Evaluation of the Risk of Postoperative Pulmonary Complications
TL;DR: Both flow at the point of functional residual capacity on flow-volume curve, and the closing capacity subtracted fromfunctional residual capacity were found to be well correlated with the occurrence of postoperative complications and can be used to evaluate the risk of pulmonary complications developing in postoperative period.
Abstract: Ten of 40 patients who underwent major thoracic or abdominal operations developed postoperative pulmonary complications, consisting of six massive atelectasis, three pneumonias and one edema. They were mostly thoracotomy cases and cigarette smokers. Many of these complications would have been prevented, if reliable pulmonary function tests are available to predict preoperatively such occurrence. Flow-volume curve tracing and closing volume measurement were evaluated in this respect. Both flow at the point of functional residual capacity on flow-volume curve, and the closing capacity subtracted from functional residual capacity were found to be well correlated with the occurrence of postoperative complications and can be used to evaluate the risk of pulmonary complications developing in postoperative period.
Citations
More filters
TL;DR: This randomized controlled study evaluated the clinical benefit and physiological effects of prophylactic chest physiotherapy in open major abdominal surgery.
Abstract: Introduction This randomized controlled study evaluated the clinical benefit and physiological effects of prophylactic chest physiotherapy in open major abdominal surgery.
Methods A group of 174 patients received chest physiotherapy including breathing with pursed lips, huffing and coughing, and information about the importance of early mobilization. In addition high-risk patients were given resistance training on inspiration and expiration with a mask. The resistance used during inspiration was −5 cmH2O and that during expiration +10 cmH2O. The control group (194 patients) received no information or treatment unless a pulmonary complication occurred.
Results Oxygen saturation on postoperative days 1–3 was significantly greater in the treatment group. Treated patients were mobilized significantly earlier. No difference was noted in peak expiratory flow rate or forced vital capacity. Postoperative pulmonary complications occurred in 6 per cent of patients in the treatment group and in 27 per cent of controls (P<0·001). In high-risk patients the numbers with pulmonary complications were six of 40 and 20 of 39 respectively. Pulmonary complications were particularly common in patients with morbid obesity.
Conclusion Preoperative chest physiotherapy reduced the incidence of postoperative pulmonary complications and improved mobilization and oxygen saturation after major abdominal surgery.
220 citations
TL;DR: The available evidence indicates that spirometry's predictive value is unproved and its full potential for risk assessment in the individual patient has not yet been realized.
Abstract: • Preoperative spirometry is commonly ordered before abdominal surgery, with the goal of predicting and preventing postoperative pulmonary complications. We assessed the evidence for this practice with a systematic literature search and critical appraisal of published studies. The search identified 135 clinical articles, of which 22 (16%) were actual investigations of the use and predictive value of preoperative spirometry. All 22 studies had important methodological flaws that preclude valid conclusions about the value of screening preoperative spirometry. The available evidence indicates that spirometry's predictive value is unproved. Unanswered questions involve (1) the yield of spirometry, in addition to history and physical examination, in patients with clinically apparent lung disease; (2) spirometry's yield in detecting surgically important occult disease; and (3) its utility, or beneficial effect on patient outcome. Spirometry's full potential for risk assessment in the individual patient has not yet been realized. (Arch intern Med1989;149:280-285)
95 citations
TL;DR: Postoperatively, pulmonary function was reduced and there was a delay in the restoration of pulmonary function in cases with postoperative pulmonary complications, and the administration of appropriate analgesics may be useful to improve postoperative ventilatory disturbances.
Abstract: In patients 70 years or older, pulmonary function tests were performed before and after abdominal surgery to correlated the results with the development of postoperative pulmonary complications which developed in 48% of these patients, compared to 15% in the control group. To predict the development of PPC, preoperative analysis of the flow-volume curve is useful and
$$4\left( {\dot V_{50} - \dot V_{25} } \right)/forced$$
vital capacity is a valuable parameter for the analysis of the flow-volume curve. Postoperatively, pulmonary function was reduced and there was a delay in the restoration of pulmonary function in cases with postoperative pulmonary complications. The administration of appropriate analgesics may be useful to improve postoperative ventilatory disturbances.
