Post Operative Pulmonary Complications
0.0 / 5
- Created by: Fredcatley
- Created on: 30-12-20 14:10
Define Post-Operative Pulmonary Complications (PPC)
Abnormality of the respiratory tract that produces identifiable disease or dysfunction that adversely affect the clinical course
1 of 21
Outline the spectrum of PPC
-Atelectasis > post-operative hypoxaemia (very common)
-Pneumonia, bronchitis
-Bronchospasm
-Exacerbation of previous lung disease
-Pulmonary collapse due to mucus plugging airways
-Respiratory failure with ventilatory support > 48 hrs
-Acute lung injury
-Pneumonia, bronchitis
-Bronchospasm
-Exacerbation of previous lung disease
-Pulmonary collapse due to mucus plugging airways
-Respiratory failure with ventilatory support > 48 hrs
-Acute lung injury
2 of 21
Describe the clinical signs of PPC's
-SPO2 < 90% on 2 consecutive days
-Chest X-rays (CRX) changes: atelectasis/pneumonia
-Temp > 38 degrees on more than 1 consecutive day
-New productive cough
-Abnormal lung auscultation
-Raised white cell count (WCC)
-+ Sputum Microbiology Test
-Increased
-Chest X-rays (CRX) changes: atelectasis/pneumonia
-Temp > 38 degrees on more than 1 consecutive day
-New productive cough
-Abnormal lung auscultation
-Raised white cell count (WCC)
-+ Sputum Microbiology Test
-Increased
3 of 21
What scale is used to diagnose PPC's and how is it used?
Melbourne group scale used by presence of 4 or more of following:
-CRX changes
-Fever > 38d
-WCC > 11.2
-SPO2 < 90%
-New green/yellow sputum production
-+ sputum microbiology
-Diagnosis of chest infection/pneumonia
-Readmission to ICU (intensive care)/
-CRX changes
-Fever > 38d
-WCC > 11.2
-SPO2 < 90%
-New green/yellow sputum production
-+ sputum microbiology
-Diagnosis of chest infection/pneumonia
-Readmission to ICU (intensive care)/
4 of 21
Discuss the scale of the problem in terms of statistics
-PPC's are leading cause of increased hospital stay (2 weeks), morbidity and mortality in surgical pt's
-Healthcare costs 50% greater than costs for post-op cardiac problems
-Healthcare costs 50% greater than costs for post-op cardiac problems
5 of 21
Name one of the main causes of PPC's
Atelectasis: alveoli collapse when functional residual capacity (FRC) is less than closing volume (CV)
6 of 21
Define + discuss FRC
-FRC: volume of air left in lungs after expiration at tidal volume
-Means that lungs are not completely emptied of air when breath out > alveoli don't collapse
-Means that lungs are not completely emptied of air when breath out > alveoli don't collapse
7 of 21
Define + discuss CV
-CV: lung volume at which airways begin to close
-Normally, FRC greater than CV > small airways remain open during respiration
-Normally, FRC greater than CV > small airways remain open during respiration
8 of 21
Discuss the complications of surgery and reduced FRC
-Major abdominal surgery = reduction in FRC
-No.of factors that contribute to risk + extent of reduced FRC:
-Pre-operatively
-Peri-operatively
-Post-operatively
-No.of factors that contribute to risk + extent of reduced FRC:
-Pre-operatively
-Peri-operatively
-Post-operatively
9 of 21
Discuss pre-op risks
-Obesity: sig. reduction in FRC due to additional weight on chest wall
-Age: respiratory muscles weaken, rib cage stiffens = loss of elastic recoil > increased CV
-Pre-existing respiratory problems
-Smoking
-Age: respiratory muscles weaken, rib cage stiffens = loss of elastic recoil > increased CV
-Pre-existing respiratory problems
-Smoking
10 of 21
Discuss the effects of pre-existing respiratory conditions
-Obstructive defects: COPD > reduced exercise capacity + bronchospasm > compensation = 6* more likely to develop PPC's
-Restrictive defects: Kyphoscoliosis > increased risk as generation of tidal volume is solely dependent on diaphragm movement
-Infecti
-Restrictive defects: Kyphoscoliosis > increased risk as generation of tidal volume is solely dependent on diaphragm movement
-Infecti
11 of 21
Discuss the effects of smoking
-Small airways narrowed
-Increased mucus production
