Post-Operative Pulmonary Complication: Difference between revisions
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== Introduction == | == Introduction == | ||
Post-operative pulmonary complication is an umbrella term of adverse changes to the respiratory system occurring immediately after surgery.<ref name=":0">Miskovic A, Lumb AB. Postoperative pulmonary complications. BJA: British Journal of Anaesthesia. 2017 Mar 1;118(3):317-34.</ref> The most common presentations include an altered function of respiratory muscles, reduced [[Lung Volumes|lung volume]], respiratory failure and [[atelectasis]].<ref name=":0" /> | |||
In terms of morbidity, PPCs, increases length of hospital stay by 13 - 17 days.<ref name=":0" /> | == Incidence and Impact == | ||
Up to 23% of patient underwent major surgery would suffer from PPCs.<ref name=":0" /> In fact, the incidence of PPCs is more common than cardiac complication.<ref>Lawrence VA, Hilsenbeck SG, Mulrow CD, Dhanda R, Sapp J, Page CP. Incidence and hospital stay for cardiac and pulmonary complications after abdominal surgery. Journal of general internal medicine. 1995 Dec 1;10(12):671-8.</ref> With people who sustain PPCs, 14% to 30% die within 30 days after a major surgery compared to only 0.2% to 3% of patient who does not have PPCs. <ref>Herbstreit F, Peters J, Eikermann M. Impaired Upper Airway Integrity by Residual Meeting AbstractsIncreased Airway Collapsibility and Blunted Genioglossus Muscle Activity in Response to Negative Pharyngeal Pressure. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2009 Jun 1;110(6):1253-60.</ref><ref>Kor DJ, Warner DO, Alsara A, Fernández-Pérez ER, Malinchoc M, Kashyap R, et al. Derivation and diagnostic accuracy of the surgical lung injury prediction model. Anesthesiology. 2011;115(1):117-128.</ref> In terms of morbidity, PPCs, increases the length of hospital stay by 13 - 17 days.<ref name=":0" /> | |||
== List of PPCs == | == List of PPCs == | ||
* Respiratory infection | * Respiratory infection | ||
* Respiratory failure | * [[Respiratory Failure|Respiratory failure]] | ||
* Pleural effusion | * Pleural effusion | ||
* [[Atelectasis]] | * [[Atelectasis]] | ||
| Line 25: | Line 20: | ||
* Aspiration pneumonia | * Aspiration pneumonia | ||
* [[Pneumonia]] | * [[Pneumonia]] | ||
* Acute respiratory distress syndrome | * [[Acute Respiratory Distress Syndrome (ARDS)|Acute respiratory distress syndrome]] | ||
* Tracheobronchitis | * Tracheobronchitis | ||
== Risk | == Risk Factors == | ||
There | There is a range of factors to predict the development of PPCs, which are divided into modifiable and non-modifiable.<ref name=":0" /> | ||
=== | === Non-Modifiable === | ||
* Age - > 60 or 65 years is found to have increased risk.<ref>Brooks-Brunn JA. Predictors of postoperative pulmonary complications following abdominal surgery. Chest. 1997 Mar 1;111(3):564-71.</ref> | * Age - > 60 or 65 years is found to have increased risk.<ref>Brooks-Brunn JA. Predictors of postoperative pulmonary complications following abdominal surgery. Chest. 1997 Mar 1;111(3):564-71.</ref> | ||
* Surgery type - Abdominal aortic aneurysm repair, thoracic, upper abdominal, neck, neurosurgery and major vascular surgery are found to have higher risk than other types of surgery.<ref>Brueckmann B, Villa-Uribe JL, Bateman BT, Grosse-Sundrup M, Hess DR, Schlett CL, | * Surgery type - Abdominal aortic aneurysm repair, thoracic, upper abdominal, neck, neurosurgery and major vascular surgery are found to have a higher risk than other types of surgery.<ref name=":1">Brueckmann B, Villa-Uribe JL, Bateman BT, Grosse-Sundrup M, Hess DR, Schlett CL, et al. Development and validation of a score for prediction of postoperative respiratory complications. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2013 Jun 1;118(6):1276-85.</ref><ref>Arozullah AM, Khuri SF, Henderson WG, Daley J. Development and validation of a multifactorial risk index for predicting postoperative pneumonia after major noncardiac surgery. Annals of internal medicine. 2001 Nov 20;135(10):847-57.</ref> | ||
