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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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