- Author
-
M.C.E. van der Woude
- Title
- Studies into optimization of care provided in the operating room and the intensive care unit
- Supervisors
-
M.J. Schultz
- Co-supervisors
-
P.E. Spronk
- Award date
- 12 November 2020
- Number of pages
- 224
- ISBN
- 9789492303370
- Document type
- PhD thesis
- Faculty
- Faculty of Medicine (AMC-UvA)
- Abstract
-
Intraoperative mechanical ventilation is a potentially harmful intervention. So-called ‘lung-protective’ ventilation improves outcome of intensive care patients, and maybe even of patients who need short-lasting intraoperative ventilation. A single center randomized clinical trial assessed the effect of intraoperative ventilation with lower tidal volumes (VT) with positive end-expiratory pressure (PEEP) versus intermediate VT without PEEP on pulmonary inflammation, lung injury and intraoperative fluid and vasopressor use in patients undergoing minimally invasive esophagectomy for cancer. While ventilation with lower tidal volumes (VT) with PEEP did not affect pulmonary inflammation or lung injury, the use of PEEP was associated with more use of vasopressors. Intermediate tidal volumes (without PEEP) may already be sufficiently protective but use of PEEP comes with side-effects which may have an adverse impact on outcome.
A secondary analysis of large worldwide observational study showed an increased use of lung–protective ventilation during general for surgery anesthesia, also during intrathoracic surgeries like for esophagectomy for cancer – however, in one-third of patients tidal volumes are still too large.
ICU patients typically suffer from pain, agitation or delirium – timely recognition and treatment of these symptoms may impact outcome. Current attitudes toward pain measurement and implementation of the ‘Pain, Agitation and Delirium’ (PAD) guideline in ICU patients in the Netherlands were evaluated in a prospective multicenter, before–after intervention study in seven Dutch ICUs. Implementing of these guidelines appears to be challenging, as scoring of pain and sedation increased, while scoring of delirium decreased. - Persistent Identifier
- https://hdl.handle.net/11245.1/b366ce62-74ec-4795-9747-1f8bc7e22dde
- Downloads
-
Thesis (complete)
Front matter
Chapter 1: General introduction and outline of the thesis
Chapter 2: Epidemiology, ventilation management and outcome in patients receiving intraoperative ventilation – The LAS VEGAS study cohort stratified for types of surgery and used airway devices
Chapter 3: Intraoperative mechanical ventilation practice in thoracic surgery patients and its association with postoperative pulmonary complications: Results of a multicenter prospective observational study
Chapter 4: Pulmonary levels of biomarkers for inflammation and lung injury in protective versus conventional one-lung ventilation for esophagectomy: A randomized clinical trial
Chapter 5: Effects intraoperative ventilation with peep versus intraoperative ventilation without peep on perioperative fluid and vasopressor management in patients undergoing minimally invasive esophagectomy – A post hoc analysis of a randomized clinical trial
Chapter 6: Current use of pain scores in Dutch intensive care units: A postal survey in the Netherlands
Chapter 7: Effects of implementation of the PAD-bundle in 7 intensive care units in the Netherlands – A multicenter study
Chapter 8: Summary
Chapter 9: General discussion
Chapter 10: Nederlandse samenvatting
Abbreviations; Authors and affiliations; PhD portfolio; Publications; Dankwoord; Biografie
- Supplementary materials
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