EUROANESTHESIA 2008 Copenhagen, Denmark, 31 May - 3 June 2008 THE EVIDENCE BASIS REGARDING POSTOPERATIVE PULMONARY COMPLICATIONS
|
|
- Caren Price
- 5 years ago
- Views:
Transcription
1 EUROANESTHESIA 2008 Copenhagen, Denmark, 31 May - 3 June 2008 THE EVIDENCE BASIS REGARDING POSTOPERATIVE PULMONARY COMPLICATIONS 05RC1 JAUME CANET, VALENTÍN MAZO, ZAHARA BRIONES Department of Anaesthesiology Hospital Universitari Germans Trias i Pujol Barcelona, Spain Saturday, May 31, :00-14:45 Auditorium 12 Postoperative pulmonary complications account for a substantial part of the risk related to surgery and anaesthesia and are a source of postoperative morbidity and mortality and longer hospital stays [1]. Postoperative pulmonary complications are at least as prevalent as cardiac postoperative complications, yet much of the literature on the assessment of peri-operative risk has been focussed on identifying cardiac risk factors [2], while information on risk factors for pulmonary complications is less complete. The aim of this Refresher Course lecture is to review the current evidence basis underpinning our understanding of postoperative pulmonary complications, particularly the identification of peri-operative risk factors. DEFINITION AND INCIDENCE Various study design flaws explain the lack of information on risk factors for postoperative pulmonary complications. One of the most important flaws is the absence of a definition. The majority of investigators include postoperative pneumonia (definite or suspected), respiratory failure (usually defined as the need for ventilatory support) and bronchospasm, but analysis of the literature shows that other complications such as unexplained fever, excessive bronchial secretions, productive cough, abnormal breath sounds, atelectasis or hypoxaemia may also be included. Furthermore, the definition of each of these categories can vary widely, and the incidence of pulmonary complications varies depending on the clinical setting patients are treated in and the kind of surgery studied. For all these reasons, the incidence rates vary dramatically, ranging between 2% and 40% [3]. CAUSES OF POSTOPERATIVE PULMONARY COMPLICATIONS The factors affecting the development of postoperative pulmonary complications are related to the prior health status of the patient and the effects of anaesthesia and surgical trauma. The synergy between these factors determines risk [4, 5]. GENERAL HEALTH STATUS The overall health of the patient has a strong influence on the development of these complications. Preexisting disorders affecting normal respiratory and cardiovascular function and those associated with an abnormal immunological response favour their development. GENERAL ANAESTHESIA General anaesthesia has biological effects that include decreasing the number and activity of alveolar macrophages, inhibiting mucociliary clearance, increasing alveolar-capillary permeability, inhibiting surfactant release, increasing the activity of pulmonary nitric oxide synthetase, and enhancing the sensitivity of the pulmonary vasculature to neurohumoral mediators [6]. Anaesthesia also results in mechanical and functional changes in the respiratory system. These begin with anaesthetic induction and can extend into the postoperative period. Anaesthesia reduces functional residual capacity with an immediate and universal development of atelectasis in the dependent regions of the lung through three mechanisms: compression of lung tissue, absorption of alveolar air, and impairment of surfactant function. As a consequence it produces a disruption of the normal activity of the respiratory muscles, in particular the diaphragm. The resulting mismatch between ventilation and perfusion leads to increased shunt and dead space and hypoxaemia. The effects of anaesthetic, analgesic and other peri-operative drugs on the central regulation of breathing change the neural drive to the upper airway and chest wall muscles and are additional factors contributing to postoperative pulmonary complications. Overall, the intensity and co-ordination of the activity of several muscle groups and the preservation of pulmonary biological mechanisms is the key to walking the thin line between recovery and severe respiratory complications [6]
2 SURGICAL TRAUMA The surgical insult contributes greatly to the development of pulmonary complications. All thoracic and abdominal surgery produces trauma near the diaphragm. At least three types of trauma are involved: functional disruption of respiratory muscles by incisions, postoperative pain causing limitation of respiratory motion, and stimulation of the viscera by mechanical traction producing reflex inhibition of the phrenic and other nerves innervating respiratory muscles [5]. Factors related to the degree of surgical insult, such as duration of the procedure or blood loss by themselves or through an interaction with the local effects described above, increase the risk of developing pulmonary complications. The postoperative immune response is extremely complex and has detrimental (pro-coagulant and immunosuppressive) effects. Pro-inflammatory cytokines, especially tumour necrosis factor and interleukin-6, play a major role in the systemic inflammatory response syndrome and multiple organ dysfunction after trauma. Again, immunological depression, in this case provoked by the surgical insult, might be invoked as a mediator to favour postoperative respiratory infection and other complications. SYSTEMATIC REVIEW: EVIDENCE THAT IS NOT SO EVIDENT Recently, guidelines for the reduction of postoperative pulmonary complications in patients undergoing non-cardiac surgery were published by the American College of Physicians. The recommendations, based on a systematic review of the literature, represent the largest attempt to find an evidence basis for our understanding of this subject [7]. The authors found 16,959 articles addressing the issue. After careful reading, 145 studies were selected. Eighty-three provided univariate data and 73 of them were cohort studies, of which less than half were prospective. Only 10 were of good quality. Another 27 studies reported multivariable analyses meeting the authors inclusion criteria. In addition to these studies, the authors collected data on 10,960 events among 324,648 patients. However, 89.8% of these patients were included in three studies which used subsets of patients from the Veterans National Surgical Quality Improvement Project (NSQIP) [8, 9]. The crude postoperative pulmonary complication rate among the cohort studies was 3.4%. Table 1 shows risk factors for postoperative pulmonary complications with good (Class A) or fair (Class B evidence according to the systematic review by the American College of Physicians). The same meta-analysis shows that there is fair or good evidence that the following factors do not increase the risk of these complications: diabetes, obesity, asthma, and hip, gynaecological and urologic surgery. TABLE 1. SIGNIFICANT RISK FACTORS ACCORDING THE SYSTEMATIC REVIEW OF THE AMERICAN COLLEGE OF PHYSICIANS
