Editorial
Multimodal Rehabilitation Program in Thoracic Surgery
Programa de rehabilitación multimodal en cirugía torácica
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"autoresLista" => "Ignacio Garutti Martínez, Federico González Aragoneses, José Manuel Ramírez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Ignacio" "apellidos" => "Garutti Martínez" "email" => array:1 [ 0 => "ngaruttimartinez@yahoo.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Federico" "apellidos" => "González Aragoneses" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0035" ] ] ] 2 => array:3 [ "nombre" => "José Manuel" "apellidos" => "Ramírez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0045" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Anestesiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía Torácica, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0035" ] 2 => array:3 [ "entidad" => "Servicio de Cirugía General, Hospital Universitario de Zaragoza, Zaragoza, Spain" "etiqueta" => "c" "identificador" => "aff0045" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Programa de rehabilitación multimodal en cirugía torácica" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">One of the main principles of medicine is that advances in knowledge and technological developments lead to improvements in patient care. In the area of surgery, 2 indisputably significant advances have emerged in the last 20 years, namely, minimally invasive surgery and multimodal rehabilitation programs, also known Fast Track protocols or Enhanced Recovery After Anesthesia (ERAS) programs. The aim of both developments is the same: to minimize surgical aggression, thereby improving post-operative recovery.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Comparative, validated data are available from numerous studies to show the benefits of these protocols for both patients (reduced morbidity and improved quality of life) and the healthcare system (shorter hospital stays),<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> but the degree of implementation needs to be examined. ERAS protocols are in essence multidisciplinary, and a lack of coordination between the various specialist areas sometimes makes them difficult to introduce. But what are ERAS programs, exactly? To paraphrase Kehlet, the father of multimodal surgical rehabilitation, ERAS is a combination of perioperative strategies supported by evidence-based medicine and aimed at improving recovery after surgical interventions.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">ERAS protocols revisit conventional perioperative practices and evaluate the specific key points of each procedure, analyzing the scientific evidence for the perioperative management of patients undergoing major surgery, to produce guidelines for helping coordinated teams improve postoperative care.</p><p id="par0020" class="elsevierStylePara elsevierViewall">These protocols cover different phases in the care of surgical patients, and address issues such as shortening the preoperative fasting period, giving carbohydrate-rich drinks before surgery, detection of malnutrition in the preoperative period, need for preventive analgesia, early postsurgical mobilization, rapid reintroduction of oral intake of fluids and food, and prompt withdrawal of unnecessary catheters and tubes. Each of these individual measures is beneficial in itself; however, to maximize the benefit, they should all be implemented together. The level of compliance is important: Gustafsson pointed out the need for implementing over 70% of the measures,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> and it is thought that the application of these protocols successfully improves postoperative progress by reducing the stress response and quickly reactivating organ function.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Most of the scientific evidence is derived from colorectal surgery,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> since this is where the multimodal approach began. Successes there have led to these practices being extended to all surgical specialties.