Abdominal Surgery Patients Research Articles

Influência de diferentes posições corporais na capacidade vital em pacientes no pós‐operatório abdominal superior

RationaleThe changes in body position can cause changes in lung function, it is necessary to understand them, especially in the postoperative upper abdominal surgery, since these patients are susceptible to postoperative pulmonary complications. ObjectiveTo assess the vital capacity in the supine position (head at 0° and 45°), sitting and standing positions in patients in the postoperative upper abdominal surgery. MethodsA cross‐sectional study conducted between August 2008 and January 2009 in a hospital in Salvador/BA. The instrument used to measure vital capacity (VC) was analogic spirometer, the choice of the sequence of positions followed a random order obtained from the draw of the four positions. Secondary data were collected from the medical records of each patient. ResultsThe sample consisted of 30 subjects with a mean age of 45.2±11.2 years, BMI 20.2±1.0 kg/m2. The position on orthostasis showed higher values of CV regarding standing (mean change: 0.15±0.03 liters; p=0.001), the supine to 45 (average difference: 0.32±0.04 liters; p=0.001) and 0° (0.50±0.05 liters; p=0.001). There was a positive trend between the values of FVC supine to upright posture (1.68±0.47; 1.86±0.48; 2.02±0.48 and 2.18±0.52 liters; respectively). ConclusionBody position affects the values of CV in patients in the postoperative upper abdominal surgery, increasing in postures where the chest is vertical.

The significance of atrial fibrillation in patients aged ≥ 55 years undergoing abdominal surgery.

The Institute of Medicine has identified atrial fibrillation (AF) among national priorities for research. We examine the incidence of AF and its association with outcomes of patients undergoing abdominal surgery. Patients ≥ 55 years who underwent abdominal surgery captured in a State Inpatient Database, 2008-2010. Three patient groups were created: (1) No diagnosis of AF (No-AF), (2) Pre-existing AF (Hx-AF), and (3) New-onset AF (New-AF). Outcomes were analysed using bivariate and multivariate methods. AF incidence among 116,477 patients was 8.6 %; approximately one in four patients aged ≥ 85 years had AF. 26.6 % of patients with AF experienced New-AF; the latter was more likely after pancreas resection (43.0 %) and least common after cholecystectomy (20.2 %). Complications (71.1, 47.3 vs. 26.5 %), mortality (8.0, 5.7 vs. 2.0 %), longer hospital stays (8.8, 5.6 vs. 3.8 days), and higher hospitalization cost ($41,427, $26,312 vs. $18,310) were more likely in patients with AF (New-AF, Hx-AF vs. No-AF respectively) (all p < 0.001). After adjustment, New-AF was among factors independently associated with mortality (OR 2.0, 95 % CI 1.7-2.4, p < 0.001); each case of New-AF increased cost of care by $4,482. Factors independently associated with New-AF included ≥ 1 complication, electrolyte imbalance, and procedure-type. Whereas 2.0 % of patients who developed New-AF were admitted from a long-term care facility, 23.8 % of patients with New-AF were discharged to a long-term care facility. AF is common among abdominal surgery patients, particularly the elderly; New-AF is a serious, potentially avoidable adverse event that could serve as an important quality of care indicator for abdominal surgery patients.

Perioperative goal-directed hemodynamic optimization using noninvasive cardiac output monitoring in major abdominal surgery: a prospective, randomized, multicenter, pragmatic trial: POEMAS Study (PeriOperative goal-directed thErapy in Major Abdominal Surgery).