3 This extensive systematic review detected literature with important limitations, including study sample sizes that were too small to measure clinically relevant pulmonary outcomes, unblinded outcome assessment, inconsistencies in how complications were defined, dependence on observational studies, and statistical issues. Most of the literature consists of observational studies that focus on the discovery of potential risk factors rather than direct hypothesis testing, and many studies use univariate pre-screening and multivariable selection methods to identify a subset of statistically significant risk factors. In addition, as has been already mentioned, the NSQUIP studies, due to the large number of patients, have excessive weight in the meta-analysis, producing a significant bias. THE VETERANS AFFAIRS NSQUIP INDEX FOR PREDICTING POSTOPERATIVE PNEUMONIA The NSQUIP study was the largest study, using data from 160,805 patients to develop a risk index for predicting postoperative pneumonia after non-cardiac surgery and its 30-day mortality [9]. The crude incidence of pneumonia was 1.5%, and the 30-day postoperative mortality rate of patients who developed pneumonia was 21%. The 14-item risk index score, divided into five classes, is shown in Table 2. Pneumonia rates were 0.2% among those with 0-15 points, 1.2% for those with points, 4.0% for those with points, 9.4% for those with points, and 15.3% for those with more than 55 points. TABLE 2. POSTOPERATIVE PNEUMONIA RISK INDEX Table taken from Arozullah AM, et al. Ann Intern Med 2001; 135: [9]
4 There are a number of limitations to this study. Firstly, the study population was atypical: the patients were virtually all male veterans with high co-morbidity. Thus, the performance of the risk index in women or healthier populations is unknown. Secondly, data collection was not uniform from institution to institution. Thirdly, the 1.5% incidence of pneumonia is lower than frequencies reported in most studies of pneumonia in selected high-risk patient cohorts. Finally, as the NSQUIP database was not designed primarily to evaluate respiratory risk, it is possible that data on relevant respiratory risk factors were missed. FURTHER ANALYSIS More recently, McAlister et al [10, 11] found only eight small studies (averaging 207 patients and 16 outcomes per study) that compared the pre-operative evaluation and postoperative pulmonary outcomes in an independent and blinded fashion in patients undergoing non-thoracic surgery. These studies were limited by non-representative samples and reported conflicting results. Although 20 variables were found to be significantly associated with postoperative pulmonary complications in at least one of the studies, only seven were significant in more than one study. For this reason they conducted a prospective cohort study in 1,055 consecutive patients attending the pre-admission clinic of a university hospital (with postoperative pulmonary complications scored by an investigator blinded to peri-operative variables) to determine the risk factors for after elective non-thoracic surgery. The mean length of stay was substantially longer for those patients who developed pulmonary complications within 7 days of surgery: 27.9 days vs. 4.5 days, p< They confirmed that eight of the 20 previously reported peri-operative variables were associated with postoperative pulmonary complications: age, pack-years smoked, positive cough test (performed by having the patient take a deep inspiration and cough once, a positive finding defined as recurrent coughing after the first cough), FEV 1, FEV 1 /FVC ratio, duration of anaesthesia, upper abdominal incision, and peri-operative placement of a nasogastric tube. However, multivariate analyses revealed that only four were independently associated with increased risk of pulmonary complications: age (odds ratio (OR) 5.9 for age 65 yr, p<0.001), positive cough test (OR 3.8, p<0.01), peri-operative nasogastric tube (OR 7.7, p<0.001), and duration of anaesthesia (OR 3.3 for operations lasting at least 2.5 h, p< 0.008). ASSESSMENT OF PERIOPERATIVE COMPLICATIONS ASSOCIATED WITH SMOKING AND ANAESTHESIA IN CATALONIA (ARISCAT) ARISCAT is a multicentre prospective cohort study conducted in Catalonia that finished at the beginning of This study included a large randomised general surgical population (2,991 patients in 59 hospitals) and aimed to explore risk factors for general postoperative outcome and particularly for postoperative pulmonary complications. Detailed pre-, intra- and postoperative questionnaires (until 3 months after surgery), described demographic, medical and quality of life characteristics. In particular, the respiratory status of all patients was recorded through detailed structured questionnaires investigating pre-existing respiratory disorders, respiratory symptoms, cough test and past and current smoking habits. Structured follow-up of intra- and postoperative complications was also performed. Complications were defined based on a medical intervention and recorded in the chart. The average rate of postoperative pulmonary complications was 5% for the in-patient surgery population overall. 1.6% of pulmonary complications were respiratory infections and 2.5% were respiratory failure. Table 3 shows the variables found to be independently associated with increased risk of pulmonary complications (predictive capacity of %) in the multivariate analysis. Postoperative length of hospital stay for patients who did not develop pulmonary complications was 3 days, compared with 12 days for those who did (p<0.001). Mortality 3 months after surgery was 1.3% vs. 24% (p<0.001), respectively
