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3. Risk assessment for major adverse cardiovascular events after noncardiac surgery using self-reported functional capacity: international prospective cohort study

Author

Lurati, Giovanna, Spadaro, Savino, Matute, Purificación, Ionescu, Daniela, Bolliger, Daniel, Szczeklik, Wojciech, Turhan, Sanem Cakar, van Waes, Judith, Lagarto, Filipa, Theodoraki, Kassiani, Howell, Simon J., Gupta, Anil, De Hert, Stefan, Ovezov, Alexey, Tollinche, Luis E., Kuzmanovska, Biljana, Barisin, Stjepan, Poredos, Peter, Arabadzhieva, Daniela, Unic-Stojanovic, Dragana, Fleischmann, Edith, Meistelman, Claude, Buggy, Donal J., Calleja, Paul, Hasani, Antigona, Kemper, Johann, Kohaupt, Lena, Witzler, Jette, Tuzhikov, Michael, Roth, Sebastian, Stroda, Alexandra, Schultze, Cornelia, Verbarg, Nele, Gehrke, Christian, Klemann, Anna Katharina, Hagebölling, Friederike, Albrecht, Svenja, Stroeder, Jakob, Schubert, Ann-Kristin, Espeter, Florian, Russe, Benedikt, Weigand, Markus A., Bergmann, Lars, Unterberg, Matthias, Bischoff, Petra, Pirzer, Raphael, Rach, Patric Rene, Ott, Klaus, Zarbock, Alexander, Kowark, Ana, Neumann, Claudia, Marchand, Bahareh, Sponholz, Christoph, Rueffert, Henrik, Kramer, Mira, Piekarski, Florian, Carollo, Melissa, Novazzi, Cecilia, Toso, Fiorenza, Bacuzzi, Alessandro, Ragazzi, Riccardo, Volta, Carlo Alberto, De Giorgi, Francesco, Bacer, Barbara, Federico, Antonio, Chiumello, Davide, Vetrugno, Luigi, Castella, Alberto, Tesoro, Simonetta, Cotoia, Antonella, Bignami, Elena, Bellissima, Agrippino, Cortegiani, Andrea, Crisman, Marco, Toninelli, Arturo, Piazza, Ornella, Mirabella, Lucia, Bossolasco, Matteo, Bona, Francesco, Perdomo, Juan Manuel, Coca-Martinez, Miquel, Carramiñana, Albert, Servén, Marta Giné, González, Astrid Batalla, Gil Sánchez, José Maria, Becerra-Bolaños, Ángel, Rodríguez-Pérez, Aurelio, Soler, Anna Artigas, Basso, Morena, Font, Anna Peig, Vernetta, Diana, Santos, Julia Hernando, Muñoz, Enrique Alday, Olivares, Mercedes Cabellos, Marco, Gregorio, Lopez, Maria Bermudez, Barrio, Javier, Forés, María Isabel, Boix, Estefanía, Ayuso, Mercedes, Petre, Bogdan Sorel, Oprea, Ioana Sorina, Latiș, Mihai Dan, Margarit, Simona, Vasian, Horatiu, Tomescu, Dana, Cîndea, Iulia, Dirzu, Dan Sebastian, Copotoiu, Sanda-Maria, Moise, Alida, Bubenek-Turconi, Serban, Valeanu, Liana, Wanner, Patrick Mark, Djurdjevic, Mirjana, Nuth, Sandra, Seeberger, Esther, Goettel, Nicolai, Kamber, Firmin, Ganter, Michael Thomas, Gerber, Thomas Jan, Schneebeli, Daniela, Pregernig, Andreas, Grape, Sina, Tomala, Simon, Pinto, Bernardo Bollen, Żukowski, Maciej, Zegan-Barańska, Małgorzata, Karolak, Igor, Krzych, Lukasz, Czajka, Szymon, Studzińska, Dorota, Kluzik, Anna, Koszel, Tomasz, Pabjańczyk, Izabela, Gajdosz, Anna, Erkoc, Suheyla Karadag, Meco, Basak Ceyda, Koltka, Ahmet Kemalettin, Dincer, Muserref Beril, Ekmekçi, Perihan, Saracoglu, Kemal Tolga, Solmaz, Filiz Alkaya, Ozcelik, Menekse, Arun, Oguzhan, Dilmen, Ozlem Korkmaz, Preckel, Benedikt, Hollmann, Markus W., Hazen, Yannick, Donald de Boer, Hans, Epema, Anne, Koopman, Seppe, Van Lier, Felix, Pinto, Rita, Carrão, André, Ribeiro, Daniel, Mourão, Joana, Coelho, Miguel, Losa, Nuno, Santos, Nuno, Cabral, Luis, Afonso, Diana, Zenha, Sérgio, Ramos, Cristina, Hipólito, Carla, Vasilaki, Maria, Andreeva, Antonia, Zaimi, Donika, Chalkias, Athanasios, Spyraki, Maria, Rekatsina, Martina, Tsaousi, Georgia, Short, Anthony, Meier, Sonja, Madhuri, Thumuluru Kavitha, Latham, Scott, Knock, James, Drummond, Andrew, Ramsden, Fiona, Kubisz-Pudelko, Agnieszka, Walker, James, Moppett, Iain, White, Louise, Jackson, Matthew, Reschreiter, Henrik, Innes, Richard, Chew, Michelle, Kalman, Sigridur, Wallden, Jakob, Schening, Anna, Jonikaite, Lina, Enlund, Anna, De Baerdemaeker, Luc, Morrison, Stuart, Rex, Steffen, Alexis, Alexandros, Khoronenko, Viktoria E., Belskii, Vladislav, Kaznacheeva, Kseniya, Gritsan, Alexey, Yeoh, Cindy B., Malinovska-Nikolovska, Liljana, Golubović, Mladjan, Kotzinger, Oskar, Des Deserts, Marc Danguy, Ducrocq, Nicolas, Bonnet, Jean François, Cusack, Barbara, Nallbani, Rajmonda, Daamen, Sylvia, Plichon, Benoit, Harlet, Pierre, Farsi, Slama, Sepehr, Saman Homayun, Espinosa, David, Lurati Buse, Giovanna A., Mauermann, Eckhard, Filipovic, Miodrag, Beck-Schimmer, Beatrice, Gillmann, Hans-Jörg, Guzzetti, Luca, Kotfis, Katarzyna, Wulf, Hinnerk, Larmann, Jan, Corneci, Dan, and Chammartin-Basnet, Frederique