In this study, our objective was to determine whether a perioperative hemodynamic protocol based on noninvasive cardiac output monitoring decreases the incidence of postoperative complications and hospital length of stay in major abdominal surgery patients requiring intensive care unit admission. Secondary objectives were the time to peristalsis recovery and the incidence of wound infection, anastomotic leaks, and mortality. A randomized clinical trial was conducted in 6 tertiary hospitals. One hundred forty-two adult patients scheduled for open colorectal surgery, gastrectomy, or small bowel resection were enrolled. A hemodynamic protocol including fluid administration and vasoactive drugs based on arterial blood pressure, cardiac index, and stroke volume response was compared with standard practice. Patients were followed until hospital discharge (determined by a surgeon blinded to the study) or death. In contrast to previous studies, we designed a pragmatic trial (as opposed to explanatory trials) to mimic real practice and obtain maximal external validity for the study. Fluid administration was similar except for the number of colloid boluses (2.4 ± 1.8 [treated] vs 1.3 ± 1.4 [control]; P < 0.001) and packed red blood cell units (0.6 ± 1.3 [treated] vs 0.2 ± 0.6 [control]; P = 0.019). Dobutamine was used in 25% (intraoperatively) and 19.4% (postoperatively) of the treated patients versus 1.4% and 0% in the control group (P < 0.001). We have observed a reduction in reoperations in the treated group (5.6% vs 15.7%; P = 0.049). However, no significant differences were observed in overall complications (40% vs 41%; relative risk 0.99 [0.67-1.44]; P = 0.397), length of stay (11.5 [8-15] vs 10.5 [8-16]; P = 0.874), time to first flatus (62 hours [40-76] vs 72 hours [48-96]; P = 0.180), wound infection (7 vs 14; P = 0.085), anastomotic leaks (2 vs 5; P = 0.23), or mortality (4.2% vs 5.7%; P = 0.67). The results of our pragmatic study indicate that a perioperative hemodynamic protocol guided by a noninvasive cardiac output monitor was not associated with a decrease in the incidence of overall complications or length of stay in major abdominal surgery.

Nosocomial candidemia; risk factors and prognosis revisited; 11 years experience from a Norwegian secondary hospital.

The aim of the study was to review the epidemiology and prognosis of candidemia in a secondary hospital, and to examine the intra-hospital distribution of candidemia patients. Study design is a retrospective cohort study. Trough 2002–2012, 110 cases of candidemia were diagnosed, giving an incidence of 2, 6/100000 citizens/year. Overall prognosis of candidemia was dismal, with a 30 days case fatality rate of 49% and one year case fatality rate of 64%. Candidemia was a terminal event in 55% of 30 days non-survivors, defined as Candida blood cultures reported positive on the day of death or thereafter (39%), or treatment refrained due to hopeless short-term prognosis (16%). In terminal event candidemias, advanced or incurable cancer was present in 29%. Non-survivors at 30 days were 9 years (median) older than survivors. In 30 days survivors, candidemia was not recognised before discharge in 13% of cases. No treatment were given and no deaths or complications were observed in this group. Candidemia patients were grouped into 8 patient categories: Abdominal surgery (35%), urology (13%), other surgery (11%), pneumonia (13%), haematological malignancy (7%), intravenous drug abuse (4%), other medical (15%), and new-borns (3%). Candidemia was diagnosed while admitted in the ICU in 46% of patients. Urology related cases were all diagnosed in the general ward. Multiple surgical procedures were done in 60% of abdominal surgery patients. Antibiotics were administered prior to candidemia in 87% of patients, with median duration 17 (1–108) days. Neutropenia was less common than expected in patients with candidemia (8/105) and closely associated to haematological malignancy (6/8). Compared with previous national figures the epidemiology of invasive candidiasis seems not to have changed over the last decade.