5 TABLE 3. SIGNIFICANT VARIABLES FOR POSTOPERATIVE PULMONARY COMPLICATIONS FROM MULTIVARIANT ANALYSIS (ARISCAT STUDY, SEE TEXT) Intrathoracic surgery (incl. cardiac surgery) Male gender Age Emergency surgery Positive cough test COPD Previous upper respiratory tract infection Chronic renal disease Upper abdominal surgery Duration of surgery >2.5 h Oncologic diagnosis Surgical insult scale 3 CONCLUSIONS The first step in reducing postoperative pulmonary complications is to identify which patients are at increased risk. By doing so, we can more closely follow high-risk patients and target future interventions toward those patients most likely to benefit. Current evidence indicates that certain peri-operative factors can be used to identify patients awaiting surgery who are at increased risk. These factors are related to the previous health status of the patients and to the anaesthetic and surgical procedure. However, the currently available information on what risk factors have true a impact on the development of postoperative pulmonary complications has important limitations. Firstly, there is a shortage of good quality studies. Secondly, the investigation of risk factors is based on observational studies which are not necessarily well designed. Such studies should be prospective with blinded analysis, although even these will never have the power to indicate causality, as can be achieved through controlled studies. Furthermore, extrapolation to a general surgical population is difficult because the majority of studies are conducted in single institutions and restricted clinical settings (specific patient types and operations) and lack a uniform definition of postoperative pulmonary complications. Thirdly, in spite of advances in epidemiology and statistics, important bias can result from the selection of variables to be introduced into the multivariate analysis. Particular attention should be paid if the ASA class is introduced as a variable. In spite of the large inter-observer variability, the ASA class is a potent predictor of all kinds of postoperative outcomes because it assesses all co-morbidities. For this reason, a multivariate analysis that includes the ASA class should be interpreted cautiously because particular co-morbidities, that could be managed clinically, will disappear from the statistical model [12]. Finally, the results obtained can be very discouraging because many of the risk factors described cannot be modified. In future investigations an effort should be made to try to reduce these multiple biases in order to more precisely determine the factors associated with postoperative pulmonary complications and strategies that limit their effect. KEY LEARNING POINTS Postoperative pulmonary complications account for a substantial part of the risk related to surgery and anaesthesia and are a source of postoperative morbidity and mortality and longer hospital stays. The current evidence basis informing us of the nature of postoperative pulmonary complications is biased because of flaws such as the inclusion of a small number of studies of good quality, the lack of a uniform definition, and the reliance on studies restricted to specific patients and kinds of surg e r y. The evidence supports that risk factors for postoperative pulmonary complications are related to the health status of the patient and with the anaesthetic and surgical procedure. Age, co-morbidity in general and pre-existing respiratory and cardiac diseases in particular, the use of general anaesthesia and overall surgical insult are the most significant factors related to the development of postoperative pulmonary complications. ACKNOWLEDGEMENT Supported by Fundació La Marató de TV3 grant: (2003)
6 REFERENCES 1. Smetana GW. Preoperative pulmonary evaluation. N Engl J Med 1999; 340: Goldman L, Caldera DL, Nussbaum SR, et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med 1977; 297: Rock P, Rich PB. Postoperative pulmonary complications. Curr Op Anaesthesiol 2003; 16: Pedersen T. Complications and death following anaesthesia. A prospective study with special reference to the influence of patient, anaesthesia and surgery related risk factors. Dan Med Bull 1994; 41: Warner DO. Preventing postoperative pulmonary complications. Anesthesiology 2000; 92: Duggan M, Kavanagh BP. Pulmonary atelectasis. A pathogenic perioperative entity. Anesthesiology 2005; 102: Smetana GW, Lawrence VA, Cornell JE. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med 2006; 144: Arozullah AM, Daley J, Henderson WG, Khuri SF, for the National Veterans Administration Surgical Quality Improvement Program. Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. Ann Surg 2000; 232: Arozullah AM, Khuri SF, Henderson WG, Daley J, for the Participants in the National Veterans Affairs Surgical Quality Improvement Program. Development and validation of a multifactorial risk index for predicting postoperative pneumonia after major noncardiac surgery. Ann Intern Med 2001; 135: McAlister FA, Khan NA, Straus SE, et al. Accuracy of the preoperative assessment in predicting pulmonary risk after nonthoracic surgery. Am J Respir Crit Care Med 2003; 167: McAlister FA, Bertsch K, Man J, et al. Incidence of and risk factors for pulmonary complications after noncardiothoracic surgery. Am J Respir Crit Care Med 2005; 171: Mazo V. On the utility of ASA. Rev Esp Anestesiol Reanim 2007; 54:
A prospective study of factors predicting postoperative pulmonary complications (PPC) in patients undergoing noncardiothoracic
ORIGINAL ARTICLE A prospective study of factors predicting postoperative pulmonary complications (PPC) in patients undergoing noncardiothoracic surgery under general anaesthsia in a developing country
More informationPreoperative Pulmonary Evaluation. Michelle Zetoony, DO, FCCP, FACOI Board Certified Pulmonary, Critical Care, Sleep and Internal Medicine
Preoperative Pulmonary Evaluation Michelle Zetoony, DO, FCCP, FACOI Board Certified Pulmonary, Critical Care, Sleep and Internal Medicine No disclosures related to this lecture. Objectives Identify pulmonary
More informationLung Recruitment Strategies in Anesthesia
Lung Recruitment Strategies in Anesthesia Intraoperative ventilatory management to prevent Post-operative Pulmonary Complications Kook-Hyun Lee, MD, PhD Department of Anesthesiology Seoul National University
More informationPERIOPERATIVE ANESTHETIC RISK IN THE GERIATRIC PATIENT
PERIOPERATIVE ANESTHETIC RISK IN THE GERIATRIC PATIENT Susan H. Noorily, M.D. Clinical Professor of Anesthesiology Medical Director University Preoperative Medicine Center IMPORTANCE Half of all currently
More informationPreoperative assessment for lung resection. RA Dyer
Preoperative assessment for lung resection RA Dyer 2016 The ideal assessment of operative risk would identify every patient who could safely tolerate surgery. This ideal is probably unattainable... Mittman,
More informationHELPING REDUCE THE TRACHEAL IMPACT OF INTUBATION1. Endotracheal tubes with TaperGuard cuff technology in the operating room
HELPING REDUCE THE TRACHEAL IMPACT OF INTUBATION1 Endotracheal tubes with TaperGuard cuff technology in the operating room SECURING AIRWAYS WITH A GENTLE TOUCH You aim to keep patients safe and comfortable
