Chapter 43 - Respiratory complications Flashcards
Risk factors for postop pulmonary complication
TABLE 43.1
Smoking cessation in this weeks range worsens postop pulmonary complication
4-8 weeks increased sputum production not clear not reproducible still should quit
Reasons to do pre-op PFT
1) identify if open surgery outweigh benefit 2) identify patients where percutaneous better 3) identify patients that would benefit from aggressive periop management
Rate of pre-op CXR to identify abnormality rate of it affecting perioperative management
1.3% 0.1%
Canet Prediction of post-op pulmonary complications
TABLE 43.2
Rate of VAP in intubated patients
9-27%
Early tracheotomy benefit
Less stay in ICU no improvement in mortality or VAP
Rate of atelectasis
Collapse or closure of alveoli Affects dependent portion of lung 90% of anesthetized patient
Bronchospasm key points
1) increased tone in bronchial smooth muscles 2) narrowing of bronchi 3) histamine, muscarinic, allergic
Acute management of bronchospasm
1) beta-2 agonist 2) iv steroids 3) iv epinephrine
hospital acquired pneumonia definition
1) pneumonia after > 48 hr hospital admission
Ventilation associated pneumonia VAP definition
HAP that develop > 48 hr after intubation
Healthcare-associated pneumonia
1) hospitalization > 2 days in acute care facility within 90 days of admission 2) resident of nursing home or long-term care facility at time of infection 3) HD within 30 days 4) patient who received IV treatment or wound care within 30 days 5) patient family member of a known patient with multidrug resistant pathogen
Etiology of VAP
1) bacterial colonization 2) aspiration of contaminated secretion of lower airway
Ortanism of VAP
1) staphlococcus aureus (MRSA 54-82%) 2) pseudomonas 3) enterobacter 4) acinetobacter 5) klebsiella
VAP score
TABLE 43.3 > 6 is VAP
Berlin definition of ARDS
TABLE 43.4
