D.A Tipisev, E.S. Gorobets, V.E. Gruzdev, M.A. Anisimov, N.B. Borovkova, E.O. Kochkovaya
Russian Oncological Research Center, Ministry of Health of Russian Federation, Moscow
For correspondence: Tipisev Dmitry Anrievich — MD, senior research fellow, Department of Anesthesiology and Intensive care, Russian Oncological Research Center, Ministry of Health of Russian Federation, Moscow; e-mail: firstname.lastname@example.org
For citation: Tipisev DA Gorobets ES, Gruzdev VE, Anisimov MA, Borovkova NB, Kochkovaya EO. Whether Postoperative Mechanical Ventilation is Always Mandatory for Patients Suffered of Intraoperative Massive Hemorrhage in Elective Surgery: Arguments and Cases of Single Hospital. Intensive Care Herald. 2016;4:52–58.
Massive hemorrage (MH) — the life-threatening complication of major cancer surgery that requires urgent measures for prevention of hemorrhagic shock and multiple organ failure. Not uncommon, at the end of surgery procedure the patient suffered of MH gained not sufficient state to be extubated, thus needed in postoperative mechanical ventilation (PMV). Nevertheless, the timely effective treatment and prevention of MH consequences founded on multimodal combined anesthesia/analgesia (epidural analgesia with light sevoflurane of desflurane anesthesia) with other complex measures (i.v. infusions, vasopressors, blood components, etc) may become the basis of patient status stable enough for safe tracheal extubation (TE) on the operation table in some cases. Since the mid 90-ies of the last century, first in cardiac surgery, then in other fields of surgery can be seen the steady tendency towards early TE that tends to achieve good results, both clinical and economic. We suggested the possibility of TE at the end of surgery for 30 patients after the loss of blood volume ³ 70 %. All of them achieved predefined endpoint criteria for secure recovery of spontaneous respiration (SB) despite the duration and extent of traumatic procedures. None of our patients required reintubation postoperatively. 29 patients had been discharged from the hospital. One lethal case occurred for the reason, not associated with the early TE. The objective and subjective reasons as well as risks associated with postoperative MV are discussed. Criteria for safe and successful ET after accomplished MH are suggested. We believe, that even after the intraoperative MH, when the steady patient state condition had been gained, the prolonged MV should be objectively justified.
Keywords: massive hemorrhage, multimodal combined anesthesia, early tracheal extubation
- Fakhry S.M., Sheldon G.F. Massive transfusion in the surgical patient. In: Jeffries L.C., Brecher M.E., eds. Massive Transfusion. Bethesda, Maryland: American Association of Blood Banks, 1994.
- Klein H.G., Anstee J. Mollison’s Blood Transfusion in Clinical Medicine, 12nd ed. Oxford, UK: Wiley & Sons, 2014: 38.
- Cata J.P., Gottumukkala V. Blood loss and massive transfusion in patients undergoing ma-jor oncological surgery: what do we know? ISRN Anesthesiology. 2012(2012); Article ID 918938. URL: http://dx.doi.org/10.5402/2012/918938.
- Alvarez P., Carrasco R., Romero-Dapueto C. et al. Transfusion-Related Acute Lung Injured (TRALI): сurrent concepts. Open Respir. Med. J. 2015; 9: 92–96.
- Marik P.E., Corwin H.L. Acute lung ingury following blood transfusion: expanding the definition. Crit. Care. Med. 2008; 36(11): 3080–3084.
- Zhu F., Lee A., Chee Y.E. Fast-track cardiac care for adult cardiac surgical patients. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD003587. doi: 10.1002/14651858.CD003587.pub2. 25.
- Guller U., Anstrom K.J., Holman W.L. et al. Outcomes of early extubation after bypass surgery in the elderly. Ann. Thorac. Surg. 2004; 77(3): 781–788.
- Mandell M.S., Stoner T.J., Barnett R. et al. A multicenter evaluation of safety of early extubation in liver transplant recipients. Liver Transpl. 2007; 13(11): 1557–1563.
- Nicholson D.J., Kowalski S.E., Hamilton G.A. et al. Postoperative pulmonary function in coronary artery bypass graft surgery patients undergoing early tracheal extubation: a comparison between short-term mechanical ventilation and early extubation. J. Cardiothorac. Vasc. Anesth. 2002; 16(1): 27–31.
- Borracci R.A., Ochoa G., Ingino C.A. et al. Routine operation theatre extubation after cardiac surgery in the elderly. Interact. Cardiovasc. Thorac. Surg. 2016; 22(5): 627–632. doi: 10.1093/icvts/ivv409.
- Lanuti M., de Delva P.E., Maher A. et al. Feasibility and outcomes of an early extubation policy after esophagectomy. Ann. Thorac. Surg. 2006; 82(6): 2037–2041.
- Chandrashekar M.V., Irving M., Wayman J. et al. Immediate extubation and epidural anal-gesia allow safe management in a high-dependency unit after two-stage oesophagectomy. Results of eight years of experience in a specialized upper gastrointestinal unit in a district general hospital. Br. J. Anaesth. 2003; 90(4): 474–47
- Stone W.M., Larson J.S., Young M. et al. Early extubation after abdominal aortic reconstruction. J. Cardiothorac. Vasc. Anesth. 1998; 12(2): 174–176.
- Gall S.A. Jr, Olsen C.O., Reves J.G. et al. Beneficial effects of endotracheal extubation on ven-tricular performance. Implications for early extubation after cardiac operations. J. Thorac. Cardiovasc. Surg. 1988; 95(5): 819–827.
