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Article: Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies.

Ramasco, Fernando / Nieves-Alonso, Jesús / García-Villabona, Esther / Vallejo, Carmen / Kattan, Eduardo / Méndez, Rosa

2024 Volume 14, Issue 2

Abstract: Sepsis and septic shock are associated with high mortality, with diagnosis and treatment remaining a challenge for clinicians. Their management classically encompasses hemodynamic resuscitation, antibiotic treatment, life support, and focus control; ... ...

Abstract	Sepsis and septic shock are associated with high mortality, with diagnosis and treatment remaining a challenge for clinicians. Their management classically encompasses hemodynamic resuscitation, antibiotic treatment, life support, and focus control; however, there are aspects that have changed. This narrative review highlights current and avant-garde methods of handling patients experiencing septic shock based on the experience of its authors and the best available evidence in a context of uncertainty. Following the first recommendation of the Surviving Sepsis Campaign guidelines, it is recommended that specific sepsis care performance improvement programs are implemented in hospitals, i.e., "Sepsis Code" programs, designed ad hoc, to achieve this goal. Regarding hemodynamics, the importance of perfusion and hemodynamic coherence stand out, which allow for the recognition of different phenotypes, determination of the ideal time for commencing vasopressor treatment, and the appropriate fluid therapy dosage. At present, this is not only important for the initial timing, but also for de-resuscitation, which involves the early weaning of support therapies, directed elimination of fluids, and fluid tolerance concept. Finally, regarding blood purification therapies, those aimed at eliminating endotoxins and cytokines are attractive in the early management of patients in septic shock.
Language	English
Publishing date	2024-02-03
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662248-8
ISSN	2075-4426
ISSN	2075-4426
DOI	10.3390/jpm14020176
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Article: Sepsis Stewardship: The Puzzle of Antibiotic Therapy in the Context of Individualization of Decision Making.

Ramasco, Fernando / Méndez, Rosa / Suarez de la Rica, Alejandro / González de Castro, Rafael / Maseda, Emilio

Journal of personalized medicine

2024 Volume 14, Issue 1

Abstract: The main recent change observed in the field of critical patient infection has been universal awareness of the need to make better use of antimicrobials, especially for the most serious cases, beyond the application of simple and effective formulas or ... ...

Abstract	The main recent change observed in the field of critical patient infection has been universal awareness of the need to make better use of antimicrobials, especially for the most serious cases, beyond the application of simple and effective formulas or rigid protocols. The increase in resistant microorganisms, the quantitative increase in major surgeries and interventional procedures in the highest risk patients, and the appearance of a significant number of new antibiotics in recent years (some very specifically directed against certain mechanisms of resistance and others with a broader spectrum of applications) have led us to shift our questions from "what to deal with" to "how to treat". There has been controversy about how best to approach antibiotic treatment of complex cases of sepsis. The individualized and adjusted dosage, the moment of its administration, the objective, and the selection of the regimen are pointed out as factors of special relevance in a critically ill patient where the frequency of resistant microorganisms, especially among the Enterobacterales group, and the emergence of multiple and diverse antibiotic treatment alternatives have made the appropriate choice of antibiotic treatment more complex, requiring a constant updating of knowledge and the creation of multidisciplinary teams to confront new infections that are difficult to treat. In this article, we have reviewed the phenomenon of the emergence of resistance to antibacterials and we have tried to share some of the ideas, such as stewardship, sparing carbapenems, and organizational, microbiological, pharmacological, and knowledge tools, that we have considered most useful and effective for individualized decision making that takes into account the current context of multidrug resistance. The greatest challenge, therefore, of decision making in this context lies in determining an effective, optimal, and balanced empirical antibiotic treatment.
Language	English
Publishing date	2024-01-18
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662248-8
ISSN	2075-4426
ISSN	2075-4426
DOI	10.3390/jpm14010106
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Article: Decrease in Mortality after the Implementation of a Hospital Model to Improve Performance in Sepsis Care: Princess Sepsis Code.

