Patient related risk factors for postop pulmonary complications
•Download as PPTX, PDF•
1 like•572 views
Slide set discussing patient related factors that are associated with postoperative pulmonary complications
Recommended
Recommended
More Related Content
What's hot
What's hot (20)
Similar to Patient related risk factors for postop pulmonary complications
Similar to Patient related risk factors for postop pulmonary complications (20)
More from Terry Shaneyfelt
More from Terry Shaneyfelt (18)
Recently uploaded
Recently uploaded (20)
Patient related risk factors for postop pulmonary complications
- 1. Patient-Related Risk Factors for Postoperative Pulmonary Complications Terry Shaneyfelt, MD, MPH Associate Professor, UAB Department of Medicine
- 2. • Adults undergoing noncardiothoracic surgery • ACP Guidelines on risk assessment for and strategies to reduce perioperative pulmonary complications have not been updated since 2006 (Ann Intern Med 2006;144:575) Disclaimer
- 3. Pulmonary Risk Assessment • Goals: 1. Assess patient-related pulmonary risk factors 2. Assess procedure-related risk factors 3. Reduce risk (if possible) • 3 components: • History • Physical exam • Testing
- 4. • Atelectasis • Pneumonia • Prolonged mechanical ventilation and respiratory failure • Exacerbation of underlying lung disease • Bronchospasm Significant Pulmonary Complications
- 5. • Age > 50 yrs • 50-60 (OR 1.50) • 60-70 (OR 2.28) • 70-80 (OR 3.90) • > 80 (OR 5.63) • ASA class ≥ 2 (4.87) • Heart failure (OR 2.93) • Total functional dependence (OR 2.51) • COPD (OR 2.36) Patient-Related Risk factors for postop pulmonary complications • Smoking (OR 1.40-1.73) • Emerging risk factors • OSA (OR 1.37-1.95) • Pulmonary HTN • Asthma is not a risk factor • Obesity is not a risk factor
Editor's Notes
- In this PowerPoint presentation I review patient-related risk factors for postoperative pulmonary complications.
- This presentation is focused on adults undergoing noncardiothoracic surgery. The “current” pulmonary preop guidelines are somewhat out of date as sleep apnea and pulmonary hypertension are emerging risk factors that are not adequately addressed. It is unknown when an update of the guideline will occur.
- Pulmonary risk assessment in the preop clinic has 2 goals: 1) to assess patient and procedure-related risk and 2) to reduce that risk as much as possible. The history and PE are the cornerstones of pulmonary risk assessment. Testing has a very limited role (see PowerPoints on this topic). The evaluation should focus on identifying identified risk factors and determining if the patient’s underlying pulmonary disease is optimally controlled.
- This slide shows the clinically important perioperative pulmonary complications. Risk prediction tools only exist for respiratory failure and pneumonia.
- Postoperative pulmonary complications are an extension of normal perioperative pulmonary physiology. General anesthesia and opioids decrease respiratory drive. Anesthetics and neuromuscular blocking agents result in diaphragmatic and chest wall dysfunction. This all leads to reduced lung volumes, both vital capacity (which is the volume of air in the lungs after maximal inhalation to maximal exhalation or total lung capacity minus residual volume) and functional residual capacity (volume of air left in the lungs after a normal exhalation). This then leads to atelectasis as FRC drops below closing capacity or closing volume.
- Cough and mucociliary clearance are impaired by narcotics and anesthesia which can result in pneumonia.
- This slide shows patient-related risk factors that have been shown to be significantly associated with postoperative pulmonary complications. The list is ordered from most important to least important causes of postoperative pulmonary complications. Age over 50 yrs caries a significant risk, even in healthy individuals. Risk increases incrementally as we age. Oldest age is the most important risk factor. American Society of Anesthesiologists (ASA) class correlated 2nd most strongly with pulmonary risk, especially when it is 2 or greater. (class 1: healthy, class 2: mild systemic disease, class 3: severe systemic disease, class 4: severe systemic disease that is a constant threat to life, class 5: moribund patient not expected to survive without operation). CHF confers greater risk than COPD for postoperative pulmonary complications. Being unable to perform any activities of daily living (total dependence) is a strong predictor of postop pulmonary complications. Current smokers have increased risk for postop pulmonary complications. 2 emerging risk factors that will be discussed in a separate presentation are sleep apnea and pulmonary hypertension. Interestingly, studies have shown that asthma and obesity do not increase the risk of postoperative pulmonary complications when controlling for other comorbidities. Obesity is related to OSA but obese patients without OSA have no increased risk.