4. What is Special
•
•
•
•
•
•
•
Pulmonary issues
Cardiac issues
Pain
Fluid therapy
Issues peculiar to the surgery
Sepsis
Specific issues
ICC 2013 : 23 Nov 2013
7. Tracheobronchial toilet
• Liquify, loosen and expell
– Forced expiration better than coughing
• Bronchoscopic lavage
• Tracheostomy
– Easier secretion extraction
– Reduces airway resistance
– Helps weaning from ventilation
– Not without complications
ICC 2013 : 23 Nov 2013
8. Cardiac Issues
• Exacerbation of a pre-existing cardiac state
– CAD
– Cor pulmonale
• New cardiac issue
– Arryhthmias commonly AF and SVT
– Ischemia
– Tamponade
– Torsion
– Herniation
ICC 2013 : 23 Nov 2013
9. Fluid Therapy
• Fluid overload and pulmonary edema can be
disastrous
• Intraoperative and Post op restriction
• Accept a lower urine output on first day
• Supportive low dose inotropes
• Colloid vs Crystalloid debate
• Care with Blood products
ICC 2013 : 23 Nov 2013
11. Chest Drains
• Commonly 1 sometimes 2 tubes
– Respiratory effort reduced
• Water seal vs Suction
– Suction when lung not expanded
• When to remove
– 100-200ml in 24hrs
ICC 2013 : 23 Nov 2013
12. Prolonged Air leak
• Air leak persisting after 7 days
– Inspiratory
– Expiratory
– Both
• Types
– Alveolar
– Open bronchus
• Management
–
–
–
–
Prevent by stapling/staple reinforcements
Conservative
Talc pleurodesis
Re exploration
ICC 2013 : 23 Nov 2013
13. Thoracic duct leak
• Commonly noted early 1-3 days
• Sometimes late presentation after 7 days
• Conservative
– Fat free diet
– TPN
• Early intervention
– Thoracoscopic / Open
– Pre emptive ligation
ICC 2013 : 23 Nov 2013
14. Chest wall Excision
• Small segments and posterior – no major
impact
• Larger segments >3ribs and anterolateral
chest wall
– Paradoxical movement
– Atelectais
– Hypoxia
– Retained secretions
– Rigid /Semirigid Fixation and Ventilation
ICC 2013 : 23 Nov 2013