Mitochondrial DNA haplogroups are associated with severe sepsis and mortality in patients who underwent major surgery

To analyse whether mitochondrial DNA (mtDNA) haplogroups are associated with severe sepsis and mortality after major surgery. We performed a case-control study on 240 cardiac or abdominal surgery patients developing severe sepsis (Case-group) and 267 cardiac or abdominal surgery patients without severe sepsis and with systemic inflammatory response syndrome (SIRS, Control-group). Furthermore, a longitudinal substudy was performed for analysing the survival in septic patients. Only European white patients within the N macro-cluster were included. Case-group underwent cardiac surgery had lower frequencies of cluster HV (p = 0.005) and haplogroup H (p = 0.005) and higher frequencies of cluster JT (p = 0.028) than Control-group; but no significant differences were found for abdominal surgery. Besides, both cluster HV and haplogroup H were associated with decreased odds of severe sepsis (adjusted odds ratio (aOR) = 0.45 (95%CI = 0.25; 0.82); p = 0.009 and aOR = 0.48 (95%CI = 0.26; 0.87); p = 0.015, respectively) among patients underwent cardiac surgery. In Case-group, 45.4% (109/240) patients died with a survival median of 39 (95%CI = 31.4; 46.62) days. When the clusters were examined, 41% (55/134) patients within cluster HV died versus 71.4% (10/14) patients within cluster IWX (p = 0.018). Additionally, patients within cluster IWX had an increased risk of death (adjusted hazard ratio (aHR) = 2.22; (95%CI = 1.14; 4.34); p = 0.019). European mitochondrial haplogroups might be related to the onset of severe sepsis in patients who underwent major cardiac surgery, but not in patients underwent major abdominal surgery. Besides, mtDNA haplogroups could have influence on mortality in septic patients.

Adherence With Postdischarge Venous Thromboembolism Chemoprophylaxis Recommendations After Colorectal Cancer Surgery Among Elderly Medicare Beneficiaries

To assess national adherence with extended venous thromboembolism (VTE) chemoprophylaxis guideline recommendations after colorectal cancer surgery. Postoperative VTE remains a major cause of morbidity and mortality after abdominal cancer surgery. On the basis of the results from randomized controlled trials, since 2007, national guidelines have suggested that these patients be discharged on VTE chemoprophylaxis. Medicare beneficiaries undergoing open colorectal cancer resections in 2008-2009 were identified using the Medicare Provider Analysis and Review data and limited to those who were enrolled and used Part D for their postoperative prescriptions. Postdischarge use of low-molecular-weight-heparin and other anticoagulants was assessed. A total of 5078 patients underwent open colorectal cancer surgery and met the inclusion criteria. Of these, 77% underwent colectomy and 23% underwent proctectomy. A prescription for an anticoagulant was filled immediately after discharge for 77 (1.5%) patients, and a low-molecular-weight-heparin for 60 (1.2%) patients. On multivariable analysis, patients were more likely to receive postdischarge VTE chemoprophylaxis if undergoing rectal cancer surgery [incidence rate ratio (IRR), 1.83; 95% confidence interval, 1.07-3.12; vs colon], if higher educational status (IRR, 2.20; 95% confidence interval, 1.23-3.95; vs low education), or if they had a higher Elixhauser comorbidity index (IRR, 1.13; 95% confidence interval, 1.01-1.25; vs lower index). Although VTE remains a major issue after abdominal cancer surgery, only 1.5% of Medicare beneficiaries undergoing colorectal cancer surgery received care consistent with established guidelines for postdischarge VTE chemoprophylaxis. Barriers to adherence must be elucidated to improve the quality of care for abdominal and pelvic cancer surgery patients.

Opening Pandora's box: understanding the nature, patterns, and 30-day outcomes of intraoperative adverse events

