后肺并发症英文.ppt

Post-PneumonectomyComplications,-AfewshortnotesAlanDLSihoe,Complications,Remember:GeneralcomplicationsVsOperation-specificcomplicationsAlso:EarlyvsLatecomplications,Post-pneumonectomycomplications,30-daypost-opmortality6-8%(RightLeft)Riskfactorsformortality:Advancedage*Bronchopleuralfistula*Cardiovasculardisease+Hematologicdisease+Rightpneumonectomy+Extendedresection+Pre-opadjuvanttherapy+Respiratoryfailure$Sepsis$Malesex$*EurJCardiothoracSurg2019;20:476-80+JThoracCardiovascSurg2019;121:1076-82$AmSurg2019;67:318-21,Respiratoryfailure:50-100%mortalityPreventionmostimportante.g.pre-opchestphysio,optimiseCOADMxetc.Smoking(AnnThoracSurg2019;72:1662-7)OnlyfactorassociatedwithMajorPulmonaryEventWithMPE:mortalityrateincreasedalmost20 x,1.Respiratorycomplications,1.Respiratorycomplications,Remember:onlyonefunctionallungleftipulmonaryreservetocopewithinfectionetc.Post-opcare:AggressivechestphysioEarlymobilisationAdequateanalgesiaBronchialtoiletingifnecessaryConsidermini-tracheostomy,Cardiacdysrhythmias:40%Esp.AtrialfibrillationCanyouthinkwhy?Myocardialinfarctionoftensimilarriskfactors(e.g.age,smoking),2.Cardiaccomplications,3.Bronchopleuralfistula,3-6%oflungresectionsEsp.post-pneumonectomylobectomyFactors:AnnThoracSurg2019;72:1662-7Technique(longstump)Medicalco-morbidities(COAD&poorFEV1,DM)Adjuvanttherapies(steroid)Ventilation/BiPAPalso:Infection,Tumour,3.Bronchopleuralfistula,Presentation:SOBCoughfluidfrompost-pneumonectomyspaceBubblingfromchestdrain(ifonepresent)DecreasedfluidlevelonCXRConfirmdiagnosisbybronchoscopy,3.Bronchopleuralfistula,Management:Resuscitation&oxygenLiewithpneumonectomysideDOWNInsertchestdrain(ifonenotinsitualready)Broad-spectrumantibioticcoverConsiderdouble-lumentubeConsiderwhywedoeachofthese!LowthresholdforSurgicalRepair,4.Post-pneumonectomysyndrome,Herniationofheart,mediastinalcontentstowardspneumonectomyspacekinking/distortionofvascularstructurescardiovascularcollapseMayrequiresurgicalcorrection?fixingduringinitialopifproblemanticipatedNote:hencecontroversyoverwhethertoleavechestdraininsituafterpneumonectomy,5.Post-pneumonectomyinfection,Highmortality?alsodevelopothercomplicationsduringprolongedtreatment(e.g.infection)Difficulttoeradicatewarm,moistspaceantibioticscannotreachMeticulousaseptictechniquerequiredduringsurgeryConsiderantibioticlavage,5.Post-pneumonectomyinfection,Mana