More informationSub-Study. PRotective Ventilation with Higher versus Lower PEEP during General Anesthesia for Surgery in OBESE Patients
PRotective Ventilation with Higher versus Lower PEEP during General Anesthesia for Surgery in OBESE Patients The PROBESE Randomized Controlled Trial Preliminary evaluation of postural reduction of peripheral
More informationProtecting the Lungs
Protecting the Lungs PGA New York 12/07 Disclosures: Peter Slinger MD, FRCPC University of Toronto 58 y.o. Male, Chronic Gallstone Pancreatitis, Open Cholecystectomy 100 pack/year smoker Dyspnea > 1 block
More informationPOSTOPERATIVE pulmonary complications (PPCs)
Anesthesiology 2010; 113:1338 50 Copyright 2010, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins Prediction of Postoperative Pulmonary Complications in a Population-based
More informationPerioperative Pulmonary Management. Objectives
Citywide Resident Perioperative Medical Consult Conference Perioperative Pulmonary Management Frank Jacono, MD May 5, 2017 Objectives Definition of post-operative pulmonary complications (PPC) Risk factors
More informationSuperiority of respiratory failure risk index in prediction of postoperative pulmonary complications after digestive surgery in Japanese patients
Superiority of respiratory failure risk index in prediction of postoperative pulmonary complications after digestive surgery in Japanese patients Satoshi Hokari a, Yasuyoshi Ohshima a, Hideaki Nakayama
More informationFariba Rezaeetalab Associate Professor,Pulmonologist
Fariba Rezaeetalab Associate Professor,Pulmonologist rezaitalabf@mums.ac.ir Patient related risk factors Procedure related risk factors Preoperative risk assessment Risk reduction strategies Age Obesity
More informationUpdated Review of Pulmonary Complications after Aortic Surgery: Systematic Review
Updated Review of Pulmonary Complications after Aortic Surgery: Systematic Review 1 ALSULAIMI, ABDULLAH MATAR M, 2 ALSHAMRANI, MOHAMMED DAIL A Abstract: Postoperative lung problems (PPC) prevail, severe
More informationPre-operative Evaluations. Objectives. General Considerations. FP Consultation Considerations. CV Credits 7/24/2017. Brian Bachelder, MD Akron, Ohio
Pre-operative Evaluations Brian Bachelder, MD Akron, Ohio Objectives Discuss the perioperative cardiopulmonary evaluation and management of patients undergoing non-cardiac surgery Objectively estimate
More information1. CONTENTS Sl.No. TITLE Page No. 1. INTRODUCTION 1 2. REVIEW OF LITERATURE 3 3. AIMS AND OBJECTIVES MATERIALS AND METHODS OBSERVATIONS AN
1. CONTENTS Sl.No. TITLE Page No. 1. INTRODUCTION 1 2. REVIEW OF LITERATURE 3 3. AIMS AND OBJECTIVES 14 4. MATERIALS AND METHODS 15 5. OBSERVATIONS AND RESULTS 28 6. DISCUSSION 69 7. CONCLUSION 77 BIBLIOGRAPHY
More informationProphylactic respiratory physiotherapy after cardiac surgery
Prophylactic respiratory physiotherapy after cardiac surgery Patrick Pasquina; Martin R Tramèr, MD, D. Phil; Bernhard Walder, MD Divisions of Surgical Intensive Care (Mr Pasquina) and Anaesthesia (Drs
More informationAssessing perioperative risk
Assessing perioperative risk Chronic Obstructive Pulmonary Disease Dr. Michelle Caldecott Respiratory & Sleep Physician Epworth Healthcare Austin Health Impact of COPD on Postoperative Outcomes: Results
More informationPredicting Short Term Morbidity following Revision Hip and Knee Arthroplasty
Predicting Short Term Morbidity following Revision Hip and Knee Arthroplasty A Review of ACS-NSQIP 2006-2012 Arjun Sebastian, M.D., Stephanie Polites, M.D., Kristine Thomsen, B.S., Elizabeth Habermann,
More informationEffect of peak inspiratory pressure on the development. of postoperative pulmonary complications.
Effect of peak inspiratory pressure on the development of postoperative pulmonary complications in mechanically ventilated adult surgical patients: a systematic review protocol Chelsa Wamsley Donald Missel
More informationPre-op Clinical Triad - Pulmonary. Sammy Pedram, MD FCCP Assistant Professor of Medicine Pulmonary & Critical Care Medicine March 16, 2018
Pre-op Clinical Triad - Pulmonary Sammy Pedram, MD FCCP Assistant Professor of Medicine Pulmonary & Critical Care Medicine March 16, 2018 Disclosures none Case Mr. G is a 64 year-old man who presents to
More informationPostoperative pulmonary complications
British Journal of Anaesthesia, 118 (3): 317 34 (2017) doi: 10.1093/bja/aex002 Review Article Postoperative pulmonary complications A. Miskovic and A. B. Lumb* Department of Anaesthesia, St James s University
More informationSleep Apnea and ifficulty in Extubation. Jean Louis BOURGAIN May 15, 2016
Sleep Apnea and ifficulty in Extubation Jean Louis BOURGAIN May 15, 2016 Introduction Repetitive collapse of the upper airway > sleep fragmentation, > hypoxemia, hypercapnia, > marked variations in intrathoracic
More informationThe effect of tens and incentive spirometer on lung function in subjects following upper abdominal surgery
2016; 3(6): 455-459 P-ISSN: 2394-1685 E-ISSN: 2394-1693 Impact Factor (ISRA): 5.38 IJPESH 2016; 3(6): 455-459 2016 IJPESH www.kheljournal.com Received: 19-09-2016 Accepted: 20-10-2016 Sudhakara PM Tutor,
More informationThoracic anaesthesia. Simon May
Thoracic anaesthesia Simon May Contents Indications for lung isolation Ways of isolating lungs Placing a DLT Hypoxia on OLV Suitability for surgery Analgesia Key procedures Indications for lung isolation
More informationPerioperative risk prediction scores
I N T E N S I V E C A R E Tutorial 343 Perioperative risk prediction scores Dr. Maria Chereshneva and Dr. Ximena Watson Anaesthetic Registrars, Croydon University Hospital, UK Dr. Mark Hamilton Anaesthetic
More informationRunning Head: INCENTIVE SPIROMETRY VERSUS DEEP BREATHING 1
Running Head: INCENTIVE SPIROMETRY VERSUS DEEP BREATHING 1 Incentive Spirometry versus Deep Breathing in Preventing Respiratory Complications Shannon McGrath and Alexis Marcou Nursing 611 December 14,
More informationInterventional procedures guidance Published: 20 December 2017 nice.org.uk/guidance/ipg600
Endobronchial valve insertion to reduce lung volume in emphysema Interventional procedures guidance Published: 20 December 2017 nice.org.uk/guidance/ipg600 Your responsibility This guidance represents
More informationRespiratory Physiology. Manuel Otero Lopez Department of Anaesthetics and Intensive Care Hôpital Européen Georges Pompidou, Paris, France
Respiratory Physiology Manuel Otero Lopez Department of Anaesthetics and Intensive Care Hôpital Européen Georges Pompidou, Paris, France Programme Functional respiratory anatomy Ventilation Mechanics of
More informationPATIENT CHARACTERISTICS AND PREOPERATIVE DATA (ecrf 1).