BackgroundLittle evidence exists regarding the characteristics of intraoperative adverse events (iAEs). MethodsAdministrative data, the American College of Surgeons - National Surgical Quality Improvement Project, and systematic review of operative reports were used to confirm iAEs in abdominal surgery patients. Standard American College of Surgeons - National Surgical Quality Improvement Project data were supplemented with variables including injury type/organ, phase of operation, adhesions, repair type, and intraoperative consultations. ResultsTwo hundred twenty-seven iAEs (187 patients) were confirmed in 9,292 patients. Most common injuries were enterotomies during intestinal surgery (68%) and vessel injuries during hepatopancreaticobiliary surgery (61%); 108 iAEs (48%) specifically occurred during adhesiolysis. A third of the iAEs required organ/tissue resection or complex reconstruction. Because of iAEs, 20 intraoperative consults (11%) were requested and 9 of the 66 (16%) laparoscopic cases were converted to open. Thirty-day mortality and morbidity were 6% and 58%, respectively. The complications included perioperative transfusions (36%), surgical site infection (19%), systemic sepsis (13%), and failure to wean off the ventilator (12%). ConclusionsiAEs commonly occur in reoperative cases requiring lysis of adhesions and possibly lead to increased patient morbidity. Understanding iAEs is essential to prevent their occurrence and mitigate their adverse effects.

Influence of high-dose intraoperative remifentanil with or without amantadine on postoperative pain intensity and morphine consumption in major abdominal surgery patients

Human volunteer studies demonstrate ketamine-reversible opioid-induced hyperalgesia, consistent with reports of increased postoperative pain and analgesic consumption. However, recent clinical trials showed controversial results after intraoperative administration of high-dose remifentanil. To investigate in lower abdominal surgery patients whether postoperative pain intensity and analgesic consumption are increased following intraoperative high-dose vs. low-dose remifentanil, and whether this could be prevented by preoperative administration of the NMDA antagonist amantadine. Randomised, placebo-controlled, clinical study. University hospital. Sixty patients scheduled for elective major lower abdominal surgery. Patients were randomly assigned to one of three anaesthetic regimens. First, in the group 'low-dose remifentanil and preoperative isotonic saline' (n=15), a remifentanil infusion was maintained at a rate of 0.1 μg kg min throughout anaesthesia, and the end-tidal concentration of sevoflurane started at 0.5 minimum alveolar concentration (MAC) and was increased by 0.2% increments according to clinical demand. Preoperatively, 500 ml NaCl 0.9% were infused as study solution. Second, in the group 'high-dose remifentanil and preoperative saline' (n=17), the end-tidal concentration of sevoflurane was maintained at 0.5 MAC throughout anaesthesia. A remifentanil infusion was started at a rate of 0.2 μg kg min and subsequently increased by 0.05 μg kg min increments to clinical demand. Preoperatively, these patients also received a solution of 500 ml NaCl 0.9% as study solution. Third, the group 'high-dose remifentanil and preoperative amantadine' (n=16) received the same anaesthetic protocol as the second group, but the preoperative study solution was substituted by amantadine (200 mg/500 ml). Pain intensity measured by the numerical rating scale and cumulative morphine consumption. The remifentanil dose in both high-dose groups was significantly higher compared with the low-dose remifentanil group (0.20±0.04 and 0.23±0.02 vs. 0.08±0.04 μg kg min; P<0.001). Pain intensity gradually increased up to 45 min postoperatively in all groups, and then decreased again towards low levels in parallel with a linear increase in morphine consumption. Postoperative pain intensity and morphine consumption did not significantly differ between groups. Moreover, preoperative amantadine revealed no additional benefit. We were not able to demonstrate any influence on routine clinical outcome parameters of pain after high-dose remifentanil. Although not without limitations, these findings are in line with other clinical trials that could not detect an opioid-induced impact on postoperative pain parameters, which might be less sensitive to detect opioid-induced hyperalgesia compared with quantitative sensory testing. DRKS00004626.

Comparison of Incentive Spirometry V/S Peak Flow Meter by Measuring the Peak Flow Rate in Post Operative Abdominal Surgery Patients

Objective:To find the effectiveness of inspiratory exercises in post operative abdominal surgery patients.To find the effectiveness of expiratory exercises in post operative abdominal surgery patients.To compare the effectiveness of inspiratory exercises v/s expiratory exercises in post operative abdominal surgery patients.