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In thoracic surgery, however, very little data is available, and the success rate is mimimal,<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6–8</span></a> despite recommendations from the British National Institute of Clinical Excellence (NICE).<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> In Spain, the Spanish Multimodal Rehabilitation Group (GERM) was formed in 2007, in an attempt to adapt the protocols to our social and healthcare setting. This initiative has produced good results in several studies, and the current goal of GERM is to work towards introducing these protocols into the care setting.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In thoracic surgery, first concerted multidisciplinary multimodal rehabilitation protocol for the management of patients lobectomized due to tumor disease has been published, following the initiative and concerted efforts of a small group of anesthetists, thoracic surgeons and nutritionists from 6 hospitals located in autonomous communities throughout Spain.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> This protocol, based on the essential phases of care, is in line with GERM philosophy, and places emphasis of the quality of analgesia and rapid withdrawal of chest tubes. Moreover, it is sufficiently flexible to be adapted to most thoracic surgery departments in the country.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The evidence supporting ERAS programs is so overwhelming that it is hard to understand why they have not been implemented sooner. To be acceptable, all protocols must receive the agreement of all participating departments (Anesthetics, Surgery, Nursing and Nutrition) and must involve the patient in the process and decision-making. To meet program objectives, the protocol needs to be followed closely, and reliable measurements are needed to analyze surgical outcomes, using indicators such as morbidity and postoperative stay. Outcomes must be audited with the aim of improving the protocol, and areas for improvement must be examined in interdisciplinary meetings, until these protocols become part of standard clinical practice.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Study Team Members</span><p id="par0045" class="elsevierStylePara elsevierViewall">Dr. Julian Arevalo Ludeña (1), Fundación Jiménez Díaz, Madrid.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Dr. José Luis Ayala Ortega (1), Hospital Rey Juan Carlos, Madrid.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Dra. Cristina Cuerda Compes (3), Hospital General Universitario Gregorio Marañón, Madrid.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Dr. Manuel De la Matta (1), Hospital Universitario Virgen del Rocío, Sevilla.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Dr. Rafael Esturi Navarro (1), Hospital de la Ribera, Alzira, Valencia.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Dr. José Marcelo Galbis Caravajal (2), Hospital de la Ribera, Alzira, Valencia.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Dr. Ignacio Garutti Martinez (1), Hospital General Universitario Gregorio Marañón, Madrid.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Dr. Federico Gonzalez Aragoneses (2), Hospital General Universitario Gregorio Marañón, Madrid.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Dr. José Miguel Izquierdo Elena (2), Hospital Universitario Donostia, San Sebastián.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Dr. Ana Lajara Montell (1), Hospital General Universitario Gregorio Marañón, Madrid.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Dr. Encarna Miñana Aragón (1), Hospital de la Ribera, Alzira, Valencia.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Dr. Nicolás Moreno Mata (2), Hospital Universitario Virgen del Rocío, Sevilla.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Dr. Ignacio Muguruza Trueba (2), Hospital Rey Juan Carlos, Madrid.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Dr. Luis Enrique Muñoz Alameda (1), Fundación Jiménez Díaz, Madrid.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Dr. Reyes Ortiz de Urbina González (1), Hospital Universitario Donostia, San Sebastián.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Dr. Rafael Peñalver Pascual (2), Hospital General Universitario Gregorio Marañón, Madrid.