=== | === Modifiable === | ||
* Co-morbidity - Patient with the following conditions has higher risk in development of PPCs: Chronic obstructive pulmonary disease, congestive heart failure, chronic liver disease.<ref | * Co-morbidity - Patient with the following conditions has a higher risk in the development of PPCs: Chronic obstructive pulmonary disease, congestive heart failure, chronic liver disease.<ref name=":1" /> | ||
* Smoking | * Smoking | ||
* Preoperative anaemia | * Preoperative anaemia | ||
* General anaesthesia - the use of GA disturbs many aspects of respiratory function, hence increases risk of patient developing PPCs.<ref name=":0" /> | * General anaesthesia - the use of GA disturbs many aspects of respiratory function, hence increases the risk of patient developing PPCs.<ref name=":0" /> | ||
* Low [[Spirometry|tidal volume]] - People who | * Low [[Spirometry|tidal volume]] - People who have lower tidal volume spontaneously are categorised as a higher risk.<ref name=":0" /> | ||
* Neuromuscular blocking drugs | * Neuromuscular blocking drugs | ||
* Nasogastric tube | * Nasogastric tube | ||
== PPC and | {{#ev:youtube|l06zTe_GM54}} | ||
== PPC and Physiotherapy == | |||
Physiotherapy services are considered preventative measures in different stages of recovery.<ref name=":0" /> | Physiotherapy services are considered preventative measures in different stages of recovery.<ref name=":0" /> | ||
=== | === Preoperative === | ||
Preoperative aerobic exercise and inspiratory muscle training are recommended to reduce PPCs and LOS in cardiac and abdominal surgery patients.<ref>Valkenet K, van de Port IG, Dronkers JJ, de Vries WR, Lindeman E, Backx FJ. The effects of preoperative exercise therapy on postoperative outcome: a systematic review. Clinical rehabilitation. 2011 Feb;25(2):99-111.</ref> It is found that preoperative IMT reduces postoperative atelectasis and pneumonia.<ref>Mans CM, Reeve JC, Elkins MR. Postoperative outcomes following preoperative inspiratory muscle training in patients undergoing cardiothoracic or upper abdominal surgery: a systematic review and meta analysis. Clinical rehabilitation. 2015 May;29(5):426-38.</ref> | Preoperative aerobic exercise and inspiratory muscle training are recommended to reduce PPCs and LOS in cardiac and abdominal surgery patients.<ref>Valkenet K, van de Port IG, Dronkers JJ, de Vries WR, Lindeman E, Backx FJ. The effects of preoperative exercise therapy on postoperative outcome: a systematic review. Clinical rehabilitation. 2011 Feb;25(2):99-111.</ref> It is found that preoperative IMT reduces postoperative atelectasis and [[pneumonia]].<ref>Mans CM, Reeve JC, Elkins MR. Postoperative outcomes following preoperative inspiratory muscle training in patients undergoing cardiothoracic or upper abdominal surgery: a systematic review and meta analysis. Clinical rehabilitation. 2015 May;29(5):426-38.</ref> | ||
=== | === Postoperative === | ||
* [[Spirometry|Incentive spirometry]]<ref name=":0" /> | * [[Spirometry|Incentive spirometry]]<ref name=":0" /> | ||
* Early mobilisation<ref name=":0" /> | * Early mobilisation<ref name=":0" /> | ||
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<references /> | <references /> | ||
[[Category:Respiratory]] | |||
[[Category:Cardiopulmonary]] | |||
[[Category:Cardiopulmonary - Conditions]] | |||
[[Category:Conditions]] | |||
Latest revision as of 01:58, 27 July 2020
Original Editor - Ronald Yip
Top Contributors - Hing Long Yip, Kim Jackson and Uchechukwu Chukwuemeka
Introduction[edit | edit source]
Post-operative pulmonary complication is an umbrella term of adverse changes to the respiratory system occurring immediately after surgery.[1] The most common presentations include an altered function of respiratory muscles, reduced lung volume, respiratory failure and atelectasis.[1]
Incidence and Impact[edit | edit source]