Méndez, Rosa / Figuerola, Angels / Ramasco, Fernando / Chicot, Marta / Pascual, Natalia F / García, Íñigo / von Wernitz, Andrés / Zurita, Nelly D / Semiglia, Auxiliadora / Pizarro, Alberto / Saez, Carmen / Rodríguez, Diego

Journal of personalized medicine

2024 Volume 14, Issue 2

Abstract: Sepsis is a time-dependent disease whose prognosis is influenced by early diagnosis and therapeutic measures. Mortality from sepsis remains high, and for this reason, the guidelines of the Surviving Sepsis Campaign recommend establishing specific care ... ...

Abstract	Sepsis is a time-dependent disease whose prognosis is influenced by early diagnosis and therapeutic measures. Mortality from sepsis remains high, and for this reason, the guidelines of the Surviving Sepsis Campaign recommend establishing specific care programs aimed at patients with sepsis. We present the results of the application of a hospital model to improve performance in sepsis care, called
Language	English
Publishing date	2024-01-29
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662248-8
ISSN	2075-4426
ISSN	2075-4426
DOI	10.3390/jpm14020149
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Article ; Online: Development and validation of a delirium risk prediction preoperative model for cardiac surgery patients (DELIPRECAS): An observational multicentre study.

de la Varga-Martínez, Olga / Gómez-Pesquera, Estefanía / Muñoz-Moreno, María Fe / Marcos-Vidal, José Miguel / López-Gómez, Amparo / Rodenas-Gómez, Frederic / Ramasco, Fernando / Álvarez-Refojo, Felisa / Tamayo, Eduardo / Gómez-Sánchez, Esther

Journal of clinical anesthesia

2020 Volume 69, Page(s) 110158

Abstract: Study objective: To develop and validate a delirium risk prediction preoperative model for patients undergoing cardiac surgery.: Design: Observational prospective multicentre study.: Setting: Six intensive care units in Spain.: Patients: 689 ... ...

Abstract	Study objective: To develop and validate a delirium risk prediction preoperative model for patients undergoing cardiac surgery. Design: Observational prospective multicentre study. Setting: Six intensive care units in Spain. Patients: 689 patients undergoing cardiac surgery consecutively, aged ≥18 years. Measurements: The primary outcome measure was the development of delirium, diagnosed using the Confusion Assessment Method in Intensive Care Units (CAM-ICU), during the stay in the intensive care unit after cardiac surgery. Main results: The model was developed with 345 consecutive patients undergoing cardiac surgery at six hospitals and validated with another 344 patients from the same hospitals. The prediction model contained four preoperative risk factors: age over 65 years, Mini-Mental State Examination (MMSE) score of 25-26 points (possible impairment of cognitive function) or < 25 (impairment of cognitive function), insomnia needing medical treatment and low physical activity (walk less than 30 min a day). The model had an area under the receiver operating characteristics curve of 0.825 (95% confidence interval: 0.76-0.89). The validation resulted in an area under the curve of 0.79 (0.73-0.85) and the pooled area under the receiver operating characteristics curve (n = 689) was 0.81 (0.76-0.85). We stratified patients in groups of low (0%-20%), moderate (> 20%-40%), high (> 40%-60%) and very high (> 60%) risk of developing delirium, with a positive and negative predictive value for the very high risk group of 70.97% and 85.56%, respectively. Conclusion: The DELIPRECAS model (DELIrium PREvention CArdiac Surgery), consisting of four well-defined clinical risk factors, can predict in the preoperative period the risk of developing postoperative delirium in patients undergoing cardiac surgery. An automatic version of the risk calculator is available.
MeSH term(s)	Adolescent ; Adult ; Aged ; Cardiac Surgical Procedures/adverse effects ; Delirium/diagnosis ; Delirium/epidemiology ; Delirium/etiology ; Humans ; Intensive Care Units ; Prospective Studies ; Risk Factors ; Spain/epidemiology
Language	English
Publishing date	2020-12-07
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Observational Study
ZDB-ID	1011618-7
ISSN	1873-4529 ; 0952-8180
ISSN (online)	1873-4529
ISSN	0952-8180
DOI	10.1016/j.jclinane.2020.110158
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Article ; Online: Influence of intraoperative and postoperative factors on the predictive capacity of the delirium risk model for cardiac surgery patients (DELIPRECAS): An observational multicentre study.

