PMID- 30236253 OWN - NLM STAT- MEDLINE DCOM- 20190122 LR - 20190122 IS - 1471-6771 (Electronic) IS - 0007-0912 (Linking) VI - 121 IP - 4 DP - 2018 Oct TI - Adoption of Lung Protective ventilation IN patients undergoing Emergency laparotomy: the ALPINE study. A prospective multicentre observational study. PG - 909-917 LID - S0007-0912(18)30456-2 [pii] LID - 10.1016/j.bja.2018.04.048 [doi] AB - BACKGROUND: Emergency abdominal surgery is associated with a high risk of postoperative pulmonary complications (PPCs). The primary aim of this study was to determine whether patients undergoing emergency laparotomy are ventilated using a lung-protective ventilation strategy employing tidal volume 5 cm H(2)O, and recruitment manoeuvres. The secondary aim was to investigate the association between ventilation factors (lung-protective ventilation strategy, intraoperative FiO(2), and peak inspiratory pressure) and the occurrence of PPCs. METHODS: Data were collected prospectively in 28 hospitals across London as part of routine National Emergency Laparotomy Audit (NELA). Patients were followed for 7 days. Complications were defined according to the European Perioperative Clinical Outcome definition. RESULTS: Data were collected from 568 patients. The median [inter-quartile range (IQR)] tidal volume observed was 500 ml (450-540 ml), corresponding to a median tidal volume of 8 ml kg(-1) ideal body weight(-1) (IQR: 7.2-9.1 ml). A lung-protective ventilation strategy was employed in 4.9% (28/568) of patients, and was not protective against the occurrence of PPCs in the multivariable analysis (hazard ratio=1.06; P=0.69). Peak inspiratory pressure of <30 cm H(2)O was protective against development of PPCs (hazard ratio=0.46; confidence interval: 0.30-0.72; P=0.001). Median FiO(2) was 0.5 (IQR: 0.44-0.53), and an increase in FiO(2) by 5% increased the risk of developing a PPC by 8% (2.6-14.1%; P=0.008). CONCLUSIONS: Both intraoperative peak inspiratory pressure and FiO(2) are independent factors significantly associated with development of a postoperative pulmonary complication in emergency laparotomy patients. Further studies are required to identify causality and to demonstrate if their manipulation could lead to better clinical outcomes. CI - Copyright (c) 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved. FAU - Watson, X AU - Watson X AD - Adult Critical Care Directorate and Department of Anaesthesia, St George's University Hospitals NHS Foundation Trust, St George's University of London, London, UK. Electronic address: ugm2xw@doctors.org.uk. FAU - Chereshneva, M AU - Chereshneva M AD - Department of Anaesthesia, Frimley Park Hospital, Frimley, Surrey, UK. FAU - Odor, P M AU - Odor PM AD - Department of Anaesthesia, St George's University Hospitals NHS Foundation Trust, London, UK. FAU - Chis Ster, I AU - Chis Ster I AD - Institute of Infection and Immunity, St George's University of London, London, UK. CN - Pan-London Perioperative Audit and Research Network (PLAN) FAU - Cecconi, M AU - Cecconi M AD - Adult Critical Care Directorate and Department of Anaesthesia, St George's University Hospitals NHS Foundation Trust, St George's University of London, London, UK. LA - eng PT - Journal Article PT - Multicenter Study PT - Observational Study DEP - 20180629 PL - England TA - Br J Anaesth JT - British journal of anaesthesia JID - 0372541 RN - S88TT14065 (Oxygen) SB - IM MH - Adult MH - Aged MH - Emergency Medical Services MH - Female MH - Humans MH - Inspiratory Capacity MH - Laparotomy/*adverse effects MH - London MH - Male MH - Middle Aged MH - Oxygen/blood MH - Positive-Pressure Respiration MH - Postoperative Complications/epidemiology/*prevention & control MH - Prospective Studies MH - Respiration, Artificial/*methods MH - Tidal Volume MH - Ventilator-Induced Lung Injury/epidemiology/*prevention & control OTO - NOTNLM OT - anesthesia, general OT - lung-protective ventilation OT - postoperative pulmonary complications OT - ventilation, mechanical FIR - Johnston, C IR - Johnston C FIR - Huddart, S IR - Huddart S FIR - Woods, J IR - Woods J FIR - Hadi, N IR - Hadi N FIR - Ali, S IR - Ali S FIR - Thorning, G IR - Thorning G FIR - Gill, P IR - Gill P