Browsing by Author "Gerd Struber"

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    The Association of Intraoperative driving pressure with postoperative pulmonary complications in open versus closed abdominal surgery patients – a posthoc propensity score–weighted cohort analysis of the LAS VEGAS study
    (2021-12-01) Guido Mazzinari; Ary Serpa Neto; Sabrine N.T. Hemmes; Goran Hedenstierna; Samir Jaber; Michael Hiesmayr; Markus W. Hollmann; Gary H. Mills; Marcos F. Vidal Melo; Rupert M. Pearse; Christian Putensen; Werner Schmid; Paolo Severgnini; Hermann Wrigge; Oscar Diaz Cambronero; Lorenzo Ball; Marcelo Gama de Abreu; Paolo Pelosi; Marcus J. Schultz; Wolfgang Kroell; Helfried Metzler; Gerd Struber; Thomas Wegscheider; Hans Gombotz; Bernhard Urbanek; David Kahn; Mona Momeni; Audrey Pospiech; Fernande Lois; Patrice Forget; Irina Grosu; Jan Poelaert; Veerle van Mossevelde; Marie Claire van Malderen; Dimitri Dylst; Jeroen van Melkebeek; Maud Beran; Stefan de Hert; Luc De Baerdemaeker; Bjorn Heyse; Jurgen Van Limmen; Piet Wyffels; Tom Jacobs; Nathalie Roels; Ann De Bruyne; Stijn van de Velde; Brigitte Leva; Sandrine Damster; Benoit Plichon; Marina Juros-Zovko; Dejana Djonovic-Omanovic; Selma Pernar; Josip Zunic; Petar Miskovic; Antonio Zilic; Slavica Kvolik; Dubravka Ivic; Darija Azenic-Venzera; Sonja Skiljic; Hrvoje Vinkovic; Ivana Oputric; Kazimir Juricic; Vedran Frkovic; Jasminka Kopic; Ivan Mirkovic; Nenad Karanovic; Mladen Carev; Natasa Dropulic; Jadranka Pavicic Saric; Gorjana Erceg; Matea Bogdanovic Dvorscak; Branka Mazul-Sunko; Anna Marija Pavicic; Tanja Goranovic; Branka Maldini; Tomislav Radocaj; Zeljka Gavranovic; Inga Mladic-Batinica; Mirna Sehovic; Petr Stourac; Hana Harazim; Olga Smekalova; Martina Kosinova; Tomas Kolacek; Kamil Hudacek; Michal Drab; Jan Brujevic; Katerina Vitkova; Katerina Jirmanova; Ivana Volfova; Paula Dzurnakova; Katarina Liskova; Radovan Dudas; Radek Filipsky; Samir el Kafrawy; Hisham Hosny Abdelwahab; Tarek Metwally; Ahmed Abdel-Razek; Ahmed Mostafa El-Shaarawy; Wael Fathy Hasan; Université de Montpellier; IRCCS San Martino Polyclinic Hospital; Hospital Universitari i Politècnic La Fe; Universitätsklinikum Bonn; Massachusetts General Hospital; Università degli Studi di Genova; Queen Mary University of London; Technische Universität Dresden; Hospital Israelita Albert Einstein; Mahidol University; Medizinische Universität Wien; Nuffield Department of Medicine; Universidade de São Paulo; BG-Kliniken Bergmannstrost Halle; Università degli Studi dell'Insubria; Uppsala Universitet; The University of Sheffield; Amsterdam UMC - University of Amsterdam
    Background: It is uncertain whether the association of the intraoperative driving pressure (ΔP) with postoperative pulmonary complications (PPCs) depends on the surgical approach during abdominal surgery. Our primary objective was to determine and compare the association of time–weighted average ΔP (ΔPTW) with PPCs. We also tested the association of ΔPTW with intraoperative adverse events. Methods: Posthoc retrospective propensity score–weighted cohort analysis of patients undergoing open or closed abdominal surgery in the ‘Local ASsessment of Ventilatory management during General Anaesthesia for Surgery’ (LAS VEGAS) study, that included patients in 146 hospitals across 29 countries. The primary endpoint was a composite of PPCs. The secondary endpoint was a composite of intraoperative adverse events. Results: The analysis included 1128 and 906 patients undergoing open or closed abdominal surgery, respectively. The PPC rate was 5%. ΔP was lower in open abdominal surgery patients, but ΔPTW was not different between groups. The association of ΔPTW with PPCs was significant in both groups and had a higher risk ratio in closed compared to open abdominal surgery patients (1.11 [95%CI 1.10 to 1.20], P < 0.001 versus 1.05 [95%CI 1.05 to 1.05], P < 0.001; risk difference 0.05 [95%CI 0.04 to 0.06], P < 0.001). The association of ΔPTW with intraoperative adverse events was also significant in both groups but had higher odds ratio in closed compared to open abdominal surgery patients (1.13 [95%CI 1.12– to 1.14], P < 0.001 versus 1.07 [95%CI 1.05 to 1.10], P < 0.001; risk difference 0.05 [95%CI 0.030.07], P < 0.001). Conclusions: ΔP is associated with PPC and intraoperative adverse events in abdominal surgery, both in open and closed abdominal surgery. Trial registration: LAS VEGAS was registered at clinicaltrials.gov (trial identifier NCT01601223).