Journal of clinical anesthesia

2021 Volume 72, Page(s) 110282

MeSH term(s)	Cardiac Surgical Procedures/adverse effects ; Delirium/diagnosis ; Delirium/epidemiology ; Delirium/etiology ; Humans ; Postoperative Complications/diagnosis ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Risk Factors
Language	English
Publishing date	2021-04-16
Publishing country	United States
Document type	Letter ; Multicenter Study ; Observational Study
ZDB-ID	1011618-7
ISSN	1873-4529 ; 0952-8180
ISSN (online)	1873-4529
ISSN	0952-8180
DOI	10.1016/j.jclinane.2021.110282
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Article ; Online: Impact of ceftazidime/avibactam versus best available therapy on mortality from infections caused by carbapenemase-producing Enterobacterales (CAVICOR study).

Castón, Juan José / Cano, Angela / Pérez-Camacho, Inés / Aguado, Jose M / Carratalá, Jordi / Ramasco, Fernando / Soriano, Alex / Pintado, Vicente / Castelo-Corral, Laura / Sousa, Adrian / Fariñas, María Carmen / Muñoz, Patricia / Abril López De Medrano, Vicente / Sanz-Peláez, Óscar / Los-Arcos, Ibai / Gracia-Ahufinger, Irene / Pérez-Nadales, Elena / Vidal, Elisa / Doblas, Antonio /

Natera, Clara / Martínez-Martínez, Luis / Torre-Cisneros, Julian

The Journal of antimicrobial chemotherapy

2022 Volume 77, Issue 5, Page(s) 1452–1460

Abstract: Background: Infections caused by carbapenemase-producing Enterobacterales (CPE) are not well represented in pivotal trials with ceftazidime/avibactam. The best strategy for the treatment of these infections is unknown.: Methods: We conducted a ... ...

Abstract	Background: Infections caused by carbapenemase-producing Enterobacterales (CPE) are not well represented in pivotal trials with ceftazidime/avibactam. The best strategy for the treatment of these infections is unknown. Methods: We conducted a multicentre retrospective observational study of patients who received ≥48 h of ceftazidime/avibactam or best available therapy (BAT) for documented CPE infections. The primary outcome was 30 day crude mortality. Secondary outcomes were 21 day clinical response and microbiological response. A multivariate logistic regression model was used to identify factors predictive of 30 day crude mortality. A propensity score to receive treatment with ceftazidime/avibactam was used as a covariate in the analysis. Results: The cohort included 339 patients with CPE infections. Ceftazidime/avibactam treatment was used in 189 (55.8%) patients and 150 (44.2%) received BAT at a median of 2 days after diagnosis of infection. In multivariate analysis, ceftazidime/avibactam treatment was associated with survival (OR 0.41, 95% CI 0.20-0.80; P = 0.01), whereas INCREMENT-CPE scores of >7 points (OR 2.57, 95% CI 1.18-1.5.58; P = 0.01) and SOFA score (OR 1.20, 95% CI 1.08-1.34; P = 0.001) were associated with higher mortality. In patients with INCREMENT-CPE scores of >7 points, ceftazidime/avibactam treatment was associated with lower mortality compared with BAT (16/73, 21.9% versus 23/49, 46.9%; P = 0.004). Ceftazidime/avibactam was also an independent factor of 21 day clinical response (OR 2.43, 95% CI 1.16-5.12; P = 0.02) and microbiological eradication (OR 0.40, 95% CI 0.18-0.85; P = 0.02). Conclusions: Ceftazidime/avibactam is an effective alternative for the treatment of CPE infections, especially in patients with INCREMENT-CPE scores of >7 points. A randomized controlled trial should confirm these findings.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Azabicyclo Compounds/therapeutic use ; Bacterial Proteins ; Ceftazidime/therapeutic use ; Drug Combinations ; Humans ; Microbial Sensitivity Tests ; beta-Lactamases
Chemical Substances	Anti-Bacterial Agents ; Azabicyclo Compounds ; Bacterial Proteins ; Drug Combinations ; avibactam (7352665165) ; Ceftazidime (9M416Z9QNR) ; beta-Lactamases (EC 3.5.2.6) ; carbapenemase (EC 3.5.2.6)
Language	English
Publishing date	2022-04-07
Publishing country	England
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	191709-2
ISSN	1460-2091 ; 0305-7453
ISSN (online)	1460-2091
ISSN	0305-7453
DOI	10.1093/jac/dkac049
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Article ; Online: Awake prone positioning does not reduce the risk of intubation in COVID-19 treated with high-flow nasal oxygen therapy: a multicenter, adjusted cohort study.

