| Contributors: |
Griffiths, Sophie V; Conway, Daniel H; Sander, Michael; Jammer, Ib; Grocott, Michael P W; Creagh-Brown; Ben, C; Javier, Bf; Blobner, M; Blot, S; Bugedo, G; Cabrini, L; Canet, J; Chiumello, D; Engoren, M; Gallart, L; Cosío Borja, G; Guérin, C; Jachymiak, I; Jammer, I; Lamas, C; Makowski, A; Malbouisson, Lm; Matamis, D; Moonesinghe, R; Moore, J; Mythen, M; Paugam-Burtz, C; Pearse, R; Pelosi, P; Poelaert, J; Ponssen, H; Rasmussen, B; Sander, M; Schuerer, D; Smetana, Gw; Summers, C; Talmor, D; Valkenet, K; Veličković, J; Vincent, Jl; Wren, Sm. |
| Description: |
Background: Post-operative pulmonary complications (POPC) are common, predictable and associated with increased morbidity and mortality, independent of pre-operative risk. Interventions to reduce the incidence of POPC have been studied individually, but the use of a care bundle has not been widely investigated. The purpose of our work was to use Delphi consensus methodology and an independently chosen expert panel to formulate a care bundle for patients identified as being at high of POPC, as preparation towards an evaluation of its effectiveness at reducing POPC.Methods: We performed a survey of members of the ESICM POIC section to inform a Delphi consensus and to share their opinions on a care bundle to reduce POPC, the POPC-CB. We formed a team of 36 experts to participate in and complete an email-based Delphi consensus over three rounds, leading to the formulation of the POPC-CB.Results: The survey had 362 respondents and informed the design of the Delphi consensus. The Delphi consensus resulted in a proposed POPC-CB that incorporates components before surgery-supervised exercise programmes and inspiratory muscle training, during surgery, low tidal volume ventilation with individualised PEEP (positive end-expiratory pressure), use of routine monitoring to avoid hyperoxia and efforts made to limit neuromuscular blockade, and post-operatively, deep breathing exercises and elevation of the head of the bed.Conclusion: A care bundle has been suggested for evaluation in surgical patients at high risk of POPC. Evaluation of feasibility of both implementation and effectiveness is now indicated. |