The Role of Physiological and Operative Severity Score for the Evaluation of Mortality and Morbility in the Stratification of Abdominal and Extrabdominal Surgery Patients

Background: Adequate stratification and scoring of risk is essential to optimize clinical practice; the ability to predict operative mortality and morbidity is important to choose the gold therapy and a proper use of resources. The Physiological And Operative Severity Score For The Evaluation Of Mortality And Morbility (POSSUM) has been proved to be the most appropriate scoring system in providing an estimation of postoperative mortality for patients undergoing abdominal surgery. The aim of our study was to verify the predictive accuracy of POSSUM in patients undergoing elec- tive extrabdominal surgery. Patients and Methods: Our study included 189 patients, all admitted to Intensive Care Unit (ICU) at S.Andrea Hospital in Rome. The sample was divided in 2 groups: group A, abdominal surgery; group B, extrabdominal surgery. All types of surgery were included except for cardiac surgery, pediatric surgery and urgent surgery. For each patient was determined the POSSUM score. Age, sex and preoperative information, surgical diagnosis, severity of the procedure , time of hospitalization, post operative complications were also recorded. The two groups were divided in classes, based on the rate of morbidity and mortality. For each class was calculated the re- lation between predicted and observed deceases, and the relation between predicted and observed complications, scoring 1 if present and 0 if not present, in order to assign a reliability score to each group. Furthermore, basing on the length of stay, were individuated three subgroups of patients: hospitalization 7 days. For each group was evaluated the correlation between observed and predicted morbidity. Results: Above 189 patients, 49 developed postoperative complications, with a real morbidity rate of 25,9% (95%CI: 20%-32%) and a predicted rate of 51,3%; the relation between observed and predicted complications (O/P ratio) was 0,50. For the A group the O/P ratio was 0,45, with a real morbidity rate of 25,53% (95% CI: 17%-34%) over a predicted rate of 56,4%. In the B group the O/P ratio was 0,53, with a real morbidity rate of 26,31% (95%CI: 17,2%-34,8%), and a pre- dicted rate of 49%. Above 189 patients, 5 deceased, with a real mortality rate of 2,64% (95% CI: 0,4%-4,8%), over a pre- dicted rate of 16,4%; the relation between observed and predicted deaths (O/P ratio) was 0,16. For the A group, O/P ratio was 0,11, with a real mortality rate of 2,1% (95% CI: 0-5%) over a predicted rate of 18,08%; for the B group, O/P ratio was 0,25, with a real rate of 3,16% (95% CI: 0-436,7%) over a predicted rate of 12,63%. Correlation between time of hospitalization and POSSUM morbidity has an average strength expressed by a ρ value = 0,4. Conclusion: Observed data confirm the possibility to extend the POSSUM score in the stratification of patients undergo- ing extrabdominal surgery. Even though it overpredicted the value of morbidity and mortality, as widely known, POS- SUM score shows an impressive uniformity and concordance between the main groups A and B. Furthermore, there is a good correlation between time of stay in ICU and the POSSUM morbidity. Our results suggest that POSSUM can be an adequate perioperative mean, recommended to evaluate the real condition of a patient after surgery and to determine the requirement of an admission to the postoperative ICU.

