Perioperative management of patients with pulmonary hypertension undergoing non-cardiothoracic, non-obstetric surgery: a systematic review and expert consensus statement.

Consensus Expert Testimony / methods Humans Hypertension, Pulmonary / diagnosis Perioperative Care / methods Postoperative Complications / diagnosis
acute right ventricular failure endoscopy perioperative management pulmonary hypertension pulmonary hypertensive crisis sedation

Journal

British journal of anaesthesia
ISSN: 1471-6771
Titre abrégé: Br J Anaesth
Pays: England
ID NLM: 0372541

Informations de publication

Date de publication:
04 2021
Historique:
received: 11 11 2020
revised: 06 01 2021
accepted: 08 01 2021
pubmed: 23 2 2021
medline: 1 4 2021
entrez: 22 2 2021
Statut: ppublish

Résumé

The risk of complications, including death, is substantially increased in patients with pulmonary hypertension (PH) undergoing anaesthesia for surgical procedures, especially in those with pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH). Sedation also poses a risk to patients with PH. Physiological changes including tachycardia, hypotension, fluid shifts, and an increase in pulmonary vascular resistance (PH crisis) can precipitate acute right ventricular decompensation and death. A systematic literature review was performed of studies in patients with PH undergoing non-cardiac and non-obstetric surgery. The management of patients with PH requiring sedation for endoscopy was also reviewed. Using a framework of relevant clinical questions, we review the available evidence guiding operative risk, risk assessment, preoperative optimisation, and perioperative management, and identifying areas for future research. Reported 30 day mortality after non-cardiac and non-obstetric surgery ranges between 2% and 18% in patients with PH undergoing elective procedures, and increases to 15-50% for emergency surgery, with complications and death usually relating to acute right ventricular failure. Risk factors for mortality include procedure-specific and patient-related factors, especially markers of PH severity (e.g. pulmonary haemodynamics, poor exercise performance, and right ventricular dysfunction). Most studies highlight the importance of individualised preoperative risk assessment and optimisation and advanced perioperative planning. With an increasing number of patients requiring surgery in specialist and non-specialist PH centres, a systematic, evidence-based, multidisciplinary approach is required to minimise complications. Adequate risk stratification and a tailored-individualised perioperative plan is paramount.

Sections du résumé

BACKGROUND
The risk of complications, including death, is substantially increased in patients with pulmonary hypertension (PH) undergoing anaesthesia for surgical procedures, especially in those with pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH). Sedation also poses a risk to patients with PH. Physiological changes including tachycardia, hypotension, fluid shifts, and an increase in pulmonary vascular resistance (PH crisis) can precipitate acute right ventricular decompensation and death.
METHODS
A systematic literature review was performed of studies in patients with PH undergoing non-cardiac and non-obstetric surgery. The management of patients with PH requiring sedation for endoscopy was also reviewed. Using a framework of relevant clinical questions, we review the available evidence guiding operative risk, risk assessment, preoperative optimisation, and perioperative management, and identifying areas for future research.
RESULTS
Reported 30 day mortality after non-cardiac and non-obstetric surgery ranges between 2% and 18% in patients with PH undergoing elective procedures, and increases to 15-50% for emergency surgery, with complications and death usually relating to acute right ventricular failure. Risk factors for mortality include procedure-specific and patient-related factors, especially markers of PH severity (e.g. pulmonary haemodynamics, poor exercise performance, and right ventricular dysfunction). Most studies highlight the importance of individualised preoperative risk assessment and optimisation and advanced perioperative planning.
CONCLUSIONS
With an increasing number of patients requiring surgery in specialist and non-specialist PH centres, a systematic, evidence-based, multidisciplinary approach is required to minimise complications. Adequate risk stratification and a tailored-individualised perioperative plan is paramount.

Identifiants

DOI: 10.1016/j.bja.2021.01.005 PMID: 33612249
pubmed: 33612249
pii: S0007-0912(21)00014-3
doi: 10.1016/j.bja.2021.01.005
pii:
doi:

Types de publication

Journal Article Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

774-790

Informations de copyright

Copyright © 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

Auteurs

Laura C Price (LC)

National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK. Electronic address: laura.price@rbht.nhs.uk.