Published
2023
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4. A framework for perioperative care for lower extremity vascular bypasses: A Consensus Statement by the Enhanced Recovery after Surgery (ERAS®) Society and Society for Vascular Surgery

Author

McGinigle, Katharine L., Spangler, Emily L., Ayyash, Katie, Vavra, Ashley K., Arya, Shipra, Settembrini, Alberto M., Thomas, Merin M., Dell, Kate E., Swiderski, Iris J., Davies, Mark G., Setacci, Carlo, Urman, Richard D., Howell, Simon J., Garg, Joy, Ljungvist, Olle, and de Boer, Hans D.

Published
2023
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5. System-level policies on appropriate opioid use, a multi-stakeholder consensus

Author

Forget, Patrice, Patullo, Champika, Hill, Duncan, Ambekar, Atul, Baldacchino, Alex, Cata, Juan, Chetty, Sean, Cox, Felicia J., de Boer, Hans D., Dinwoodie, Kieran, Dom, Geert, Eccleston, Christopher, Fullen, Brona, Jutila, Liisa, Knaggs, Roger D., Lavand’homme, Patricia, Levy, Nicholas, Lobo, Dileep N., Pogatzki-Zahn, Esther, Scherbaum, Norbert, Smith, Blair H., van Griensven, Joop, and Gilbert, Steve

Published
2022
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6. Perioperative care in open aortic vascular surgery: A consensus statement by the Enhanced Recovery After Surgery (ERAS) Society and Society for Vascular Surgery

Author

McGinigle, Katharine L., Spangler, Emily L., Pichel, Adam C., Ayyash, Katie, Arya, Shipra, Settembrini, Alberto M., Garg, Joy, Thomas, Merin M., Dell, Kate E., Swiderski, Iris J., Lindo, Fae, Davies, Mark G., Setacci, Carlo, Urman, Richard D., Howell, Simon J., Ljungqvist, Olle, and de Boer, Hans D.

