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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Curr+Opin+Anaesthesiol
2017 ; 30
(3
): 399-408
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Prevention of respiratory complications of the surgical patient: actionable plan
for continued process improvement
#MMPMID28323670
Ruscic KJ
; Grabitz SD
; Rudolph MI
; Eikermann M
Curr Opin Anaesthesiol
2017[Jun]; 30
(3
): 399-408
PMID28323670
show ga
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.