-Impaired mucociliary clearance
-Increased CV
-Smokers incidence of PPC's > 4* greater than those who quit smoking 8 weeks prior to surgery
-Increased mucus production
-Impaired mucociliary clearance
-Increased CV
-Smokers incidence of PPC's > 4* greater than those who quit smoking 8 weeks prior to surgery
12 of 21
Name peri-operative risks
-Position
-General Anaesthesia
-Incision
-General Anaesthesia
-Incision
13 of 21
Discuss the effects of position on the patient
Position:
-FRC affected by gravity
-FRC greatest in standing
-In supine > abdominal contents push on diaphragm
-In normal subjects FRC reduced by 500-1000 ml in supine
-FRC affected by gravity
-FRC greatest in standing
-In supine > abdominal contents push on diaphragm
-In normal subjects FRC reduced by 500-1000 ml in supine
14 of 21
Explain why general anaesthesia is a risk factor
-Diaphragm displaced, cephalad and compresses lung tissue > reducing FRC by 500 mls
15 of 21
Explain why incision is a risk factor
-Upper abdominal + thoracic incisions = high incidence of PPC's
-Laparotomy incision (vertical midline) = greatest peri-operative risk factor
-Pain, respiratory splinting, loss of normal breathing mechanics > reduced FRC
-Laparotomy incision (vertical midline) = greatest peri-operative risk factor
-Pain, respiratory splinting, loss of normal breathing mechanics > reduced FRC
16 of 21
Name some post-op risks
-Effects of pain
-Reduced mobility
-Atelectasis
-Reduced mobility
-Atelectasis
17 of 21
Discuss the effects of pain as a risk factor
Pain causes:
-Guarding and spasm of trunk muscles
-Reduced diaphragm excursion
-Impairs bucket handle movement of ribs
-Inhibition of breathing
-Reduced FRC
-Guarding and spasm of trunk muscles
-Reduced diaphragm excursion
-Impairs bucket handle movement of ribs
-Inhibition of breathing
-Reduced FRC
18 of 21
Explain why reduced mobility is a risk factor
-FRC reduced in supine/sitting > greater risk of PPC's
-Early mobility reduces incidence of PPC's
-Early mobility reduces incidence of PPC's
19 of 21
Explain why Atelectasis is a risk factor
-Reduced lung v
-V/Q mismatch
-Sputum retention
-Infection
-Type 1 respiratory failure
-V/Q mismatch
-Sputum retention
-Infection
-Type 1 respiratory failure
20 of 21
Discuss how you predict high risk patients
5 main risk factors for PPC development:
-Duration of anaesthesia's > 180 mins
-Type of surgery = USA/Thoracic
-Presence of pre-op respiratory problems
-Smoking (last 8 weeks)
-Reduced levels of pre-op mobility
-Duration of anaesthesia's > 180 mins
-Type of surgery = USA/Thoracic
-Presence of pre-op respiratory problems
-Smoking (last 8 weeks)
-Reduced levels of pre-op mobility
21 of 21
Other cards in this set
Card 2
Front
Outline the spectrum of PPC
Back
-Atelectasis > post-operative hypoxaemia (very common)
-Pneumonia, bronchitis
-Bronchospasm
-Exacerbation of previous lung disease
-Pulmonary collapse due to mucus plugging airways
-Respiratory failure with ventilatory support > 48 hrs
-Acute lung injury
-Pneumonia, bronchitis
-Bronchospasm
-Exacerbation of previous lung disease
-Pulmonary collapse due to mucus plugging airways
-Respiratory failure with ventilatory support > 48 hrs
-Acute lung injury
Card 3
Front
Describe the clinical signs of PPC's
Back
Card 4
Front
What scale is used to diagnose PPC's and how is it used?
Back
Card 5
Front
Discuss the scale of the problem in terms of statistics
Back
Related discussions on The Student Room
- dissertation topic »
- Aorta, coronary artery, pulmonary artery or pulmonary vein? »
- AQA A Level Biology Mass transport in animals »
- AQA alevel biology textbook questions »
- Ocr biology as - i need to know everything on the heart »
- i hate cardio. »
- Feel bloated after general anaesthetic »
- OCR A GCSE Biology Paper 3 Higher Tier [16th May 2023] Exam Chat »
- alevel biology »
- Spire Healthcare: Death of NHS-funded private patient raises safety concerns »
Similar Other resources:
0.0 / 5
0.0 / 5
0.0 / 5
0.0 / 5
0.0 / 5
0.0 / 5
0.0 / 5
5.0 / 5 based on 1 rating
Comments
No comments have yet been made