Published
2022
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18. Adaptive radiotherapy: The Elekta Unity MR-linac concept

Author

Winkel, Dennis, Bol, Gijsbert H., Kroon, Petra S., van Asselen, Bram, Hackett, Sara S., Werensteijn-Honingh, Anita M., Intven, Martijn P.W., Eppinga, Wietse S.C., Tijssen, Rob H.N., Kerkmeijer, Linda G.W., de Boer, Hans C.J., Mook, Stella, Meijer, Gert J., Hes, Jochem, Willemsen-Bosman, Mirjam, de Groot-van Breugel, Eline N., Jürgenliemk-Schulz, Ina M., and Raaymakers, Bas W.

Published
2019
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19. Individual lymph nodes: “See it and Zap it”

Author

Winkel, Dennis, Werensteijn-Honingh, Anita M., Kroon, Petra S., Eppinga, Wietse S.C., Bol, Gijsbert H., Intven, Martijn P.W., de Boer, Hans C.J., Snoeren, Louk M.W., Hes, Jochem, Raaymakers, Bas W., and Jürgenliemk-Schulz, Ina M.

Published
2019
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25. Microcirculatory tissue perfusion during general anaesthesia and noncardiac surgery

Author

Flick, Moritz, Schreiber, Tim-Henrik, Montomoli, Jonathan, Krause, Linda, de Boer, Hans D, Kouz, Karim, Scheeren, Thomas W L, Ince, Can, Hilty, Matthias P, Saugel, Bernd, Intensive Care, University of Zurich, Saugel, Bernd, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), Biomedical Engineering and Physics, ACS - Microcirculation, Graduate School, Translational Physiology, and ACS - Atherosclerosis & ischemic syndromes

Subjects
OUTCOMES, SEPSIS, Microcirculation, Microcirculation/physiology, Surgical Wound, Hemodynamics, BLOOD-PRESSURE, 610 Medicine & health, Hemodynamics/physiology, Anesthesia, General, THERAPY, SUBLINGUAL MICROCIRCULATION, Perfusion, Anesthesiology and Pain Medicine, Humans, Anesthesia, MAJOR ABDOMINAL-SURGERY, ALGORITHM, 2703 Anesthesiology and Pain Medicine, 10023 Institute of Intensive Care Medicine, General, HIGH-RISK PATIENTS, INDEX
Abstract

BACKGROUND: Handheld vital microscopy allows direct observation of red blood cells within the sublingual microcirculation. Automated analysis allows quantifying microcirculatory tissue perfusion variables - including tissue red blood cell perfusion (tRBCp), a functional variable integrating microcirculatory convection and diffusion capacities.OBJECTIVE: We aimed to describe baseline microcirculatory tissue perfusion in patients presenting for elective noncardiac surgery and test that microcirculatory tissue perfusion is preserved during elective general anaesthesia for noncardiac surgery.DESIGN: Prospective observational study.SETTING: University Medical Center Hamburg-Eppendorf, Hamburg, Germany.PATIENTS: 120 elective noncardiac surgery patients (major abdominal, orthopaedic or trauma and minor urologic surgery) and 40 young healthy volunteers.MAIN OUTCOME MEASURES: We measured sublingual microcirculation using incident dark field imaging with automated analysis at baseline before induction of general anaesthesia, under general anaesthesia before surgical incision and every 30 min during surgery. We used incident the dark field imaging technology with a validated automated analysis software.RESULTS: A total of 3687 microcirculation video sequences were analysed. Microcirculatory tissue perfusion variables varied substantially between individuals - but ranges were similar between patients and volunteers. Under general anaesthesia before surgical incision, there were no important changes in tRBCp, functional capillary density and capillary haematocrit compared with preinduction baseline. However, total vessel density was higher and red blood cell velocity and the proportion of perfused vessels were lower under general anaesthesia. There were no important changes in any microcirculatory tissue perfusion variables during surgery.CONCLUSION: In patients presenting for elective noncardiac surgery, baseline microcirculatory tissue perfusion variables vary substantially between individuals - but ranges are similar to those in young healthy volunteers. Microcirculatory tissue perfusion is preserved during general anaesthesia and noncardiac surgery - when macrocirculatory haemodynamics are maintained.

