Complications of pulmonary surgery

1. JAMIA MILLIA ISLAMIA
Topic :complications of pulmonary surgery
CENTER FOR PHYSOTHERAPY AND
REHABILITATION SCIENCES
Physiotherapy in cardiopulmonary conditions(402)
Submitted to : DR. Jamal Ali Moiz
Submitted by : Noor Jahan
BPT 4th year
ROLL NO.17BPTO27
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2. • Postoperative pulmonary complications are defined as pulmonary
abnormalities occurring in the postoperative period that produce
clinically significant identifiable disease or dysfunction that
adversely affects the clinical course.
• Surgical factors such as the site of the incision, the type and
duration of anesthesia, and postoperative analgesic and sedative care
are probably more important determinants of postoperative pulmonary
complications than the patient-related factors.
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3. • Factors associated with an increased risk for postoperative pulmonary
complications include the following:
• surgical site
• prolonged duration of surgery
• underlying lung disease
• smoking history (>20 pack years)
• obesity (BMI >25)
• poor nutritional status
• age >60 years
• inadequate nurse staffing in postoperative care areas
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4. • Pathogenesis The pathogenesis of postoperative pulmonary complications
begins in the operating room.
• Hypoventilation and reduced lung volumes from anesthesia and surgery
combine to produce atelectasis and predispose to respiratory tract infection.
• Immobility leads to higher risk of thromboembolic disease.
• Respiratory muscle dysfunction is common, especially following cardiac,
chest, or upper abdominal procedures.
• Cardiac surgeries are associated with a 10–85% incidence of phrenic nerve
dysfunction due to phrenic nerve injury, either from cold injury or via direct
operative damage.
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5. Complications of pulmonary surgeries include
• Hypoxemia
• Atelectasis
• Respiratory failure
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6. Hypoxemia
• Hypoxemia is common after surgery. It is defined as an arterial saturation less than
90% or a PaO2 that is 75% or less of the preoperative value. Mild hypoxemia may
be seen after up to 40% of surgeries and may be severe in 6 to 7% cases.
• The frequency and severity of postoperative hypoxemia depends upon the surgical
site, with thoracic and upper abdominal surgeries the risk of hypoxemia is
much higher.
• The average PaO2 drops by 10%–30% immediately after surgery. In upper
abdominal surgery, arterial oxygen typically decreases by 20%–30% in the first 48
hours after surgery. In non-abdominal, non-thoracic surgery it will decrease by
(05%–10%).
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7. • The risk of postoperative hypoxemia is further increased for
• Obese patients
• Those requiring intravenous opioids for postoperative pain control.
• For individuals with underlying chronic airflow obstruction.
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8. Atelectasis
• Atelectasis is the collapse of a group of alveoli, a small lobule, a
bronchopulmonary segment, a lobe, or rarely a whole lung.
• it occurs when the tiny air sacs (alveoli) within the lung become
deflated or possibly filled with alveolar fluid.
• It is the most common pulmonary complications in the post-operative
patient.
• atelectasis appers about 90% all the patients who are anesthetized.
• Abdominal surgery does not add much to the atelectasis, but it can
persist for several days during the postoperative period. It is likely to
be a focus of infection and may contribute to pulmonary
complications.
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9. • Atelectasis is clinically important because it leads to increased
work of breathing, impaired gas exchange, and a predisposition to
infection. Symptoms resulting from acute lobar collapse are in
proportion to underlying lung diseases. An otherwise healthy person
will have few symptoms from lobar collapse while a person with
chronic lung disease can become significantly hypoxic and
tachypnea(elevated respiratory rate).
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10. • Various therapeutic maneuvers have been used to treat atelectasis.
Treatment modalities include early mobilization, incentive
spirometry, deep breathing exercises, yawning, coughing, chest
physiotherapy, and nasal CPAP.
• Intermittent positive pressure breathing (IPPB)has been abandoned
because of problems with barotrauma.
• Chest physiotherapy generally consists of deep breathing exercises,
chest percussion, and postural drainage where needed. Deep
breathing is most effective when 5 sequential breaths are held at TLC
for 5–6 seconds and repeated hourly during waking hours
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11. Respiratory failure
• Post operative respiratory failure that, can be considered as pulmonary
gas exchange impairment that presents after a surgical procedure and
as a result of the changes induced by anesthesia and surgery.
• respiratory failure is well defined as inadequate exchange of oxygen
and carbon dioxide. It is diagnosed when exchange does not meet
metabolic needs
• The decrease in PaO2 that occurs in most patients under general
anesthesia is compensated for by administering a high oxygen
concentration. However, if the oxygen concentration is over 80% there
is risk of adsorption atelectasis
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12. • Post respiratory failure is usually managed with some kind of non
routine respiratory support: oxygen therapy , physiotherapy, or
invasive or noninvasive ventilator support. Severity can range from
transient hypoxemia in the early postoperative period to the most life-
threatening form late-stage acute respiratory distress syndrome
(ARDS).
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13. POST-OPERATIVE RESPIRATORY MUSCLE DYSFUNCTION
• The normal physiology of the respiratory system relies on balance
between respiratory pump muscles, which create a negative pressure
leading to an urge to ventilate , and the upper airway dilator muscles
which counterbalance the collapsing forces of the negative pressure
and ensure upper airway patency.
• During emergence from anesthesia and over the postoperative period,
respiratory muscle function is affected to different degrees. Early
after surgery, residual effects of sedatives and opiates reduce
central stimulation of both the upper airway (hypoglossal nerve)
and pump muscles (phrenic nerve).
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14. • At the same time affecting the upper airway dilator muscles to a
greater extent than the diaphragm. These events increase upper airway
collapsibility and predispose patients to PRF, particularly in the
presence of comorbid conditions such as
• Obesity,
• Obstructive sleep apnea(it is characterized by the presence of
repetitive episodes of shallow or paused breathing),
• COPD,
• Smoking addiction.
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15. References
• Canet J, Gallart L. Postoperative respiratory failure: pathogenesis,
prediction, and prevention. Curr Opin Crit Care. 2014
• Honig, E. G. (2006). Postoperative pulmonary complications. In M. F.
Lubin, R. B. Smith, T. F. Dodson, N. O. Spell, & H. K. Walker
(Eds.), Medical Management of the Surgical Patient
• Hedenstierna, G., & Edmark, L. (2010). Mechanisms of atelectasis in
the perioperative period. Best Practice & Research Clinical
Anaesthesiology, 24(2), 157–169. doi:10.1016/j.bpa.2009.12.002
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16. Thank you
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