Ferrando, Carlos / Mellado-Artigas, Ricard / Gea, Alfredo / Arruti, Egoitz / Aldecoa, César / Adalia, Ramón / Ramasco, Fernando / Monedero, Pablo / Maseda, Emilio / Tamayo, Gonzalo / Hernández-Sanz, María L / Mercadal, Jordi / Martín-Grande, Ascensión / Kacmarek, Robert M / Villar, Jesús / Suárez-Sipmann, Fernando

Critical care (London, England)

2020 Volume 24, Issue 1, Page(s) 597

Abstract: Background: Awake prone positioning (awake-PP) in non-intubated coronavirus disease 2019 (COVID-19) patients could avoid endotracheal intubation, reduce the use of critical care resources, and improve survival. We aimed to examine whether the ... ...

Abstract	Background: Awake prone positioning (awake-PP) in non-intubated coronavirus disease 2019 (COVID-19) patients could avoid endotracheal intubation, reduce the use of critical care resources, and improve survival. We aimed to examine whether the combination of high-flow nasal oxygen therapy (HFNO) with awake-PP prevents the need for intubation when compared to HFNO alone. Methods: Prospective, multicenter, adjusted observational cohort study in consecutive COVID-19 patients with acute respiratory failure (ARF) receiving respiratory support with HFNO from 12 March to 9 June 2020. Patients were classified as HFNO with or without awake-PP. Logistic models were fitted to predict treatment at baseline using the following variables: age, sex, obesity, non-respiratory Sequential Organ Failure Assessment score, APACHE-II, C-reactive protein, days from symptoms onset to HFNO initiation, respiratory rate, and peripheral oxyhemoglobin saturation. We compared data on demographics, vital signs, laboratory markers, need for invasive mechanical ventilation, days to intubation, ICU length of stay, and ICU mortality between HFNO patients with and without awake-PP. Results: A total of 1076 patients with COVID-19 ARF were admitted, of which 199 patients received HFNO and were analyzed. Fifty-five (27.6%) were pronated during HFNO; 60 (41%) and 22 (40%) patients from the HFNO and HFNO + awake-PP groups were intubated. The use of awake-PP as an adjunctive therapy to HFNO did not reduce the risk of intubation [RR 0.87 (95% CI 0.53-1.43), p = 0.60]. Patients treated with HFNO + awake-PP showed a trend for delay in intubation compared to HFNO alone [median 1 (interquartile range, IQR 1.0-2.5) vs 2 IQR 1.0-3.0] days (p = 0.055), but awake-PP did not affect 28-day mortality [RR 1.04 (95% CI 0.40-2.72), p = 0.92]. Conclusion: In patients with COVID-19 ARF treated with HFNO, the use of awake-PP did not reduce the need for intubation or affect mortality.
MeSH term(s)	Aged ; COVID-19 ; Cohort Studies ; Coronavirus Infections/therapy ; Female ; Humans ; Intubation, Intratracheal/adverse effects ; Male ; Middle Aged ; Oxygen Inhalation Therapy/methods ; Pandemics ; Pneumonia, Viral/therapy ; Prone Position ; Risk Assessment ; Wakefulness
Keywords	covid19
Language	English
Publishing date	2020-10-06
Publishing country	England
Document type	Journal Article ; Multicenter Study ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2041406-7
ISSN	1466-609X ; 1364-8535
ISSN (online)	1466-609X
ISSN	1364-8535
DOI	10.1186/s13054-020-03314-6
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Article: Awake prone positioning does not reduce the risk of intubation in COVID-19 treated with high-flow nasal oxygen therapy: a multicenter, adjusted cohort study