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    Intraoperative ventilator settings and their association with postoperative pulmonary complications in neurosurgical patients: Post-hoc analysis of LAS VEGAS study
    (2020-04-02) Chiara Robba; Sabrine N.T. Hemmes; Ary Serpa Neto; Thomas Bluth; Jaume Canet; Michael Hiesmayr; M. Wiersma Hollmann; Gary H. Mills; Marcos F. Vidal Melo; Christian Putensen; Samir Jaber; Werner Schmid; Paolo Severgnini; Hermann Wrigge; Denise Battaglini; Lorenzo Ball; Marcelo Gama De Abreu; Marcus J. Schultz; Paolo Pelosi; Wolfgang Kroell; Helfried Metzler; Gerd Struber; Thomas Wegscheider; Hans Gombotz; Michael Hiesmayr; Werner Schmid; Bernhard Urbanek; David Kahn; Mona Momeni; Audrey Pospiech; Fernande Lois; Patrice Forget; Irina Grosu; Jan Poelaert; Veerle Van Mossevelde; Marie Claire Van Malderen; Dimitri Dylst; Jeroen Van Melkebeek; Maud Beran; Stefan De Hert; Luc De Baerdemaeker; Bjorn Heyse; Jurgen Van Limmen; Piet Wyffels; Tom Jacobs; Nathalie Roels; Ann De Bruyne; Stijn Van De Velde; Brigitte Leva; Sandrine Damster; Benoit Plichon; Marina Juros-Zovko; Dejana Djonoviċ-Omanoviċ; Selma Pernar; Josip Zunic; Petar Miskovic; Antonio Zilic; Slavica Kvolik; Dubravka Ivic; Darija Azenic-Venzera; Sonja Skiljic; Hrvoje Vinkovic; Ivana Oputric; Kazimir Juricic; Vedran Frkovic; Jasminka Kopic; Ivan Mirkovic; Nenad Karanovic; Mladen Carev; Natasa Dropulic; Jadranka Pavicic Saric; Gorjana Erceg; Matea Bogdanovic Dvorscak; Branka Mazul-Sunko; Anna Marija Pavicic; Tanja Goranovic; Branka Maldini; Tomislav Radocaj; Zeljka Gavranovic; Inga Mladic-Batinica; Mirna Sehovic; Petr Stourac; Hana Harazim; Olga Smekalova; Martina Kosinova; Tomas Kolacek; Kamil Hudacek; Michal Drab; Jan Brujevic; Katerina Vitkova; Katerina Jirmanova; Ivana Volfova; Paula Dzurnakova; Katarina Liskova; Radovan Dudas; Radek Filipsky; Samir El Kafrawy; Hisham Hosny Abdelwahab; Tarek Metwally; Ahmed Abdel-Razek; Ospedale Policlinico San Martino; CHU Montpellier; Universitäts-Klinikum Bonn und Medizinische Fakultät; Massachusetts General Hospital; Dresden University Faculty of Medicine and University Hospital Carl Gustav Carus; Università degli Studi di Genova; Hospital Israelita Albert Einstein; Mahidol University; Hospital Universitari de Bellvitge; Medizinische Universitat Wien; Universität Leipzig; Università degli Studi dell'Insubria; University of Sheffield; Amsterdam UMC - University of Amsterdam
    © 2020 The Author(s). Background: Limited information is available regarding intraoperative ventilator settings and the incidence of postoperative pulmonary complications (PPCs) in patients undergoing neurosurgical procedures. The aim of this post-hoc analysis of the 'Multicentre Local ASsessment of VEntilatory management during General Anaesthesia for Surgery' (LAS VEGAS) study was to examine the ventilator settings of patients undergoing neurosurgical procedures, and to explore the association between perioperative variables and the development of PPCs in neurosurgical patients. Methods: Post-hoc analysis of LAS VEGAS study, restricted to patients undergoing neurosurgery. Patients were stratified into groups based on the type of surgery (brain and spine), the occurrence of PPCs and the assess respiratory risk in surgical patients in Catalonia (ARISCAT) score risk for PPCs. Results: Seven hundred eighty-four patients were included in the analysis; 408 patients (52%) underwent spine surgery and 376 patients (48%) brain surgery. Median tidal volume (VT) was 8 ml [Interquartile Range, IQR = 7.3-9] per predicted body weight; median positive end-expiratory pressure (PEEP) was 5 [3 to 5] cmH20. Planned recruitment manoeuvres were used in the 6.9% of patients. No differences in ventilator settings were found among the sub-groups. PPCs occurred in 81 patients (10.3%). Duration of anaesthesia (odds ratio, 1.295 [95% confidence interval 1.067 to 1.572]; p = 0.009) and higher age for the brain group (odds ratio, 0.000 [0.000 to 0.189]; p = 0.031), but not intraoperative ventilator settings were independently associated with development of PPCs. Conclusions: Neurosurgical patients are ventilated with low VT and low PEEP, while recruitment manoeuvres are seldom applied. Intraoperative ventilator settings are not associated with PPCs.