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- Brocki, Barbara Cristina, et al.
(författare)
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Can the Melbourne Scoring Scale be used to assess postoperative pulmonary complications in high-risk patients following lung resection?
- 2018
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Ingår i: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 52:Suppl. 62
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: Postoperative pulmonary complications (PPC) are common following lung resections, but there is no consensus in the literature on the definition of a clinically relevant PPC. This study aimed to use the Melbourne Scoring Scale (MGS) to determine the frequency and predictors of PPC in patients scheduled for lung resection on suspicion of or due to cancer.Methods: In a prospective observational design, we assessed 87 consecutive patients following lung resections in Aalborg University Hospital, Denmark. Patients were preoperatively classified as being at high PPC-risk (n= 68) or low PPC-risk (n=19), based on the presence of one or more of the items: FEV1 or carbon monoxide diffusion capacity (DLCO) ≤70%, age ≥70 years or scheduled pneumonectomy. Data on PPC was collected daily and re-evaluated two weeks postoperatively. Multivariate regression analysis was used to evaluate variables associated with PPC.Results: The actual frequency of PPC according to the MGS was 11% (n=10), all cases within the predefined high-risk group, with pneumonia accounting for 10% of the cases. We found that preoperative FEV1 and DLCO ≤60% were significantly associated with a higher PPC risk (area under the ROC curve 0.851), 95% CI 2.2-56.6 and 1.1-36.8 for FEV1 and DLCO, respectively.Conclusions: The MGS can be used to identify patients at high risk of postoperative clinically relevant PPC after lung resections, in particular in patients with preoperative values of FEV1 ≤ 60% or DLCO ≤ 60%. More research is needed to evaluate the effect of preventable interventions targeting patients at high-risk of developing PPC.
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| 3. |
- Brocki, Barbara Cristina, 1957-, et al.
(författare)
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Improvements in physical performance and health-related quality of life one year after radical operation for lung cancer
- 2015
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Ingår i: Cancer Treatment Communications. - : Elsevier. - 2213-0896. ; 4, s. 65-74
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Tidskriftsartikel (refereegranskat)abstract
- Micro abstract: This study assessed physical performance and health-related quality of life one year after lung cancer surgery and investigated the potential association between both outcomes. We found that the walked distance was associated with the subjective perception of the physical functioning. Patients improved health-related quality of life, reaching values similar to a healthy reference population.Background: Resuming an acceptable level of lifestyle and health-related quality of life after lung cancer surgery has become an important issue. We aimed to evaluate the course of recovery of physical performance and health-related quality of life following pulmonary resection for lung cancer, as well as examine the potential association between these outcomes.Methods: In an observational design, we assessed 78 individuals radically operated for lungcancer. We measured health-related quality of life (SF-36), six-minute walk test (6MWT) and lung function (spirometry)three weeks (baseline), four and twelve months after surgery. SF-36 values were compared to an age-and gender-matched reference population.Results: The mean age was 65 years (SD9), 59% were males. Thoracotomy was performed in 77% of the cases. Compared to baseline values, we found significant improvements after one year in SF-36 physical and mental component summary components of large effect size (0.8 and 0.9 respectively). Values for both SF-36 summary components were comparable to those of the reference population. The improvement in 6MWT was of moderate effect size (0.6). We found a positive association between 6MWT and the SF-36 domain for physical functioning (β=0.05, 95% CI [0.00;0.09], p=0.03) one year after surgery.Conclusion: Individuals who were radically operated for lung cancer improved health-related quality of life one year after surgery, reaching values similar to a healthy reference population. The walked distance was positively associated with the subjective perception of physical functioning. The clinical significance of these findings deserves further investigation.
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| 4. |
- Brocki, Barbara Cristina, et al.
