Hypoxia Clinical Trial
Official title:
Evaluation of Operating Room Reverse Trendelenburg Positioning and Its Effect on Postoperative Hypoxemia, Aspiration, and Length of Stay: a Retrospective Study of Consecutive Patients
The purpose of this study is to investigate whether intraoperative reverse Trendelenburg positioning decreases postoperative hypoxemia and perioperative pulmonary aspiration rates.
Intraoperative pulmonary aspiration can cause death and lead to morbidity. In addition,
reliable estimates of aspiration rates are uncertain. In part, this ambiguity relates to the
lack of prospective data. Relevant studies are retrospective chart reviews or results from
voluntary reporting databases. Furthermore, aspiration diagnosis can be imprecise. The
finding is certain when there is aspiration of bile or particulate matter from the
tracheobronchial tree or there is endoscopic visualization. However, the diagnosis is
presumptive when there is intraoperative or postoperative development of a new chest x-ray
infiltrate and attendant tachypnea, hypoxia, wheezing, or changes in ventilator airway
pressures.
Most patients undergoing general endotracheal anesthesia are in the supine or horizontal
position. However, evidence from the literature demonstrates that the supine position in
mechanically ventilated patients is a risk for aspiration and ventilator associated
pneumonia (VAP). During intensive care unit (ICU) mechanical ventilation, the Institute for
Healthcare Improvement recommends elevating the head of the bed to prevent pulmonary
aspiration and VAP. Other investigations have shown a profound relationship between
horizontal positioning and intra-operative aspiration. There is substantial operating room,
ICU, and animal investigative evidence that aspiration occurs despite the presence of a
cuffed endotracheal tube. Likewise, previous work by this group showed a 30% perioperative
hypoxemia rate, which was significantly associated with horizontal positioning. The
post-operative length of hospital stay was 2 days longer with hypoxemia, compared to no
hypoxemia (p <0.0001) and this represented a total of 300 additional days for the 2 months
of the study.
The purpose of this retrospective study is to repeat the investigation after adopting a
recent policy change of 10-degree Reverse Trendelenburg position as the routine for surgical
patients, unless deemed inappropriate by either the anesthesiology or operating room nursing
staff.
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Observational Model: Cohort, Time Perspective: Retrospective
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