concept of prevention of complications zislin

THE CONCEPT OF PREVENTION OF POSTOPERATIVE RESPIRATORY

COMPLICATIONS IN LUNG SURGERY

M. Kontorovich, B. Zislin

Yekaterinburg Russian Federation

Ural Reaserch Institute for Phtiziopulmonology

translated by Alexander Postoev

Postoperative pulmonary complications (PPC) account for about 50% of the total number of non-surgical complications.

After lobectomy the frequency of respiratory complications is 7.2%-36.5% , after combined pneumonectomy is 70%.

Magnusson l., Spahn D.R. New concepts of atelectasis during general anaesthesia // British J. of Anaesthesia , 2003. Vol. 91 (1). P. 61–72.

Saratov Journal of Medical Scientific Research // 2010. Vol. 6, № 3

Postoperative pulmonary complications (PPC) are the most frequently observed complications following lung resection, of which pneumonia and atelectasis are the most common. PPCs have a significant clinical and economic impact associated with increased observed number of deaths, morbidity, length of stay and associated cost.

Thirty-four of 234 subjects (14.5%) had clinical evidence of PPC.

P. Agostini, H. Cieslik, S. Rathinam et al. Postoperative pulmonary complications following thoracic surgery…/Thorax 2010;65:815-818

Postoperative pulmonary complications are reported in the range of 2% – 39%, and include atelectasis, pneumonia and respiratory failure.

Ruben D. Restrepo, Richard Wettstein, Leo Wittnebel, Michael TracyAARC Clinical Practice Guideline: Incentive Spirometry // 2011

Pulmonary complications have been reported in 20% to 70% of patients undergoing thoracic operations compared with a 4% incidence of pulmonary complications after urologic or orthopedic surgery.

Ramona L. Doyle. Assessing and Modifying the Risk of Postoperative Pulmonary Complications // Chest 1999-115; S.77-81

Atelectasis makes up 90 percent of PPC.

Colleen M. Kigin. Chest Physical Therapy for the Postoperative or Traumatic Injury Patient / PHYSICAL THERAPY , 1981 Vol. 61, № 12

Emergence of bilateral mikroatelektasis the early postoperative period after cardiac and pulmonary operation in the 30% - 70% noted.

A.N.Kuzovlev, A.V.Vlasenko, A.I.Yaroshetsky et al., A.A.Romanov et al., Yu.A.Zorin et al. - Reports of the All-Russian Congress dedicated to the

100th anniversary of acad. V.A.Negovsky, Moscow, March 2009

HFJVCMV

HFJV EFFECTS

RESPIRATORY PHYSIOLOGY Rodney A. Rhoades, Ph.D., George A. Tanner, Ph.D., 2006

Copyright 2005, Elsevier Inc. with changes

PHFJV

CMV

Atelectasis zone

Hyperinflation zone

V

P

T

HFJV

CMVHyperinflation zone

Atelectasis zone

Copyright 2005, Elsevier Inc. with changes

ZISLINE JV-100

ZISLINE JV-110

CMV HFJV Р*

Patients (total) 313 310Postoperative atelectasis 62 (19,8%) 18 (5,8%) =0,000

sexm 48 (77%) 10 (55%)f 14 (23% 8 (45%)total 62 (100%) 18 (100%)

Age (M±SD) 41,3±13,1 47,3±14,0

Diagnosis

tuberculosis 44 (70,1%) 6 (33,3%) =0,008cancer 12 (19%) 8 (44,4%)_ =0,059прочие 6 (10,9%) 4 (22,2%)total 62 (100%) 18 (100%)

Operation

pneumonectomy 2 (0,1%) =0,042lobectomy 10 (16%) 5 (27,8%)segmentectomy 41 (66,1%) 7 (38,9)thoracotomy 11 (17,9%) 4 (33,2%) =0,026

*criterion Z

0

20

40

60

80 62

18

CMV (n=313)HFJV(n=310)

THE INCIDENCE OF ATELECTASIS

19,8%5,8%

INCENTIVE SPIROMETRY,EXPIRATORY TRAINING

NON-INVASIVE HFJV (СРАРHF)

THE CONCEPT OF PREVENTION OF POSTOPERATIVE RESPIRATORY COMPLICATIONS

AFTER LUNG SURGERY INCLUDES:

HFJV CMV

Thank

you

translated by Alexander Postoev

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