(författare)
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Inspiratory Muscle Training in High-Risk Patients Following Lung Resection May Prevent a Postoperative Decline in Physical Activity Level
- 2018
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Ingår i: Integrative Cancer Therapies. - : Sage Publications. - 1534-7354 .- 1552-695X. ; 17:4, s. 1095-1102
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To describe postoperative self-reported physical activity (PA) level and assess the effects of 2 weeks of postoperative inspiratory muscle training (IMT) in patients at high risk for postoperative pulmonary complications following lung resection.METHODS: This is a descriptive study reporting supplementary data from a randomized controlled trial that included 68 patients (mean age = 70 ± 8 years), randomized to an intervention group (IG; n = 34) or a control group (CG; n = 34). The IG underwent 2 weeks of postoperative IMT added to a standard postoperative physiotherapy given to both groups. The standard physiotherapy consisted of breathing exercises, coughing techniques, and early mobilization. We evaluated self-reported physical activity (Physical Activity Scale 2.1 questionnaire) and health status (EuroQol EQ-5D-5L questionnaire), assessed the day before surgery and 2 weeks postoperatively.RESULTS: A significant percentage of the patients in the IG reported less sedentary activity 2 weeks postoperatively when compared with the CG (sedentary 6% vs 22%, low activity 56% vs 66%, moderate activity 38% vs 12%, respectively; P = .006). The mean difference in EQ-5D-5L between the IG and CG 2 weeks postoperatively was nonsignificant ( P = .80). The overall preoperative EQ-5D-5L index score for the study population was comparable to a reference population.CONCLUSION: Postoperative IMT seems to prevent a decline in PA level 2 weeks postoperatively in high-risk patients undergoing lung resection. More research is needed to confirm these findings.
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| 5. |
- Brocki, Barbara C, 1957-
(författare)
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Physiotherapy interventions and outcomes following lung cancer surgery
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to evaluate the effect of exercise training and inspiratory muscle training and to describe pulmonary function, respiratory muscle strength, physical performance and health-related quality of life (HRQoL) following lung cancer surgery.Study I was a randomised controlled trial including 78 patients radically operated for lung cancer. The intervention group received 10 sessions of supervised exercise training in addition to home-based exercise; the control group was instructed on home-exercise alone. Supervised compared to non-supervised exercise training did not result in differences between groups in HRQoL, except for the SF-36 bodily pain domain four months after the surgery. No effects of supervised training were found for any outcome after one year.Study II was descriptive and was based on the study I sample. We evaluated the course of recovery of HRQoL and physical performance up to one year following surgery. All patients improved HRQoL and physical performance one year after the surgery, reaching values comparable to a reference healthy population. The walked distance was positively associated with the SF-36 domain for physical functioning.Study III was descriptive, included 81 patients and evaluated the influence of surgery on respiratory muscle strength, lung function and physical performance two weeks and six months after surgery. We found that respiratory muscle strength was not affected after the second postoperative week and that muscle-sparring thoracotomy did not deteriorate respiratory muscle strength, compared to video-assisted thoracic surgery. Compared to preoperative values, physical performance was recovered, whereas lung function remained reduced six months postoperatively.Study IV was a randomised controlled trial including 68 patients at high risk of developing postoperative pulmonary complications (PPC). This study evaluated the effects of two weeks of postoperative inspiratory muscle training in addition to breathing exercises and early mobilisation on respiratory muscle strength and the incidence of PPC. Additional inspiratory muscle training did not increase respiratory muscle strength, but improved postoperative oxygenation. Respiratory muscle strength was recovered in both groups two weeks postoperatively.
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| 6. |
- Brocki, Barbara Cristina, 1957-, et al.
(författare)
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Postoperative inspiratory muscle training in addition to breathing exercises and early mobilization improves oxygenation in high-risk patients after lung cancer surgery : a randomized controlled trial
- 2016
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Ingår i: European Journal of Cardio-Thoracic Surgery. - : Oxford University Press. - 1010-7940 .- 1873-734X. ; 49:5, s. 1483-1491
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES The aim was to investigate whether 2 weeks of inspiratory muscle training (IMT) could preserve respiratory muscle strength in high-risk patients referred for pulmonary resection on the suspicion of or confirmed lung cancer. Secondarily, we investigated the effect of the intervention on the incidence of postoperative pulmonary complications.METHODS The study was a single-centre, parallel-group, randomized trial with assessor blinding and intention-to-treat analysis. The intervention group (IG, n = 34) underwent 2 weeks of postoperative IMT twice daily with 2 × 30 breaths on a target intensity of 30% of maximal inspiratory pressure, in addition to standard postoperative physiotherapy. Standard physiotherapy in the control group (CG, n = 34) consisted of breathing exercises, coughing techniques and early mobilization. We measured respiratory muscle strength (maximal inspiratory/expiratory pressure, MIP/MEP), functional performance (6-min walk test), spirometry and peripheral oxygen saturation (SpO2), assessed the day before surgery and again 3–5 days and 2 weeks postoperatively. Postoperative pulmonary complications were evaluated 2 weeks after surgery.RESULTS The mean age was 70 ± 8 years and 57.5% were males. Thoracotomy was performed in 48.5% (n = 33) of cases. No effect of the intervention was found regarding MIP, MEP, lung volumes or functional performance at any time point. The overall incidence of pneumonia was 13% (n = 9), with no significant difference between groups [IG 6% (n = 2), CG 21% (n = 7), P = 0.14]. An improved SpO2 was found in the IG on the third and fourth postoperative days (Day 3: IG 93.8 ± 3.4 vs CG 91.9 ± 4.1%, P = 0.058; Day 4: IG 93.5 ± 3.5 vs CG 91 ± 3.9%, P = 0.02). We found no association between surgical procedure (thoracotomy versus thoracoscopy) and respiratory muscle strength, which was recovered in both groups 2 weeks after surgery.CONCLUSIONS Two weeks of additional postoperative IMT, compared with standard physiotherapy alone, did not preserve respiratory muscle strength but improved oxygenation in high-risk patients after lung cancer surgery. Respiratory muscle strength recovered in both groups 2 weeks after surgery.
