Division of Acute Care Surgery, The FH "Sammy" Ross Jr Trauma Center, Carolinas Medical Center, Atrium Health, Charlotte, NC.
Division of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington, MA.
J Am Coll Surg. 2019 Nov;229(5):458-466.e1. doi: 10.1016/j.jamcollsurg.2019.06.004. Epub 2019 Jul 27.
Postoperative pulmonary complications (PPCs) cause high morbidity and mortality. Targeted treatment for patients at risk for PPCs can improve outcomes. This multicenter prospective trial examined the impact of oscillation and lung expansion (OLE) therapy, using continuous high-frequency oscillation and continuous positive expiratory pressure on PPCs in high-risk patients.
In stage I, CPT and ICD codes were queried for patients (n = 210) undergoing thoracic, upper abdominal, or aortic open procedures at 3 institutions from December 2014 to April 2016. Patients were selected randomly. Age, comorbidities, American Society of Anesthesiologists physical status classification scores, and PPC rates were determined. In stage II, 209 subjects were enrolled prospectively from October 2016 to July 2017 using the same criteria. Stage II subjects received OLE treatment and standard respiratory care. The PPCs rate (prolonged ventilation, high-level respiratory support, pneumonia, ICU readmission) were compared. We also compared ICU length of stay (LOS), hospital LOS, and mortality using t-tests and analysis of covariance. Data are mean ± SD.
There were 419 subjects. Stage II patients were older (61.1 ± 13.7 years vs 57.4 ± 15.5 years; p < 0.05) and had higher American Society of Anesthesiologists scores. Treatment with OLE decreased PPCs from 22.9% (stage I) to 15.8% (stage II) (p < 0.01 adjusted for age, American Society of Anesthesiologists score, and operation time). Similarly, OLE treatment reduced ventilator time (23.7 ± 107.5 hours to 8.5 ± 27.5 hours; p < 0.05) and hospital LOS (8.4 ± 7.9 days to 6.8 ± 5.0 days; p < 0.05). No differences in ICU LOS, pneumonia, or mortality were observed.
Aggressive treatment with OLE reduces PPCs and resource use in high-risk surgical patients.
术后肺部并发症（PPCs）会导致高发病率和死亡率。针对 PPCs 高危患者进行靶向治疗可以改善预后。这项多中心前瞻性试验研究了使用连续高频振荡和持续正压通气对高危患者进行振荡和肺扩张（OLE）治疗对 PPCs 的影响。
在第一阶段，我们使用连续高频振荡和持续正压通气对 2014 年 12 月至 2016 年 4 月期间在 3 家机构接受胸、上腹部或主动脉开放手术的 210 名患者（n=210）的 CPT 和 ICD 代码进行了查询。患者被随机选择。确定了年龄、合并症、美国麻醉医师协会身体状况分类评分和 PPC 发生率。在第二阶段，我们使用相同的标准，于 2016 年 10 月至 2017 年 7 月前瞻性地招募了 209 名患者。第二阶段的患者接受 OLE 治疗和标准呼吸护理。比较 PPCs 发生率（延长通气、高级呼吸支持、肺炎、ICU 再入院）。我们还使用 t 检验和协方差分析比较了 ICU 住院时间（LOS）、住院 LOS 和死亡率。数据为平均值±标准差。
共纳入 419 例患者。第二阶段的患者年龄较大（61.1±13.7 岁 vs 57.4±15.5 岁；p<0.05），美国麻醉医师协会评分较高。OLE 治疗可将 PPCs 从 22.9%（第一阶段）降低至 15.8%（第二阶段）（p<0.01，经年龄、美国麻醉医师协会评分和手术时间调整）。同样，OLE 治疗也降低了呼吸机使用时间（23.7±107.5 小时至 8.5±27.5 小时；p<0.05）和住院时间（8.4±7.9 天至 6.8±5.0 天；p<0.05）。但 ICU LOS、肺炎或死亡率无差异。
对高危手术患者进行积极的 OLE 治疗可降低 PPCs 和资源使用。
