PMID- 28852473
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200929
IS  - 2047-0525 (Print)
IS  - 2047-0525 (Electronic)
IS  - 2047-0525 (Linking)
VI  - 6
DP  - 2017
TI  - Evaluation of operating room reverse Trendelenburg positioning and its effect on 
      postoperative hypoxemia, aspiration, and length of stay: a retrospective study of 
      consecutive patients.
PG  - 10
LID - 10.1186/s13741-017-0067-2 [doi]
LID - 10
AB  - BACKGROUND: In 2014, this group published an investigation of surgical patients 
      from 2012 who had substantial rates of postoperative hypoxemia (POH) and 
      perioperative pulmonary aspiration (POPA). Therefore, we investigated whether 
      intraoperative reverse Trendelenburg positioning (RTP) decreases POH and POPA 
      rates. METHODS: Consecutive ASA I-IV surgical patients who had preoperative 
      pulmonary stability requiring general anesthesia with endotracheal intubation 
      were evaluated. Using pulse oximetry, hypoxemia was documented intraoperatively 
      and during the 48 h following PACU discharge. POPA was the presence of a 
      pulmonary infiltrate with hypoxemia. In early 2015, a multifaceted effort was 
      undertaken to enhance anesthesiologist and operating nurse awareness of RTP to 
      potentially decrease POH and POPA rates. Analyses included (1) combining 2012 and 
      2015 cohorts to assess risk conditions, (2) comparing post-campaign 2015 
      (increased RTP) and 2012 cohorts, and (3) comparing 2015 patients with 
      audit-documented RTP during surgery to the other 2015 patients. RESULTS: 
      Combining the 500 patients in 2012 with the 1000 in 2015 showed that POH had 
      increased mortality (2.3%), compared to no POH (0.2%; p = 0.0004). POH had 
      increased postoperative length of stay (LOS) (4.6 days), compared to no POH 
      (2.0 days; p < 0.0001). POPA had increased mortality (7.7%) and LOS (8.8 days), 
      compared to no POPA (0.4%; p = 0.0004; 2.3 days; p < 0.0001). Open aortic, 
      cranial, laparotomy, and neck procedures had greater POH (41.3%) and LOS 
      (4.0 days), compared to other procedures (16.3%; p < 0.0001; 2.2 days; 
      p < 0.0001). Glycopyrrolate on induction had lower POH (17.4%) and LOS 
      (1.9 days), compared to no glycopyrrolate (21.6%; p = 0.0849; 2.7 days; 
      p < 0.0001). POH was lower (18.1%) in 2015, than in 2012 (25.6%; p = 0.0007). 
      POPA was lower with RTP in 2015 (0.6%), than in 2012 (4.8%; p = 0.0088). For the 
      2015 patients, LOS was lower with audit-documented RTP (2.2 days), compared to 
      other patients (2.7 days; p = 0.0246). CONCLUSIONS: These findings are only 
      hypothesis-generating. A randomized clinical trial is needed to confirm whether 
      RTP has an inverse association with POH and POPA, and if RTP and glycopyrrolate 
      are associated with improved outcomes. TRIAL REGISTRATION: ClinicalTrials.gov, 
      NCT02984657.
