背景:胸膜外全肺切除术(EPP)和扩展胸膜切除术/去皮切除术(ePD)是外科细胞减灭术,旨在实现诸如胸膜间皮瘤等恶性胸膜肿瘤的宏观切除,非间皮瘤胸膜恶性肿瘤如胸腺瘤和肉瘤,很少有胸膜结核,以更有限的方式。尽管对手术技术和后果进行了广泛的研究,关于如何最好地应对EPP和ePD的围手术期麻醉挑战,仍然存在显著的知识差距.尚不清楚此类手术的风险分层过程是否标准化,或术前采用哪种类型的功能和动态心脏和肺部检查来协助围手术期风险分层。Further,目前尚不清楚所采用的麻醉和镇痛技术的类型,以及使用的血流动力学监测工具的类型,对结果的影响。还不清楚是否使用个性化的血液动力学方案来指导合理使用液体,血管活性药物和抗张剂。最后,缺乏关于如何在术后最好地监测这些患者的证据,或者最有效的强化恢复方案是什么,以最好地减轻术后并发症和加速出院.为了增加我们对EPP/ePD患者的围手术期和麻醉治疗的认识,本范围审查试图综合文献并确定这些知识差距。
方法:本范围审查将根据系统审查的首选报告项目和范围审查方案的Meta分析扩展方法进行。电子数据库,OVIDMedline,EMBASE和Cochrane图书馆,系统检索EPP或ePD及围手术期或麻醉管理相关文献。将根据围手术期的三个阶段对数据进行描述性分析和总结,并进行组织:术前,临床护理中的术中和术后因素。
背景:不需要伦理批准。研究结果将通过专业网络传播,科学期刊上的会议演讲和出版物。
BACKGROUND: Extrapleural pneumonectomy (EPP) and extended pleurectomy/decortication (ePD) are surgical cytoreductive techniques aimed at achieving macroscopic resection in malignant pleural tumours such as pleural mesothelioma, non-mesothelioma pleural malignancies such as thymoma and sarcoma, and rarely for pleural tuberculosis, in a more limited fashion. Despite extensive studies on both surgical techniques and consequences, a significant knowledge gap remains regarding how best to approach the perioperative anaesthesia challenges for EPP and ePD.It is unknown if the risk stratification processes for such surgeries are standardised or what types of functional and dynamic cardiac and pulmonary tests are employed preoperatively to assist in the perioperative risk stratification. Further, it is unknown whether the types of anaesthesia and analgesia techniques employed, and the types of haemodynamic monitoring tools used, impact on outcomes. It is also unknown whether individualised haemodynamic protocols are used to guide the rational use of fluids, vasoactive drugs and inotropes.Finally, there is a dearth of evidence regarding how best to monitor these patients postoperatively or what the most effective enhanced recovery protocols are to best mitigate postoperative complications and accelerate hospital discharge. To increase our knowledge of the perioperative and anaesthetic treatment for patients undergoing EPP/ePD, this scoping
review attempts to synthesise the literature and identify these knowledge gaps.
METHODS: This scoping
review will be conducted in accordance with the Preferred Reporting Items for Systematic
Review and Meta-Analysis Extension for Scoping
Review Protocols methodology. Electronic databases, OVID Medline, EMBASE and the Cochrane Library, will be systematically searched for relevant literature corresponding to EPP or ePD and perioperative or anaesthetic management. Data will be analysed and summarised descriptively and organised according to the three perioperative stages: preoperative, intraoperative and postoperative factors in clinical care.
BACKGROUND: Ethics approval was not required. The findings will be disseminated through professional networks, conference presentations and publications in scientific journals.