PATIENT CHARACTERISTICS AND PREOPERATIVE DATA (ecrf 1). 1 Inform Consent Date: / / dd / Mmm / yyyy 2 Patient identifier: Please enter the 6 digit Patient identification number from your site patient log
More informationPulmonary Rehabilitation in Acute Spinal Cord Injury. Jatuporn Jatutawanit Physical therapist, Physical therapy unit, Prince of songkla university
Pulmonary Rehabilitation in Acute Spinal Cord Injury Jatuporn Jatutawanit Physical therapist, Physical therapy unit, Prince of songkla university Causes of spinal cord injury Traumatic injury Motor vehicle
More informationPostoperative Respiratory failure( PRF) Dr.Ahmad farooq
Postoperative Respiratory failure( PRF) Dr.Ahmad farooq Is it really or/only a postoperative issue Multi hit theory first hits second hits Definition Pulmonary gas exchange impairment that presents after
More informationPreoperative pulmonary evaluation in patients scheduled for lung operations
Journal of BUON 12: 163-171, 2007 2007 Zerbinis Medical Publications. Printed in Greece REVIEW ARTICLE Preoperative pulmonary evaluation in patients scheduled for lung operations P. Myrianthefs 1, C. Batistaki
More informationGroup B: Directed self-study Group C: Anatomy lab. Lecture: Structure and function of larynx. Lecture: Dead space & compliance of lungs
Timetable Week 1 (1 st January 2018) Theme: Structure and functions of the lungs Group A: Anatomy lab Group C: Histology lab Upper Group B: Anatomy lab Group C: Anatomy lab Group A: Histology lab Upper
More informationLung Injury and Protection in the Perioperative Period
J. Earl Wynands Lung Injury and Protection in the Perioperative Period Non-injured Lungs: Perioperative Experience (Surgeon) Injured Lungs: Anesthesiologist 78 y.o. Male, Chronic Gallstone Pancreatitis,
More informationEnhanced Perioperative Management of Older Adults
Enhanced Perioperative Management of Older Adults Bernardo Reyes, MD Assistant Professor of Geriatrics Charles E. Schmidt College of Medicine Disclosures None Interesting Facts Warhol was a sickly child,
More informationIndex. Note: Page numbers of article titles are in boldface type
Index Note: Page numbers of article titles are in boldface type A Acute coronary syndrome, perioperative oxygen in, 599 600 Acute lung injury (ALI). See Lung injury and Acute respiratory distress syndrome.
More informationPOINT Peri-Operative Insufflatory Nasal Therapy
PINT Peri-perative Insufflatory Nasal Therapy by Armstrong Medical Helping prevent peri-operative pulmonary complications PST-P RECVERY PERATING RMS Hypoxia; a peri-operative risk Pulmonary complications
More informationPOSTGRADUATE INSTITUTE OF MEDICINE UNIVERSITY OF COLOMBO
POSTGRADUATE INSTITUTE OF MEDICINE UNIVERSITY OF COLOMBO MD (ANAESTHESIOLOGY) FINAL EXAMINATION AUGUST 2013 Date : 2 nd August 2013 Time : 1.00 p.m. 4.00 p.m. Answer any three questions. Answer each question
More informationRespiratory Physiology
Respiratory Physiology Dr. Aida Korish Associate Prof. Physiology KSU The main goal of respiration is to 1-Provide oxygen to tissues 2- Remove CO2 from the body. Respiratory system consists of: Passages
More informationConflicts of Interest. Evaluation of Cardiac and Pulmonary Risk in the Preop Patient. Introduction. Risk Assessment. Risk Assessment: RCRI
Evaluation of Cardiac and Pulmonary Risk in the Preop Patient Conflicts of Interest I have no conflicts of interest to declare Adam Schaffer, MD Brigham and Women s Hospital July 20, 2012 Introduction
More informationAudit of perioperative management of patients with fracture neck of femur
Audit of perioperative management of patients with fracture neck of femur *M Dissanayake 1, N Wijesuriya 2 Registrar in Anaesthesia 1, Consultant Anaesthetist 2, North Colombo Teaching Hospital, Ragama,
More informationDr. Stuart McCorkell BSc FRCA FFICM Anaesthetic Department, Guy s & St. Thomas s NHS Foundation Trust 2017 POPS
Dr. Stuart McCorkell BSc FRCA FFICM Anaesthetic Department, Guy s & St. Thomas s NHS Foundation Trust Why assess (estimate) risk? Patient information and informed consent (patient, surgeon) Stratify resource
More informationModified ASA Physical Status (7 grades) May Be More Practical In Recent Use For Preoperative Risk Assessment
ISPUB.COM The Internet Journal of Anesthesiology Volume 15 Number 1 Modified ASA Physical Status (7 grades) May Be More Practical In Recent Use For Preoperative Risk T Higashizawa, Y Koga Citation T Higashizawa,
More informationTransfusion & Mortality. Philippe Van der Linden MD, PhD
Transfusion & Mortality Philippe Van der Linden MD, PhD Conflict of Interest Disclosure In the past 5 years, I have received honoraria or travel support for consulting or lecturing from the following companies:
More informationOriginal article. Abstract. Anil Raj A*, B V Kathyayani.
