Top

Published in:

01-08-2003 | Original

Respiratory function after aortic aneurysm repair: a comparison between retroperitoneal and transperitoneal approaches

Authors: Carlo A. Volta, Enrico Ferri, Elisabetta Marangoni, Riccardo Ragazzi, Marco Verri, Valentina Alvisi, Silvia Zardi, Sara Bertacchini, Gaetano Gritti, Raffaele Alvisi

Published in: Intensive Care Medicine | Issue 8/2003

Abstract

Objective

Elective abdominal aneurysm repair can be performed by using the transperitoneal or the retroperitoneal approach. The latter has been described as having a better outcome, reducing the impairment of respiratory function or the incidence of lung complications. Hence, the retroperitoneal approach has been proposed for treatment of medically high-risk patients. However, the superiority of one technique or the other in preserving pulmonary function has not been conclusively demonstrated. The aim of this study was to ascertain whether the retroperitoneal and the transperitoneal approaches affect respiratory function differently.

Design

A prospective randomized study.

Setting

Two four-bed surgical-medical ICUs of a University hospital.

Patients

Twenty-three consecutive patients undergoing abdominal aortic aneurysm repair were randomized to the retroperitoneal (12 patients) and transperitoneal approach (11 patients). They were studied: a) within 30 min the end of surgery; b) 8 h after the end of surgery; and c) during a T-piece tube-weaning trial.

Measurements

The comparison between the two groups was based on respiratory mechanics, partitioned between lung and chest wall components, basic spirometry, tension-time index of the inspiratory muscle, weaning indexes, and length of stay both in ICU and hospital.

Results

The two surgical techniques do not differ in their impact on either respiratory mechanics or inspiratory muscle function or weaning indexes. However, there was a tendency for retroperitoneal patients to stay for less time both in ICU and in the hospital.

Conclusions

During the first 24 h after surgery, the postoperative impairment of respiratory function is independent of the surgical approach.

Gelman S (1995) The pathophysiology of aortic cross-clamping and unclamping. Anesthesiology 82:1026–1060PubMed

Johnston KW (1989) Multicenter prospective study of nonruptured abdominal aortic aneurysm. Part II. Variables predicting morbidity and mortality. J Vasc Surg 9:437–447CrossRefPubMed

Sicard GA, Freeman MB, VanderWoude JC, Anderson CB (1987) Comparison between the transabdominal and retroperitoneal approach for reconstruction of the infrarenal abdominal aorta. J Vasc Surg 5:19–27CrossRefPubMed

Kirby LB, Rosenthal D, Atkins CP, Brown GA, Matsuura JH, Clark MD, Pallos L (1999) Comparison between the transabdominal and retroperitoneal approach for reconstruction of the infrarenal abdominal aorta. J Vasc Surg 30:400–405PubMed

Calligaro KD, Azurin DJ, Dougherty MJ, Dandora R, Bajgier SM, Simper S, Savarese RP, Raviola CA, DeLaurentis DA (1993) Pulmonary risk factors of elective abdominal aortic surgery. J Vasc Surg 18:914–920CrossRefPubMed

Darling RC, Shah DM, McClellan WR, Chang BB, Leather RP (1992) Decreased morbidity associated with retroperitoneal exclusion treatment for abdominal aortic aneurysm. J Cardiovasc Surg 33:65–69

Shepard AD, Scott GR, Mackey WC, O'Donnel TF Jr, Bush HL, Callow AD (1986) Retroperitoneal approach to high-risk abdominal aortic aneurysms. Arch Surg 121:444–449PubMed

Cambria RP, Brewster DC, Abbott WM, Freehan M, Megerman J, LaMuraglia G, Wilson R, Wilson D, Teplick R, Davison JK (1990) Transperitoneal versus retroperitoneal approach for aortic reconstruction: a randomized prospective study. J Vasc Surg 11:314–324CrossRefPubMed

Sieunarine K, Lawrence-Brown MM, Goodman MA (1997) Comparison of transperitoneal and retroperitoneal approaches for infrarenal aortic surgery: early and late results. Cardiovasc Surg 5:71–76CrossRefPubMed

10.

Volta CA, Verri M, Righini ER, Ragazzi R, Pavoni V, Alvisi R, Gritti G (1999) Respiratory mechanics during and after anaesthesia for major vascular surgery. Anaesthesia 54:1041–1047CrossRefPubMed

11.

Jonsson F, Madsen P, Jørgensen LG, Lunding M, Secher NH (1995) Thoracic electrical impedance and fluid balance during aortic surgery. Acta Anaesthesiol Scand 39:513–517PubMed

12.

Dureuil B, Cantineau JP, Desmonts JM (1987) Effects of upper or lower abdominal surgery on diaphragmatic function. Br J Anaesth 59:1230–1235PubMed

13.

Field S, Sanci S, Grassino A (1984) Respiratory muscle oxygen consumption estimated by the diaphragm pressure-time index. J Appl Physiol 57:44–51PubMed

14.

Eltayara L, Becklake MR, Volta CA, Milic-Emili J (1996) Relationship between chronic dyspnea and expiratory flow limitation in patients with chronic obstructive pulmonary disease. Am J Resp Crit Care Med 154:1726–1734PubMed

15.

Higgs BD, Behrakis PK, Bevan DR, Milic-Emili J (1983) Measurements of pleural pressure with esophageal balloon in anesthetized humans. Anesthesiology 59:340–343PubMed

16.

Behrakis PK, Higgs BD, Baydur A, Zinn WA, Milic-Emili J (1983) Respiratory mechanics during halotane anesthesia and anesthesia-paralysis in humans. J Appl Physiol 55:1085–1092PubMed

17.

Bates JHT, Rossi A, Milic-Emili J (1985) Analysis of the behavior of the respiratory system with constant inspiratory flow. J Appl Physiol 58:1840–1848PubMed

18.

