后肺并发症英文.pptxVIP

后肺并发症英文第1页/共13页 ComplicationsRemember:General complicationsVsOperation-specific complicationsAlso: Early vs Late complications第2页/共13页 Post-pneumonectomy complications30-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第3页/共13页 Respiratory failure: 50-100% mortalityPrevention most importante.g. pre-op chest physio, optimise COAD Mx etc.Smoking (Ann Thorac Surg 2001; 72: 1662-7)Only factor associated with Major Pulmonary EventWith MPE: mortality rate increased almost 20x1. Respiratory complications第4页/共13页 1. Respiratory complicationsRemember: only one functional lung left i pulmonary reserve to cope with infection etc.Post-op care:Aggressive chest physioEarly mobilisationAdequate analgesiaBronchial toileting if necessaryConsider mini-tracheostomy第5页/共13页 Cardiac dysrhythmias: ~ 40% Esp. Atrial fibrillationCan you think why ?Myocardial infarctionoften similar risk factors (e.g. age, smoking)2. Cardiac complications第6页/共13页 3. Bronchopleural fistula3-6% of lung resectionsEsp. post-pneumonectomy lobectomyFactors: 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]第7页/共13页 3. Bronchopleural fistulaPresentation:SOBCough fluid from post-pneumonectomy spaceBubbling from chest drain (if one present)Decreased fluid level on CXRConfirm diagnosis by bronchoscopy第8页/共13页 3. Bronchopleural fistulaManagement:Resuscitation oxygenLie with pneumonectomy side DOWNInsert chest drain (if one not in situ already)Broad-spectrum antibiotic coverConsider double-lumen tube Consider why we do each of these !Low threshold for Surgical Repair第9页/共13页 4. Post-