Original article Abstract Raj AA, et al: Breathing exercises for pulmonary complications Pre-operative breathing exercise using instructional demonstrationin preventing post-operative pulmonary complications
More informationDoes the Use of Positive End Expiratory Pressure (PEEP) During Surgery Decrease Respiratory Complications Twenty-Four Hours Post Operative?
Rhode Island College Digital Commons @ RIC Master's Theses, Dissertations, Graduate Research and Major Papers Overview Master's Theses, Dissertations, Graduate Research and Major Papers 2016 Does the Use
More informationSupplementary Online Content
Supplementary Online Content Regan EA, Lynch DA, Curran-Everett D, et al; Genetic Epidemiology of COPD (COPDGene) Investigators. Clinical and radiologic disease in smokers with normal spirometry. Published
More informationAnnals of Internal Medicine
Annals of Internal Medicine Clinical Guidelines Risk Assessment for and Strategies To Reduce Perioperative Pulmonary Complications for Patients Undergoing Noncardiothoracic Surgery: A Guideline from the
More informationEndobronchial valve insertion to reduce lung volume in emphysema
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Interventional procedure consultation document Endobronchial valve insertion to reduce lung volume in emphysema Emphysema is a chronic lung disease that
More informationINTRODUCTION The effect of CPAP works on lung mechanics to improve oxygenation (PaO 2
2 Effects of CPAP INTRODUCTION The effect of CPAP works on lung mechanics to improve oxygenation (PaO 2 ). The effect on CO 2 is only secondary to the primary process of improvement in lung volume and
More informationWhat do pulmonary function tests tell you?
Pulmonary Function Testing Michael Wert, MD Assistant Professor Clinical Department of Internal Medicine Division of Pulmonary, Critical Care, and Sleep Medicine The Ohio State University Wexner Medical
More informationThoracoscopic Lobectomy for Locally Advanced Lung Cancer. Masters of Minimally Invasive Thoracic Surgery Orlando September 19, 2014
for Locally Advanced Lung Cancer Masters of Minimally Invasive Thoracic Surgery Orlando September 19, 2014 Thomas A. D Amico MD Gary Hock Endowed Professor and Vice Chair of Surgery Chief Thoracic Surgery
More informationPostoperative Surgical Site Infection after Incisional Hernia Repair: Link to Previous Surgical Site Infection? Zulfiqar Ali, AG Rehan
Original Article Postoperative Surgical Site Infection after Incisional Hernia Repair: Link to Previous Surgical Site Infection? Zulfiqar Ali, AG Rehan ABSTRACT Objective: Aim of the study was to determine
More informationRESPIRATORY PHYSIOLOGY Pre-Lab Guide
RESPIRATORY PHYSIOLOGY Pre-Lab Guide NOTE: A very useful Study Guide! This Pre-lab guide takes you through the important concepts that where discussed in the lab videos. There will be some conceptual questions
More informationDesigning Clinical Trials in Perioperative Sleep Medicine
Designing Clinical Trials in Perioperative Sleep Medicine A Rationale and Pragmatic Approach Daniel J. Gottlieb, MD, MPH Director, Sleep Disorders Center, VA Boston Healthcare System Program in Sleep and
More informationWhen is Anaesthesia & Ventilation a Worry?
Respiratory Function in Adult Congenital Heart Disease When is Anaesthesia & Ventilation a Worry? Bruce Cartwright Cardiac Anaesthesia Royal Prince Alfred Hospital University of Sydney OUTLINE Quantifying
More informationa. Describe the physiological consequences of intermittent positive pressure ventilation and positive end-expiratory pressure.
B. 10 Applied Respiratory Physiology a. Describe the physiological consequences of intermittent positive pressure ventilation and positive end-expiratory pressure. Intermittent positive pressure ventilation
More informationT3 NSCLC: Chest Wall, Diaphragm, Mediastinum
for T3 NSCLC: Chest Wall, Diaphragm, Mediastinum AATS Postgraduate Course April 29, 2012 Thomas A. D Amico MD Professor of Surgery, Chief of Thoracic Surgery Duke University Health System Disclosure No
More informationBelow is summarised some of the tools and papers that are worth looking at if you have an interest in the area.
What happens to the high risk patients who don t die? Perioperative SIG meeting PBLD Noosa 2015 Nicola Broadbent, Auckland, NZ In the process of writing this problem based learning discussion I have read
More informationCharisma High-flow CPAP solution
Charisma High-flow CPAP solution Homecare PNEUMOLOGY Neonatology Anaesthesia INTENSIVE CARE VENTILATION Sleep Diagnostics Service Patient Support charisma High-flow CPAP solution Evidence CPAP therapy
More informationAnaesthetic considerations for laparoscopic surgery in canines
Vet Times The website for the veterinary profession https://www.vettimes.co.uk Anaesthetic considerations for laparoscopic surgery in canines Author : Chris Miller Categories : Canine, Companion animal,
More informationPostoperative pulmonary complications following non-cardiothoracic surgery
BJA Education, 17 (9): 295 300 (2017) doi: 10.1093/bjaed/mkx012 Advance Access Publication Date: 10 June 2017 Matrix reference 1H02, 2A07, 3A03 Postoperative pulmonary complications following non-cardiothoracic
More informationEFFECTIVENESS OF PREOPERATIVE PLANNED TEACHING PROGRAMME ON PREVENTION OF POST OPERATIVE PULMONARY COMPLICATIONS AMONG
Asia Pacific Journal of Research Vol: I Issue XX, December ISSN: -, E-ISSN--9 EFFECTIVENESS OF PREOPERATIVE PLANNED TEACHING PROGRAMME ON PREVENTION OF POST OPERATIVE PULMONARY COMPLICATIONS AMONG PATIENTS
More informationPre-operative detection of valvular heart disease by anaesthetists
Anaesthesia, 2006, 61, pages 127 132 doi:10.1111/j.1365-2044.2005.04505.x Pre-operative detection of valvular heart disease by anaesthetists W. A. van Klei, 1 C. J. Kalkman, 1 M. Tolsma, 1 C. L. G. Rutten
More informationAerosol Therapy. Aerosol Therapy. RSPT 1410 Humidity & Aerosol Therapy Part 4
1 RSPT 1410 Humidity & Part 4 Wilkins Chapter 36; p. 801-806 2 Stability: the tendency for aerosol particles to remain in Size: the the particle, the greater the tendency toward stability the the particle,
More informationDoes ambroxol confer a protective effect on the lungs in patients undergoing cardiac surgery or having lung resection?
