Postoperative Pulmonary Problems Research Articles

Effects of Early Mobilisation on Post Operative Pulmonary Complication in Patients with Open Abdominal Surgery

Background: Patients undergoing open abdominal surgery are the focus of this research, namely the effect of earlymobilisation on postoperative pulmonary problems. Early mobilization is proposed as a potential intervention toenhance respiratory function and reduce the risk of PPCs.Purpose: The purpose of this study is to evaluate the impact of pre-operative mobilisation on the incidence ofpulmonary complications in patients undergoing open abdominal surgery.Materials and Methods: This quasi-experimental study included 50 subjects who underwent open abdominalsurgery at Saveetha Medical Hospital, SIMTS. Convenient sampling was used to select the participants. Measuresof oxygen saturation (SPO2) and pulmonary function (FEV1) from a spirometer were employed as functionaloutcome indicators. After two weeks, participants were given a post-test to record their progress.Results: Data collected before and after early mobilisation exercise were analysed using a paired t-test. Theexperimental group showed significant improvements in SPO2, FIM, and FEV1 (P<0.0001), indicating highervalues post-intervention. Post-test demonstrated higher statistical significance compared to pre-test.Conclusion: As a result, it was shown that early mobilisation Exercise is beneficial for reducing pulmonarycomplications after surgery.

High flow nasal cannula effect on pulmonary complications after major elective upper abdominal surgeries: A randomized control study

ABSTRACT Background Postoperative pulmonary complications (PPCs) are a challenge for anesthesiologists, especially following major surgeries. Using a high-flow nasal cannula (HFNC) postoperatively may decrease this challenge. Purpose The study aimed to assess the clinical effect of HFNC after extubation compared with simple face mask oxygen following major elective upper abdominal surgeries regarding PPCs, the need to escalate the respiratory support, days of intensive care unit stay, and days of hospital stay. Methods Eighty adult patients were randomly assigned to two groups (each with 40 patients): group I received HFNC, while group II received a standard oxygen face mask. Five days later, postoperative pulmonary problems were evaluated. Results There was statistically significantly less lung atelectasis in the HFNC group than in the face mask group. The p-value was 0.029. There was no statistically significant difference concerning the need to escalate the respiratory support. The length of hospital and ICU stay days for the HFNC group was statistically significantly lower than for the face mask group. Conclusion HFNC is more efficient than a simple oxygen face mask in lowering lung atelectasis following major upper abdominal procedures, improving oxygenation with decreasing respiratory rate and reducing ICU and hospital days of stay.

A prospective evaluation of the risk factors for development of wound dehiscence and incisional hernia.

Post-laparotomy wound dehiscence, evantration and evisceration are important complications leading to an increase in both morbidity and mortality. Incisional hernias are frequently observed following abdominal surgeries and their occurrence is related to various local and systemic factors. This study aims to analyze the factors affecting wound healing by investigating the parameters that may cause wound dehiscence, incisional hernia, sinus formation and chronic incisional pain. The records of 265 patients who underwent major abdominal surgery were analyzed. The data on patient characteristics, medication, surgical procedure type, type of suture and surgical instruments used and complications were recorded. The patients were followed up with respect to sinus formation, incisional hernia occurrence and presence of chronic incision pain. Statistical analysis was performed using SPSS 10.00 program. The groups were compared via chi-square tests. Significance was determined as p<0.05. Multi-variate analysis was done by forward logistic regression analysis. 115 (43.4%) patients were female and 150 (56.6%) were male. Ninety-four (35.5%) patients were under 50 years old and 171 (64.5%) were older than 50 years. The median follow-up period was 28 months (0-48). Factors affecting wound dehiscence were found to be; creation of an ostomy (p=0.002), postoperative pulmonary problems (p=0.001) and wound infection (p=0.001). Factors leading to incisional hernia were; incision type (p=0.002), formation of an ostomy (p=0.002), postoperative bowel obstruction (p=0.027), postoperative pulmonary problems (p=0.017) and wound infection (p=0.011). Awareness of the factors causing wound dehiscence and incisional hernia in abdominal surgery, means of intervention to the risk factors and taking relevant measures may prevent complications. Surgical complications that occur in the postoperative period are especially related to wound healing problems.

Smokers and Cosmetic Surgery

Cosmetic surgeons usually require that a patient cease smoking at least 2 weeks prior to a surgical procedure because there is an increased incidence of flap necrosis, slow wound healing, and postoperative pulmonary problems. The author reviews some of the literature on smokers and nicotine as well as formulates recommendations for the surgeon.

Peri-operative care in patients treated for testicular cancer.

The success of combination chemotherapy in treating advanced metastatic germ cell tumors has led to new challenges for the genitourinary oncologic surgeon in the peri-operative care of patients. Surgery remains an integral part of the management of patients with advanced germ cell tumors. Retroperitoneal node dissections following chemotherapy or radiation, or both, are technically more demanding and subject to higher rates of peri-operative complications. Overall post-therapy surgical complication rates range from 33% to 75%, with the highest rates among patients who receive both radiation and chemotherapy. Although most patients with testicular cancer are young and healthy, residual pulmonary, renal, vascular, and neurologic toxicities from chemotherapy can increase the risk of peri-operative complications. In addition, the volume and location of tumor can increase the technical demands, especially when there is a tremendous soft tissue reaction to the chemotherapy. Identification of pre-operative risk factors for peri-operative complications is imperative and the first step in pre-operative planning. Pulmonary toxicity and vascular (cardiac or peripheral) events are the two most immediately life-threatening complications that can occur in the peri-operative period. Due to the high incidence of subclinical pulmonary toxicity, one must consider all patients who have received bleomycin pre-operatively at risk to develop postoperative pulmonary problems. Pre-operative evaluation and judicious fluid management have been shown to reduce the risk of life-threatening respiratory complications in the postoperative period.

