Treatment Of Postoperative Pulmonary Complications Research Articles

Is Incentive Spirometry Superior to Standard Care in Postoperative Cardiac Surgery on Clinical Outcomes and Length of Hospital and Intensive Care Unit Stay? A Systematic Review with Meta-Analysis.

Cardiac surgery is a frequent surgical procedure and may present a high risk of complications. Among the prophylactic strategies studied to decrease the rates of negative outcomes, respiratory care seems to reduce pulmonary complications. Incentive spirometry (IS) is a low-cost, respiratory exercise technique, used for the prevention and treatment of postoperative pulmonary complications (PPC). The aim of this review was to evaluate whether IS is superior to respiratory care, mobilization exercises, and noninvasive ventilation on PPC, and clinical outcomes. Systematic review. Medical Literature Analysis and Retrieval System Online (or MEDLINE®), Embase®, Cochrane Central Register of Controlled Trials (or CENTRAL), Physiotherapy Evidence Database (or PEDro), Cumulative Index of Nursing and Allied Health (or CINAHL®), Latin American and Caribbean Health Sciences Literature (or LILACS), Scientific Electronic Library Online (or SciELO), Allied, Scopus®, and OpenGrey databases, clinical trial registration sites, conferences, congresses, and symposiums were searched. Twenty-one randomized trials and one quasi-randomized trial (1,677 participants) were included. For partial pressure of oxygen (PaO2), IS was inferior to respiratory care (mean difference [MD] -4.48; 95% confidence interval [CI] -8.32 to -0.63). Flow-oriented IS was inferior to respiratory care on PaO2 (MD -4.53; 95% CI -8.88 to -0.18). However, compared to respiratory care, flow-oriented IS was superior on recovery vital capacity. This meta-analysis revealed that IS was not superior to standard respiratory care for PPCs and clinical outcomes, therefore its use should not be widely recommended until further studies with high quality be performed to ensure this clinical guidance.

Perioperative Medicine: Managing for Outcome, 2nd Edition

Perioperative Medicine: Managing for Outcome, 2nd Edition

Interventions targeting postoperative pulmonary complications (PPCs) in patients undergoing esophageal cancer surgery: a systematic review of randomized clinical trials and narrative discussion.

Postoperative pulmonary complications (PPCs) represent the most common complications after esophageal cancer surgery. The lack of a uniform reporting nomenclature and a severity classification has hampered consistency of research in this area, including the study of interventions targeting prevention and treatment of PPCs. This systematic review focused on RCTs of clinical interventions used to minimize the impact of PPCs. Searches were conducted up to 08/02/2021 on MEDLINE (OVID), CINAHL, Embase, Web of Science, and the COCHRANE library for RCTs and reported in accordance with PRISMA guidelines. A total of 339 citations, with a pooled dataset of 1,369 patients and 14 RCTs, were included. Heterogeneity of study design and outcomes prevented meta-analysis. PPCs are multi-faceted and not fully understood with respect to etiology. The review highlights the paucity of high-quality evidence for best practice in the management of PPCs. Further research in the area of intraoperative interventions and early postoperative ERAS standards is required. A consistent uniform for definition of pneumonia after esophagectomy and the development of a severity scale appears warranted to inform further RCTs and guidelines.

Perioperative care for major elective surgery: a survey of Brazilian physiotherapists

Abstract Introduction: Major surgeries are highly complex procedures and have a higher incidence of respiratory morbidity and mortality compared to other types of surgery. Postoperative pulmonary complications (PPC) are common after such surgeries and are associated with increased hospital stay, health care costs and surgical patient mortality. Objective: To investigate the most commonly used physical therapy techniques for the prevention and treatment of PPC among thoracic and abdominal surgery patients in all regions of Brazil. Methods: A total of 489 randomly selected physiotherapists who provided perioperative care for patients undergoing elective abdominal, thoracic or cardiac surgeries participated in this study. A questionnaire with nine questions about routine care and therapeutic choices for the surgical population was developed and assessed by 10 specialists before being administered to the physiotherapists. Results: Among the physiotherapists (63% with at least 5 years of experience with surgical patients), 50.9% considered the patient’s surgical risk in their treatment either always or often. A total of 53.8% patients were treated by the physiotherapist following a physician’s prescription. The most mentioned physical therapy techniques used to prevent PPC were postoperative mobilization/exercises (59.3%), postoperative lung expansion (52.8%), and preoperative advice (50.7%). In addition, 80.6% of the physiotherapists believe that incentive spirometry prevents PPC, while 72.8% expected this effect from positive airway pressure devices. Conclusion: Most physiotherapists in Brazil who work with surgical patients offer preoperative professional advice, use postoperative early mobilization and lung expansion techniques to prevent PPC, and consider the patient's surgical risk during treatment. In addition, some physical therapy sessions are routinely performed preoperatively.

