1. Guidelines on enhanced recovery after pulmonary lobectomy
- Author
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Alex Fourdrain, Christophe Quesnel, Patrick Bagan, Harry Etienne, Y^n-Lan Nguyen, Hadrien Roz, Jalal Assouad, Morgan Le Guen, Emmanuel Lorne, Pascal Berna, Marc Garnier, Pierre-Benoit Pagès, Marc Leone, CHU Amiens-Picardie, CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Victor Dupouy, Hôpital Foch [Suresnes], Virologie et Immunologie Moléculaires (VIM (UR 0892)), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Saclay-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Critical Care Medicine, Hôpital Nord, Marseille, Clinique du Millénaire - Oc Santé [Montpellier], Oc Santé [Montpellier], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Lipides - Nutrition - Cancer [Dijon - U1231] (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Université de Bourgogne (UB), Hôpital Haut-Lévêque [CHU Bordeaux], and CHU Bordeaux [Bordeaux]
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medicine.medical_specialty ,Industry funding ,medicine.medical_treatment ,Population ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,0302 clinical medicine ,Enhanced recovery ,030202 anesthesiology ,Pulmonary lobectomy ,Medicine ,guidelines ,Grading (education) ,education ,education.field_of_study ,Rehabilitation ,business.industry ,pulmonary lobectomy ,enhanced recovery after surgery (ERAS) ,General surgery ,030208 emergency & critical care medicine ,General Medicine ,Guideline ,Evidence-based medicine ,3. Good health ,Anesthesiology and Pain Medicine ,business ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
International audience; Objective : To establish recommendations for optimisation of the management of patients undergoing pulmonary lobectomy, particularly Enhanced Recovery After Surgery (ERAS).Design : A consensus committee of 13 experts from the French Society of Anaesthesia and Intensive Care Medicine (Soci,t, franOaise d'anesth,sie et de r,animation, SFAR) and the French Society of Thoracic and Cardiovascular Surgery (Soci,t, franOaise de chirurgie thoracique et cardiovasculaire, SFCTCV) was convened. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence.Methods : Five domains were defined: 1) patient pathway and patient information; 2) preoperative management and rehabilitation; 3) anaesthesia and analgesia for lobectomy; 4) surgical strategy for lobectomy; and 5) enhanced recovery after surgery. For each domain, the objective of the recommendations was to address a number of questions formulated according to the PICO model (Population, Intervention, Comparison, Outcome). An extensive literature search on these questions was carried out and analysed using the GRADE® methodology. Recommendations were formulated according to the GRADE® methodology, and were then voted by all experts according to the GRADE grid method.Results : The SFAR/SFCTCV guideline panel provided 32 recommendations on the management of patients undergoing pulmonary lobectomy. After two voting rounds and several amendments, a strong consensus was reached for 31 of the 32 recommendations and a moderate consensus was reached for the last recommendation. Seven of these recommendations present a high level of evidence (GRADE 1+), 23 have a moderate level of evidence (18 GRADE 2+ and 5 GRADE 2-), and 2 correspond to expert opinions. Finally, no recommendation was provided for 2 of the questions.Conclusions : A strong consensus was expressed by the experts to provide recommendations to optimise the whole perioperative management of patients undergoing pulmonary lobectomy.
- Published
- 2021
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