FAU - Michael Dunham, C
AU  - Michael Dunham C
AD  - Trauma, Critical Care, and General Surgery Services, St. Elizabeth Youngstown 
      Hospital, 1044 Belmont Ave., Youngstown, OH 44501 USA. GRID: grid.451516.2
FAU - Hileman, Barbara M
AU  - Hileman BM
AD  - Trauma and Neurosciences Research Department, St. Elizabeth Youngstown Hospital, 
      1044 Belmont Ave., Youngstown, OH 44501 USA. GRID: grid.451516.2
FAU - Hutchinson, Amy E
AU  - Hutchinson AE
AD  - Department of Anesthesiology, St. Elizabeth Youngstown Hospital, 1044 Belmont 
      Ave., Youngstown, OH 44501 USA. GRID: grid.451516.2
FAU - Antonaccio, Tamara
AU  - Antonaccio T
AD  - OR Nursing Staff, St. Elizabeth Youngstown Hospital, 1044 Belmont Ave., 
      Youngstown, OH 44501 USA. GRID: grid.451516.2
FAU - Chance, Elisha A
AU  - Chance EA
AD  - Trauma and Neurosciences Research Department, St. Elizabeth Youngstown Hospital, 
      1044 Belmont Ave., Youngstown, OH 44501 USA. GRID: grid.451516.2
FAU - Huang, Gregory S
AU  - Huang GS
AD  - Trauma, Critical Care, and General Surgery Services, St. Elizabeth Youngstown 
      Hospital, 1044 Belmont Ave., Youngstown, OH 44501 USA. GRID: grid.451516.2
FAU - Szmaj, Gregory
AU  - Szmaj G
AD  - Department of Anesthesiology, St. Elizabeth Youngstown Hospital, 1044 Belmont 
      Ave., Youngstown, OH 44501 USA. GRID: grid.451516.2
FAU - Calabro, Kristen
AU  - Calabro K
AD  - Department of Surgery, St. Elizabeth Youngstown Hospital, 1044 Belmont Ave., 
      Youngstown, OH 44501 USA. GRID: grid.451516.2
FAU - Bishop, Cynthia
AU  - Bishop C
AD  - Surgical and Perioperative Services, St. Elizabeth Youngstown Hospital, 1044 
      Belmont Ave., Youngstown, OH 44501 USA. GRID: grid.451516.2
FAU - Schrickel, Tyson T
AU  - Schrickel TT
AD  - Department of Orthopedic Surgery, St. Elizabeth Youngstown Hospital, 1044 Belmont 
      Ave., Youngstown, OH 44501 USA. GRID: grid.451516.2
LA  - eng
SI  - ClinicalTrials.gov/NCT02984657
PT  - Journal Article
DEP - 20170822
PL  - England
TA  - Perioper Med (Lond)
JT  - Perioperative medicine (London, England)
JID - 101609072
PMC - PMC5568354
OTO - NOTNLM
OT  - Aspiration, respiratory
OT  - Hypoxemia
OT  - Operating rooms
OT  - Period, perioperative
OT  - Reverse Trendelenburg
OT  - Supine position
COIS- AUTHORS' INFORMATION: CMD has 35 years experience as a trauma surgeon and is a 
      retired board-certified surgical intensivist and general surgeon. BMH and EAC are 
      experienced full-time research assistants for the Trauma and Neurosciences 
      Research Department. AEH is a board-certified anesthesiologist and the chief of 
      anesthesiology. TA is the assistant nurse manager of the operating room nursing 
      staff. GSH is a board-certified general surgeon, a trauma surgeon, and a 
      board-certified surgical intensivist. GS is an experienced and registered nurse 
      anesthetist. KC is a senior general surgical resident. CB is the director of 
      surgical and perioperative services. TTS is the chief of orthopedic trauma 
      surgery. ETHICS APPROVAL AND CONSENT TO PARTICIPATE: This study was approved by 
      the Mercy Health Institutional Review Board for human investigations (15-023). 
      The need for written informed consent was waived, because of the study's 
      retrospective nature. CONSENT FOR PUBLICATION: Not applicable. COMPETING 
      INTERESTS: The authors declare that they have no competing interests. PUBLISHER'S 
      NOTE: Springer Nature remains neutral with regard to jurisdictional claims in 
      published maps and institutional affiliations.
EDAT- 2017/08/31 06:00
MHDA- 2017/08/31 06:01
PMCR- 2017/08/22
CRDT- 2017/08/31 06:00
PHST- 2016/12/06 00:00 [received]
PHST- 2017/08/03 00:00 [accepted]
PHST- 2017/08/31 06:00 [entrez]
PHST- 2017/08/31 06:00 [pubmed]
PHST- 2017/08/31 06:01 [medline]
PHST- 2017/08/22 00:00 [pmc-release]
AID - 67 [pii]
AID - 10.1186/s13741-017-0067-2 [doi]
PST - epublish
SO  - Perioper Med (Lond). 2017 Aug 22;6:10. doi: 10.1186/s13741-017-0067-2. 
      eCollection 2017.