Published
2022

26. NaCl 3% bolus therapy as emergency treatment for severe hyponatremia: Comparison of 100 ml versus 250 ml. Supplemental material

Author

Massop, Karen, Haverkort, Dieneke, Bech, Anneke, and De Boer, Hans

Abstract

This containsthe supplemental material of the following article: NaCl 3% bolus therapy as emergency treatment for severe hyponatremia: Comparison of 100 ml versus 250 ml.,Karen Massop, MD, Dieneke A Haverkort, MD, Anneke P Bech, MD, PhD, Hans de Boer, MD, PhD, The Journal of Clinical Endocrinology & Metabolism, 2023

Published
2023
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28. Development of an Enhanced Recovery After Surgery Surgical Safety Checklist Through a Modified Delphi Process

Author

Pilkington, Mercedes, Nelson, Gregg, Cauley, Christy, Holder, Kari, Ljungqvist, Olle, Molina, George, Oodit, Ravi, Brindle, Mary E., Alvarez, Adrian, Cardosa-Wagner, Ainsley, Lee, Alan, Gregory, Alexander, Cochran, Allyson R, Altman, Alon, Kefleyesus, Amaniel, Cameron, Anna, Fagotti, Anna, Fabrizio, Anne, Gil-Moreno, Antonio, Babaier, Aziz, Pultram, B B, Pache, Basile, Riedel, Bernhard, Jim, Brent, Jago, Caitlin, Achtari, Chahin, Jones, Chris, Noss, Chris, Aubrey, Christa, Fotopoulou, Christina, Temple-Oberle, Claire, Warden, Claire, Laflamme, Claude, Vrochides, Dionisios, Coetzee, Emile, Chacon, Enrique, Miralpeix, Ester, Panieri, Eugenio, Bhandoria, Geetu, Glaser, Gretchen, de Boer, Hans, Smid, Henriette, Thomas, Jackie, Ripolles-Melchor, Javier, Huang, Jeffrey, Bennett, Jessica, Dort, Joseph C, McGinigle, Katharine, Arendt, Katherine, Eias, Kevin, How, Kwang Yeong, Meyer, Larissa, Hopkins, Laura, Wijk, Lena, Roberts, Lesley, Helpman, Limor, Mack, Lloyd, Burns, Mairead, Roxas, Manuel, Sioson, Marianna, Hubner, Martin, Scott, Michael, Yang, Michael, Alruwaisan, Mohammed, Thomakos, Nikolaos, Sgarbura, Olivia, Chu, Pamela, Vendittoli, Pascal-André, Trudeau, Pat, Ramirez, Pedro, Findley, Rachelle, Arora, Rakesh, Stone, Rebecca, Ferguson, Sarah, Dowdy, Sean, Pin, Sophia, Bisch, Steven, Wallace, Sumer, Rockall, Timothy, Paul, Timothy, and Addor, Valerie

Subjects
General Medicine
Published
2023

32. Expert Multinational Consensus Statement for Total Intravenous Anaesthesia (TIVA) Using the Delphi Method

Author

Uitenbosch, Giulia, primary, Sng, Daniel, additional, Carvalho, Hugo N., additional, Cata, Juan P., additional, De Boer, Hans D., additional, Erdoes, Gabor, additional, Heytens, Luc, additional, Lois, Fernande Jane, additional, Rousseau, Anne-Françoise, additional, Pelosi, Paolo, additional, Forget, Patrice, additional, and Nesvadba, David, additional

Published
2022
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38. Application of postmortem imaging modalities in cases of sudden death due to cardiovascular diseases–current achievements and limitations from a pathology perspective

Author

Katarzyna, Michaud, Christina, Jacobsen, Cristina, Basso, Jytte, Banner, Blokker, Britt M., de Boer, Hans H., Fabrice, Dedouit, Chris, O’Donnell, Giordano, Carla, Virginie, Magnin, Silke, Grabherr, Kim Suvarna, S., Krzysztof, Wozniak, Sarah, Parsons, and van der Wal, Allard C.

