British journal of anaesthesia
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Randomized Controlled Trial Multicenter Study
Postoperative prophylactic intermittent noninvasive ventilation versus usual postoperative care for patients at high risk of pulmonary complications: a multicentre randomised trial.
Pulmonary complications are an important cause of morbidity and mortality after surgery. We evaluated the clinical effectiveness of noninvasive ventilation (NIV) in preventing postoperative acute respiratory failure. ⋯ NCT03629431 and EudraCT 2017-001011-36.
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Review Meta Analysis
Impact of pharmacological interventions on intrapulmonary shunt during one-lung ventilation in adult thoracic surgery: a systematic review and component network meta-analysis.
Intrapulmonary shunt is a major determinant of oxygenation in thoracic surgery under one-lung ventilation. We reviewed the effects of available treatments on shunt, Pao2/FiO2 and haemodynamics through systematic review and network meta-analysis. ⋯ PROSPERO CRD42022310313.
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Anaesthetists play an important role in the evaluation and treatment of patients with signs of thoracic trauma. Anaesthesia involvement can provide valuable input using both advanced diagnostic and therapeutic interventions. ⋯ This evidence-based review discusses traumatic thoracic injuries with a focus on new interventions and modern anaesthesia techniques. This review further serves to support the early involvement of anaesthetists in the emergency department and other areas where they can provide value to the trauma care pathway.
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Postoperative pulmonary complications are a source of morbidity after major surgery. In patients at increased risk of postoperative pulmonary complications we sought to assess the association between neuromuscular blocking agent reversal agent and development of postoperative pulmonary complications. ⋯ In a cohort of patients at increased risk for pulmonary complications compared with neostigmine, use of sugammadex was independently associated with reduced risk of subsequent development of pneumonia or respiratory failure.
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Editorial Comment
Experimental asynchrony to study self-inflicted lung injury.
Patient self-inflicted lung injury may be associated with worse clinical outcomes and higher mortality. Patient-ventilator asynchrony is associated with increased ventilator days and mortality, and it has been hypothesised as one of the important mechanisms leading to patient self-inflicted lung injury. ⋯ Their results suggest that increased patient-ventilator asynchrony associated with poor clinical outcomes reported in observational trials could be a marker, rather than a cause of patient self-inflicted lung injury. These findings on their own are not sufficient to justify a greater tolerance of patient-ventilator asynchrony amongst clinicians, a change for which further experimental work and clinical evidence is needed.