Post-operative Pulmonary Complications (PPC) Flashcards
<p>Risk factors for developing PPC</p>
- duration of anasthesia > 180 min</p>
- type of surgery performed (upper abdominal, chest surgery)</p>
- Co-morbidities (respiratory and cardiac disease) [i.e COPD, Type II diabetes]</p>
- BMI - obesity, malnourished</p>
- current Smoking "within last 8 weeks"</p>
- reduced level of preoperative activity</p>
- advanced age
To reduce the development of PPC, pre-operative inspiratory muscle training is effective. T or F?
True
[it is effective for “high risk” patients, but there is no evidence for “low risk” patients.]
What is PPC? Definition:
” a pulmonary abnormality that produces identifiable disease or dysfunctions that is clinically significant and adversely affects the clinical course”
PPC may include:
- respiratory failure
- atelectasis
- pneumonia
- pulmonary oedema
- pleural effusion etc….
<p>A PPC will be diagnosed by presence of 4 or more of the following: (Parry et al, 2014)</p>
- SpO2 < 90% on two consecutive days
- Chest radiograph report of atelectasis / consolidation
<p>-raised oral temperature (febrile is >37.5C) often defined as >38C on more than one consecutive day [as a raised temp on the first day after surgery is common]</p>
<p>-production of yellow or green sputum (differ from pre-op)</p>
<p>-Diagnosis of pneumonia/ chest infection by attending physician</p>
<p>-positive signs of infection on sputum microbiology</p>
<p>-otherwise unexplained raised white cell count (> 11 x 109/L)</p>
<p>-Readmission to the ITU with problems which are respiratory in origin</p>
“Hypoxaemia”(an abnormally low level of O2 in the blood) is caused by
- V/Q mismatch
- Hypoventilation
- Diffusion limitation
- Decrease in FiO2
- Imbalance between consumption and delivery
“Mild” hypoxaemia is PaO2 __ - __ kPa; SaO2 __ - ___%
PaO2: 8 - 10.5 kPa, SaO2: 90 - 94%
“Moderate” hypoxaemia is PaO2 __ - __ kPa; SaO2 __ - ___%
PaO2: 5.3 - 7.9 kPa, SaO2: 75 - 89%
The normal PaO2 is _ - __ kPa
10.7 - 13.3
“Hypercapnia” (an abnormally high level of CO2 in the blood) is caused by
- Hypoventilation (=respiratory depression) (e.g. pain, medication)
- Increased metabolism (e.g. burns)
- Increased dead space (e.g. pneumonia)
list the drips and drains in situ after Oesophagogastrectomy
- Chest drains
- IV line
- Nasogastric tube (feed or drain)
- Urinary Catheter
- Oxygen
- PCA (epidural or IV)
“Nill by mouth” for how many days after Oesophagogastrectomy
around 5 days
commence sips of clear fluid; Barium swallows to check anastamotic leak before intake of clear fluid
Discharge may be in ___ to ___ days
7 - 10 days
Post-operative PT management
- Initiate coughing
- TEE
- IS (Insentive spirometry)
- Early mobilisation (reduce risk of atelectasis)
If a Px weighs 80kg, how much urine output you expect hourly?
40ml/kg/hr
approximately half a body weight
