The effect of local anesthetic continuous wound infusion for the prevention of postoperative pneumonia after on-pump cardiac surgery with sternotomy: the STERNOCAT randomized clinical trial

被引：17

作者：

Amour, Julien ^{[1
]}

Cholley, Bernard ^{[2
]}

Ouattara, Alexandre ^{[3
,4
]}

Longrois, Dan ^{[5
]}

Leprince, Pascal ^{[6
]}

Fellahi, Jean-Luc ^{[7
]}

Riou, Bruno ^{[8
]}

Hariri, Sarah ^{[1
]}

Latremouille, Christian ^{[9
]}

Remy, Alain ^{[3
,4
]}

Provenchere, Sophie ^{[5
]}

Carillion, Aude ^{[1
]}

Achouh, Paul ^{[9
]}

Labrousse, Louis ^{[10
]}

Dinh, Alexy Tran ^{[5
]}

Hamou, Nora Ait ^{[1
]}

Charfeddine, Ahmed ^{[1
]}

Lafourcade, Alexandre ^{[11
]}

Hajage, David ^{[11
]}

Bougle, Adrien ^{[1
]}

Puybasset, Louis ^{[12
,13
]}

Margetis, Dimitri ^{[12
,13
]}

Lebreton, Guillaume ^{[12
,13
]}

Laalie, Mojgane ^{[12
,13
]}

Barreda, Theodoro ^{[12
,13
]}

D'Alessandro, Cossimo ^{[12
,13
]}

Boughenou, Marie-Fazia ^{[14
]}

Bel, Alain ^{[14
]}

Jouan, Jerome ^{[14
]}

Montbrun, Leonara Du Puy ^{[14
]}

Menasche, Philippe ^{[14
]}

Quessard, Astrid ^{[15
]}

机构：

[1] Sorbonne Univ, Pitie Salpetriere Hosp, Dept Anesthesiol & Crit Care Med,Inst Cardiol,IHU, Reanimat Chirurg Cardiaque,Ap HP,INSERM,UMR 1166, 47-83 Blvd Hop, F-75013 Paris, France

[2] Univ Paris 05, Sorbonne Paris Cite, Hop Europeen Georges Pompidou, AP HP,Dept Anesthesiol & Critical Care Med, Paris, France

[3] Univ Bordeaux, INSERM, Biol Cardiovasc Dis, Magellan Medicosurg Ctr,UMR 1034, Bordeaux, France

[4] Univ Bordeaux, INSERM, Dept Anesthesiol & Crit Care, Magellan Medicosurg Ctr,UMR 1034, Bordeaux, France

[5] Univ Paris Diderot, Sorbonne Paris Cite, Dept Anesthesiol & Crit Care Med,Lab Vasc Transla, Hop Bichat Claude Bernard Unite INSERM,U1148,AP H, Paris, France

[6] Sorbonne Univ, Pitie Salpetriere Hosp, Dept Cardiovasc & Thorac Surg, INSERM,UMR 1166,IHU ICAN, Paris, France

[7] Univ Claude Bernard Lyon 1, Hop Louis Pradel, Hosp Civils Lyon, INSERM,U1060,Dept Anesthesiol & Crit Care Med, Lyon, France

[8] Sorbonne Univ, INSERM, Pitie Salpetriere Hosp, AP HP,UMR 1166,IHU ICAN,Dept Emergency Med & Surg, Paris, France

[9] Univ Paris 05, Sorbonne Paris Cite, Hop Europeen Georges Pompidou, AP HP,Dept Cardiovasc & Thorac Surg, Paris, France

[10] Univ Bordeaux, Magellan Medicosurg Ctr, Dept Cardiovasc & Thorac Surg, INSERM,UMR 1034, Bordeaux, France

[11] Sorbonne Univ, Pitie Salpetriere Hosp, AP HP, Dept Biostat Publ Hlth & Med Informat, Paris, France

[12] Hop La Pitie Salpetriere, AP HP, Paris, France

[13] Sorbonne Univ, AP HP, Paris, France

[14] Hop Europeen Georges Pompidou, Paris, France

[15] Magellan Medicosurg Ctr, Bordeaux, France

来源：

INTENSIVE CARE MEDICINE | 2019年 / 45卷 / 01期

关键词：

Pneumonia; Cardiac surgery; Critical care medicine; Postoperative pain; Local anesthetics; VENTILATOR-ASSOCIATED PNEUMONIA; PULMONARY DYSFUNCTION; EPIDURAL HEMATOMA; PAIN MANAGEMENT; HEART-SURGERY; ANALGESIA; BYPASS; INFECTIONS; PATIENT;

D O I：

10.1007/s00134-018-5497-x

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

PurposePostoperative pain after cardiac surgery, exacerbated by cough and sternal mobilization, limits clearance of bronchopulmonary secretions and may predispose to postoperative pneumonia. In this study, we tested the ability of local anesthetic continuous wound infusion to prevent pneumonia after cardiac surgery with sternotomy and cardiopulmonary bypass (CPB) owing to better analgesia and bronchopulmonary drainage.MethodsIn this randomized, double-blind, placebo-controlled trial conducted in five academic centers, patients undergoing cardiac surgery with sternotomy and CPB were enrolled from February 2012 until November 2014, and were followed over 30days. Patients were assigned to a 48-h infusion (10mlh(-1)) of l-bupivacaine (12.5mgh(-1)) or placebo (saline) via a pre-sternal multiperforated catheter. Anesthesia and analgesia protocols were standardized. The primary end point was the incidence of pneumonia during the study period, i.e., until hospital discharge or 30days. We hypothesized a 30% reduction in the incidence of pneumonia.ResultsAmong 1493 randomized patients, 1439 completed the trial. Pneumonia occurred in 36/746 patients (4.9%) in the l-bupivacaine group and in 42/739 patients (5.7%) in the placebo group (absolute risk difference taking into account center and baseline risk of postoperative pneumonia, -1.3% [95% CI -3.4; 0.8] P=0.22). In the predefined subgroup of patients at high risk, l-bupivacaine decreased the incidence of pneumonia (absolute risk difference, -5.6% [95% CI -10.0; -1.1], P=0.01).ConclusionsAfter cardiac surgery with sternotomy, continuous wound infusion of l-bupivacaine failed to decrease the incidence of pneumonia. These findings do not support the use of local anesthetic continuous wound infusion in this indication. Further study should investigate its effect in high-risk patients.Trial registrationEudraCT Number: 2011-003292-10; Clinicaltrials.gov Identifier: NCT01648777.

引用

页码：33 / 43

页数：11

共 33 条

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