Subjects
aorta, autopsy, myocardial infarction, PMCTA, coronary arteries, PMMR, postmortem imaging, sudden cardiac death
Published
2022

44. The radiographic relationship between the cortical overlap view (COV) and the tip of the greater trochanter

Author

Link, Bjorn-Christian, primary, van Veelen, Nicole M., additional, Boernert, Katja, additional, Kittithamvongs, Piyabuth, additional, Beeres, Frank J.P., additional, de Boer, Hans H., additional, Migliorini, Filippo, additional, Nebelung, Sven, additional, Knobe, Matthias, additional, Ruchholtz, Steffen, additional, Babst, Reto, additional, and Jiamton, Chittawee, additional

Published
2021
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45. The histopathological spectrum of myocardial inflammation in relation to circumstance of death: a retrospective cohort study in clinical and forensic autopsies.

Author

du Long, Romy, Fronczek, Judith, Niessen, Hans W. M., van der Wal, Allard C., and de Boer, Hans H.

Subjects
AUTOPSY, HISTOPATHOLOGY, CAUSES of death, COHORT analysis, INFLAMMATION, RETROSPECTIVE studies
Abstract

Interpreting a myocardial inflammation as causal, contributory or as of no significance at all in the cause of death can be challenging, especially in cases where other pathologic and/or medico-legal findings are also present. To further evaluate the significance of myocardial inflammation as a cause of death we performed a retrospective cohort study of forensic and clinical autopsy cases. We revised the spectrum of histological inflammatory parameters in the myocardium of 79 adult autopsy cases and related these to the reported cause of death. Myocardial slides were reviewed for the distribution and intensity of inflammatory cell infiltrations, the predominant inflammatory cell type, and the presence of inflammation-associated myocyte injury, fibrosis, edema and hemorrhage. Next, the cases were divided over three groups, based on the reported cause of death. Group 1 (n = 27) consisted of all individuals with an obvious unnatural cause of death. Group 2 (n = 29) included all individuals in which myocarditis was interpreted to be one out of more possible causes of death. Group 3 (n = 23) consisted of all individuals in which myocarditis was reported to be the only significant finding at autopsy, and no other cause of death was found. Systematic application of our histological parameters showed that only a diffuse increase of inflammatory cells could discriminate between an incidental presence of inflammation (Group 1) or a potentially significant one (Groups 2 and 3). No other histological parameter showed significant differences between the groups. Our results suggest that generally used histological parameters are often insufficient to differentiate an incidental myocarditis from a (potentially) significant one. [ABSTRACT FROM AUTHOR]

Published
2022
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46. Viral presence and immunopathology in patients with lethal COVID-19: a prospective autopsy cohort study: a prospective autopsy cohort study

Author

Schurink, Bernadette, Roos, Eva, Radonic, Teodora, Barbe, Ellis, Bouman, Catherine S. C., de Boer, Hans H., de Bree, Godelieve J., Bulle, Esther B., Aronica, Eleonora M., Florquin, Sandrine, Fronczek, Judith, Heunks, Leo M. A., de Jong, Menno D., Guo, Lihui, du Long, Romy, Lutter, Rene, Molenaar, Pam C. G., Neefjes-Borst, E. Andra, Niessen, Hans W. M., van Noesel, Carel J. M., Roelofs, Joris J. T. H., Snijder, Eric J., Soer, Eline C., Verheij, Joanne, Vlaar, Alexander P. J., Vos, Wim, van der Wel, Nicole N., van der Wal, Allard C., van der Valk, Paul, Bugiani, Marianna, Intensive Care Medicine, Infectious diseases, AII - Infectious diseases, APH - Aging & Later Life, APH - Global Health, Graduate School, Pathology, APH - Mental Health, ANS - Cellular & Molecular Mechanisms, Pulmonology, ACS - Diabetes & metabolism, ACS - Microcirculation, Medical Biology, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, ACS - Heart failure & arrhythmias, and ACS - Pulmonary hypertension & thrombosis

