Incidence of mortality and morbidity related to postoperative lung injury in patients who have undergone abdominal or thoracic surgery: a systematic review and meta-analysis
Por:
Neto, AS, Hemmes, SNT, Barbas, CSV, Beiderlinden, M, Fernandez-Bustamante, A, Futier, E, Hollmann, MW, Jaber, S, Kozian, A, Licker, M, Lin, WQ, Moine, P, Scavonetto, F, Schilling, T, Selmo, G, Severgnini, P, Sprung, J, Treschan, T, Unzueta, C, Weingarten, TN, Wolthuis, EK, Wrigge, H, de Abreu, MG, Pelosi, P, Schultz, MJ
Publicada:
1 dic 2014
Resumen:
Background Lung injury is a serious complication of surgery. We did a systematic review and meta-analysis to assess whether incidence, morbidity, and in-hospital mortality associated with postoperative lung injury are affected by type of surgery and whether outcomes are dependent on type of ventilation.
Methods We searched MEDLINE, CINAHL, Web of Science, and Cochrane Central Register of Controlled Trials for observational studies and randomised controlled trials published up to April, 2014, comparing lung-protective mechanical ventilation with conventional mechanical ventilation during abdominal or thoracic surgery in adults. Individual patients' data were assessed. Attributable mortality was calculated by subtracting the in-hospital mortality of patients without postoperative lung injury from that of patients with postoperative lung injury.
Findings We identified 12 investigations involving 3365 patients. The total incidence of postoperative lung injury was similar for abdominal and thoracic surgery (3.4% vs 4.3%, p=0.198). Patients who developed postoperative lung injury were older, had higher American Society of Anesthesiology scores and prevalence of sepsis or pneumonia, more frequently had received blood transfusions during surgery, and received ventilation with higher tidal volumes, lower positive end-expiratory pressure levels, or both, than patients who did not. Patients with postoperative lung injury spent longer in intensive care (8.0 [SD 12.4] vs 1.1 [3.7] days, p<0.0001) and hospital (20.9 [18.1] vs 14.7 [14.3] days, p<0.0001) and had higher in-hospital mortality (20.3% vs 1.4% p<0.0001) than those without injury. Overall attributable mortality for postoperative lung injury was 19% (95% CI 18-19), and differed significantly between abdominal and thoracic surgery patients (12.2%, 95% CI 12.0-12.6 vs 26.5%, 26.2-27.0, p=0.0008). The risk of in-hospital mortality was independent of ventilation strategy (adjusted HR 0.71, 95% CI 0.41-1.22).
Interpretation Postoperative lung injury is associated with increases in in-hospital mortality and durations of stay in intensive care and hospital. Attributable mortality due to postoperative lung injury is higher after thoracic surgery than after abdominal surgery. Lung-protective mechanical ventilation strategies reduce incidence of postoperative lung injury but does not improve mortality.
Funding None.
Filiaciones:
Neto, AS:
Univ Amsterdam, Acad Med Ctr, Dept Intens Care, NL-1105 AZ Amsterdam, Netherlands
ABC Med Sch, Med Intens Care Unit, Santo Andre, Brazil
Hosp Israelita Albert Einstein, Dept Crit Care Med, BR-05652900 Sao Paulo, Brazil
Hemmes, SNT:
Univ Amsterdam, Acad Med Ctr, Dept Intens Care, NL-1105 AZ Amsterdam, Netherlands
Univ Amsterdam, Acad Med Ctr, Dept Anaesthesiol, NL-1105 AZ Amsterdam, Netherlands
Barbas, CSV:
Hosp Israelita Albert Einstein, Dept Crit Care Med, BR-05652900 Sao Paulo, Brazil
Beiderlinden, M:
Univ Dusseldorf, Dusseldorf Univ Hosp, Dept Anaesthesiol, Dusseldorf, Germany
Marien Hosp, Dept Anaesthesiol, Osnabruck, Germany
Fernandez-Bustamante, A:
Univ Colorado, Dept Anesthesiol, Aurora, CO USA
Futier, E:
Estaing Univ Hosp, Dept Aneasthesiol & Crit Care Med, Clermont Ferrand, France
Hollmann, MW:
Univ Amsterdam, Acad Med Ctr, Dept Anaesthesiol, NL-1105 AZ Amsterdam, Netherlands
Jaber, S:
St Eloi Univ Hosp, Dept Crit Care Med & Anaesthesiol SAR B, Montpellier, France
Kozian, A:
Univ Magdeburg, Dept Anaesthesiol & Intens Care Med, D-39106 Magdeburg, Germany
Licker, M:
Univ Hosp Geneva, Fac Med, Dept Anaesthesiol Pharmacol & Intens Care, Geneva, Switzerland
Lin, WQ:
Sun Yat Sen Univ, Ctr Canc, State Key Lab Oncol South China, Guangzhou 510275, Guangdong, Peoples R China
Moine, P:
Univ Colorado, Dept Anesthesiol, Aurora, CO USA
Scavonetto, F:
Mayo Clin, Coll Med, Dept Anesthesiol, Rochester, MN USA
Mayo Clin, Coll Med, Anesthesia Clin Res Unit, Rochester, MN USA
Schilling, T:
Univ Magdeburg, Dept Anaesthesiol & Intens Care Med, D-39106 Magdeburg, Germany
Selmo, G:
Azienda Osped Fdn Macchi, Osped Circolo, Dept Anaesthesia, Varese, Italy
Severgnini, P:
Univ Insubria, Dept Biotechnol & Life Sci, Varese, Italy
Sprung, J:
Mayo Clin, Coll Med, Dept Anesthesiol, Rochester, MN USA
Mayo Clin, Coll Med, Anesthesia Clin Res Unit, Rochester, MN USA
Treschan, T:
Univ Dusseldorf, Dusseldorf Univ Hosp, Dept Anaesthesiol, Dusseldorf, Germany
Unzueta, C:
Hosp Santa Creu & Sant Pau, Dept Anaesthesiol, Barcelona, Spain
Weingarten, TN:
Mayo Clin, Coll Med, Dept Anesthesiol, Rochester, MN USA
Mayo Clin, Coll Med, Anesthesia Clin Res Unit, Rochester, MN USA
Wolthuis, EK:
Univ Amsterdam, Acad Med Ctr, Dept Intens Care, NL-1105 AZ Amsterdam, Netherlands
Wrigge, H:
Univ Leipzig, Dept Anaesthesiol & Intens Care Med, D-04109 Leipzig, Germany
de Abreu, MG:
Univ Hosp Carl Gustav Carus, Dept Anaesthesiol & Intens Care Med, Dresden, Germany
Pelosi, P:
Univ Genoa, IRCCS San Martino IST, Dept Surg Sci & Integrated Diagnost, Genoa, Italy
Schultz, MJ:
Univ Amsterdam, Acad Med Ctr, Dept Intens Care, NL-1105 AZ Amsterdam, Netherlands
Univ Amsterdam, Acad Med Ctr, Lab Expt Intens Care & Anaesthesiol, NL-1105 AZ Amsterdam, Netherlands
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