Routine use of continuous positive airway pressure after major abdominal surgery

The prevention, recognition, and treatment of postoperative pulmonary complications utilises considerable equipment and personnel resources worldwide. Early mobilisation and a variety of respiratory therapies have been used in an effort to reduce the incidence of postoperative pulmonary complications. These therapies include intermittent positive pressure breathing, incentive spirometry, chest physiotherapy, positive expiratory pressure, and continuous positive airway pressure (CPAP).1 In The Lancet Respiratory Medicine, the PRISM trial group reported the effect of CPAP for the prevention of pneumonia, re-intubation, and death after major abdominal surgery.

Research progress on the perioperative strategy of prevention and treatment of postoperative pulmonary complications

Postoperative pulmonary complication (PPC) has drawn increasing attention due to high incidence and mortality in surgical patients. However, there are many debates its diagnosis and treatment. This review summarized the pathogenesis, diagnosis, predictive risk indicators, and strategy of lung protective ventilation, as well as surgical, anesthesiological, nursing care and other preventative measures that can be taken in the perioperative period. It also introduces the progress on domestic and oversea researches. In the new era when the concept of enhanced recovery after surgery is widely accepted, close multi- disciplinary cooperation is required to cope with PPC and reduce its severity. Key words: Lung; Postoperative complications; Perioperative period; Lung protective ventilation

Effect of incentive spirometry after cardiac surgery: protocol for a systematic review

Introduction: Patients receiving cardiac surgeries present high risk of developing postoperative complications. Incentive spirometry (IS) is used for the prevention and treatment of postoperative pulmonary complications in patients undergoing cardiac surgeries. Publications have suggested that IS is ineffective. In contrast, some studies have shown that when IS is adequately used, it may lead to beneficial outcomes. Objectives: To assess the effect of IS in patients undergoing cardiac surgeries. Methods/design: Systematic Reviews with randomised and quasi-randomised trials with adult patients undergoing cardiac surgeries, evaluating the effect of flow or volume-oriented IS. Outcome measures: postoperative pulmonary complications; adverse events; mortality; length of hospital stay; length of intensive care unit stay; reintubation rate; pulmonary function; antibiotic use; oxygenation; and respiratory muscle strength. Search: MEDLINE, EMBASE, CENTRAL, PEDro, CINAHL, LILACS, SCIELO, Allied, AMED, Scopus, Open Grey database, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), ClinicalTrials.gov, clinicaltrialsregister.eu, and ReBec. Two authors will independently extract data. PEDro scale will be used to evaluate the methodological quality of the studies. Meta-analysis will be performed using the inverse variance method and the random effects model in RevMan 5.3. We will use the I2 statistic to estimate the amount of heterogeneity across studies in each meta-analysis. Ethics and dissemination: The approval of an ethical committee is not required. Only clinical trials that have complied with ethical guidelines and followed the Declaration of Helsinki, will be included in this systematic review. The findings of this study will help clarify uncertainties about the effects of incentive spirometry in the postoperative period of cardiac surgery and may be disseminated to clinicians, assisting in decision making and including the best evidence in the treatment of their patients. Discussion: This review will clarify the uncertainty over whether IS is a useful technique for patients undergoing cardiac surgeries. While good quality studies have shown IS is an effective prophylactic technique, other studies have suggested that there is no evidence to support IS utilization.Keywords: incentive spirometry, cardiac surgery, postoperative.

Effect of Combination of Acapella Device and Breathing Exercises on Treatment of Pulmonary Complications After Upper Abdominal Surgeries