Crit Care

Abstract: BACKGROUND: Awake prone positioning (awake-PP) in non-intubated coronavirus disease 2019 (COVID-19) patients could avoid endotracheal intubation, reduce the use of critical care resources, and improve survival. We aimed to examine whether the combination ...

Abstract	BACKGROUND: Awake prone positioning (awake-PP) in non-intubated coronavirus disease 2019 (COVID-19) patients could avoid endotracheal intubation, reduce the use of critical care resources, and improve survival. We aimed to examine whether the combination of high-flow nasal oxygen therapy (HFNO) with awake-PP prevents the need for intubation when compared to HFNO alone. METHODS: Prospective, multicenter, adjusted observational cohort study in consecutive COVID-19 patients with acute respiratory failure (ARF) receiving respiratory support with HFNO from 12 March to 9 June 2020. Patients were classified as HFNO with or without awake-PP. Logistic models were fitted to predict treatment at baseline using the following variables: age, sex, obesity, non-respiratory Sequential Organ Failure Assessment score, APACHE-II, C-reactive protein, days from symptoms onset to HFNO initiation, respiratory rate, and peripheral oxyhemoglobin saturation. We compared data on demographics, vital signs, laboratory markers, need for invasive mechanical ventilation, days to intubation, ICU length of stay, and ICU mortality between HFNO patients with and without awake-PP. RESULTS: A total of 1076 patients with COVID-19 ARF were admitted, of which 199 patients received HFNO and were analyzed. Fifty-five (27.6%) were pronated during HFNO; 60 (41%) and 22 (40%) patients from the HFNO and HFNO + awake-PP groups were intubated. The use of awake-PP as an adjunctive therapy to HFNO did not reduce the risk of intubation [RR 0.87 (95% CI 0.53-1.43), p = 0.60]. Patients treated with HFNO + awake-PP showed a trend for delay in intubation compared to HFNO alone [median 1 (interquartile range, IQR 1.0-2.5) vs 2 IQR 1.0-3.0] days (p = 0.055), but awake-PP did not affect 28-day mortality [RR 1.04 (95% CI 0.40-2.72), p = 0.92]. CONCLUSION: In patients with COVID-19 ARF treated with HFNO, the use of awake-PP did not reduce the need for intubation or affect mortality.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #818129
Database	COVID19

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Article ; Online: Critically ill patients with community-onset intraabdominal infections: Influence of healthcare exposure on resistance rates and mortality.

Maseda, Emilio / Ramírez, Sofía / Picatto, Pedro / Peláez-Peláez, Eva / García-Bernedo, Carlos / Ojeda-Betancur, Nazario / Aguilar, Gerardo / Forés, Beatriz / Solera-Marín, Jorge / Aliaño-Piña, María / Tamayo, Eduardo / Ramasco, Fernando / García-Álvarez, Raquel / González-Lisorge, Ada / Giménez, María-José / Suárez-de-la-Rica, Alejandro

PloS one

2019 Volume 14, Issue 9, Page(s) e0223092

Abstract: The concept of healthcare-associated infections (as opposed to hospital-acquired infections) in intraabdominal infections (IAIs) is scarcely supported by data in the literature. The aim of the present study was to analyse community-onset IAIs (non- ... ...