Risk factors for pulmonary complications in the postoperative head and neck surgery patient.

Pulmonary complications are a primary source of increased cost and morbidity in surgically treated head and neck cancer patients. This study investigates potential risk factors related to postoperative pulmonary complications (pneumonia, adult respiratory distress syndrome (ARDS), and prolonged mechanical ventilation) in head and neck cancer patients. Data from 144 major head and neck procedures performed at the University of Washington between 1985 and 1991 were retrospectively reviewed. Univariate and multivariate analysis were used to evaluate preoperative and perioperative variables identified as potential risk factors for postoperative pulmonary complications. Fifteen percent of patients had a postoperative pulmonary complication, (n = 21: 18 postoperative pneumonia; 2 ARDS; and 4 prolonged ventilation). The most common pneumonia pathogen was Staphylococcus aureus (62%). Univariate analysis identified smoking and weight loss as significant factors associated with pulmonary complications. The variables preoperative blood urea nitrogen, white blood cell count, and operative chest flap closure all approached but did not reach significance. Multivariate analysis of a subgroup of patients identified smoking history and perioperative antibiotic choice as the only independently significant variables. Patient smoking history was the primary variable related to postoperative pulmonary problems, with evidence of increasing risk with increased exposure. Other variables added only limited additional risk association information after multivariate analysis.

RIGHT PHRENIC NERVE INJURY IN ORTHOTOPIC LIVER TRANSPLANTATION

Right hemidiaphragm paralysis has been previously documented in patients after orthotopic liver transplantation (OLT) and it may contribute to the development of postoperative pulmonary problems. It has been postulated that a crush injury to the right phrenic nerve during OLT is the cause of dysfunction of the right hemidiaphragm. To assess the incidence and effect of right phrenic nerve injury after OLT, we prospectively studied 48 adult liver recipients. Twelve patients who underwent liver resection (LR), in whom the suprahepatic vena cava was not clamped, were used as a comparison group. Diaphragm excursion by ultrasound and pulmonary function were performed preoperatively and postoperatively; transcutaneous phrenic nerve conduction studies were performed postoperatively. Right phrenic nerve injury and hemidiaphragm paralysis occurred in 79% and 38% of the liver recipients but not after LR. Conduction along the right phrenic nerve was absent in 53% and reduced in another 26%. Left phrenic nerve conduction and left hemidiaphragm excursion were normal in both liver recipients and the patients who had LR. Liver recipients with no conduction in the right phrenic nerve had a significantly greater decrease in vital capacity in the supine position (29 +/- 9.8%) compared with those with some conduction (14 +/- 6.9%, P < 0.001). However, neither the time on the ventilator nor the hospital stay was significantly different in the latter two groups. Complete recovery of phrenic nerve conduction and diaphragm function took until nine months in some patients. Right phrenic nerve injury is common after OLT and it is the cause of right hemidiaphragm dysfunction.

Treatment of acute pulmonary failure by CPAP via face mask: when can intubation be avoided?

Continuous positive airway pressure (CPAP) is used frequently to improve gas exchange in acute pulmonary failure. We investigated clinical and respiratory variables in 98 patients presenting with two or more of the classical criteria for endotracheal intubation and mechanical ventilation. CPAP applied by a face mask was efficient in 60 cases. Posttraumatic and postoperative pulmonary problems responded better to this therapy than lung dysfunction secondary to left heart failure, sepsis or pneumonia. Abundant expectorations, discoordination of respiratory movements and an increase in arterial carbon dioxide were frequently associated with failure of CPAP by mask and the necessity of endotracheal intubation and mechanical ventilation.

Intermittent positive-pressure breathing. A critical appraisal.

There are relatively few valid indications for the use of intermittent positive-pressure breathing (IPPB). It is of limited or no value as prophylaxis of postoperative pulmonary problems (pneumonia, atelectasis) or as a means of delivering aerosol medications or treating stable chronic obstructive pulmonary disease. In these situations, IPPB has few if any advantages over voluntary hyperventilation or deep breathing.

The Role of Intercostal Block and Three General Anesthetic Agents as Predisposing Factors to Postoperative Pulmonary Problems

BRIDENBAUGH, PHILLIP O. M.D.; BRIDENBAUGH, L. DONALD M.D.; MOORE, DANIEL C. M.D.; THOMPSON, GALE E. M.D. Author Information

The Importance of Bronchial and Bronchiolar Physiology and Pathophysiologic Changes in the Management of Chest Injuries

In this presentation attention to the bronchi has been called in an attempt toward better understanding of pulmonary complications following trauma. Emphasis has been placed upon the similarity between abnormal bronchial states and normal dynamics of bronchial physiology. Many of the more severe post traumatic and postoperative pulmonary problems have as their underlying basis bronchitis which antedated the injury. Methods of detecting occult hypoventilatory states and objectives and methods of treatment and control were specified.