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Continuous perioperative heart rate variability monitoring in video-assisted thoracoscopic surgery lobectomy-a pilot study.

ABSTRACT: Heart rate variability (HRV) is a measure of cardiac autonomic modulation and is potentially related to hypotension, postoperative atrial fibrillation, and orthostatic intolerance. However, there is a lack of knowledge on which specific time points and indices to measure. To improve future study design, there is a need for procedure-specific studies in an enhanced recovery after surgery (ERAS) video-assisted thoracic surgery (VATS) lobectomy setting, and for continuous measurement of perioperative HRV. HRV was measured continuously from 2 days before until 9 days after VATS lobectomy in 28 patients. After VATS lobectomy, with median length of stay = 4 days, the standard deviation between normal-to-normal beats and the total power of HRV were reduced for 8 days during the night and day times, while low-to-high frequency variation and detrended fluctuation analysis were stable. This is the first detailed study to show that HRV measures of total variability were reduced following ERAS VATS lobectomy, while other measures were more stable. Further, preoperative HRV measures showed circadian variation. The patch was well tolerated among participants, but actions should be taken to ensure proper mounting of the measuring device. These results demonstrate a valid design platform for future HRV studies in relation to postoperative outcomes.

SUBMITTER: Frandsen MN

PROVIDER: S-EPMC10372135 | biostudies-literature | 2023 Aug

REPOSITORIES: biostudies-literature

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Continuous perioperative heart rate variability monitoring in video-assisted thoracoscopic surgery lobectomy-a pilot study.

Frandsen Mikkel Nicklas MN Huang Lin L Petersen René Horsleben RH Foss Nicolai Bang NB Mehlsen Jesper J Kehlet Henrik H

Journal of clinical monitoring and computing 20230527 4

Heart rate variability (HRV) is a measure of cardiac autonomic modulation and is potentially related to hypotension, postoperative atrial fibrillation, and orthostatic intolerance. However, there is a lack of knowledge on which specific time points and indices to measure. To improve future study design, there is a need for procedure-specific studies in an enhanced recovery after surgery (ERAS) video-assisted thoracic surgery (VATS) lobectomy setting, and for continuous measurement of perioperati ...[more]

PMID: 37243951

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Project description:BACKGROUND:In recent years, the technique of uniportal video-assisted thoracoscopic surgery has been developed. As a new surgical method, its feasibility and safety have not been generally recognized. The aim of this study is to review the technology in the treatment of lung cancer patients in stage I to part of stage IIIa. METHODS:The clinical data of patients accepted thoracoscopic resection of lung cancer by a same medical group from May 2018 to March 2019 in The First Affiliated Hospital of Soochow University were retrospectively analyzed. After remove of cases that did not meet the requirements, the patients were divided into uniportal group (55 cases) and biportal group (87 cases). The clinical data of the two groups were collected and statistically analyzed. RESULTS:All the 142 patients underwent lobectomy and systemic lymph node dissection. There is no perioperative death in both groups. There was no significant difference in age, location of tumors, pathological type, size of tumors and pathological tumor-node-metastasis (pTNM) staging between uniportal group and biportal group (P>0.05). The operation time [(167.65±43.85) min vs (181.71±51.28) min], the intraoperative bleeding volume [(57.45±50.19) mL vs (87.47±132.54) mL], the indwelling time of drainage tube [(4.82±2.82) d vs (5.84±3.43) d] and the hospital stay [(6.91±3.88) d vs (7.74±3.87) d] were less in uiportal group compared to biportal group, though no significant difference occurred (P>0.05 ). The total drainage volume of uniportal group was significantly lower than that of biportal group [(1,064.82±776.38) mL vs (1,658.71±1,722.38) mL], and the visual analogue score of 24 hours and 72 hours after operation [(4.73±0.73) points vs (5.25±0.74) points; (2.16±0.71) points vs (2.55±0.86) points] were lower in uniportal group (P<0.05). CONCLUSIONS:Uniportal video-assisted thoracoscopic radical resection of lung cancer is safe and feasible for stage I to part of stage IIIa lung cancer patients.

Project description:BackgroundVideo-assisted thoracoscopic surgery (VATS) lobectomy serves as a standard surgical approach for the management of resectable lung cancer. The double micro-portal VATS lobectomy technique, a viable surgical procedure, has gained widespread acceptance in clinical settings within our center. In this study, we present a retrospective analysis of our institutional experience with the double micro-portal VATS lobectomy, including an assessment of the learning curve.MethodsThe cumulative sum (CUSUM) analysis method was used to analyze the learning curve of 106 cases of double micro-portal VATS lobectomy for resectable lung cancer, all belonging to the same treatment group within the Department of Thoracic Surgery, the 2nd Affiliated Hospital of Air Force Medical University of Chinese People's Liberation Army, from March 2015 to December 2016. The learning curve was derived through accumulating and fitting the operation time and intraoperative bleeding, enabling a comprehensive comparison and analysis of perioperative data across distinct learning phases.ResultsWith the gradual increase in the number of operations, the operation time gradually shortened. Through the application of CUSUM analysis, the goodness-of-fit coefficient peaked at R2=0.878, corresponding to the formula y=134.6 + 15.84×n - 0.1397×n2 - 0.000215×n3. Notably, a vertex crossing occurred when the number of operations reached 51 cases. Similarly, intraoperative bleeding also exhibited a decreasing trend with the increasing number of operations. The goodness-of-fit coefficient attained its maximum value of R2=0.858 using CUSUM analysis, with the formula expressed as y=-238.89 + 81.87×x - 0.9912×x2 + 0.002161×x3. A vertex crossing was achieved when the number of operations reached 49 cases. Based on these findings, 106 surgical patients were categorized into two distinct stages: the learning stage and the proficiency stage, with 51 cases serving as the dividing line. Statistically significant differences were observed in both operation time and intraoperative blood loss (IBL) between these two stages (P<0.05).ConclusionsThe learning curve of double micro-portal VATS lobectomy is fitted by CUSUM analysis. When the cumulative number of operation cases reaches 51 cases, the operation can achieve a relatively stable level.

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Continuous perioperative heart rate variability monitoring in video-assisted thoracoscopic surgery lobectomy-a pilot study.

Publications

Continuous perioperative heart rate variability monitoring in video-assisted thoracoscopic surgery lobectomy-a pilot study.

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