9 citations
Okayama University1, Jikei University School of Medicine2, Niigata University3, Osaka City University4, Kyoto University5, Kanazawa University6, Nagoya University7, Kagoshima University8, Kurume University9, Gifu University10, Osaka University11, Chiba University12, Kyushu University13, St. Marianna University School of Medicine14, University of Tsukuba15, Kitasato University16, Juntendo University17, Kyorin University18, Yokohama City University19, University of Tokyo20, Yamaguchi University21, Asahikawa Medical College22, Keio University23, Shinshu University24
TL;DR: Serum secretory IgA was reduced in chronic liver disease while it was increased in obstructive jaundice, and Abnormally basic y-globulin which was dominantly found in chronic hepatitis B sera was determined to be monomeric IgG.
Abstract: 1) Serum secretory IgA was reduced in chronic liver disease while it was increased in obstructive jaundice. 2) Serum anti-dsDNA antibody was slightly increased in chronic liver disease, especially it was significantly increased in lupoid hepatitis in which its titer paralelled with the course of disease activity. 3) Serum Clq binding activity, Clq binding inhibition activity and polyclonal rheumatoid factor binding inhibition activity were increased in chronic liver disease and their disease activity was correlated with concentration of macromolecular immune complexes which were fractionated with sucrose density gradient ultracentrifugation. 4) Abnormally basic y-globulin which was dominantly found in chronic hepatitis B sera was determined to be monomeric IgG. I t was increased in aggravation of the disease but has no correlation with Clq binding monomeric IgG. 5) Liver membrane specific lipoprotein (LP-1), Espinosa's liver specific antigen (LSA), Nerenberg's hepatorenal antigen (HRA) and Tamm-Horsfall glycoprotein (THGP) had positive charge, and LP-2 and F-antigen did negative charge. 6) Human liver cell membrane fraction could not be obtained by the method of Ray or aqueous two phase polymer system which have been used for rat liver.
References
More filters
TL;DR: A theoretical relationship between the static recoil of lungs and the maximum rate at which gas can be expelled from them is developed and the configuration of maximum expiratory flow-volume curves are found.
Abstract: I N THIS PAPER we develop a theoretical relationship between the static recoil of lungs and the maximum rate at which gas can be expelled from them. This relationship (the maximum flow-static recoil curve, MFSR) defines the resistance to gas flow offered by a particular segment of the bronchial tree, namely that running between the alveoli and points downstream where pressures at the inside wall of the airways equal pleural pressure. Changes in this resistance with changes in lung volume reflect the relative contributions of two components of the resistance: one, due to frictional losses, is small at high lung volumes and increases progressively as lung volume decreases; the other, due to convective acceleration of gas, mainly reflects the cross section of large airways and has its greatest effect at high lung volumes. We show that the relative magnitude of these components changes systematically with age in human subjects and we discuss the structural basis for these changes. We also relate our analysis to mechanisms limiting flow during forced expirations. We show that the configuration of maximum expiratory flow-volume curves, which we find to have
890 citations
TL;DR: When anesthetized dogs were allowed to breathe spontaneously or were paralyzed and ventilated in the resting tidal range by means of a pump, pulmonary compliance fell progressively.
Abstract: When anesthetized dogs were allowed to breathe spontaneously or were paralyzed and ventilated in the resting tidal range by means of a pump, pulmonary compliance fell progressively. These changes w...
391 citations
257 citations
TL;DR: Extension of these simple therapeutic measures to large numbers of poor risk patients should reduce postoperative morbidity and mortality, allow earlier discharge, and lower the costs of patient care.
Abstract: Simple pulmonary function studies can be utilized successfully for diagnosis of pulmonary problems in surgery patients preoperatively. In the present study, randomly selected "poor risk" patients were treated preoperatively and postoperatively with cessation of smoking, bronchodilator drugs, antibiotics, inhalation of humidified gases, segmental postural drainage, and chest physiotherapy. When compared to nontreated poor risk patients, the treated patients had a marked reduction in postoperative morbidity and mortality due to pulmonary complications. Although the frequency and the severity of pulmonary complications were somewhat greater in the treated patients than in a group of "good risk" patients who were considerably younger in age, the differences were not significant. Extension of these simple therapeutic measures to large numbers of poor risk patients should reduce postoperative morbidity and mortality, allow earlier discharge, and lower the costs of patient care.
213 citations