FIR - Boomers, O IR - Boomers O FIR - Rope, T IR - Rope T FIR - Bartlett, R IR - Bartlett R FIR - Kuttler, A IR - Kuttler A FIR - O'Carroll-Kuehn, B IR - O'Carroll-Kuehn B FIR - Dickinson, M IR - Dickinson M FIR - Lyness, C IR - Lyness C FIR - Jha, R IR - Jha R FIR - Patel, S IR - Patel S FIR - Raj, A IR - Raj A FIR - Tanqueray, T IR - Tanqueray T FIR - Cox, M IR - Cox M FIR - Khader, A IR - Khader A FIR - Vashisht, S IR - Vashisht S FIR - Liyanage, S IR - Liyanage S FIR - Ahmed, K IR - Ahmed K FIR - Whitehead, J IR - Whitehead J FIR - Patel, N IR - Patel N FIR - Liu, S IR - Liu S FIR - Patel, C IR - Patel C FIR - Hayward, L IR - Hayward L FIR - Leonard, S IR - Leonard S FIR - Hare, S IR - Hare S FIR - Saha, R IR - Saha R FIR - de Bois, J IR - de Bois J FIR - Winterbottom, T IR - Winterbottom T FIR - Choo, Y IR - Choo Y FIR - Oliver, C M IR - Oliver CM FIR - Timbrell, D IR - Timbrell D FIR - Sinnott, M IR - Sinnott M FIR - Yip, E IR - Yip E FIR - Trask, N IR - Trask N FIR - Sothisrihar, S IR - Sothisrihar S FIR - Shaw, M IR - Shaw M FIR - Thorat, P IR - Thorat P FIR - Shah, D IR - Shah D FIR - Leir, S IR - Leir S FIR - Farag, M IR - Farag M FIR - Duffen, A IR - Duffen A FIR - McCretton, T IR - McCretton T FIR - Wojcikiewicz, T IR - Wojcikiewicz T FIR - King, C IR - King C FIR - Pennington, J IR - Pennington J FIR - Patel, M IR - Patel M FIR - Kok, W IR - Kok W FIR - Gunarathna, D IR - Gunarathna D FIR - Carter, L IR - Carter L FIR - Spence, E IR - Spence E FIR - Chambers, K IR - Chambers K FIR - Cervi, E IR - Cervi E FIR - Cummins, J IR - Cummins J FIR - Shah, N IR - Shah N FIR - Eeles, A IR - Eeles A FIR - Chu, A IR - Chu A FIR - Webb, C IR - Webb C FIR - Nolan, L IR - Nolan L FIR - McHugh, B IR - McHugh B FIR - Walls, A IR - Walls A FIR - Lakhani, R IR - Lakhani R FIR - Matthews, S IR - Matthews S FIR - Hussein, Z IR - Hussein Z FIR - Wang, S IR - Wang S FIR - Weisskopf, R IR - Weisskopf R FIR - Talbot, H IR - Talbot H FIR - Verney, C IR - Verney C FIR - Nurmi, E IR - Nurmi E FIR - Henderson, K IR - Henderson K FIR - Beesley, O R IR - Beesley OR FIR - Hunter, J IR - Hunter J FIR - Nicholls, L IR - Nicholls L FIR - Robles, A IR - Robles A FIR - Lee, S IR - Lee S FIR - Hawkins, R IR - Hawkins R FIR - Patel, K IR - Patel K FIR - Kwok, A IR - Kwok A FIR - Han, J IR - Han J FIR - Allana, A IR - Allana A FIR - Kestner, S IR - Kestner S FIR - Roopra, A IR - Roopra A FIR - Edwards, L IR - Edwards L FIR - O'Dell, T IR - O'Dell T FIR - Selby, J IR - Selby J FIR - Bickmore, E IR - Bickmore E FIR - Remeta, P IR - Remeta P FIR - Karsten, E IR - Karsten E FIR - Winterbottom, T IR - Winterbottom T FIR - Daum, P IR - Daum P FIR - Loughnan, A IR - Loughnan A FIR - Heggarty, A IR - Heggarty A FIR - Patel, S IR - Patel S FIR - Bowes, H IR - Bowes H FIR - Gunaratna, D IR - Gunaratna D FIR - Cronin, J IR - Cronin J FIR - Post, B IR - Post B FIR - Blunt, N IR - Blunt N FIR - Gilbert-Kawai, E IR - Gilbert-Kawai E FIR - Gray, M IR - Gray M FIR - Highton, D IR - Highton D FIR - Edwards, L IR - Edwards L FIR - Robles, A IR - Robles A FIR - Finlay, C IR - Finlay C FIR - Pennington, J IR - Pennington J FIR - Clancy, O IR - Clancy O FIR - Bampoe, S IR - Bampoe S FIR - O'Carroll, J IR - O'Carroll J FIR - Wickham, A IR - Wickham A FIR - Wordsworth, H IR - Wordsworth H FIR - Williams, F IR - Williams F FIR - Hackney, J IR - Hackney J FIR - King, C IR - King C FIR - Marsh, V IR - Marsh V FIR - Davies, O IR - Davies O FIR - Bird, R IR - Bird R FIR - Patel, R IR - Patel R FIR - Finlay, C IR - Finlay C FIR - Philips, S IR - Philips S FIR - Laycock, H IR - Laycock H FIR - Morkane, C IR - Morkane C FIR - Grailey, K IR - Grailey K FIR - El-Boghdadly, K IR - El-Boghdadly K FIR - Hansen, T P IR - Hansen TP FIR - McHugh, B IR - McHugh B EDAT- 2018/09/22 06:00 MHDA- 2019/01/23 06:00 CRDT- 2018/09/22 06:00 PHST- 2017/11/01 00:00 [received] PHST- 2018/04/03 00:00 [revised] PHST- 2018/05/23 00:00 [accepted] PHST- 2018/09/22 06:00 [entrez] PHST- 2018/09/22 06:00 [pubmed] PHST- 2019/01/23 06:00 [medline] AID - S0007-0912(18)30456-2 [pii] AID - 10.1016/j.bja.2018.04.048 [doi] PST - ppublish SO - Br J Anaesth. 2018 Oct;121(4):909-917. doi: 10.1016/j.bja.2018.04.048. Epub 2018 Jun 29.