Serge Molliex1, Sylvie Passot2, Jerome Morel3, Emmanuel Futier4, Jean Yves Lefrant5, Jean Michel Constantin6, Yannick Le Manach7, Bruno Pereira8. 1. Department of Anaesthesiology and Critical Care Medicine, Centre Hospitalier Universitaire (CHU) de Saint-Étienne, Université Jean-Monnet Saint-Étienne, 42055 Saint-Étienne, France. Electronic address: serge.molliex@chu-st-etienne.fr. 2. Department of Anaesthesiology and Critical Care Medicine, Centre Hospitalier Universitaire (CHU) de Saint-Étienne, Université Jean-Monnet Saint-Étienne, 42055 Saint-Étienne, France. Electronic address: sylvie.passot@chu-st-etienne.fr. 3. Department of Anaesthesiology and Critical Care Medicine, Centre Hospitalier Universitaire (CHU) de Saint-Étienne, Université Jean-Monnet Saint-Étienne, 42055 Saint-Étienne, France. Electronic address: jerome.morel@chu-st-etienne.fr. 4. Department of Perioperative Medicine, Centre Hospitalier Universitaire (CHU) de Clermont-Ferrand, Université Clermont-Auvergne, CNRS, Inserm, 63000 Clermont-Ferrand, France. Electronic address: efutier@chu-clermontferrand.fr. 5. Department of Anaesthesiology, Critical Care and Emergency Medicine, Centre Hospitalier Universitaire (CHU) de Nîmes, Université de Montpellier-Nîmes, 30029 Nîmes, France. Electronic address: jean.yves.lefrant@chu-nimes.fr. 6. Department of Perioperative Medicine, Centre Hospitalier Universitaire (CHU) de Clermont-Ferrand, Université Clermont-Auvergne, CNRS, Inserm, 63000 Clermont-Ferrand, France. Electronic address: jmconstantin@chu-clermontferrand.fr. 7. Departments of Anaesthesia and Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. Electronic address: Yannick.Lemanach@phri.ca. 8. Biostatistic Unit, Direction de la Recherche Clinique (DRCI), Centre Hospitalier Universitaire (CHU) de Clermont-Ferrand, 63003 Clermont-Ferrand, France. Electronic address: bpereira@chu-clermontferrand.fr.
Abstract
INTRODUCTION: In elderly patients, goal-directed haemodynamic therapy (GDHT), depth of anaesthesia monitoring and lung-protective ventilation have been shown to improve postoperative outcomes. The aim of this study was to evaluate current practices concerning strategies of anaesthesia optimisation in patients aged≥75 years. PATIENTS AND METHODS: A multicentre observational study was performed from February to May 2015 in 23 French academic centres. On 30 consecutive days in each centre, patients≥75 years with at least one major comorbidity undergoing elective or emergency procedures (femoral-neck fractures surgery, intraperitoneal abdominal surgery or vascular surgery) were included. Patient characteristics and data related to GHDT, management of hypotension, monitoring of temperature and depth of anaesthesia, lung ventilation, point of care haemoglobin testing were collected. RESULTS: In total, 807 patients were included. Only 2% of patients [95% CI: 1-3] received GHDT in full accordance with guidelines. Depth of anaesthesia monitoring was largely performed (53% [95% CI: 50-56]). The multifaceted strategy of lung-protective ventilation combining low tidal volumes (6-8mL/kg), PEEP of 5-8cm cmH2O, and repeated recruitment manoeuvres, was performed in only 4% [95% CI: 3-5] of patients. A centre effect was a major determinant of variation concerning implementation of these strategies. DISCUSSION: In patients'≥75 years, strategies of anaesthesia optimisation are not in accordance with eligible guidelines. Implementation of these techniques varies independently of factors related to the patient or the type of surgery and may be dependent on the generated constraints.
INTRODUCTION: In elderly patients, goal-directed haemodynamic therapy (GDHT), depth of anaesthesia monitoring and lung-protective ventilation have been shown to improve postoperative outcomes. The aim of this study was to evaluate current practices concerning strategies of anaesthesia optimisation in patients aged≥75 years. PATIENTS AND METHODS: A multicentre observational study was performed from February to May 2015 in 23 French academic centres. On 30 consecutive days in each centre, patients≥75 years with at least one major comorbidity undergoing elective or emergency procedures (femoral-neck fractures surgery, intraperitoneal abdominal surgery or vascular surgery) were included. Patient characteristics and data related to GHDT, management of hypotension, monitoring of temperature and depth of anaesthesia, lung ventilation, point of care haemoglobin testing were collected. RESULTS: In total, 807 patients were included. Only 2% of patients [95% CI: 1-3] received GHDT in full accordance with guidelines. Depth of anaesthesia monitoring was largely performed (53% [95% CI: 50-56]). The multifaceted strategy of lung-protective ventilation combining low tidal volumes (6-8mL/kg), PEEP of 5-8cm cmH2O, and repeated recruitment manoeuvres, was performed in only 4% [95% CI: 3-5] of patients. A centre effect was a major determinant of variation concerning implementation of these strategies. DISCUSSION: In patients'≥75 years, strategies of anaesthesia optimisation are not in accordance with eligible guidelines. Implementation of these techniques varies independently of factors related to the patient or the type of surgery and may be dependent on the generated constraints.
Authors: Alexandre Joosten; Joseph Rinehart; Aurélie Bardaji; Philippe Van der Linden; Vincent Jame; Luc Van Obbergh; Brenton Alexander; Maxime Cannesson; Susana Vacas; Ngai Liu; Hichem Slama; Luc Barvais Journal: Anesthesiology Date: 2020-02 Impact factor: 7.892