TY - JOUR
T1 - Efficacy of Oscillation and Lung Expansion in Reducing Postoperative Pulmonary Complication
AU - Huynh, Toan T.
AU - Liesching, Timothy N.
AU - Cereda, Maurizio
AU - Lei, Yuxiu
AU - Frazer, Michael J.
AU - Nahouraii, Michael R.
AU - Diette, Gregory B.
N1 - Funding Information:
Disclosure Information: Dr Diette is a consultant to and receives support for travel, fees for participation in review activities, and payment for writing or reviewing manuscripts for Hill-Rom, the sponsor of the study. Hill-Rom Company Inc provided funding for the study, assisted with development of the study protocol, provided oversight of the conduct of the study, and reviewed the study manuscript.Support: Dr Diette's institution receives grant payments from the NIH and the US Economic Development Administration.
Publisher Copyright:
© 2019 by the American College of Surgeons
PY - 2019/11
Y1 - 2019/11
N2 - Background: Postoperative pulmonary complications (PPCs) cause high morbidity and mortality. Targeted treatment for patients at risk for PPCs can improve outcomes. This multicenter prospective trial examined the impact of oscillation and lung expansion (OLE) therapy, using continuous high-frequency oscillation and continuous positive expiratory pressure on PPCs in high-risk patients. Methods: In stage I, CPT and ICD codes were queried for patients (n = 210) undergoing thoracic, upper abdominal, or aortic open procedures at 3 institutions from December 2014 to April 2016. Patients were selected randomly. Age, comorbidities, American Society of Anesthesiologists physical status classification scores, and PPC rates were determined. In stage II, 209 subjects were enrolled prospectively from October 2016 to July 2017 using the same criteria. Stage II subjects received OLE treatment and standard respiratory care. The PPCs rate (prolonged ventilation, high-level respiratory support, pneumonia, ICU readmission) were compared. We also compared ICU length of stay (LOS), hospital LOS, and mortality using t-tests and analysis of covariance. Data are mean ± SD. Results: There were 419 subjects. Stage II patients were older (61.1 ± 13.7 years vs 57.4 ± 15.5 years; p < 0.05) and had higher American Society of Anesthesiologists scores. Treatment with OLE decreased PPCs from 22.9% (stage I) to 15.8% (stage II) (p < 0.01 adjusted for age, American Society of Anesthesiologists score, and operation time). Similarly, OLE treatment reduced ventilator time (23.7 ± 107.5 hours to 8.5 ± 27.5 hours; p < 0.05) and hospital LOS (8.4 ± 7.9 days to 6.8 ± 5.0 days; p < 0.05). No differences in ICU LOS, pneumonia, or mortality were observed. Conclusions: Aggressive treatment with OLE reduces PPCs and resource use in high-risk surgical patients.
AB - Background: Postoperative pulmonary complications (PPCs) cause high morbidity and mortality. Targeted treatment for patients at risk for PPCs can improve outcomes. This multicenter prospective trial examined the impact of oscillation and lung expansion (OLE) therapy, using continuous high-frequency oscillation and continuous positive expiratory pressure on PPCs in high-risk patients. Methods: In stage I, CPT and ICD codes were queried for patients (n = 210) undergoing thoracic, upper abdominal, or aortic open procedures at 3 institutions from December 2014 to April 2016. Patients were selected randomly. Age, comorbidities, American Society of Anesthesiologists physical status classification scores, and PPC rates were determined. In stage II, 209 subjects were enrolled prospectively from October 2016 to July 2017 using the same criteria. Stage II subjects received OLE treatment and standard respiratory care. The PPCs rate (prolonged ventilation, high-level respiratory support, pneumonia, ICU readmission) were compared. We also compared ICU length of stay (LOS), hospital LOS, and mortality using t-tests and analysis of covariance. Data are mean ± SD. Results: There were 419 subjects. Stage II patients were older (61.1 ± 13.7 years vs 57.4 ± 15.5 years; p < 0.05) and had higher American Society of Anesthesiologists scores. Treatment with OLE decreased PPCs from 22.9% (stage I) to 15.8% (stage II) (p < 0.01 adjusted for age, American Society of Anesthesiologists score, and operation time). Similarly, OLE treatment reduced ventilator time (23.7 ± 107.5 hours to 8.5 ± 27.5 hours; p < 0.05) and hospital LOS (8.4 ± 7.9 days to 6.8 ± 5.0 days; p < 0.05). No differences in ICU LOS, pneumonia, or mortality were observed. Conclusions: Aggressive treatment with OLE reduces PPCs and resource use in high-risk surgical patients.
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U2 - 10.1016/j.jamcollsurg.2019.06.004
DO - 10.1016/j.jamcollsurg.2019.06.004
M3 - Article
C2 - 31362061
AN - SCOPUS:85072282645
SN - 1072-7515
VL - 229
SP - 458-466.e1
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 5
ER -