Up to 23% of patient underwent major surgery would suffer from PPCs.[1] In fact, the incidence of PPCs is more common than cardiac complication.[2] With people who sustain PPCs, 14% to 30% die within 30 days after a major surgery compared to only 0.2% to 3% of patient who does not have PPCs. [3][4] In terms of morbidity, PPCs, increases the length of hospital stay by 13 - 17 days.[1]
List of PPCs[edit | edit source]
- Respiratory infection
- Respiratory failure
- Pleural effusion
- Atelectasis
- Pneumothorax
- Bronchospasm
- Aspiration pneumonia
- Pneumonia
- Acute respiratory distress syndrome
- Tracheobronchitis
Risk Factors[edit | edit source]
There is a range of factors to predict the development of PPCs, which are divided into modifiable and non-modifiable.[1]
Non-Modifiable[edit | edit source]
- Age - > 60 or 65 years is found to have increased risk.[5]
- Surgery type - Abdominal aortic aneurysm repair, thoracic, upper abdominal, neck, neurosurgery and major vascular surgery are found to have a higher risk than other types of surgery.[6][7]
Modifiable[edit | edit source]
- Co-morbidity - Patient with the following conditions has a higher risk in the development of PPCs: Chronic obstructive pulmonary disease, congestive heart failure, chronic liver disease.[6]
- Smoking
- Preoperative anaemia
- General anaesthesia - the use of GA disturbs many aspects of respiratory function, hence increases the risk of patient developing PPCs.[1]
- Low tidal volume - People who have lower tidal volume spontaneously are categorised as a higher risk.[1]
- Neuromuscular blocking drugs
- Nasogastric tube
PPC and Physiotherapy[edit | edit source]
Physiotherapy services are considered preventative measures in different stages of recovery.[1]
Preoperative[edit | edit source]
Preoperative aerobic exercise and inspiratory muscle training are recommended to reduce PPCs and LOS in cardiac and abdominal surgery patients.[8] It is found that preoperative IMT reduces postoperative atelectasis and pneumonia.[9]
Postoperative[edit | edit source]
- Incentive spirometry[1]
- Early mobilisation[1]
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 Miskovic A, Lumb AB. Postoperative pulmonary complications. BJA: British Journal of Anaesthesia. 2017 Mar 1;118(3):317-34.
- ↑ Lawrence VA, Hilsenbeck SG, Mulrow CD, Dhanda R, Sapp J, Page CP. Incidence and hospital stay for cardiac and pulmonary complications after abdominal surgery. Journal of general internal medicine. 1995 Dec 1;10(12):671-8.
- ↑ Herbstreit F, Peters J, Eikermann M. Impaired Upper Airway Integrity by Residual Meeting AbstractsIncreased Airway Collapsibility and Blunted Genioglossus Muscle Activity in Response to Negative Pharyngeal Pressure. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2009 Jun 1;110(6):1253-60.
- ↑ Kor DJ, Warner DO, Alsara A, Fernández-Pérez ER, Malinchoc M, Kashyap R, et al. Derivation and diagnostic accuracy of the surgical lung injury prediction model. Anesthesiology. 2011;115(1):117-128.
- ↑ Brooks-Brunn JA. Predictors of postoperative pulmonary complications following abdominal surgery. Chest. 1997 Mar 1;111(3):564-71.
- ↑ 6.0 6.1 Brueckmann B, Villa-Uribe JL, Bateman BT, Grosse-Sundrup M, Hess DR, Schlett CL, et al. Development and validation of a score for prediction of postoperative respiratory complications. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2013 Jun 1;118(6):1276-85.
- ↑ Arozullah AM, Khuri SF, Henderson WG, Daley J. Development and validation of a multifactorial risk index for predicting postoperative pneumonia after major noncardiac surgery. Annals of internal medicine. 2001 Nov 20;135(10):847-57.
- ↑ Valkenet K, van de Port IG, Dronkers JJ, de Vries WR, Lindeman E, Backx FJ. The effects of preoperative exercise therapy on postoperative outcome: a systematic review. Clinical rehabilitation. 2011 Feb;25(2):99-111.
- ↑ Mans CM, Reeve JC, Elkins MR. Postoperative outcomes following preoperative inspiratory muscle training in patients undergoing cardiothoracic or upper abdominal surgery: a systematic review and meta analysis. Clinical rehabilitation. 2015 May;29(5):426-38.