Interactive CardioVascular and Thoracic Surgery 18 (2014) 830 834 doi:10.1093/icvts/ivu061 Advance Access publication 12 March 2014 BEST EVIDENCE TOPIC THORACIC Does ambroxol confer a protective effect
More informationOPEN ACCESS TEXTBOOK OF GENERAL SURGERY
OPEN ACCESS TEXTBOOK OF GENERAL SURGERY PRE-OPERATIVE ASSESSMENT AND POST-OPERATIVE CARE L Mitchell INTRODUCTION All but the most trivial surgical procedures result in a systemic response that may affect
More informationInformation Often Given to the Nurse at the Time of Admission to the Postanesthesia Care Unit
Information Often Given to the Nurse at the Time of Admission to the Postanesthesia Care Unit * Patient s name and age * Surgical procedure and type of anesthetic including drugs used * Other intraoperative
More informationComplex Thoracoscopic Resections for Locally Advanced Lung Cancer
Complex Thoracoscopic Resections for Locally Advanced Lung Cancer Duke Thoracoscopic Lobectomy Workshop March 21, 2018 Thomas A. D Amico MD Gary Hock Professor of Surgery Section Chief, Thoracic Surgery,
More informationC CONFERENCIAS MAGISTRALES Vol. 36. Supl. 1 Abril-Junio 2013 pp S61-S68 Management of hyperglycemia in the perioperative patient. 39 th Annual Refresher Course on Anesthesiology and Perioperative Medicine,
More informationCLINICAL USE CASES FOR RMT
1 of 5 CLINICAL USE CASES FOR RMT USE CASE: WEANING FROM MECHANICAL VENTILATOR Benefits: Quicker time to ventilator liberation and trach decannulation A majority of LTAC patients are hard to wean from
More informationEffect of deep breathing exercises on oxygenation after major head and neck surgery
Otolaryngology Head and Neck Surgery (2008) 139, 281-285 ORIGINAL RESEARCH HEAD AND NECK CANCER Effect of deep breathing exercises on oxygenation after major head and neck surgery Arzu Genç, PhD, PT, Ahmet
More informationYue Jin, 1 Guohao Xie, 1 Haihong Wang, 2 Lielie Jin, 3 Jun Li, 4 Baoli Cheng, 1 Kai Zhang, 1 Andreas Hoeft, 5 and Xiangming Fang 1. 1.
BioMed Research International Volume 2015, Article ID 265165, 10 pages http://dx.doi.org/10.1155/2015/265165 Clinical Study Incidence and Risk Factors of Postoperative Pulmonary Complications in Noncardiac
More informationCOUGH Dr. A m A it i e t sh A g A garwa w l Le L ctu t rer Departm t ent t o f f M e M dic i in i e
COUGH Dr. Amitesh Aggarwal Lecturer Department of Medicine Cough is an explosive expiration that provides a normal protective mechanism for clearing the tracheobronchial tree of secretions and foreign
More informationPostoperative pulmonary complications are as common. Clinical Guidelines
Annals of Internal Medicine Clinical Guidelines Strategies To Reduce Postoperative Pulmonary Complications after Noncardiothoracic Surgery: Systematic Review for the American College of Physicians Valerie
More informationAnaesthesia and Morbid Obesity
Anaesthesia and Morbid Obesity Facts 20% adults Obese (1% Morbidly Obese) BMI >35 with comorbidity / BMI >40 without comorbidity = morbidly obese BMI > 55 = super-morbidly obese BMI > 30 rapid increase
More informationIs surgical Apgar score an effective assessment tool for the prediction of postoperative complications in patients undergoing oesophagectomy?
Interactive CardioVascular and Thoracic Surgery 27 (2018) 686 691 doi:10.1093/icvts/ivy148 Advance Access publication 9 May 2018 BEST EVIDENCE TOPIC Cite this article as: Li S, Zhou K, Li P, Che G. Is
More informationPreoperative Management. Presley Regional Trauma Center Department of Surgery University of Tennessee Health Science Center Memphis, Tennessee
Preoperative Management Presley Regional Trauma Center Department of Surgery University of Tennessee Health Science Center Memphis, Tennessee Perioperative Care Consideration Medical care provided to prepare
More informationPulmonary Function Testing. Ramez Sunna MD, FCCP
Pulmonary Function Testing Ramez Sunna MD, FCCP Lecture Overview General Introduction Indications and Uses Technical aspects Interpretation Patterns of Abnormalities When to perform a PFT 1. Evaluation
More informationRESPIRATORY COMPLICATIONS AFTER SCI
SHEPHERD.ORG RESPIRATORY COMPLICATIONS AFTER SCI NORMA I RIVERA, RRT, RCP RESPIRATORY EDUCATOR SHEPHERD CENTER 2020 Peachtree Road, NW, Atlanta, GA 30309-1465 404-352-2020 DISCLOSURE STATEMENT I have no
More informationPreoperative Assessment. Block Prof JLA Rantloane Department of Anaesthesiology
Preoperative Assessment Block 18 2013 Prof JLA Rantloane Department of Anaesthesiology!1 Principles All patients scheduled to undergo surgery should have a preoperative evaluation to assist in planning
More informationCardiorespiratory Physiotherapy Tutoring Services 2017
VENTILATOR HYPERINFLATION ***This document is intended to be used as an information resource only it is not intended to be used as a policy document/practice guideline. Before incorporating the use of
More informationDELIRIUM IN ICU: Prevention and Management. Milind Baldi
DELIRIUM IN ICU: Prevention and Management Milind Baldi Contents Introduction Risk factors Assessment Prevention Management Introduction Delirium is a syndrome characterized by acute cerebral dysfunction
More informationProblem Based Learning Session. Mr Robinson is a 67 year old man. He visits the GP as he has had a cough and fever for 5 days.
