Sidiuk O. Perioperative prevention of pulmonary complications in thoracic anesthesiology

In dissertation work on the basis of the conducted complex analysis of data new direction is presented in the decision of науково-практичної issue of the day for modern medical science are the improved results of treatment of patients then торакальних operations by development and application of algorithm of the anaesthetic providing of періопераційної prophylaxis of pulmonary complications. At the first stage, preoperative assessment of patients with thoracic diseases was performed. The main purpose of preoperative assessment of patients scheduled for thoracic surgery is primarily to identify patients at high risk of postoperative complications and the introduction of appropriate prevention protocols to reduce the risk of their development. It has been shown that spirometry age of the lungs was associated with the incidence of postoperative pulmonary complications in patients operated on for thoracic diseases. This parameter is noteworthy as a predictor of the likelihood of postoperative pneumonia after esophageal removal and can help assess the state of respiratory function in patients. Therefore, in this study, we developed a standardized mathematical formula for determining the appropriate size of the left bilateral lumen for use in thoracic anesthesiology. Statistical analysis included generalized multiple linear regression models, and five indicators were used as a factor: gender, height, weight, DLMB, and age. The stepwise method with an input threshold p<0.1 and a removal threshold p>0.2 was used to select factors that significantly affect the size of the tube. As a result of selection, three factors were identified: gender, height and DLMB. The linear regression model based on the selected features was adequate (coefficient of determination, adjusted R2 = 0.85; criterion value, F = 361 at p<0.001). Thus, the tube size increases (p<0.001) by 0.121 per centimeter of patient growth, increases (p <0.001) by 7.22 per centimeter of DLGB, for men more (p<0.001) by 1.27 other things being equal. The equation for determining the size of the tube can be described by formula (1): Y = 0.121X1 + 7.22X2 + 1.27X3 + 7.1 (1) Y is the predicted value of the tube size, X1 is the patient’s height (cm), X2 is the patient’s DLGB (cm), X3 is 0 for women and 1 for men. When using the method of construction and analysis of multifactor models of logistic regression, 4 main risk factors were identified: method, sex, weight, ASA. The area under the ROC curve is AUC = 0.72 (95% CI 0.65–0.78), which indicates the average severity of the relationship between the method of prevention of complications, sex, weight, ASA with the risk of complications. Thus, the multifactor analysis revealed that the proposed method of prevention of pulmonary complications can reduce (p=0.001) the risk of development, HS = 0.27 (95% CI 0.13–0.58) compared with the control group (with standardization by sex, weight, ASA of the patient). One-factor analysis revealed a link between the risk of complications and the indicators method, sex, PaCO2, PaO2. For the study group, the risk of complications is lower (p=0.001), HR = 0.30 (95% CI 0.15–0.61) compared with the control group. The risk of complications for men is higher (p=0.048), HR = 2.33 (95% CI 1.01–5.37) compared to women. An increase (p<0.001) in the risk of complications with an increase in PaCO2 (p<0.001), HR = 1.34 (95% CI 1.21–1.49) with an increase of 1 unit, respectively. With increasing PaO2, the risk of complications decreases (p <0.001): HR = 0.96 (95% CI 0.94–0.98) – with increasing 1 unit. This analysis once again confirms that with better blood oxygen saturation in the perioperative period, the number of postoperative pulmonary complications decreases and, conversely, with increasing levels of PaCO2 in the blood, the number of postoperative pulmonary complications increases proportionally. Thus, one-factor analysis revealed an association (p=0.001) with the risk of pulmonary complications with perioperative prophylaxis. The main indicator of the effectiveness of the developed algorithm for perioperative prevention of pulmonary complications in thoracic anesthesiology is the number of these complications after thoracic surgery. In this study, pulmonary complications developed in 33 (34.4%) patients of the control group and in 13 (13.5%) patients of the study group, the difference was statistically significant, p=0.001. This is evidence of effective perioperative management of patients with diseases of the thoracic cavity and shows that clear and consistent use of simple, innovative methods of prevention of postoperative pulmonary complications in thoracic patients significantly reduces the number of these complications. Thus, the application of the proposed technique reduces (p=0.001) the risk of complications, HR = 0.39 (95% CI 0.22–0.70) compared to traditional methods. The risk decreased 2.5 times.