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Perioper Med (Lond). 2018 Apr 17;7:7. doi: 10.1186/s13741-018-0084-9. eCollection 2018.

What are the optimum components in a care bundle aimed at reducing post-operative pulmonary complications in high-risk patients?

Author information

1
1Faculty of Medicine, University of Southampton, Southampton, SO16 6YD UK.
2
Department of Anaesthesia and Critical Care, Central Manchester Foundation Trust, M13 9WL, Manchester, UK.
3
3Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Gießen, Giessen, Germany.
4
4Department of Anaesthesiology and Intensive Care, Haukeland University Hospital, Bergen, Norway.
5
5Department of Clinical Medicine, University of Bergen, Bergen, Norway.
6
6Critical Care Research Group, Southampton NIHR Biomedical Research Centre, Southampton University Hospitals NHS Trust/University of Southampton, Southampton, SO16 6YD UK.
7
7Intensive Care Unit, Royal Surrey County Hospital, Guildford, GU2 7XX UK.
8
8Surrey Perioperative Anaesthetic Critical care collaborative group (SPACeR), FHMS, University of Surrey, Guildford, GU2 7XH UK.

Abstract

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.

KEYWORDS:

Care bundle; Delphi consensus; Inspiratory muscle training; Intra-operative ventilation; Nosocomial pneumonia; Post-operative pulmonary complications

Conflict of interest statement

Not applicable.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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