Imperial College London
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Dr Harriet Kemp

Faculty of Medicine, Department of Surgery & Cancer

Clinical Lecturer
 
 
 
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h.kemp

 
 
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Location

 

Chelsea and Westminster HospitalChelsea and Westminster Campus

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Summary

 

Publications

Citation

BibTex format

@article{Watson:2018:10.1016/j.bja.2018.04.048,
author = {Watson, X and Chereshneva, M and Odor, PM and Chis, Ster I and Johnston, C and Huddart, S and Woods, J and Hadi, N and Ali, S and Thorning, G and Gill, P and Boomers, O and Rope, T and Bartlett, R and Kuttler, A and O'Carroll-Kuehn, B and Dickinson, M and Lyness, C and Jha, R and Patel, S and Raj, A and Tanqueray, T and Cox, M and Khader, A and Vashisht, S and Liyanage, S and Ahmed, K and Whitehead, J and Patel, N and Liu, S and Patel, C and Hayward, L and Leonard, S and Hare, S and Saha, R and de, Bois J and Winterbottom, T and Choo, Y and Oliver, CM and Timbrell, D and Sinnott, M and Yip, E and Trask, N and Sothisrihar, S and Shaw, M and Thorat, P and Shah, D and Leir, S and Farag, M and Duffen, A and McCretton, T and Wojcikiewicz, T and King, C and Pennington, J and Patel, M and Kok, W and Gunarathna, D and Carter, L and Spence, E and Chambers, K and Cervi, E and Cummins, J and Shah, N and Eeles, A and Chu, A and Webb, C and Nolan, L and McHugh, B and Walls, A and Lakhani, R and Mat},
doi = {10.1016/j.bja.2018.04.048},
journal = {British Journal of Anaesthesia},
pages = {909--917},
title = {Adoption of lung protective ventilation IN patients undergoing emergency laparotomy: the ALPINE study. A prospective multicentre observational study},
url = {http://dx.doi.org/10.1016/j.bja.2018.04.048},
volume = {121},
year = {2018}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BackgroundEmergency abdominal surgery is associated with a high risk of postoperative pulmonary complications (PPCs). The primary aim of this study was to determine whether patients undergoing emergency laparotomy are ventilated using a lung-protective ventilation strategy employing tidal volume ≤8 ml kg−1 ideal body weight−1, PEEP >5 cm H2O, and recruitment manoeuvres. The secondary aim was to investigate the association between ventilation factors (lung-protective ventilation strategy, intraoperative FiO2, and peak inspiratory pressure) and the occurrence of PPCs.MethodsData were collected prospectively in 28 hospitals across London as part of routine National Emergency Laparotomy Audit (NELA). Patients were followed for 7 days. Complications were defined according to the European Perioperative Clinical Outcome definition.ResultsData were collected from 568 patients. The median [inter-quartile range (IQR)] tidal volume observed was 500 ml (450–540 ml), corresponding to a median tidal volume of 8 ml kg−1 ideal body weight−1 (IQR: 7.2–9.1 ml). A lung-protective ventilation strategy was employed in 4.9% (28/568) of patients, and was not protective against the occurrence of PPCs in the multivariable analysis (hazard ratio=1.06; P=0.69). Peak inspiratory pressure of <30 cm H2O was protective against development of PPCs (hazard ratio=0.46; confidence interval: 0.30–0.72; P=0.001). Median FiO2 was 0.5 (IQR: 0.44–0.53), and an increase in FiO2 by 5% increased the risk of developing a PPC by 8% (2.6–14.1%; P=0.008).ConclusionsBoth intraoperative peak inspiratory pressure and FiO2 are independent factors significantly associated with development of a postoperative pulmonary complication in emergency laparotomy patients. Further studies are required to identify causality and to demonstrate if their manipulation could lead to better clinical outcomes.
AU  - Watson,X
AU  - Chereshneva,M
AU  - Odor,PM
AU  - Chis,Ster I
AU  - Johnston,C
AU  - Huddart,S
AU  - Woods,J
AU  - Hadi,N
AU  - Ali,S
AU  - Thorning,G
AU  - Gill,P
AU  - Boomers,O
AU  - Rope,T
AU  - Bartlett,R
AU  - Kuttler,A
AU  - O'Carroll-Kuehn,B
AU  - Dickinson,M
AU  - Lyness,C
AU  - Jha,R
AU  - Patel,S
AU  - Raj,A
AU  - Tanqueray,T
AU  - Cox,M
AU  - Khader,A
AU  - Vashisht,S
AU  - Liyanage,S
AU  - Ahmed,K
AU  - Whitehead,J
AU  - Patel,N
AU  - Liu,S
AU  - Patel,C
AU  - Hayward,L
AU  - Leonard,S
AU  - Hare,S
AU  - Saha,R
AU  - de,Bois J
AU  - Winterbottom,T
AU  - Choo,Y
AU  - Oliver,CM
AU  - Timbrell,D
AU  - Sinnott,M
AU  - Yip,E
AU  - Trask,N
AU  - Sothisrihar,S
AU  - Shaw,M
AU  - Thorat,P
AU  - Shah,D
AU  - Leir,S
AU  - Farag,M
AU  - Duffen,A
AU  - McCretton,T
AU  - Wojcikiewicz,T
AU  - King,C
AU  - Pennington,J
AU  - Patel,M
AU  - Kok,W
AU  - Gunarathna,D
AU  - Carter,L
AU  - Spence,E
AU  - Chambers,K
AU  - Cervi,E
AU  - Cummins,J
AU  - Shah,N
AU  - Eeles,A
AU  - Chu,A
AU  - Webb,C
AU  - Nolan,L
AU  - McHugh,B
AU  - Walls,A
AU  - Lakhani,R
AU  - Matthews,S
AU  - Hussein,Z
AU  - Wang,S
AU  - Weisskopf,R
AU  - Talbot,H
AU  - Verney,C
AU  - Nurmi,E
AU  - Henderson,K
AU  - Beesley,OR
AU  - Hunter,J
AU  - Nicholls,L
AU  - Robles,A
AU  - Lee,S
AU  - Hawkins,R
AU  - Patel,K
AU  - Kwok,A
AU  - Han,J
AU  - Allana,A
AU  - Kestner,S
AU  - Roopra,A
AU  - Edwards,L
AU  - O'Dell,T
AU  - Selby,J
AU  - Bickmore,E
AU  - Remeta,P
AU  - Karsten,E
AU  - Winterbottom,T
AU  - Daum,P
AU  - Loughnan,A
AU  - Heggarty,A
DO  - 10.1016/j.bja.2018.04.048
EP  - 917
PY  - 2018///
SN  - 0007-0912
SP  - 909
TI  - Adoption of lung protective ventilation IN patients undergoing emergency laparotomy: the ALPINE study. A prospective multicentre observational study
T2  - British Journal of Anaesthesia
UR  - http://dx.doi.org/10.1016/j.bja.2018.04.048
UR  - https://www.sciencedirect.com/science/article/pii/S0007091218304562?via%3Dihub
VL  - 121
ER  -
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