Guillermo Martinez (G)

Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK.

Aimee Brame (A)

National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; Intensive Care unit and Pulmonary Hypertension Service, London, UK.

Thomas Pickworth (T)

Department of Anaesthesia, Royal Brompton Hospital, London, UK.

Chinthaka Samaranayake (C)

National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK.

David Alexander (D)

Department of Anaesthesia, Royal Brompton Hospital, London, UK.

Benjamin Garfield (B)

National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; Adult Intensive Care Unit, Royal Brompton Hospital, London, UK.

Tuan-Chen Aw (TC)

Department of Anaesthesia, Royal Brompton Hospital, London, UK.

Colm McCabe (C)

National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.

Bhashkar Mukherjee (B)

National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; Intensive Care unit and Pulmonary Hypertension Service, London, UK.

Carl Harries (C)

National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK.

Aleksander Kempny (A)

National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.

Michael Gatzoulis (M)

National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.

Philip Marino (P)

Intensive Care unit and Pulmonary Hypertension Service, London, UK.

David G Kiely (DG)

Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.

Robin Condliffe (R)

Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.

Luke Howard (L)

National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK.

Rachel Davies (R)

National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK.

Gerry Coghlan (G)

National Pulmonary Hypertension Service, Royal Free Hospital, London, UK.

Benjamin E Schreiber (BE)

National Pulmonary Hypertension Service, Royal Free Hospital, London, UK.

James Lordan (J)

National Pulmonary Hypertension Service, Freeman Hospital, Newcastle upon Tyne, UK.

Dolores Taboada (D)

Pulmonary Vascular Disease Unit, Royal Papworth Hospital, Cambridge, UK.

Sean Gaine (S)

National Pulmonary Hypertension Unit, Mater Misericordiae University Hospital, Dublin, Ireland.

Martin Johnson (M)

Scottish Pulmonary Vascular Unit, NHS Golden Jubilee, Clydebank, UK.

Colin Church (C)

Scottish Pulmonary Vascular Unit, NHS Golden Jubilee, Clydebank, UK.

Samuel V Kemp (SV)

Department of Respiratory Medicine, Royal Brompton Hospital, London, UK.

Davina Wong (D)

Intensive Care unit and Pulmonary Hypertension Service, London, UK.

Andrew Curry (A)

Cardiothoracic Anaesthesia, University Hospital Southampton, Southampton, Hampshire, UK.

Denny Levett (D)

Anaesthesia and Critical Care Research Area, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.

Susanna Price (S)

Adult Intensive Care Unit, Royal Brompton Hospital, London, UK.

Stephane Ledot (S)

Adult Intensive Care Unit, Royal Brompton Hospital, London, UK.

Anna Reed (A)

National Heart and Lung Institute, Imperial College London, London, UK; Respiratory and Lung Transplantation, Harefield Hospital, Uxbridge, UK.

Konstantinos Dimopoulos (K)

National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.

Stephen John Wort (SJ)

National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female

Evaluation of Low-Value Services Across Major Medicare Advantage Insurers and Traditional Medicare.

Ciara Duggan, Adam L Beckman, Ishani Ganguli et al.
1.00
Humans United States Aged Cross-Sectional Studies Medicare Part C

Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial.

Hallie Tankha, Devyn Gaskins, Amanda Shallcross et al.
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH

questionsmedicales.fr › Phénomènes psychologiques › Processus mentaux › Pensée (activité mentale) › Prise de décision › Consensus › Perioperative management of patients with...
questionsmedicales.fr › Organisations et économie des soins de santé › Contrôle social formel › Jurisprudence › Expertise › Perioperative management of patients with...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Perioperative management of patients with...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Hypertension artérielle › Hypertension pulmonaire › Perioperative management of patients with...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Soins périopératoires › Perioperative management of patients with...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Complications postopératoires › Perioperative management of patients with...