Venous Thrombo-embolism prophylaxis: Intermittent pneumatic compression

Abstract Pulmonary embolism (PE) is the most preventable cause of hospital deaths in Europe. Autopsy-proven fatal pulmonary emboli were found in 2.5% of 200 hospitalized medical patients followed-up prospectively. The number of venous thrombo-embolism (VTE) related deaths throughout the Europe (543,454) is more than double the amount of deaths attributed to AIDS, breast cancer, prostate cancer and transport accidents combined (209,926). Only 58.5% of surgical patients and 39.5% of medical patients receive the appropriate thrombo-prophylaxis for their conditions. An ideal VTE prophylaxis for any given patient should be (1) risk adjusted, (2) targeted, (3) personalized and (4) effective. Intermittent pneumatic compression (IPC) devices are best suited for: (1) ICU patients who are either bleeding or have a high bleeding risk; (2) low risk elective general abdominal or pelvic surgery patients; (3) high risk elective general abdominal or pelvic surgery patients who have a high bleeding risk. In high risk elective general abdominal or pelvic surgery patients who are not at high risk for major bleeding, combined prophylaxis (IPC+LMWH) are recommended. Combined modalities target virtually all aspects of the Virchow's triad: (1) IPC and stockings prevent “stasis”, (2) stockings prevent “endothelial damage”, (3) IPC increases fibrinolysis, and LMWH exert anti-thrombotic effects to prevent “hypercoagulability”. In patients undergoing major surgery, IPC devices have a broader area of application due to fewer contra-indications and similar efficacy as compared to LMWH. Whenever indicated, every effort should be undertaken to provide a combined prophylaxis method.

Pathfast Presepsin Assay for Early Diagnosis of Bacterial Infections in Surgical Patients: Preliminary Study

BackgroundVarious biomarkers have been studied for diagnosing bacterial infections, seeking to stop the sepsis cascade. Presepsin, which is ∼13 kDa in size, has been identified to increase specifically in the blood of sepsis patients. Additionally, measurement of presepsin is useful to evaluate the severity of infection and monitor clinical responses. We evaluated the analytical and clinical performance of the Pathfast presepsin (PFP) assay system for early diagnosis of infection. Materials and MethodsFrom November 2011 to June 2012 we studied 70 adult patients, including 35 cadaveric organ transplant recipients and 35 abdominal surgery patients. The 32 female and 38 male subjects had a mean age of 56.1 years (range, 19–70). Heparinized whole blood for PFP assay was tested at 48 hours after surgery together with blood cultures. ResultsThe mean presepsin level (PL) in the 50 positive patients was 3,957.45 pg/mL (range 255–20,000). For transplant patients, PL was 3,034.43 ± 2,880.791 pg/mL, with 30 positive results. Microbiologic findings confirmed the presence of bacterial infections within 69 ± 2.5 hours from enrollment despite that when the test was performed, 70% showed no sign or symptom of infection. In 15 abdominal surgery patients, the PFP test was negative with negative blood cultures. The positive PFP test in 20 other abdominal surgery patients showed PL of 2,363 ± 7,988.47 pg/mL in the absence of signs or symptoms of infection in 25% of them. The 20 positive patients showed positive blood cultures within 67 ± 1.8 hours from enrollment. ConclusionsThe PFP test had a (100%) sensitivity to show the presence of infection in a short time (15 min), confirmed by positive blood cultures.

KPC - 3 Klebsiella pneumoniaeST258 clone infection in postoperative abdominal surgery patients in an intensive care setting: analysis of a case series of 30 patients

BackgroundAbdominal surgery carries significant morbidity and mortality, which is in turn associated with an enormous use of healthcare resources. We describe the clinical course of 30 Intensive Care Unit (ICU) patients who underwent abdominal surgery and showed severe infections caused by Klebsiella pneumoniae sequence type (ST) 258 producing K. pneumoniae carbapenemase (KPC-Kp). The aim was to evaluate risk factors for mortality and the impact of a combination therapy of colistin plus recommended regimen or higher dosage of tigecycline.MethodsA prospective assessment of severe monomicrobial KPC-Kp infections occurring after open abdominal surgery carried out from August 2011 to August 2012 in the same hospital by different surgical teams is presented. Clinical and surgical characteristics, microbiological and surveillance data, factors associated with mortality and treatment regimens were analyzed. A combination regimen of colistin with tigecycline was used. A high dose of tigecycline was administered according to intra-abdominal abscess severity and MICs for tigecycline.ResultsThe mean age of the patients was 56.6 ± 15 and their APACHE score on admission averaged 22.72. Twenty out of 30 patients came from the surgical emergency unit. Fifteen patients showed intra-abdominal abscess, eight anastomotic leakage, four surgical site infection (SSI) and three peritonitis. The overall crude ICU mortality rate was 40% (12 out of 30 patients). Twelve of the 30 patients were started on a combination treatment of high-dose tigecycline and intravenous colistin. A significantly lower mortality rate was observed among those patients compared to patients treated with approved dose of tigecycline plus colistin. No adverse events were reported with high doses of tigecycline.ConclusionsCritically-ill surgical patients are prone to severe post-surgical infectious complications caused by KPC-Kp. Timely microbiological diagnosis and optimizing antibiotic dosing regimens are essential to prevent worse outcomes. Further studies and well-controlled clinical trials are needed to define the optimal treatment of infections by KPC-Kp and, more generally, carbapenem-resistant bacteria.