Problem Based Learning Session Mr Robinson is a 67 year old man. He visits the GP as he has had a cough and fever for 5 days. The GP takes a history from him and examines his chest. Over the left base
More informationTuesday, December 13, 16. Respiratory System
Respiratory System Trivia Time... What is the fastest sneeze speed? What is the surface area of the lungs? (hint... think of how large the small intestine was) How many breaths does the average person
More informationPerioperative use of high oxygen concentration
Perioperative use of high oxygen concentration F. Javier Belda MD, PhD, Professor of Anesthesiology Head of Department of Anesthesia and Critical Care Hospital Clinico Universitario, University of Valencia,
More informationSleep Labs are Obsolete for Perioperative Assessment of Sleep-Disordered Breathing: Pro
Sleep Labs are Obsolete for Perioperative Assessment of Sleep-Disordered Breathing: Pro Lawrence J. Epstein, MD Brigham and Women s Hospital Harvard Medical School Welltrinsic Sleep Network Conflicts of
More informationAssociation of Preoperative Spirometry with Cardiopulmonary Exercise Capacity and Postoperative Outcomes in Surgical Patients
Association of Preoperative Spirometry with Cardiopulmonary Exercise Capacity and Postoperative Outcomes in Surgical Patients by Ashwin Sankar A thesis submitted in conformity with the requirements for
More informationObjectives. Old School. Preoperative Evaluation and Postoperative Complications: Where are the opportunities for risk reduction?
Preoperative Evaluation and Postoperative Complications: Where are the opportunities for risk reduction? Jeffrey Carter, MD RMHMS October 5, 2010 Objectives Understand the preoperative cardiac evaluation
More informationIntroduction and Overview of Acute Respiratory Failure
Introduction and Overview of Acute Respiratory Failure Definition: Acute Respiratory Failure Failure to oxygenate Inadequate PaO 2 to saturate hemoglobin PaO 2 of 60 mm Hg ~ SaO 2 of 90% PaO 2 of 50 mm
More informationKENNEDY DISEASE PULMONARY CONSIDERATIONS: SCIENCE & MANAGEMENT STRATEGIES
KENNEDY DISEASE PULMONARY CONSIDERATIONS: SCIENCE & MANAGEMENT STRATEGIES When you can t breathe nothing else matters American Lung Association Noah Lechtzin, MD; MHS Associate Professor of Medicine Johns
More informationSECTION 1: INCLUSION, EXCLUSION & RANDOMISATION INFORMATION
SECTION 1: INCLUSION, EXCLUSION & RANDOMISATION INFORMATION DEMOGRAPHIC INFORMATION Given name Family name Date of birth Consent date Gender Female Male Date of surgery INCLUSION & EXCLUSION CRITERIA YES
More informationICU Volume 14 - Issue 3 - Autumn Matrix
ICU Volume 14 - Issue 3 - Autumn 2014 - Matrix Prevention of Perioperative Complications: It Takes a Village to Raise a Child" Authors Yuda Sutherasan, MD Department of Surgical Sciences and Integrated
More informationBasic approach to PFT interpretation. Dr. Giulio Dominelli BSc, MD, FRCPC Kelowna Respiratory and Allergy Clinic
Basic approach to PFT interpretation Dr. Giulio Dominelli BSc, MD, FRCPC Kelowna Respiratory and Allergy Clinic Disclosures Received honorarium from Astra Zeneca for education presentations Tasked Asked
More informationImpact of Tidal Volume on Complications after Thoracic Surgery
Management of One-lung Ventilation Impact of Tidal Volume on Complications after Thoracic Surgery ABSTRACT Background: The use of lung-protective ventilation (LPV) strategies may minimize iatrogenic lung
More informationPERIOPERATIVE pulmonary complications are common,
Epidural Analgesia Is Associated with Improved Health Outcomes of Surgical Patients with Chronic Obstructive Pulmonary Disease Felix van Lier, M.D., Ph.D.,* Patrick J. van der Geest, M.D., Sanne E. Hoeks,
More informationPAPER DE LA VNI EN LA RETIRADA DE LA VENTILACIÓ INVASIVA I FRACÀS D EXTUBACIÓ
PAPER DE LA VNI EN LA RETIRADA DE LA VENTILACIÓ INVASIVA I FRACÀS D EXTUBACIÓ Dr. Miquel Ferrer UVIIR, Servei de Pneumologia, Hospital Clínic, IDIBAPS, CibeRes, Barcelona. E- mail: miferrer@clinic.ub.es
More informationTreatment of Clinical Stage I Lung Cancer: Thoracoscopic Lobectomy is the Standard
Treatment of Clinical Stage I Lung Cancer: Thoracoscopic Lobectomy is the Standard AATS General Thoracic Surgery Symposium May 5, 2010 Thomas A. D Amico MD Professor of Surgery, Duke University Medical
More informationLandmark articles on ventilation
Landmark articles on ventilation Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity ARDS AECC DEFINITION-1994 ALI Acute onset Bilateral chest infiltrates PCWP
More information