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Dr. Fernando Sánchez (1), Hospital de la Ribera, Alzira, Valencia.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Dr. José Zapatero Gaviria (2), Fundación Jiménez Díaz, Madrid.</p><p id="par0135" class="elsevierStylePara elsevierViewall">1: Department of Anestesiology; 2: Department of Thoracic Surgery; 3: Department of Endocrinology and Nutrition.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0140" class="elsevierStylePara elsevierViewall">No funding was received for the preparation of this manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of Interests</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Study Team Members" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of Interests" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Garutti Martínez I, González Aragoneses F, Ramírez JM. Programa de rehabilitación multimodal en cirugía torácica. Arch Bronconeumol. 2015;51:159–160.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The enhanced recover after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized trials" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K.K. Varandhan" 1 => "K.R. Neal" 2 => "C.H. Dejong" 3 => "K.C. Fearon" 4 => "O. Ljungqvist" 5 => "D.N. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 3 | 9 |
| 2024 October | 41 | 15 | 56 |
| 2024 September | 37 | 14 | 51 |
| 2024 August | 63 | 37 | 100 |
| 2024 July | 44 | 18 | 62 |
| 2024 June | 59 | 35 | 94 |
| 2024 May | 95 | 32 | 127 |
| 2024 April | 39 | 24 | 63 |
| 2024 March | 38 | 14 | 52 |
| 2024 February | 37 | 23 | 60 |
| 2023 March | 7 | 4 | 11 |
| 2023 February | 34 | 16 | 50 |
| 2023 January | 24 | 56 | 80 |
| 2022 December | 37 | 63 | 100 |
| 2022 November | 52 | 34 | 86 |
| 2022 October | 41 | 31 | 72 |
| 2022 September | 31 | 30 | 61 |
| 2022 August | 26 | 39 | 65 |
| 2022 July | 33 | 36 | 69 |
| 2022 June | 27 | 45 | 72 |
| 2022 May | 39 | 40 | 79 |
| 2022 April | 27 | 29 | 56 |
| 2022 March | 33 | 39 | 72 |
| 2022 February | 38 | 29 | 67 |
| 2022 January | 18 | 37 | 55 |
| 2021 December | 22 | 31 | 53 |
| 2021 November | 22 | 35 | 57 |
| 2021 October | 33 | 44 | 77 |
| 2021 September | 22 | 41 | 63 |
| 2021 August | 13 | 32 | 45 |
| 2021 July | 18 | 35 | 53 |
| 2021 June | 31 | 36 | 67 |
| 2021 May | 40 | 29 | 69 |
| 2021 April | 76 | 83 | 159 |
| 2021 March | 45 | 23 | 68 |
| 2021 February | 28 | 23 | 51 |
| 2021 January | 28 | 21 | 49 |
| 2020 December | 27 | 22 | 49 |
| 2020 November | 25 | 15 | 40 |
| 2020 October | 20 | 20 | 40 |
| 2020 September | 23 | 18 | 41 |
| 2020 August | 25 | 21 | 46 |
| 2020 July | 20 | 19 | 39 |
| 2020 June | 25 | 15 | 40 |
| 2020 May | 22 | 10 | 32 |
| 2020 April | 25 | 20 | 45 |
| 2020 March | 24 | 11 | 35 |
| 2020 February | 35 | 15 | 50 |
| 2020 January | 24 | 17 | 41 |
| 2019 December | 28 | 23 | 51 |
| 2019 November | 19 | 15 | 34 |
| 2019 October | 17 | 10 | 27 |
| 2019 September | 18 | 15 | 33 |
| 2019 August | 23 | 19 | 42 |
| 2019 July | 26 | 13 | 39 |
| 2019 June | 24 | 17 | 41 |
| 2019 May | 36 | 11 | 47 |
| 2019 April | 41 | 34 | 75 |
| 2019 March | 35 | 20 | 55 |
| 2019 February | 32 | 21 | 53 |
| 2019 January | 31 | 16 | 47 |
| 2018 December | 26 | 23 | 49 |
| 2018 November | 43 | 19 | 62 |
| 2018 October | 66 | 33 | 99 |
| 2018 September | 44 | 14 | 58 |
| 2018 May | 18 | 1 | 19 |
| 2018 April | 24 | 16 | 40 |
| 2018 March | 47 | 10 | 57 |
| 2018 February | 31 | 9 | 40 |
| 2018 January | 100 | 14 | 114 |
| 2017 December | 89 | 11 | 100 |
| 2017 November | 20 | 6 | 26 |
| 2017 October | 28 | 13 | 41 |
| 2017 September | 20 | 22 | 42 |
| 2017 August | 23 | 14 | 37 |
| 2017 July | 15 | 25 | 40 |
| 2017 June | 43 | 39 | 82 |
| 2017 May | 32 | 30 | 62 |
| 2017 April | 30 | 26 | 56 |
| 2017 March | 21 | 19 | 40 |
| 2017 February | 14 | 12 | 26 |
| 2017 January | 18 | 13 | 31 |
| 2016 December | 34 | 18 | 52 |
| 2016 November | 38 | 18 | 56 |
| 2016 October | 42 | 20 | 62 |
| 2016 September | 50 | 19 | 69 |
| 2016 August | 43 | 13 | 56 |
| 2016 July | 31 | 12 | 43 |
| 2016 March | 2 | 0 | 2 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 50 | 2 | 52 |
| 2015 September | 32 | 8 | 40 |
| 2015 August | 37 | 11 | 48 |
| 2015 July | 25 | 12 | 37 |
| 2015 May | 0 | 1 | 1 |
| 2015 April | 0 | 3 | 3 |
Show all
