Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Apr 17;7:7.
doi: 10.1186/s13741-018-0084-9. eCollection 2018.

What Are the Optimum Components in a Care Bundle Aimed at Reducing Post-Operative Pulmonary Complications in High-Risk Patients?

Collaborators, Affiliations
Free PMC article

What Are the Optimum Components in a Care Bundle Aimed at Reducing Post-Operative Pulmonary Complications in High-Risk Patients?

Sophie V Griffiths et al. Perioper Med (Lond). .
Free PMC article


Background: Post-operative pulmonary complications (POPC) are common, predictable and associated with increased morbidity and mortality, independent of pre-operative risk. Interventions to reduce the incidence of POPC have been studied individually, but the use of a care bundle has not been widely investigated. The purpose of our work was to use Delphi consensus methodology and an independently chosen expert panel to formulate a care bundle for patients identified as being at high of POPC, as preparation towards an evaluation of its effectiveness at reducing POPC.

Methods: We performed a survey of members of the ESICM POIC section to inform a Delphi consensus and to share their opinions on a care bundle to reduce POPC, the POPC-CB. We formed a team of 36 experts to participate in and complete an email-based Delphi consensus over three rounds, leading to the formulation of the POPC-CB.

Results: The survey had 362 respondents and informed the design of the Delphi consensus. The Delphi consensus resulted in a proposed POPC-CB that incorporates components before surgery-supervised exercise programmes and inspiratory muscle training, during surgery, low tidal volume ventilation with individualised PEEP (positive end-expiratory pressure), use of routine monitoring to avoid hyperoxia and efforts made to limit neuromuscular blockade, and post-operatively, deep breathing exercises and elevation of the head of the bed.

Conclusion: A care bundle has been suggested for evaluation in surgical patients at high risk of POPC. Evaluation of feasibility of both implementation and effectiveness is now indicated.

Keywords: Care bundle; Delphi consensus; Inspiratory muscle training; Intra-operative ventilation; Nosocomial pneumonia; Post-operative pulmonary complications.

Conflict of interest statement

Not applicable.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.


Fig. 1
Fig. 1
Flow diagram to summarise the methods

Similar articles

See all similar articles

Cited by 2 articles


    1. Arozullah AM, Daley J, Henderson WG, Khuri SF, Program NVASQI Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. Annals of Surg. 2000;232:242–253. doi: 10.1097/00000658-200008000-00015. - DOI - PMC - PubMed
    1. Berg H, Viby-Mogensen J, Roed J, Mortensen C, Engbæk J, Skovgaard LT, Krintel J. Residual neuromuscular block is a risk factor for postoperative pulmonary complications. A prospective, randomised, and blinded study of postoperative pulmonary complications after atracurium, vecuronium and pancuronium. Acta Anaesthesiol Scand. 1997;41:1095–1103. doi: 10.1111/j.1399-6576.1997.tb04851.x. - DOI - PubMed
    1. Brower R, Lanken P, MacIntyre N, Matthay M, Morris A, Ancukiewicz M, Schoenfeld D, Thompson B. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med. 2004;351:327. doi: 10.1056/NEJMoa032193. - DOI - PubMed
    1. Canet J, Gallart L, Gomar C, Paluzie G, Valles J, Castillo J, Sabate S, Mazo V, Briones Z, Sanchis J, Group A Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010;113:1338–1350. doi: 10.1097/ALN.0b013e3181fc6e0a. - DOI - PubMed
    1. Canet J, Sabate S, Mazo V, Gallart L, de Abreu MG, Belda J, Langeron O, Hoeft A, Pelosi P, group P Development and validation of a score to predict postoperative respiratory failure in a multicentre European cohort: a prospective, observational study. Eur J Anaesthesiol. 2015;32:458–470. doi: 10.1097/EJA.0000000000000223. - DOI - PubMed

LinkOut - more resources