后肺并发症-英文课件.ppt

Post-Pneumonectomy Complications - A few short notes – Alan D L Sihoe Complications Remember: General complications Vs Operation-specific complications Also: Early vs Late complications Post-pneumonectomy complications 30-day post-op mortality 6-8% (Right Left) Risk factors for mortality: Advanced age* Bronchopleural fistula* Cardiovascular disease+ Hematologic disease+ Right pneumonectomy+ Extended resection+ Pre-op adjuvant therapy+ Respiratory failure$ Sepsis$ Male sex$ * Eur J Cardiothorac Surg 2001; 20: 476-80 + J Thorac Cardiovasc Surg 2001; 121: 1076-82 $ Am Surg 2001; 67: 318-21 1. Respiratory complications Respiratory failure: 50-100% mortality Prevention most important e.g. pre-op chest physio, optimise COAD Mx etc. Smoking (Ann Thorac Surg 2001; 72: 1662-7) Only factor associated with Major Pulmonary Event With MPE: mortality rate increased almost 20x 1. Respiratory complications Remember: only one functional lung left i pulmonary reserve to cope with infection etc. Post-op care: Aggressive chest physio Early mobilisation Adequate analgesia Bronchial toileting if necessary Consider mini-tracheostomy 2. Cardiac complications Cardiac dysrhythmias: ~ 40% Esp. Atrial fibrillation Can you think why ? Myocardial infarction often similar risk factors (e.g. age, smoking) 3. Bronchopleural fistula 3-6% of lung resections Esp. post-pneumonectomy lobectomy Factors: Ann Thorac Surg 2001; 72: 1662-7 Technique (long stump) Medical co-morbidities (COAD poor FEV1, DM) Adjuvant therapies (steroid) Ventilation/BiPAP [also: Infection, Tumour] 3. Bronchopleural fistula Presentation: SOB Cough fluid from post-pneumonectomy space Bubbling from chest drain (if one present) Decreased fluid level on CXR Confirm diagnosis by bronchoscopy 3. Bronchopleural fistula Management: Resuscitation oxygen Lie with pneumonectomy side DOWN Insert chest drain (if one not in situ already) Broad-spectrum antibiotic cover Consider double-lumen tube Consider why we do each of t