. Bertran, Thomas Rimmelé, C. Truc, Catherine Paugam, G. Lebuffe, Philippe Cuvillon, Paul-Michel Mertes, C. Vaisse, M. Ben Abdelkarim, Bertrand Debaene, C. Bechis, Christian Martin, J. Ripart, Mathilde Lefevre, S. Dagois, N. Bruder, Vincent Minville, Jean-Michel Constantin, M. Baussier, M. Poirier, M. Carles, Serge Molliex, Emmanuel Futier, Olivier Langeron, M. Khaled, P. Lambert, A. Cabart, J. Morel, T. Godet, F. Lallemant, A. Vincent, B. Tavernier, Matthieu Boisson, J. Gavory, M. Baulieu, Philippe Montravers, B. Beauchesne, Yannick Le Manach, J.Y. Bien, P. Meuret, L. Oehlkern, M. Delannoy, G. Dupont, K. Nouette-Gaulain, B. Planté, B. Baffeleuf, C. Faulcon, O. Collange, F. Lion, A. de Jong, A.M. Beraud, P. Zufferey, C. Meistelman, Marc Leone, Jean-Luc Hanouz, P Diemunsch, S. Simon-Pene, M. Biais, N. Abdelkrim, F. Bart, D. Joganah, V. Cero, Frédéric Aubrun, D. Verzilli, S. Thibault, Samir Jaber, E. Chambade, C. Delsuc, Fabrice Ferré, P. Bouzat, L. Tran, Vincent Piriou, C. Lemery, Sylvie Passot, Mathieu Raux, J. Lanoiselée, Jean Yves Lefrant, C. Rabuel, M.C. Laplace, S. Berthier-Berrada, Belaid Bouhemad, Bruno Pereira, E. Roland, G. Godet, Louis Bernard, Jean-Stéphane David, Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Université Jean Monnet - Saint-Étienne (UJM), CHU Clermont-Ferrand, Université Clermont Auvergne (UCA), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), McMaster University [Hamilton, Ontario], Opti-Aged group, Azurea clinical research Network: N Bruder 9 , C Vaisse 9 , C Bechis 10 , L Bernard 10 , M Leone 10 , M Poirier 10 , A Vincent 10 , N Abdelkrim 11 , C Paugam 11 , F Lion 12 , P Montravers 12 , O Langeron 13 , M Raux 13 , M Baussier 14 , K Xu 14 , F Bart 15 , S Dagois 15 , B Plaud 15 , C Rabuel 15 , E Roland 15 , M Biais 16 , K Nouette-Gaulain 16 , A Cabart 17 , J L Hanouz 17 , C Lambert 18 , T Godet 18 , S Thibault 18 , B Bouhemad 19 , E Chambade 19 , P Bouzat 20 , M Garot 21 , G Lebuffe 21 , F Lallemant 22 , C Lemery 22 , B Tavernier 22 , A de Jong 23 , S Jaber 23 , D Verzilli 23 , M Delannoy 24 , C Meistelman 24 , M Carles 25 , L Tran 25 , S Bertran 26 , P Cuvillon 26 , J Ripart 26 , S Simon-Pene 26 , M Boisson 27 , B Debaene 27 , H Beloeil 28 , G Godet 28 , O Collange 29 , P M Mertes 29 , P Diemunsch 30 , D Joganah 30 , L Oehlkern 30 , M Baulieu 31 , B Beauchesne 31 , A M Beraud 31 , S Berthier-Berrada 31 , J Y Bien 31 , G Dupont 31 , J Gavory 31 , P Lambert 31 , J Lanoiselée 31 , P Zufferey 31 , F Ferré 32 , C Martin 32 , V Minville 32 , B Planté 32 , B Baffeleuf 33 , M Ben Abdelkarim 33 , J S David 33 , P Incagnoli 33 , M Khaled 33 , M C Laplace 33 , M Lefevre 33 , V Piriou 33 , F Aubrun 34 , V Cero 35 , C Delsuc 35 , C Faulcon 35 , P Meuret 35 , T Rimmelé 35 , C Truc 35, Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Assistance Publique-Hôpitaux de Marseille (AP-HM), Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), Université Jean Monnet [Saint-Étienne] (UJM), Université de Nîmes (UNIMES), and CCSD, Accord Elsevier
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Emergency Medical Services ,Hemodynamics ,Comorbidity ,Critical Care and Intensive Care Medicine ,Body Temperature ,Positive-Pressure Respiration ,Postoperative Complications ,0302 clinical medicine ,030202 anesthesiology ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Abdomen ,General anaesthesia ,Prospective Studies ,Cardiac Output ,ComputingMilieux_MISCELLANEOUS ,[SDV.MP.VIR] Life Sciences [q-bio]/Microbiology and Parasitology/Virology ,[SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases ,Aged, 80 and over ,[SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases ,Electroencephalography ,General Medicine ,[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Haemodynamic ,Elective Surgical Procedures ,[SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology ,[SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Breathing ,France ,Guideline Adherence ,Hypotension ,Vascular Surgical Procedures ,[SDV.MP.PAR] Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology ,medicine.medical_specialty ,Anesthesia, General ,03 medical and health sciences ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Tidal Volume ,medicine ,Humans ,[SDV.MP.PAR]Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology ,Point of care ,Aged ,business.industry ,Hemodynamic Monitoring ,Anaesthesia management: Monitoring ,030208 emergency & critical care medicine ,Vascular surgery ,medicine.disease ,Respiration, Artificial ,[SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology ,Femoral Neck Fractures ,Anesthesiology and Pain Medicine ,Emergency medicine ,Ventilation ,Observational study ,[SDV.MP.BAC] Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology ,business ,Abdominal surgery - Abstract
Introduction In elderly patients, goal-directed haemodynamic therapy (GDHT), depth of anaesthesia monitoring and lung-protective ventilation have been shown to improve postoperative outcomes. The aim of this study was to evaluate current practices concerning strategies of anaesthesia optimisation in patients aged ≥ 75 years. Patients and methods A multicentre observational study was performed from February to May 2015 in 23 French academic centres. On 30 consecutive days in each centre, patients ≥ 75 years with at least one major comorbidity undergoing elective or emergency procedures (femoral-neck fractures surgery, intraperitoneal abdominal surgery or vascular surgery) were included. Patient characteristics and data related to GHDT, management of hypotension, monitoring of temperature and depth of anaesthesia, lung ventilation, point of care haemoglobin testing were collected. Results In total, 807 patients were included. Only 2% of patients [95% CI: 1–3] received GHDT in full accordance with guidelines. Depth of anaesthesia monitoring was largely performed (53% [95% CI: 50–56]). The multifaceted strategy of lung-protective ventilation combining low tidal volumes (6–8 mL/kg), PEEP of 5–8 cm cmH2O, and repeated recruitment manoeuvres, was performed in only 4% [95% CI: 3–5] of patients. A centre effect was a major determinant of variation concerning implementation of these strategies. Discussion In patients’ ≥ 75 years, strategies of anaesthesia optimisation are not in accordance with eligible guidelines. Implementation of these techniques varies independently of factors related to the patient or the type of surgery and may be dependent on the generated constraints.
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- 2019
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