Abstract	The concept of healthcare-associated infections (as opposed to hospital-acquired infections) in intraabdominal infections (IAIs) is scarcely supported by data in the literature. The aim of the present study was to analyse community-onset IAIs (non-postoperative/non-nosocomial) in patients admitted to intensive care units (ICUs), to investigate differences in resistance patterns linked to healthcare exposure and mortality-associated factors. A one-year prospective observational study (17 Spanish ICUs) was performed distributing cases as healthcare-associated infections (HCAI), community-acquired infections (CAI) and immunocompromised patients (ICP). Bacteria producing extended-spectrum β-lactamases (ESBL) and/or carbapenemase (CPE), high-level aminoglycoside- and/or methicillin- and/or vancomycin- resistance were considered antimicrobial resistant (AMR). Mortality-associated factors were identified by regression multivariate analysis. Of 345 patients included (18.8% HCAI, 6.1% ICP, 75.1% CAI), 51.6% presented generalized peritonitis; 32.5% were >75 years (55.4% among HCAI). Overall, 11.0% cases presented AMR (7.0% ESBL- and/or CPE), being significantly higher in HCAI (35.4%) vs. CAI (5.8%) (p<0.001) vs. ICP (0%) (p = 0.003). Overall 30-day mortality was 14.5%: 23.1% for HCAI and 11.6% for CAI (p = 0.016). Mortality (R2 = 0.262, p = 0.021) was positively associated with age >75 years (OR = 6.67, 95%CI = 2.56-17.36,p<0.001), Candida isolation (OR = 3.05, 95%CI = 1.18-7.87,p = 0.022), and SAPS II (per-point, OR = 1.08, 95%CI = 1.05-1.11, p<0.001) and negatively with biliary infections (OR = 0.06, 95%CI = 0.01-0.48,p = 0.008). In this study, the antimicrobial susceptibility pattern of bacteria isolated from patients with healthcare contact was shifted to resistance, suggesting the need for consideration of the healthcare category (not including hospital-acquired infections) for severe IAIs. 30-day mortality was positively related with age >75 years, severity and Candida isolation but not with AMR.
MeSH term(s)	Adult ; Age Factors ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/pharmacology ; Anti-Bacterial Agents/therapeutic use ; Bacteria/drug effects ; Bacteria/isolation & purification ; Community-Acquired Infections/diagnosis ; Community-Acquired Infections/drug therapy ; Community-Acquired Infections/microbiology ; Community-Acquired Infections/mortality ; Critical Illness/mortality ; Critical Illness/therapy ; Cross Infection/diagnosis ; Cross Infection/drug therapy ; Cross Infection/microbiology ; Cross Infection/mortality ; Drug Resistance, Bacterial ; Female ; Humans ; Intensive Care Units/statistics & numerical data ; Intraabdominal Infections/diagnosis ; Intraabdominal Infections/drug therapy ; Intraabdominal Infections/microbiology ; Intraabdominal Infections/mortality ; Male ; Middle Aged ; Prospective Studies ; Risk Factors ; Severity of Illness Index ; Spain/epidemiology
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2019-09-26
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Multicenter Study ; Observational Study
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0223092
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Article ; Online: Individualised, perioperative open-lung ventilation strategy during one-lung ventilation (iPROVE-OLV): a multicentre, randomised, controlled clinical trial.

