risks for and prevention of pulmonary complications in non cardiac surgery patients l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Risks for and Prevention of Pulmonary Complications in Non-Cardiac Surgery Patients PowerPoint Presentation
Download Presentation
Risks for and Prevention of Pulmonary Complications in Non-Cardiac Surgery Patients

Loading in 2 Seconds...

play fullscreen
1 / 15

Risks for and Prevention of Pulmonary Complications in Non-Cardiac Surgery Patients - PowerPoint PPT Presentation


  • 421 Views
  • Uploaded on

Risks for and Prevention of Pulmonary Complications in Non-Cardiac Surgery Patients. Robert Folzenlogen MD Assistant Professor of Clinical Medicine Hospitalist, University of Missouri Columbia, Missouri. Pulmonary Complications in Non-Cardiac Surgery Patients. Overall incidence: 6.8%

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Risks for and Prevention of Pulmonary Complications in Non-Cardiac Surgery Patients' - libitha


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
risks for and prevention of pulmonary complications in non cardiac surgery patients

Risks for and Prevention of Pulmonary Complications in Non-Cardiac Surgery Patients

Robert Folzenlogen MD

Assistant Professor of Clinical Medicine

Hospitalist, University of Missouri

Columbia, Missouri

pulmonary complications in non cardiac surgery patients
Pulmonary Complications in Non-Cardiac Surgery Patients
  • Overall incidence: 6.8%
  • Prolong hospitalization 2x cardiac compli- cations; LOS increase up to 6x expected
  • Primary complications
    • Atelectasis
    • Pulmonary Infection
    • Respiratory Failure/Prolonged Ventilation
    • Bronchospasm
independent risk factors for pulmonary complications
Independent Risk Factorsfor Pulmonary Complications
  • Age over 60
  • History of COPD
  • History of CHF
  • Functional Dependence
  • Tobacco cessation within past 8 weeks?
  • ASA Class II or greater
  • Serum Albumin < 3.5
serum albumin and surgical complication risk
Serum Albumin and Surgical Complication Risk
  • Gibbs et al., 1999 VA, n=54,000+
  • Looked at age, functional status, emergency surgery, lab values
  • Serum albumin was best predictor of morbidity/mortality in postop month
  • Serum albumin also best predictor of postop infection/sepsis
  • Low albumin: 5x fail to wean, 4x postop pneumonia, 3x reintubation
surgical risk in copd patients
Surgical Risk in COPD Patients
  • Definition: FEV1< 50% Predicted
  • Pulmonary Complication risk increase of 2-6x
  • Overall surgical complication rate of 56% in major abdominal procedures
  • Overall surgical complication rate of 38% for procedures > 2 hrs (73% if > 4 hrs)
factors associated with a moderate increase in risk
Factors associated with aModerate Increase in Risk
  • Chronic Tobacco or Alcohol Use
  • Altered Mental Status
  • Weight Loss (>10% in last 6 months)
  • History of CVA
  • Clinical Chest Findings/Abnormal CXR
  • BUN > 21
  • Perioperative Transfusion
no independent risk of pulmonary complications
Obesity

Controlled Asthma

Diabetes Mellitus

Obstructive Sleep Apnea

Chronic Steroid Use

HIV Infection

History of Cardiac Arrythmias

Poor Exercise Tolerance

Abnormal Pre-Op Spirometry

No independent Risk ofPulmonary Complications
procedure related risk
Procedure-related Risk
  • Procedures lasting > 3 hours
  • Emergency Surgery
  • Aortic/Vascular Surgery
  • Thoracic or Upper Abdominal Surgery
  • Neurosurgery
  • Neck Surgery
  • General Anesthesia
  • Use of Long-acting NM blockade
procedures not associated with increased risk
Procedures not associated with increased risk
  • Esophageal Surgery
  • Gynecologic Surgery
  • Urologic Surgery
  • Hip Fracture Repair
  • Open vs. Laparascopic Procedures
respiratory failure index
Respiratory Failure Index
  • Arozullah et al., VA, 2000, n=81,719 men
  • Prospective of Major Non-Cardiac Surgery
  • Excluded: DNR, Comatose, Ventilator Dependent
  • Postop Resp Failure (3.4%) – need for vent >48hrs or reintubation
arozullah respiratory failure index
AAA Surgery (27)

Thoracic Surg (21)

Neurosurg (14)

Upper Abd Surg (14)

Vascular Surg (14)

Neck Surg (11)

Emergency Surg (11)

Serum Alb <3.0 (9)

BUN >30 (8)

Dependency (7)

Hx COPD (6)

Age 70 or over (6)

Age 60-69 (4)

>40 pts: 26.6% risk

28-40 pts: 10.1%

20-27 pts: 4.2%

11-19 pts: 1.8%

<10 pts: 0.5%

Arozullah Respiratory Failure Index
recommended pre op assessment and intervention
Recommended Pre-Op Assessment and Intervention
  • PFTs only:
    • Before lung resection to estimate postop lung volumes
    • To maximize preop control of COPD/asthma
    • To investigate cause of dyspnea/exercise intolerance
  • Tobacco cessation – only if >8weeks before surgery
  • Optimize medication regimen for COPD or asthma
preop testing interventions with no proven value to assess reduce risk
PreOp testing/interventions with no proven value to assess/reduce risk
  • Routine spirometry
  • Routine ABGs
  • Routine CXR (controversial for age >50)
  • Right Heart Catheterization
  • Routine TPN or Enteral Supplementation
  • Pulmonary Artery Catheter
post op recommendations to reduce pulmonary complications
Post-Op recommendations to reduce Pulmonary Complications
  • Deep Breathing Exercises/Incentive Spirometry
  • CPAP – if patient cannot cooperate for I.S.
  • Avoid routine use of NG tubes
  • Adequate Pain Control
references
References
  • Qaseen, Amir et al., Risk Assessment for and Strategies to Reduce Perioperative Complications for Patients Undergoing Noncardiothoracic Surgery: A Guideline from the ACP; Annals of IM 144, No.8, 575-580, 4/18/06
  • Smetana MD, Gerald W. et al., Preoperative Pulmonary Risk Stratification for Noncardiothoracic Surgery: Systemic Review for the ACP; Annals of IM 144, No.8, 581-595, 4/18/06
  • Arozullah, Ahsan M. et al., Multifactorial Risk Index for Predicting Postoperative Respiratory Failure in Men after Major Non-Cardiac Surgery, Annals Surgery, 2000:232, pgs 242-253
  • Smetana, Gerald, Preoperative Pulmonary Evaluation: Identifying and Reducing Risks for Pulmonary Complications, Cleveland Clinic J. Medicine, Supplement 73, pages 36-41, 3/06
  • Gibbs J. et al., Preoperative Serum Albumin Level as a Predictor of Operative Morbidity and Mortality: Results from the National VA Surgical Risk Study, Archives of Surgery, 1999, 134:36-42
  • McAlister, F.A. et al. Incidence of and Risk Factors for Pulmonary Complications after Non-Thoracic Surgery, Am J Resp Critical Care Med, 171:514-517, 3/05
  • Kroenke, LTC Kurt et al., Operative Risk in Patients with Severe COPD, Archives of IM, 152:967-971, 5/92