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) targets multiple organs and causes severe coagulopathy. Histopathological organ changes might not only be attributable to a direct virus-induced effect, but also the immune response. The aims of this study were to assess the duration of viral presence, identify the extent of inflammatory response, and investigate the underlying cause of coagulopathy. Methods: This prospective autopsy cohort study was done at Amsterdam University Medical Centers (UMC), the Netherlands. With informed consent from relatives, full body autopsy was done on 21 patients with COVID-19 for whom autopsy was requested between March 9 and May 18, 2020. In addition to histopathological evaluation of organ damage, the presence of SARS-CoV-2 nucleocapsid protein and the composition of the immune infiltrate and thrombi were assessed, and all were linked to disease course. Findings: Our cohort (n=21) included 16 (76%) men, and median age was 68 years (range 41–78). Median disease course (time from onset of symptoms to death) was 22 days (range 5–44 days). In 11 patients tested for SARS-CoV-2 tropism, SARS-CoV-2 infected cells were present in multiple organs, most abundantly in the lungs, but presence in the lungs became sporadic with increased disease course. Other SARS-CoV-2-positive organs included the upper respiratory tract, heart, kidneys, and gastrointestinal tract. In histological analyses of organs (sampled from nine to 21 patients per organ), an extensive inflammatory response was present in the lungs, heart, liver, kidneys, and brain. In the brain, extensive inflammation was seen in the olfactory bulbs and medulla oblongata. Thrombi and neutrophilic plugs were present in the lungs, heart, kidneys, liver, spleen, and brain and were most frequently observed late in the disease course (15 patients with thrombi, median disease course 22 days [5–44]; ten patients with neutrophilic plugs, 21 days [5–44]). Neutrophilic plugs were observed in two forms: solely composed of neutrophils with neutrophil extracellular traps (NETs), or as aggregates of NETs and platelets. Interpretation: In patients with lethal COVID-19, an extensive systemic inflammatory response was present, with a continued presence of neutrophils and NETs. However, SARS-CoV-2-infected cells were only sporadically present at late stages of COVID-19. This suggests a maladaptive immune response and substantiates the evidence for immunomodulation as a target in the treatment of severe COVID-19. Funding: Amsterdam UMC Corona Research Fund.

Published
2020

50. Driving Pressure During General Anesthesia for Open Abdominal Surgery (DESIGNATION): study protocol of a randomized clinical trial

Author

Hol, Liselotte, Nijbroek, Sunny G. L. H., Neto, Ary Serpa, de Abreu, Marcelo Gama, Pelosi, Paolo, Hemmes, Sabrine N. T., Aarts, Leon P. H. J., Akkerman, Ronald D. L., Albersen, Juliette J. E., Aurilio, Caterina, Battaglini, Denise, de Boer, Hans D., Boom, Annemieke, Boer, Christa, Brouwer, Tammo, Buhre, Wolfgang F. F. A., Bulte, Carolina S. E., Edward-Rutten, Gitara M., Godfried, Marc B., Helmerhorst, Hendrik J. F., Hofland, Jan, Hoogenboom, Hester, Ten Hoope, W., Houweling, Bernard M., Huhn, Ragnar, Konijn, Wanda, Koopman-van Gemert, Ankie W. M. M., De Korte-de Boer, Dianne J., Kortekaas, Minke C., Van Lier, Felix, Preckel, Benedikt, Rad, Mandana, Sansone, Pasquale, Stamkot, Andre, Stolker, Robert Jan, Thiel, Bram, Ubben, Johannes F. H., Struys, Michel, In 't Veld, Bastiaan A., Wrigge, Hermann, Zeillemaker-Hoekstra, Miriam, van der Zwan, Tim, Zwijsen, Johannes H. M. J., Hollmann, Markus W., Schultz, Marcus J., Anesthesiology, ACS - Diabetes & metabolism, Hol, L, Nijbroek, Sglh, Neto, A, de Abreu, Mg, Pelosi, P, Hemmes, Snt, Aarts, Lphj, Akkerman, Rdl, Albersen, Jje, Aurilio, C, Battaglini, D, de Boer, Hd, Boom, A, Boer, C, Brouwer, T, Buhre, Wffa, Bulte, Cse, Edward-Rutten, Gm, Godfried, Mb, Helmerhorst, Hjf, Hofland, J, Hoogenboom, H, Ten Hoope, W, Houweling, Bm, Huhn, R, Konijn, W, Koopman-van Gemert, Awmm, De Korte-de Boer, Dj, Kortekaas, Mc, van Lier, F, Preckel, B, Rad, M, Sansone, P, Stamkot, A, Stolker, Rj, Thiel, B, Ubben, Jfh, Struys, Mmrf, 't Veld, Bai, Wrigge, H, Zeillemaker-Hoekstra, M, van der Zwan, T, Zwijsen, Jhmj, Hollmann, Mw, Schultz, Mj, MUMC+: Centrum voor Acute en Kritieke Zorg (3), Anesthesiologie, MUMC+: MA Anesthesiologie (9), RS: MHeNs - R3 - Neuroscience, Graduate School, Intensive Care Medicine, APH - Quality of Care, ACS - Heart failure & arrhythmias, ACS - Pulmonary hypertension & thrombosis, ACS - Microcirculation, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), Radiotherapy, Intensive Care, and Cardiology

