后肺并发症-英文课件

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Post-Pneumonectomy Complications,- A few,short,notes ,Alan D L,Sihoe,1,Complications,Remember:,General,complications,Vs,Operation-specific,complications,Also:,Early vs Late complications,2,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: 318-21,3,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,4,1. 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,5,Cardiac dysrhythmias: 40%,Esp.,Atrial,fibrillation,Can you think why ?,Myocardial infarction,often similar risk factors (e.g. age, smoking),2. Cardiac complications,6,3. 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,7,3. 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,8,3. 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 these !,Low threshold for,Surgical Repair,9,4. Post-pneumonectomy syndrome,Herniation,of heart, mediastinal contents towards pneumonectomy space,k,inking/distortion of vascular structures,cardiovascular collapse,May require surgical correction,?fixing during initial op if problem anticipated,Note: hence controversy over whether to leave chest drain in situ after pneumonectomy,10,5. Post-pneumonectomy infection,High mortality,?also develop other complications during prolonged treatment (e.g. infection),Difficult to eradicate,warm, moist space,antibiotics cannot reach,Meticulous aseptic technique required during surgery,Consider antibiotic lavage,11,5. Post-pneumonectomy infection,Management options:,Drainage & antibiotics,Lavage via chest drain,Surgical drainage & decortication,Open drainage / thoracostomy,Thoracoplasty,12,