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• W2023163815 abstract "To determine the magnitude, duration, and associated factors of perioperative changes in pulmonary function, we retrospectively reviewed the medical records of 145 patients who required preoperative mechanical ventilation for acute respiratory failure before undergoing 200 surgical procedures. Patients were grouped into five pulmonary diagnostic categories: (1) adult respiratory distress syndrome (ARDS) (n = 49); (2) pneumonia (n = 20); (3) atelectasis (n = 65); (4) congestive heart failure (n = 11); and (5) acute ventilatory failure (n = 55). Sixty patients underwent intra-abdominal surgery, 135 patients required surgery on the periphery, and five patients had a thoracotomy. For all patients, Pao2/FIo2 declined significantly from 321 mm Hg (mean) preoperatively to 258 mm Hg intra-operatively, and shunt fraction (Qs/Qt) increased from 0.16 to 0.23 without a significant change in PaCO2. The magnitude of the increase in Qs/Qt did not differ among pulmonary diagnostic groups. Preoperatively, patients undergoing laparotomy had lower PaO2/FIo2 (278 vs 340) and higher Qs/Qt (0.19 vs 0.14) than patients requiring surgery on the periphery. Intra-operatively, Qs/Qt increased more during abdominal procedures than during peripheral procedures. Intra-operative hypoxemia (PaO2/FIo2<80 mm Hg) occurred during 13 procedures. Hypoxemic patients had a mean increase in Qs/Qt of 0.20 (0.25 preoperatively to 0.45 intra-operatively), and a significant increase in PaCO2 from 38 mm Hg to 45 mm Hg intra-operatively). In general, these patients had ARDS (n = 10), sepsis (n = 10), a laparotomy (n = 9), and intra-operative mechanical ventilation via the Ohio Anesthesia ventilator (n = 8), a commonly used operating room ventilator. Their preoperative peak airway pressure (54 cm H2O) and minute ventilation (20 L/min) requirements exceeded the capabilities of the Ohio Anesthesia ventilator and likely contributed to impaired gas exchange intra-operatively. Within the first several hours postoperatively, PaO2/FIo2 recovered to preoperative levels in all patients, even in those who had severe intra-operative hypoxemia develop and who underwent laparotomy. We conclude that most patients with acute respiratory failure receiving preoperative mechanical ventilation experienced mild-to-moderate deterioration in intra-operative pulmonary oxygen exchange that rapidly returned to preoperative levels after surgery. We recommend that necessary surgery not be postponed by concern that pulmonary function will be worsened by surgery and anesthesia. To determine the magnitude, duration, and associated factors of perioperative changes in pulmonary function, we retrospectively reviewed the medical records of 145 patients who required preoperative mechanical ventilation for acute respiratory failure before undergoing 200 surgical procedures. Patients were grouped into five pulmonary diagnostic categories: (1) adult respiratory distress syndrome (ARDS) (n = 49); (2) pneumonia (n = 20); (3) atelectasis (n = 65); (4) congestive heart failure (n = 11); and (5) acute ventilatory failure (n = 55). Sixty patients underwent intra-abdominal surgery, 135 patients required surgery on the periphery, and five patients had a thoracotomy. For all patients, Pao2/FIo2 declined significantly from 321 mm Hg (mean) preoperatively to 258 mm Hg intra-operatively, and shunt fraction (Qs/Qt) increased from 0.16 to 0.23 without a significant change in PaCO2. The magnitude of the increase in Qs/Qt did not differ among pulmonary diagnostic groups. Preoperatively, patients undergoing laparotomy had lower PaO2/FIo2 (278 vs 340) and higher Qs/Qt (0.19 vs 0.14) than patients requiring surgery on the periphery. Intra-operatively, Qs/Qt increased more during abdominal procedures than during peripheral procedures. Intra-operative hypoxemia (PaO2/FIo2<80 mm Hg) occurred during 13 procedures. Hypoxemic patients had a mean increase in Qs/Qt of 0.20 (0.25 preoperatively to 0.45 intra-operatively), and a significant increase in PaCO2 from 38 mm Hg to 45 mm Hg intra-operatively). In general, these patients had ARDS (n = 10), sepsis (n = 10), a laparotomy (n = 9), and intra-operative mechanical ventilation via the Ohio Anesthesia ventilator (n = 8), a commonly used operating room ventilator. Their preoperative peak airway pressure (54 cm H2O) and minute ventilation (20 L/min) requirements exceeded the capabilities of the Ohio Anesthesia ventilator and likely contributed to impaired gas exchange intra-operatively. Within the first several hours postoperatively, PaO2/FIo2 recovered to preoperative levels in all patients, even in those who had severe intra-operative hypoxemia develop and who underwent laparotomy. We conclude that most patients with acute respiratory failure receiving preoperative mechanical ventilation experienced mild-to-moderate deterioration in intra-operative pulmonary oxygen exchange that rapidly returned to preoperative levels after surgery. We recommend that necessary surgery not be postponed by concern that pulmonary function will be worsened by surgery and anesthesia." @default.
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• W2023163815 title "Factors Affecting Perioperative Pulmonary Function in Acute Respiratory Failure" @default.
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• W2023163815 doi "https://doi.org/10.1378/chest.98.6.1455" @default.
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