Optimizing of heterologous expression of human recombinant His-tagged prethrombin-2 in Escherichia coli

Various biomarkers have been studied for diagnosing bacterial infections, seeking to stop the sepsis cascade. Presepsin, which is ∼13 kDa in size, has been identified to increase specifically in the blood of sepsis patients. Additionally, measurement of presepsin is useful to evaluate the severity of infection and monitor clinical responses. We evaluated the analytical and clinical performance of the Pathfast presepsin (PFP) assay system for early diagnosis of infection.From November 2011 to June 2012 we studied 70 adult patients, including 35 cadaveric organ transplant recipients and 35 abdominal surgery patients. The 32 female and 38 male subjects had a mean age of 56.1 years (range, 19–70). Heparinized whole blood for PFP assay was tested at 48 hours after surgery together with blood cultures.The mean presepsin level (PL) in the 50 positive patients was 3,957.45 pg/mL (range 255–20,000). For transplant patients, PL was 3,034.43 ± 2,880.791 pg/mL, with 30 positive results. Microbiologic findings confirmed the presence of bacterial infections within 69 ± 2.5 hours from enrollment despite that when the test was performed, 70% showed no sign or symptom of infection. In 15 abdominal surgery patients, the PFP test was negative with negative blood cultures. The positive PFP test in 20 other abdominal surgery patients showed PL of 2,363 ± 7,988.47 pg/mL in the absence of signs or symptoms of infection in 25% of them. The 20 positive patients showed positive blood cultures within 67 ± 1.8 hours from enrollment.The PFP test had a (100%) sensitivity to show the presence of infection in a short time (15 min), confirmed by positive blood cultures.

Predictive nursing on prevention of lung infection after abdominal surgery with anesthesia intubation

Objective To explore clinical effect of predictive nursing on prevention of lung infection after abdominal surgery with anesthesia intubation in Gynecology department.Meethods Totals of 190 cases of abdominal surgery patients with anesthesia intubation were divided into observation group (n =95) and control group (n =95) randomly.Patients in observation group were treated by using predictive nursing,and control group were treated general care measures.The lung infection morbidity between two groups were observed and compared.Results The lung infection morbidity in observation group and control group was 1.05％ (1/95)and 8.42％ (8/95),respectively,and the difference was statistically significant (x2 =5.72,P ＜ 0.05).Conclusions Predictive nursing intervention on prevention of lung infection after abdominal surgery with anesthesia intubation can reduce the occurrence of hospital acquired pulmonary infection. Key words: Predictive nursing; Anesthesia intubation; Abdominal surgery; Hospital-acquired infection; Pulmonary infection

Music intervention study in abdominal surgery patients: Challenges of an intervention study in clinical practice

Evidence-based nursing requires carefully designed interventions. This paper discusses methodological issues and explores practical solutions in the use of music intervention in pain management among adults after major abdominal surgery. There is a need to study nursing interventions that develop and test the effects of interventions to advanced clinical nursing knowledge and practice. There are challenges in carrying out intervention studies in clinical settings because of several interacting components and the length and complexity of the causal chains linking intervention with outcome. Intervention study is time-consuming and requires both researchers and participants' commitment to the study. Interdisciplinary and multiprofessional collaboration is also paramount. In this study, patients were allocated into the music group, in which patients listened to music 30 minutes at a time, or the control group, in which patients did not listen to any music during the same period.