Ferrando, Carlos / Carramiñana, Albert / Piñeiro, Patricia / Mirabella, Lucia / Spadaro, Savino / Librero, Julián / Ramasco, Fernando / Scaramuzzo, Gaetano / Cervantes, Oriol / Garutti, Ignacio / Parera, Ana / Argilaga, Marta / Herranz, Gracia / Unzueta, Carmen / Vives, Marc / Regi, Kevin / Costa-Reverte, Marta / Sonsoles Leal, María / Nieves-Alonso, Jesús /

García, Esther / Rodríguez-Pérez, Aurelio / Fariña, Roberto / Cabrera, Sergio / Guerra, Elisabeth / Gallego-Ligorit, Lucia / Herrero-Izquierdo, Alba / Vallés-Torres, J / Ramos, Silvia / López-Herrera, Daniel / De La Matta, Manuel / Gokhan, Sertcakacilar / Kucur, Evrim / Mugarra, Ana / Soro, Marina / García, Laura / Sastre, José Alfonso / Aguirre, Pilar / Salazar, Claudia Jimena / Ramos, María Carolina / Morocho, Diego Rolando / Trespalacios, Ramón / Ezequiel-Fernández, Félix / Lamanna, Angella / Pia Cantatore, Leonarda / Laforgia, Donato / Bellas, Soledad / López, Carlos / Navarro-Ripoll, Ricard / Martínez, Samira / Vallverdú, Jordi / Jacas, Adriana / Yepes-Temiño, María José / Belda, Francisco Javier / Tusman, Gerardo / Suárez-Sipmann, Fernando / Villar, Jesús

The Lancet. Respiratory medicine

2023 Volume 12, Issue 3, Page(s) 195–206

Abstract: Background: It is uncertain whether individualisation of the perioperative open-lung approach (OLA) to ventilation reduces postoperative pulmonary complications in patients undergoing lung resection. We compared a perioperative individualised OLA (iOLA) ...

Abstract	Background: It is uncertain whether individualisation of the perioperative open-lung approach (OLA) to ventilation reduces postoperative pulmonary complications in patients undergoing lung resection. We compared a perioperative individualised OLA (iOLA) ventilation strategy with standard lung-protective ventilation in patients undergoing thoracic surgery with one-lung ventilation. Methods: This multicentre, randomised controlled trial enrolled patients scheduled for open or video-assisted thoracic surgery using one-lung ventilation in 25 participating hospitals in Spain, Italy, Turkey, Egypt, and Ecuador. Eligible adult patients (age ≥18 years) were randomly assigned to receive iOLA or standard lung-protective ventilation. Eligible patients (stratified by centre) were randomly assigned online by local principal investigators, with an allocation ratio of 1:1. Treatment with iOLA included an alveolar recruitment manoeuvre to 40 cm H Findings: Between Sept 11, 2018, and June 14, 2022, we enrolled 1380 patients, of whom 1308 eligible patients (670 [434 male, 233 female, and three with missing data] assigned to iOLA and 638 [395 male, 237 female, and six with missing data] to standard lung-protective ventilation) were included in the final analysis. The proportion of patients with the composite outcome of severe postoperative pulmonary complications within the first 7 postoperative days was lower in the iOLA group compared with the standard lung-protective ventilation group (40 [6%] vs 97 [15%], relative risk 0·39 [95% CI 0·28 to 0·56]), with an absolute risk difference of -9·23 (95% CI -12·55 to -5·92). Recruitment manoeuvre-related adverse events were reported in five patients. Interpretation: Among patients subjected to lung resection under one-lung ventilation, iOLA was associated with a reduced risk of severe postoperative pulmonary complications when compared with conventional lung-protective ventilation. Funding: Instituto de Salud Carlos III and the European Regional Development Funds.
MeSH term(s)	Adult ; Humans ; Female ; Male ; Adolescent ; One-Lung Ventilation ; Respiration ; Continuous Positive Airway Pressure ; Lung/surgery ; Oxygen
Chemical Substances	Oxygen (S88TT14065)
Language	English
Publishing date	2023-12-05
Publishing country	England
Document type	Randomized Controlled Trial ; Multicenter Study ; Journal Article
ZDB-ID	2686754-0
ISSN	2213-2619 ; 2213-2600
ISSN (online)	2213-2619
ISSN	2213-2600
DOI	10.1016/S2213-2600(23)00346-6
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