- Higgins T.L. Pro: early endotracheal extubation is preferable to late extubation in patients following coronary artery surgery. J. Cardiothorac. Vasc. Anesth. 1992; 6(4): 488–493.
- Kozek-Langenecker S.A., Afshari A., Albaladejo P. et al. Management of severe perioperative bleeding Guidelines from the European Society of Anaesthesiology. Eur. J. Anaesthesiol. 2013; 30: 270–382.
- Stainsby D., MacLennan S., Thomas D. et al. Guidelines on the management of massive blood loss British Committee for Standards in Haematology. British Journal of Haematology. 2006; 135: 634–641.
- Wuethrich P.Y., Burkhard F.C., Thalmann G.N. et al. Restrictive deferred hydration combined with preemptive norepinephrine infusion during radical cystectomy reduces postoperative complications and hospitalization time: a randomized clinical trial. Anesthesiology. 2014; 120(2): 365–3 doi: 10.1097/ALN.0b013e3182a44440.
- Popovsky M.A. Transfusion-associated circulatory overload. ISBT Science Series. 2008; 3: 166–169. doi:10.1111/j.1751-2824.2008.00153.x.
- Narick C., Triulzi D.J., Yazer M.H. Transfusion-associated circulatory over-load after plasma transfusion. Transfusion. 2012; 52: 160–165. doi:10.1111/j.1537-2995.2011.03247.x.
- Ломидзе С.В. Интенсивная терапия в раннем послеоперационном периоде у онкологических больных, перенесших массивную интраоперационную кровопотерю: Автореф. дис. … канд. мед. наук. М., 2007 [Lomidze S.V. Intensive therapy in the early postoperative period in patients with cancer undergoing massive intraoperative blood loss. Moscow, 2007. (In Russ)]
- Gajic O., Dara S.I., Mendez J.L. et al. Ventilator-associated lung injury in patients without acute lung injury at the onset of mechanical ventilation. Crit. Care Med. 2004; 32(9): 1817–1824.
- Rocco P.R., Dos Santos C., Pelosi P. Pathophysiology of ventilator-associated lung injury. Curr. Opin. Anaesthesiol. 2012; 25(2): 123–130. doi: 10.1097/ACO.0b013e32834f8c7f.
- Vassilakopoulos T., Petrof J. Ventilator-induced Diaphragmatic Dysfunction. American Journal of Respiratory and Critical Care Medicine. 2004);169(3): 336–341. doi: 10.1164/rccm.200304-489CP.
- Hope W. Laryngeal and Tracheal injury. In: Atlee J.L. (ed.) Complications in Anesthesia, 2nd Philadelphia: Saunders Elsevier, 2007.
- Cairo J.M. Pilbeam’s Mechanical Ventilation: Physiological and Clinical Applications, 6th Elsevier, 2016: 219.
- Pierson D.J. Complications associated with mechanical ventilation. Crit. Care Clin. 1990; 6(3): 711–724.
- Brambrink A.M., Kirsch R. Essentials of Neurosurgical Anesthesia & Critical Care: Strategies for prevention, early detection and successful management of perioperative complications. Springer, 2011.
- Pennock B.E., Crawshaw L., Maher T. et al. Distressful events in the ICU as perceived by patients recovering from coronary artery bypass surgery. Heart Lung. 1994; 23(4): 323–327.
- Siobal M.S., Kallet R.H., Kivett V.A. et al. Use of dexmedetomidine to facilitate extubation in surgical intensive-care-unit patients who failed previous weaning attempts following prolonged mechanical ventilation: a pilot study. Respir. Care. 2006; 51(5): 492–496.
- Ibrahim E.H., Iregui M., Prentice D. et al. Deep vein thrombosis during prolonged mechanical ventilation despite prophylaxis. Crit. Care Med. 2002; 30(4): 771–774.
- Rice T.W., Wheeler A.P., Bernard G.R. et al. National Institutes of Health, National Heart, Lung, and Blood Institute ARDS Network. Comparison of the SpO2/FIO2 ratio and the PaO2/FIO2 ratio in patients with acute lung injury or ARDS. Chest. 2007; 132(2): 410–417.
- Bilan N., Dastranji A., Ghalehgolab Behbahani A. Comparison of the SpO2/FiO2 Ratio and the PaO2/FiO2 Ratio in Patients With Acute Lung Injury or Acute Respiratory Distress Syndrome. Journal of Cardiovascular and Thoracic Research. 2015; 7(1): 28–31. doi: 15171/jcvtr.2014.06.
- Carson J.L., Duff A., Poses R.M. et al. Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet. 1996; 348(9034):1055–1060. doi: http://dx.doi.org/10.1016/S0140-6736(96)04330-9.
- Fitch Z.W., Debesa O., Ohkuma R. et al. A protocol-driven approach to early extubation after heart surgery. J. Thorac. Cardiovasc. Surg. 2014; 147: 1344–1350.
- Slinger P. Update on anesthetic management for pneumonectomy Curr. Opin. Anaesthesiol. 2009; 22: 31–37.
- Cerfolio R.J., Pickens A., Bass C., Katholi C. Fast-tracking pulmonary resections. J. Thorac. Cardiovasc. Surg. 2001; 122: 318–324.
- Hartigan P.M. Practical Handbook of Thoracic Anesthesia. New York: Springer, 2012: 492.