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| 8. |
- Raghavan, Maanasa, et al.
(författare)
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The genetic prehistory of the New World Arctic
- 2014
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Ingår i: Science. - : American Association for the Advancement of Science (AAAS). - 0036-8075 .- 1095-9203. ; 345:6200, s. 1020-
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Tidskriftsartikel (refereegranskat)abstract
- The New World Arctic, the last region of the Americas to be populated by humans, has a relatively well-researched archaeology, but an understanding of its genetic history is lacking. We present genome-wide sequence data from ancient and present-day humans from Greenland, Arctic Canada, Alaska, Aleutian Islands, and Siberia. We show that Paleo-Eskimos (similar to 3000 BCE to 1300 CE) represent a migration pulse into the Americas independent of both Native American and Inuit expansions. Furthermore, the genetic continuity characterizing the Paleo-Eskimo period was interrupted by the arrival of a new population, representing the ancestors of present-day Inuit, with evidence of past gene flow between these lineages. Despite periodic abandonment of major Arctic regions, a single Paleo-Eskimo metapopulation likely survived in near-isolation for more than 4000 years, only to vanish around 700 years ago.
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| 9. |
- Thomassen, Sisse Anette, et al.
(författare)
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Regional muscle tissue saturation is an indicator of global inadequate circulation during cardiopulmonary bypass : a randomized porcine study using muscle, intestinal and brain tissue metabolomics
- 2017
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Ingår i: Perfusion. - : SAGE Publications. - 0267-6591 .- 1477-111X. ; 32:3, s. 192-199
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Tidskriftsartikel (refereegranskat)abstract
- Background: Muscle tissue saturation (StO(2)) measured with near-infrared spectroscopy has generally been considered a measurement of the tissue microcirculatory condition. However, we hypothesized that StO2 could be more regarded as a fast and reliable measure of global than of regional circulatory adequacy and tested this with muscle, intestinal and brain metabolomics at normal and two levels of low cardiopulmonary bypass blood flow rates in a porcine model. Methods: Twelve 80 kg pigs were connected to normothermic cardiopulmonary bypass with a blood flow of 60 mL/kg/min for one hour, reduced randomly to 47.5 mL/kg/min (Group I) or 35 mL/kg/min (Group II) for one hour followed by one hour of 60 mL/kg/min in both groups. Regional StO(2) was measured continuously above the musculus gracilis (non-cannulated leg). Metabolomics were obtained by brain tissue oxygen monitoring system (Licox) measurements of the brain and microdialysis perfusate from the muscle, intestinal mucosa and brain. A non-parametric statistical method was used. Results: The systemic parameters showed profound systemic ischaemia during low CPB blood flow. StO(2) did not change markedly in Group I, but in Group II, StO(2) decreased immediately when blood flow was reduced and, furthermore, was not restored despite blood flow being normalized. Changes in the metabolomics from the muscle, colon and brain followed the changes in StO(2). Conclusion: We found, in this experimental cardiopulmonary bypass model, that StO(2) reacted rapidly when the systemic circulation became inadequate and, furthermore, reliably indicate insufficient global tissue perfusion even when the systemic circulation was restored after a period of systemic hypoperfusion.
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