TY - JOUR
T1 - Preemptive light sedation in intensive care unit may reduce pulmonary complications in geriatrics receiving pancreaticoduodenectomy
AU - Chen, Tien Hua
AU - Su, Cheng Hsi
AU - Hsiao, Chen Yuan
AU - Kao, Shih Yi
AU - Tsai, Pei Jiun
N1 - Funding Information:
This study was sponsored by grants from Taipei Veterans General Hospital (V108B-002), Cheng Hsin General Hospital (CY10716, CY10821), and Ten-Chan General Hospital Zhongli to T-H Chen. Dr. Pei-Jiun Tsai received grant support from Taipei Veterans General Hospital (V108B-002), Yen Tjing Ling Medical Foundation (CI-106-20), and the Ministry of Science and Technology (MOST107-2314-B-010-056-MY3). We declare that the sponsors of the study and the authors have no conflicts of interest to report. The funding sources had no role in the study design, data collection, data interpretation, data analysis, or writing of the report. The corresponding authors have full access to all of the data from the study, as well as responsibility for the final decision to submit the manuscript for publication.
Publisher Copyright:
Copyright © 2020, the Chinese Medical Association.
PY - 2020/7
Y1 - 2020/7
N2 - Background: Patients undergoing pancreaticoduodenectomy (PD) for periampullary lesions are usually elderly with a high risk of postoperative morbidity and mortality. This retrospective cohort study investigated whether postoperative preemptive light sedation aids in recovery of elderly patients following PD. Methods: Ninety-nine geriatric patients undergoing PD at one hospital were enrolled from 2009 to 2018. Patients in the sedation group received mechanical ventilation support and preemptively light sedation with fentanyl and propofol or dexmedetomidine in the first 5 days postoperatively in the intensive care unit (ICU). Patients in the control group underwent early extubation and received morphine for pain control but no postoperative sedatives in the ordinary ward. Patients in the two groups were matched 1:1 using propensity scoring. The postoperative complication rate, surgical mortality, and postoperative hospital length of stay (LOS) were recorded. We also tested inflammation in an immortal human bronchial epithelial cell line. Results: After 1:1 matching, 40 patients in the sedation group were compared with 40 patients in the control group. The sedation group had a significantly lower pulmonary complication rate and fewer patients with postoperative gastroparesis. Both groups had similar postoperative hospital LOS and identical surgical mortality rates. Patients in the sedation group had significantly better postoperative quality of life, including less pain and less heartbeat variation. In vitro cell experiments supported the above clinical observations, showing that adequate use of sedatives could significantly elevate the cell viability rate, protect cells from damage, decrease interleukin-6 production, and reduce inflammation. Conclusion: Postoperative preemptive light sedation in the ICU in geriatric patients following PD may not only reduce the rates of postoperative pulmonary complications and gastroparesis but also improve postoperative quality of life without prolonging the postoperative hospital LOS.
AB - Background: Patients undergoing pancreaticoduodenectomy (PD) for periampullary lesions are usually elderly with a high risk of postoperative morbidity and mortality. This retrospective cohort study investigated whether postoperative preemptive light sedation aids in recovery of elderly patients following PD. Methods: Ninety-nine geriatric patients undergoing PD at one hospital were enrolled from 2009 to 2018. Patients in the sedation group received mechanical ventilation support and preemptively light sedation with fentanyl and propofol or dexmedetomidine in the first 5 days postoperatively in the intensive care unit (ICU). Patients in the control group underwent early extubation and received morphine for pain control but no postoperative sedatives in the ordinary ward. Patients in the two groups were matched 1:1 using propensity scoring. The postoperative complication rate, surgical mortality, and postoperative hospital length of stay (LOS) were recorded. We also tested inflammation in an immortal human bronchial epithelial cell line. Results: After 1:1 matching, 40 patients in the sedation group were compared with 40 patients in the control group. The sedation group had a significantly lower pulmonary complication rate and fewer patients with postoperative gastroparesis. Both groups had similar postoperative hospital LOS and identical surgical mortality rates. Patients in the sedation group had significantly better postoperative quality of life, including less pain and less heartbeat variation. In vitro cell experiments supported the above clinical observations, showing that adequate use of sedatives could significantly elevate the cell viability rate, protect cells from damage, decrease interleukin-6 production, and reduce inflammation. Conclusion: Postoperative preemptive light sedation in the ICU in geriatric patients following PD may not only reduce the rates of postoperative pulmonary complications and gastroparesis but also improve postoperative quality of life without prolonging the postoperative hospital LOS.
KW - Intensive care unit
KW - Pancreaticoduodenectomy
KW - Postoperatively preemptive light sedation
KW - Pulmonary complication
KW - Surgical stress response
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U2 - 10.1097/JCMA.0000000000000347
DO - 10.1097/JCMA.0000000000000347
M3 - Article
C2 - 32628429
AN - SCOPUS:85087666384
SN - 1726-4901
VL - 83
SP - 661
EP - 668
JO - Journal of the Chinese Medical Association
JF - Journal of the Chinese Medical Association
IS - 7
ER -