Subjects
Lung Diseases, Male, ATELECTASIS, medicine.medical_treatment, Medicine (miscellaneous), Atelectasis, Intraoperative ventilation, law.invention, Positive-Pressure Respiration, DEFINITIONS, Study Protocol, 0302 clinical medicine, Mechanical ventilation, Randomized controlled trial, 030202 anesthesiology, law, OBESE-PATIENTS, Clinical endpoint, Medicine and Health Sciences, Medicine, Pharmacology (medical), END-EXPIRATORY-PRESSURE, 030212 general & internal medicine, Tidal volume, Postoperative pulmonary, Randomized Controlled Trials as Topic, Aged, 80 and over, lcsh:R5-920, Postoperative pulmonary complications, Delta P, Positive end-expiratory pressure, Abdominal Cavity, Pulmonary, Middle Aged, respiratory system, Treatment Outcome, Recruitment maneuver, Anesthesia, Surgical Procedures, Operative, Breathing, Female, lcsh:Medicine (General), therapeutics, Compliance, circulatory and respiratory physiology, Adult, Pulmonary complication, ΔP, complications, Anesthesia, General, 03 medical and health sciences, Young Adult, Postoperative complications, Double-Blind Method, Tidal Volume, Humans, LOW-TIDAL-VOLUME, Aged, POSTOPERATIVE PULMONARY COMPLICATIONS, business.industry, CHEST-WALL MECHANICS, medicine.disease, PREVENTION, Postoperative complication, PROTECTIVE MECHANICAL VENTILATION, respiratory tract diseases, Pulmonary complications, business, Postoperative pulmonary complication, LUNG, Abdominal surgery
Abstract

BackgroundIntraoperative driving pressure (ΔP) is associated with development of postoperative pulmonary complications (PPC). When tidal volume (VT) is kept constant, ΔP may change according to positive end-expiratory pressure (PEEP)-induced changes in lung aeration. ΔP may decrease if PEEP leads to a recruitment of collapsed lung tissue but will increase if PEEP mainly causes pulmonary overdistension. This study tests the hypothesis that individualized high PEEP, when compared to fixed low PEEP, protects against PPC in patients undergoing open abdominal surgery.MethodsThe “Driving prESsure durIng GeNeral AnesThesIa for Open abdomiNal surgery trial” (DESIGNATION) is an international, multicenter, two-group, double-blind randomized clinical superiority trial. A total of 1468 patients will be randomly assigned to one of the two intraoperative ventilation strategies. Investigators screen patients aged ≥ 18 years and with a body mass index ≤ 40 kg/m2, scheduled for open abdominal surgery and at risk for PPC. Patients either receive an intraoperative ventilation strategy with individualized high PEEP with recruitment maneuvers (RM) (“individualized high PEEP”) or one in which PEEP of 5 cm H2O without RM is used (“low PEEP”). In the “individualized high PEEP” group, PEEP is set at the level at which ΔP is lowest. In both groups of the trial, VTis kept at 8 mL/kg predicted body weight. The primary endpoint is the occurrence of PPC, recorded as a collapsed composite of adverse pulmonary events.DiscussionDESIGNATION will be the first randomized clinical trial that is adequately powered to compare the effects of individualized high PEEP with RM versus fixed low PEEP without RM on the occurrence of PPC after open abdominal surgery. The results of DESIGNATION will support anesthesiologists in their decisions regarding PEEP settings during open abdominal surgery.Trial registrationClinicaltrials.gov,NCT03884543. Registered on 21 March 2019.

Published
2020

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