DGI-069 The Importance of Clinical Pharmacist Counselling in Improving Patient Medication Adherence

BackgroundAdherence is a key factor in achieving good clinical outcomes in patients undergoing long-term treatment. Meeting with patients is fundamental in educating them on correct drug use, and recommending dietary...

Transversus Abdominis Block: Clinical Uses, Side Effects, and Future Perspectives

Poorly controlled acute pain during the postoperative setting after abdominal surgery can be detrimental to the patient. Current pain management practices for the postoperative abdominal surgery patient rely heavily on opioids, which are associated with many unwanted side effects. Recently, interest surrounding regional anesthesia has been growing owing to its demonstrated efficacy and safety outcomes. More specifically, the transversus abdominis plane (TAP) block procedure has attracted attention owing to its ability to successfully block peripheral pain signaling in the abdomen, its ease of use, few complications, and its greater acceptability. A majority of the studies published has demonstrated the successful reduction in pain in many abdominal surgical procedures using local anesthetics during the TAP block. However, the short duration of the pain block causes the patient to still rely on other analgesics throughout the additional postoperative days. Preliminary studies using continuous infusion catheters placed in the TAP has been one of the ways to prolong the nerve block in the abdomen; however, technical and operational issues currently limit the widespread adoption of this method. In this review, current studies will be presented and summarized to update the field on the potential benefits of the TAP block procedure, in addition to providing insight into the future direction of the drugs that could be used for TAP block.

Guarding the Gut

The postoperative period following abdominal surgery presents many challenges to patients and clinicians as recovery progresses and discharge from the intensive care unit approaches. Physiologic changes including the release of inflammatory mediators, increased fatigue and reduction in body mass, and a decline in pulmonary function occurring after abdominal surgery are often potentiated by bed rest and immobility. Evidence-based interventions have the potential to prevent pulmonary complications, wound instability, drain displacement, and orthostatic hypotension. Promoting early mobility is one example of an evidence-based strategy to improve patient outcomes. By understanding the specific needs of the abdominal surgery population, the clinician can safely and effectively implement a mobility plan. The purpose of this article was to briefly review the inflammatory effects associated with bed rest, critical illness, and surgery; review the literature related to mobility in the abdominal surgery patient; describe the effects of immobility on postoperative outcomes; discuss the safety concerns and barriers to mobilization; discuss strategies to overcome barriers; and provide suggestions for application in practice.

Breathing Exercises with Positive Expiratory Pressure after Abdominal Surgery–The Current Physical Therapy Practice in Sweden

Objectives: In Sweden breathing exercises with Positive Expiratory Pressure (PEP) are commonly recommended for the prevention of pulmonary complications after abdominal surgery. Scientific documentation of the effects of PEP treatment is limited. The aim of this national survey was to describe the current physical therapy practice of PEP treatment after abdominal surgery in Sweden. Methods: A questionnaire was sent by e-mail to the 45 physical therapists who work with abdominal surgery patients in all seven university hospitals in Sweden. The questionnaire contained questions about the usage of PEP after abdominal surgery. Results: In total, 24 (54%) of the physical therapists answered the questionnaire. All reported using PEP as a treatment option after abdominal surgery. The most commonly used PEP device was the Blow bottle system and the PEP ventil system connected to a mouthpiece. Recommendations regarding treatment frequency and implementation varied significantly across respondents. The number of breaths per treatment varied considerably. Conclusion: All respondentsreported using PEP as a postoperative treatment on abdominal surgery wards. The treatment is most often recommended hourly during the first postoperative days. The common first-choice PEP devices were the Blow bottle system, Pep/Rmt set with mouthpiece or mask, Breathing exerciser/PEP valve system 22, and the Mini-PEP.