Kacmarek R, Hess D (1994) Basic principles of ventilator machinery. In: Tobin MJ (ed) Principles and practice of mechanical ventilation. McGraw-Hill, pp 99–101

19.

Kochi T, Okubo S, Zin Milic-Emili J (1988) Flow and volume dependence of pulmonary mechanics in anesthetized cats. J Appl Physiol 64:441–450PubMed

20.

Musch G, Foti G, Cereda M, Pelosi P, Poppi D, Pesenti A (1997) Lung and chest wall mechanics in normal anaesthetized subjects and in patients with COPD at different PEEP levels. Eur Respir J 10:2545–2552CrossRefPubMed

21.

Alvisi R, Volta CA, Righini ER, Capuzzo M, Ragazzi R, Verri M, Candini G, Gritti G, Milic-Emili J (2000) Predictors of weaning outcome in COPD patients. Eur Respir J 15:4, 656–662CrossRef

22.

Vallverdú I, Calaf N, Subirana M, Net A, Benito S, Mancebo J. (1998) Clinical characteristics, respiratory functional parameters, and outcome of a two-hour T-piece trial in patients weaning from mechanical ventilation. Am J Respir Crit Care Med 158:1855–1862PubMed

23.

Marini JJ, Smith TC, Lamb VJ (1986) Estimation of inspiratory muscle strength in mechanically ventilated patients: the measurement of maximal inspiratory pressure. J Crit Care 1:32–38

24.

Jubran A, Tobin MJ (1997) Pathophysiological basis of acute respiratory distress in patients who fail a trial of weaning from mechanical ventilation. Am J Respir Crit Care Med 155:906–915PubMed

25.

Ali J, Ali Khan T (1979) The comparative effects of muscle transection and median upper abdominal incision. Surtg Gynecol Obstet 148:863–866

26.

Drummond GB (1998) Diaphragmatic dysfunction: an outmoded concept. Br J Anaesth 80:227–280

27.

Ford GT, Rosenal TW, Clergue F, Withelaw WA (1993) Respiratory physiology in upper abdominal surgery. Clin Chest Med 14:237–252PubMed

28.

Ford GT, Whitelaw WA, Rosenal TW, Cruse PJ, Guenter CA (1983) Diaphragm function after upper abdominal surgery in humans. Am Rev Respir Dis 127:431–436PubMed

29.

Gandevia SC, McKenzie DK (1985) Activation of the human diaphragm during maximal static efforts. J Appl Physiol 367:45–56

30.

Groeneveld AB, Raijmakers PG, Rauwerda JA, Hack CE (1997) The inflammatory response to vascular surgery-associated ischaemia and reperfusion in man: effect on postoperative pulmonary function. Eur Endovasc Surg 14:351–359

31.

Raijmakers PG, Groeneveld AB, Rauwerda JA, Schneider AJ, Teule GJ, Hack CE, Thijs LG (1995) Transient increase in interleukin-8 and pulmonary microvascular permeability following aortic surgery. Am J Respir Crit Care Med 151:698–705PubMed

32.

Abraham E, Matthay MA, Dinarello CA, Vincent JL, Cohen J, Opal SM, Glauser M, Parson P, Fisher CJ Jr, Repine JE (2000) Consensus conference definitions for sepsis, septic shock, acute lung injury, and acute respiratory distress syndrome: Time for a reevaluation. Crit Care Med 28:232–235

33.

Mutoh T, Lamm WJ, Embree LJ, Hildebrandt J, Albert RK (1992) Volume infusion produces abdominal distension, lung compression, and chest wall stiffening in pigs. J Appl Physiol 72:575–582PubMed

34.

Ranieri VM, Vitale N, Grasso S, Puntillo F, Mascia L, Paparella D, Tunzi P, Giuliani R, de Luca Tupputi L, Fiore T (1999) Time-course of impairment of respiratory mechanics after cardiac surgery and cardiopulmonary bypass. Crit Care Med 27:1454–1460PubMed

35.

Nevelsteen A, Smet G, Weymans M, Depre H, Suy R (1988) Transabdominal or retroperitoneal approach to the aorto-iliac tract: a pulmonary function study. Eur J Vasc Surg 2:229–232PubMed

36.

Cohen J, Loewinger J, Hutin K, Sulkes J, Zelikowsky A, Singer P (2001) The safety of immediate extubation after abdominal aortic surgery: a prospective, randomized trial. Anesth Analg 93:1546–1549PubMed

Title: Respiratory function after aortic aneurysm repair: a comparison between retroperitoneal and transperitoneal approaches
Authors: Carlo A. Volta
Enrico Ferri
Elisabetta Marangoni
Riccardo Ragazzi
Marco Verri
Valentina Alvisi
Silvia Zardi
Sara Bertacchini
Gaetano Gritti
Raffaele Alvisi
Publication date: 01-08-2003
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 8/2003
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-003-1786-z

At a glance: The STEP trials

Springer Medicine

Respiratory function after aortic aneurysm repair: a comparison between retroperitoneal and transperitoneal approaches

Abstract

Objective

Design

Setting

Patients

Measurements

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Design

Setting

Patients

Measurements

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2003

Coupled plasma filtration adsorption

Tracheostomy for long-term ventilated patients: a postal survey of ICU practice in The Netherlands

Outcome prediction in terms of functional disability and mortality at 1 year among ICU-admitted severe stroke patients: a prospective epidemiological study in the south of the European Union (Evascan Project, Andalusia, Spain)

Tubular proteinuria and enzymuria following open heart surgery

Microalbuminuria in severe sepsis: timing is difficult, "normal" levels are uncertain

Assessing cardiac preload or fluid responsiveness? It depends on the question we want to answer