Hypoxemia, Lung Cancer (Diagnosis)
Conditions
Brief summary
Thoracoscopic surgery is the most common surgical approach in thoracic surgery, which reduces surgical trauma and postoperative pain compared with open thoracotomy, but postoperative complications should not be overlooked, with hypoxemia being particularly prominent. Postoperative hypoxemia is highly prevalent among patients recovering from non-cardiac surgery, accounting for over one-third of all cases. Hypoxemia impairs wound healing and leads to other severe complications such as cerebral dysfunction, arrhythmia, and myocardial ischemia, all of which adversely affect postoperative recovery. Although oxygen therapy can prevent and treat hypoxemia, many patients still experience hypoxia in the post-anesthesia care unit (PACU). Numerous studies have investigated various ventilation techniques aimed at enhancing postoperative pulmonary function, but the benefits of protective ventilation strategies may be lost during emergence from anesthesia. Several other studies also indicate that intraoperative ventilation measures do not improve postoperative pulmonary function. The lack of evidence demonstrating the efficacy of oxygen therapy or protective ventilation techniques in treating postoperative hypoxemia underscores the need to explore alternative strategies. Patient positioning during emergence from anesthesia is associated with perioperative and postoperative complications. Although no consensus exists on the optimal patient position during emergence, the supine position is often favored by anesthesiologists due to its simplicity and ease of monitoring. However, the reduced functional residual capacity associated with the supine position tends to promote airway closure and diminish gas exchange.
Detailed description
Thoracoscopic surgery is the most common surgical approach in thoracic surgery, which reduces surgical trauma and postoperative pain compared with open thoracotomy, but postoperative complications should not be overlooked, with hypoxemia being particularly prominent. Postoperative hypoxemia is highly prevalent among patients recovering from non-cardiac surgery, accounting for over one-third of all cases. Hypoxemia impairs wound healing and leads to other severe complications such as cerebral dysfunction, arrhythmia, and myocardial ischemia, all of which adversely affect postoperative recovery. Although oxygen therapy can prevent and treat hypoxemia, many patients still experience hypoxia in the post-anesthesia care unit (PACU). Numerous studies have investigated various ventilation techniques aimed at enhancing postoperative pulmonary function, but the benefits of protective ventilation strategies may be lost during emergence from anesthesia. Several other studies also indicate that intraoperative ventilation measures do not improve postoperative pulmonary function. The lack of evidence demonstrating the efficacy of oxygen therapy or protective ventilation techniques in treating postoperative hypoxemia underscores the need to explore alternative strategies. Patient positioning during emergence from anesthesia is associated with perioperative and postoperative complications. Although no consensus exists on the optimal patient position during emergence, the supine position is often favored by anesthesiologists due to its simplicity and ease of monitoring. However, the reduced functional residual capacity associated with the supine position tends to promote airway closure and diminish gas exchange. In contrast, the semi-recumbent position (SRP) has been shown to increase vital capacity by 10% to 15%, enhance functional lung volume and residual capacity, and improve diaphragmatic range of motion, thereby promoting lung expansion and gas exchange. Currently, only one study has found that in patients undergoing laparoscopic-assisted upper abdominal surgery, 30° SRP during anesthesia recovery can reduce the incidence of postoperative hypoxemia. Therefore, we conducted this real-world study to test the efficacy and optimal tilt angle of SRP in reducing hypoxemia during anesthesia recovery in a large sample of patients undergoing thoracoscopic surgery.
Interventions
BEHAVIORALSemi-reclining position
During anesthesia recovery, the patient's position should be in a semi-recumbent position
Sponsors
Shanghai Pulmonary Hospital, Shanghai, China
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Age 18-85 years old; Undergo thoracoscopic segment/lobectomy; American Society of Anesthesiologists (ASA) grade 1\ 3
Exclusion criteria
* Patients with mental or cognitive dysfunction who cannot communicate normally; Patients with tracheal catheters retained in ICU; Patients with cervical spondylosis, ankylosing spondylitis and other patients who cannot lift their upper body; Patients who have participated in other clinical trials; Patients who refuse to sign informed consent; Patients who have had chest surgery in the past.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of post-PACU hypoxemia | Perioperative | defined as SpO2 \<90% for less than 60 seconds |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Breathing comfort | Perioperative | Use a digital rating scale ranging from 0 to 10, with higher scores indicating greater comfort |
| blood gas analysis | Perioperative | — |
| The duration of PACU stay | Perioperative | — |
| Heart rate | Upon admission, before induction, after intubation, immediately after the end of surgery, immediately before extubation, immediately after admission to PACU and adjustment of position, 10 minutes after admission to PACU, and upon departure from PACU | — |
| Mean arterial pressure | Upon admission, before induction, after intubation, immediately after the end of surgery, immediately before extubation, immediately after admission to PACU and adjustment of position, 10 minutes after admission to PACU, and upon departure from PACU | — |
| The incidence of severe hypoxemia | Perioperative | SpO2\<75% or SpO2\<90% lasting for more than 60 seconds at any time |
| the time of the first episode of hypoxemia | Perioperative | — |
| Airway first aid | Perioperative | Defined as the need for jaw support to open the airway, mask noninvasive positive pressure ventilation, or pharyngeal or nasopharyngeal airway assisted ventilation, reintubulation or laryngoscope placement |
| Wound pain VAS score | measured and recorded at rest and cough, 5 and 30 minutes after extubation, before leaving PACU and 24,48 and 72 hours postoperative | — |
Other
| Measure | Time frame | Description |
|---|---|---|
| Postoperative inflammatory markers | On the first day after surgery | C-reactive protein, absolute value of neutrophils, absolute value of lymphocytes, absolute value of monocytes, white blood cell count, platelet count |
| length of hospital stay | 3-5 days after surgery | — |
| 15-item recovery quality scale (Quality of Recovery-15, QoR-15) scores | at 1 and 3 days postoperative | — |
| Adverse events related to position | Perioperative | hypotension, arrhythmia |
Countries
China
Outcome results
None listed