postop pulmonary complications
TRANSCRIPT
![Page 1: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/1.jpg)
PULMONARY COMPLICATIONS
POSTOPERATIVE
SANEESH P JSultan Qaboos University Hospital, Muscat
![Page 2: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/2.jpg)
![Page 3: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/3.jpg)
Respiratory complications after surgery
JACKSON EQUESTRIAN MONUMENT downtown Charlottesville, Virginia “Stonewall” Jackson
Confederate General
…dying of pneumonia 10 days after an otherwise successful ether anesthetic
1863
![Page 4: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/4.jpg)
SIGNIFICANCE OF
PULMONARY COMPLICATIONS
POSTOPERATIVE
![Page 5: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/5.jpg)
Lack of uniform definition
PneumoniaDefinite /Suspected Respiratory failure
Requiring mechanical ventilatory support
Bronchospasm
![Page 6: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/6.jpg)
Lack of uniform definition
Unexplained fever
Excessive bronchial secretionsAbnormal breath sounds
“Productive” cough
Atelectasis
Hypoxemia
![Page 7: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/7.jpg)
Cardiac / Pulmonary Complications?
Hospital stay
Complis05
10152025 22.7
9.610.75.7
PULMCARDIAC
![Page 8: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/8.jpg)
Causes of
PULMONARY COMPLICATIONS
POSTOPERATIVE
![Page 9: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/9.jpg)
Causes of PPCs
Disruption of normal activity of respiratory
muscles
Altered neural drive for respiration• Distribution• Timing
![Page 10: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/10.jpg)
Causes of PPCs
Begins with induction of anesthesia
Continues into postop period
![Page 11: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/11.jpg)
EXPIRATION
![Page 12: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/12.jpg)
INSPIRATIONAWAKE
COORDINATED
![Page 13: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/13.jpg)
INSPIRATIONANESTHETISED
INCOORDINATED
![Page 14: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/14.jpg)
Incoordination of Resp Muscles
Reduces efficiency
Decreases FRC
Atelectasis in dependent lung
Impair pulmonary gas exchange
![Page 15: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/15.jpg)
Effects of surgical trauma
Impair effectiveness
Voluntary limitation of respiratory motionDecreased phrenic
motor neuron output
![Page 16: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/16.jpg)
Other factors
Bronchoconstriction • Airway instrumentation; drugs- release of
inflammatory mediatorsImpaired mucociliary transport• Anesthetic gases; tracheal intubationFunctional impairment of pulm inflammatory cells• Prolonged surgery, anesthesia
Surgical/anesth intervention related• Aspiration pneuminitis; ALI –after CPB;
Pneumothorax- barotrauma/surgical trauma; Negative Pr Pulm Edema
![Page 17: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/17.jpg)
Risk factors for
PULMONARY COMPLICATIONS
POSTOPERATIVE
![Page 18: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/18.jpg)
The most important risk factor for postoperative pulmonary complications?
A. High-risk surgical site
B. General anesthesia
C. COPD D. Obesity
![Page 19: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/19.jpg)
GOOD evidencePatient-relatedAdvanced age
ASA PS >2
Cong Heart failureFunctional dependencyCOPD
Surgery-relatedAortic aneurysm repairThoracic surgery
Abdominal surgeryUpper abdominal surgeryNeurosurgery
Prolonged surgeryHead & Neck surgeryEmergency surgery
Vascular surgeryUse of General Anesthesia
![Page 20: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/20.jpg)
FAIR evidence
Patient-relatedWeight-loss
Impaired sensorium
Cigarette use
Alcohol useAbnormal chest exam
Surgery-relatedPerioperative transfusion
![Page 21: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/21.jpg)
Good evidence AGAINST being a risk factor
Patient-relatedWell-controlled asthmaObesity
Surgery-relatedHip surgery
GU/Gynaec surgery
![Page 22: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/22.jpg)
Insufficient data
Patient-relatedObstructive sleep apnoea #Poor exercise capacity
Surgery-relatedEsophageal surgery
# - subsequent evidence : OSA – possible risk factor
![Page 23: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/23.jpg)
Which of the following is a recently identified novel risk factor for PPCs?
C. Pulmonary Hypertension
B. Insulin-treated diabetes
A. Epidural anesthesia
D. Immobility
![Page 24: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/24.jpg)
Strategies for risk reduction
PULMONARY COMPLICATIONS
POSTOPERATIVE
![Page 25: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/25.jpg)
Strategies for Risk reduction
Postoperative lung expansion modalities• Incentive spirometry• Deep breathing exercises• Int. Positive Pressure
Breathing • CPAP
![Page 26: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/26.jpg)
Strategies for Risk reduction
Selective postop NG tube useNG tubes potentially increase risk of aspirationUse in select patients:• Symptomatic abdominal distention• Inability to tolerate oral intake • Nausea
![Page 27: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/27.jpg)
Strategies for Risk reduction
Laparoscopic (vs Open) operation
Evidence begins to follow intuitionOpen surgery:• Higher rate of sepsis• CV events
![Page 28: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/28.jpg)
Strategies for Risk reduction
Routine TPN or enteral nutritionRight heart catheterization
While hypoalbuminemia and malnutrition increase postoperative complications, including pneumonia, routine TPN has no benefit over either TEN or no hyperalimentation.
Inadequate intake
Atrophy of intestinal villi
Bacterial translocation across
gut mucosa Subsequent sepsis
![Page 29: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/29.jpg)
Strategies for Risk reduction
Intraop neuraxial blockadePostop epidural analgesia
Insufficient or conflicting data? Selection bias? Insufficiently powered study- Study on low-risk procedure
![Page 30: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/30.jpg)
Strategies for Risk reduction
Intraop neuraxial blockadePostop epidural analgesia
IV PCA vs PCEA vs On-demand analgesia? Timing issues (Heparin prophylaxis)
![Page 31: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/31.jpg)
Strategies for Risk reduction
Smoking cessation
The jury is still out!!!Early reports - those who quit shortly before surgery actually had higher complication rates Question remains unanswered
![Page 32: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/32.jpg)
Promising New Intervention
PULMONARY COMPLICATIONS
POSTOPERATIVE
![Page 33: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/33.jpg)
Preop Intensive Lung Expansion
Preoperative lung expansion Inspiratory Muscle Training
![Page 34: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/34.jpg)
Preop Intensive Lung Expansion
Preop IMT can be done in chest physical therapy OPD or a pulmonary rehabilitation clinic
![Page 35: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/35.jpg)
Take Home Messages
PULMONARY COMPLICATIONS
POSTOPERATIVE
![Page 36: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/36.jpg)
Summary
PPCs incidence
More common than cardiac complications after non-cardiac surgery
![Page 37: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/37.jpg)
Summary
Surgical site
Most important predictor of risk of PPCs:Aortic, thoracic and upper abdominal surgeries are high-risk procedures, even in healthy patients
![Page 38: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/38.jpg)
Summary
OSA & Pulmonary HTN
Recently identified as risk factors;Limited available evidence does not support preop screening (in patients without symptoms)
![Page 39: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/39.jpg)
Summary
Postop CPAP
Effective for reducing pulmonary complications in patients who are unable to perform deep breathing or incentive spirometry exercises
![Page 40: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/40.jpg)
Summary
Smoking cessation
As an effective strategy to reduce pulmonary risk remains unanswered…
![Page 41: Postop pulmonary complications](https://reader038.vdocuments.mx/reader038/viewer/2022103105/5873fcfc1a28abb1528b750b/html5/thumbnails/41.jpg)
https://www.facebook.com/saneeshpj