<i>Introduction: Background. </i>Upper abdominal surgery alters postoperative pulmonary function, as observed by impairment of lung volumes such as total lung capacity, vital capacity. Impaired clearance of sputum results in a vicious cycle of colonization and infection of bronchi with pathogenic organisms, dilation of bronchi and further production of sputum. <i>The aim</i> was to investigate the effect of combination of Acapella device and breathing exercises on treatment of post operative pulmonary complications after upper abdominal surgeries. <i>Subjects and methods: </i>Sixty patients underwent upper abdominal surgery were assigned randomly into two equal groups; their ages ranged from 20-50 years. The study group received breathing exercises, Acapella device and traditional chest physical therapy program (postural drainage. percussion, vibration, cough training and early ambulation). Control group received traditional chest physical therapy program (postural drainage. percussion, vibration, cough training and early ambulation). All groups received three sessions per week for four successful weeks. The data were collected before and after the same period of treatment for both groups. Evaluation procedures were carried out to measure pulmonary function: Forced vital capacity (FVC) and Forced expiratory volume in one second (FEV1) using electronic spirometer. <i>Results: </i>Post treatment results showed that there was a significant improvement difference in FVC and FEV1 in both groups in favor of the study group. Percentage of improvement of FVC in the study group was 42.28%, while it was 16.31%in the control group. Percentage of improvement of FEV1 in the study group was 49.05%, while it was 20.79%in the control group. <i>Conclusion: </i>Combination of Acapella device and breathing exercises were considered to be an effective modality for treatment of postoperative pulmonary complications and removal of secretions after upper abdominal surgeries.

Perioperative pulmonary function protection in patients of fragile pulmonary function

Background As the ageing of the population,the number of patients with fragile pulmonary function underwent operation and anesthesia increase with years.Perioperative pulmonary function protection more and more get attention of Clinical doctors pay.Objective To learn factors affecting pulmonaryfunction and methods protecting pulmonary function.Content To review perioperative factors affecting pulmonaryfunction and corresponding methos protecting pulmonary function.Trend There are potential factors affecting pulmonary function during the perioperative period,perioperative protection of pulmonary function,prevention and treatment of postoperative pulmonary complications (PPC) is very important,which is powerful guarantee to promote fast recovery of patients. Key words: Fragile pulmonary function; Perioperative period; Protection of pulmonary function

Chest physiotherapy for the surgical patient.

This article reviews the evidence that chest physiotherapy is effective in the prevention and treatment of pulmonary complications after major abdominal and thoracic surgery. There is some evidence that regular chest physiotherapy significantly decreases the incidence of pulmonary complications, although the mechanism of this effect is uncertain. It is not known whether chest physiotherapy is effective in the treatment of postoperative pulmonary complications after they have developed.

Prevention and Treatment of Postoperative Pulmonary Complications

Prevention and Treatment of Postoperative Pulmonary Complications

Tobacco bronchitis; an anesthesiologic study.

Excerpt Bronchitis is a recognized hazard in anesthesia and surgery because coughing and tracheobronchial hyperirritability and hypersecretion predispose the patient to the following complications:...

Treatment of pulmonary complications in neurosurgical patients by tracheotomy.

SINCE the advent of modern surgery, prevention and treatment of postoperative pulmonary complications have been subjects of intensive interest and research. In 1924 Leopold¹first pointed out the similarity of physical findings in postoperative atelectasis and in instances of foreign bodies obstructing a bronchus. This led to the original work of Lee and Tucker,²who successfully treated postoperative atelectasis by bronchoscopy. In attempting to reproduce the condition experimentally, Tucker, Lee and Clerf³inserted secretions which had been previously aspirated from a patient into one of the main bronchi of dogs. They found that atelectasis could be produced by this method, but only after the animal was anesthetized deeply enough to abolish the cough reflex. From these experiments was developed the present concept that two factors are responsible for postoperative atelectasis: (1) suppressed or ineffectual cough and (2) presence of abnormal secretion in the tracheobronchial tree. Management of

Toward prevention and treatment of postoperative pulmonary complications

The first reports about postoperative pulmonary complications we find in Gusenbacher and Piеtrzikowsky'oro, who drew attention to the connection between herniotomy for impinged hernias and the pulmonary complications that developed after it.Postoperative pulmonary complications undoubtedly occurred before, but then they were overshadowed by other, more formidable complications - septic ones, which abounded in the pre-antiseptic era. Now the latter have been minimized, but we have inherited the pulmonary complications entirely. They still visit every surgical hospital without exception, and surgeons are still far from being the winners in the fight against them. Only a very few surgeons have not had them in their practice at all.

On treatment of postoperative pulmonary complications

Among the postoperative complications that can threaten the life of the operated patient, postoperative bronchitis and bronchopneumonia developing from it are especially numerous and dangerous; the latter mostly have a severe course, often putting the very life of the patient at risk. Hence, it is natural that successful control of postoperative pulmonary complications is one of the next and practically important tasks of modern surgery. Therefore, it is not surprising that the surgical thought is constantly dealing with this issue, considering it both from the preventive and the therapeutic side.