Lung Protective Strategies in Abdominal Surgeries
Mohamed Alaaedin Mohamed;
Abstract
Postoperative pulmonary complications play an important role in the risk for patients undergoing abdominal surgery. Factors affecting upper airway patency result in the development of PPCs.
These factors include major surgical trauma, which is the main determinant of postoperative modifications in the respiratory function, other several additional causative mechanisms are encountered during abdominal surgery, including impaired respiratory arousal, REM rebound effect on respiratory muscles and the effects of sedatives, opioids and neuromuscular blockage agents which can all create the conditions for PPCs. Mechanical ventilation is a more insidious mechanism that may be responsible for additional lung aggression, especially in the context of major surgery. Age, general co-morbidity and pre-existing respiratory diseases also affect respiratory muscle function leading to PPCs.
PPCs are defined as any condition that adversely affects the respiratory tract and can lead to adverse clinical outcomes after surgery, including atelectasis, bronchospasm, pneumonia, acute upper airway obstruction, postoperative respiratory failure, exacerbation of OSA, chemical pnemonitis ,negative pressure pulmonary edema and abdominal compartmental syndrome. Nevertheless, several risk indices for PPCs were made including The cardiopulmonary risk index, Pulmonary risk indeces and specific risk indeces including Pneumonia risk index and Respiratory failure risk index.
Strategies to improve postoperative respiratory muscle function and avoid respiratory failure are involved in the perioperative period. It begins in the preoperative period with Smoking cessation, antibiotics therapy if indicated, chest physical therapy and management of current diseases. Then it extends to the intraoperative period including appropriate selection of the anesthetic technique and neuromuscular blockade, appropriate fluid therapy, less invasive surgical management and the usage of prophylactic lung protective mechanical ventilation. Lung protective strategies continue in the postoperative period with lung expansion maneuvers, adequate analgesia and selective usage of nasogastric tube after abdominal surgeries.
These factors include major surgical trauma, which is the main determinant of postoperative modifications in the respiratory function, other several additional causative mechanisms are encountered during abdominal surgery, including impaired respiratory arousal, REM rebound effect on respiratory muscles and the effects of sedatives, opioids and neuromuscular blockage agents which can all create the conditions for PPCs. Mechanical ventilation is a more insidious mechanism that may be responsible for additional lung aggression, especially in the context of major surgery. Age, general co-morbidity and pre-existing respiratory diseases also affect respiratory muscle function leading to PPCs.
PPCs are defined as any condition that adversely affects the respiratory tract and can lead to adverse clinical outcomes after surgery, including atelectasis, bronchospasm, pneumonia, acute upper airway obstruction, postoperative respiratory failure, exacerbation of OSA, chemical pnemonitis ,negative pressure pulmonary edema and abdominal compartmental syndrome. Nevertheless, several risk indices for PPCs were made including The cardiopulmonary risk index, Pulmonary risk indeces and specific risk indeces including Pneumonia risk index and Respiratory failure risk index.
Strategies to improve postoperative respiratory muscle function and avoid respiratory failure are involved in the perioperative period. It begins in the preoperative period with Smoking cessation, antibiotics therapy if indicated, chest physical therapy and management of current diseases. Then it extends to the intraoperative period including appropriate selection of the anesthetic technique and neuromuscular blockade, appropriate fluid therapy, less invasive surgical management and the usage of prophylactic lung protective mechanical ventilation. Lung protective strategies continue in the postoperative period with lung expansion maneuvers, adequate analgesia and selective usage of nasogastric tube after abdominal surgeries.
Other data
| Title | Lung Protective Strategies in Abdominal Surgeries | Other Titles | الإستراتيجيات الواقية للرئتين فى عمليات البطن | Authors | Mohamed Alaaedin Mohamed | Issue Date | 2015 |
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