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Pulmonary Complications (pulmonary + complications)

Distribution by Scientific Domains

Medical Sciences	100%

Distribution within Medical Sciences

Respiratory Medicine	31%
Anesthesia & Pain Management	6%
10 Other Subdomains	57%

Kinds of Pulmonary Complications

postoperative pulmonary complications

Selected Abstracts

RISK FACTORS FOR POSTOPERATIVE PULMONARY COMPLICATIONS IN UPPER ABDOMINAL SURGERY

ANZ JOURNAL OF SURGERY, Issue 3 2007
Fikret Kanat
Background: Pulmonary complications are the most frequent cause of postoperative morbidity and mortality in upper abdominal surgery (UAS). We aimed to examine the influence of possible preoperative, operative and postoperative risk factors on the development of early postoperative pulmonary complications (POPC) after UAS. Methods: A prospective study of 60 consecutive patients was conducted who underwent elective UAS in general surgical unit. Each patient's preoperative respiratory status was assessed by an experienced chest physician using clinical examination, chest radiographs, spirometry and blood gas analysis . Anaesthetical risks, surgical indications, operation time, incision type, duration of nasogastric catheter and mobilization time were noted. Forty-eight hours after the operation, pulmonary examinations of the patients were repeated. Results: Postoperative pulmonary complications were observed in 35 patients (58.3%). The most common complication was pneumonia, followed by pneumonitis, atelectasis, bronchitis, pulmonary emboli and acute respiratory failure. The presence of preoperative respiratory symptoms and the spirometric parameter of forced expiratory volume in 1 s/forced vital capacity were the most valuable risk factors for early prediction of POPC. The sensitivity, specificity and diagnostic efficiency of the presence of preoperative respiratory symptoms in the POPC prediction were 70, 61 and 66%, respectively. Conclusion: We recommend a detailed pulmonary examination and spirometry in patients who will undergo UAS by chest physicians to identify the patients at high risk for POPC, to manage respiratory problems of the patients before surgery and also to help surgeons to take early measures in such patients before a most likely POPC occurrence. Improvement of lung function in those patients at risk for POPC before operation may decrease morbidity in surgical patients. [source]

Airway reactivity in children before and after stem cell transplantation

PEDIATRIC PULMONOLOGY, Issue 9 2009
Lea Bentur MD
Abstract Stem cell transplantation (SCT) is associated with pulmonary complications. We encountered several children post-SCT with a clinical picture suggestive of airway hyper-reactivity (AHR) and evidence of reversible airway obstruction that was not reported pre-transplant. We evaluated the possibility of increased AHR as assessed by methacholine challenge test (MCT) following the course of SCT, and assessed a possible correlation between AHR and pulmonary complications. This was a prospective study evaluating consecutive patients referred for SCT to the Department of Pediatric Hemato-Oncology. Evaluation included pulmonary function test and MCT before and after SCT, and assessment of pulmonary complications. Twenty-one of 33 patients completed the study. The mean PC20 was 14.3,±,4.1 mg/ml prior to SCT; afterward the mean PC20 decreased to 11.2,±,5.6 mg/ml (P,=,0.018). The number of patients with airway reactivity (PC20,,,8 mg/ml) increased from 2/21 patients before SCT to 8/21 patients after SCT (P,=,0.043; McNemar test with Yates correction). Pulmonary complications and hospitalization were recorded in 33.3% of the patients (7/21 patients): 62.5% of the patients (5 patients) with AHR compared to 15.4% (2 patients) in the group without AHR (P,=,0.041; Fisher exact test). There were 10 hospitalizations among the 8 patients with positive MCT compared to 2 hospitalizations in 13 patients with negative MCT (median 1 vs. 0, P,=,0.045; Mann,Whitney U -test). Increased airway reactivity was observed in our study following the course of SCT. Positive MCT after SCT may be associated with increased risk of pulmonary complications. Larger prospective studies are needed to evaluate the possible mechanisms responsible for increased AHR and the clinical importance of these findings. Pediatr Pulmonol. 2009; 44:845,850. © 2009 Wiley-Liss, Inc. [source]

Shrinking Lung Syndrome in a 14-Year-Old Boy with Systemic Lupus Erythematosus

PEDIATRIC PULMONOLOGY, Issue 2 2006
Polly J. Ferguson MD
Abstract Pulmonary complications occur frequently in people with systemic lupus erythematosus. We report on an adolescent with an acute onset of dyspnea and pleuritic chest pain with severe restrictive lung physiology on pulmonary function testing (forced vital capacity, 20% of predicted) who had no evidence of parenchymal lung or pleural disease. He was found to have restricted diaphragmatic movement as assessed by fluoroscopy, without evidence of generalized respiratory muscle weakness. His clinical presentation and results of diagnostic tests were typical for shrinking lung syndrome. Given the rarity of shrinking lung syndrome in the pediatric age range, many clinicians are not aware of it as a clinical entity. Shrinking lung syndrome should be included in the differential diagnosis of dyspnea in both children and adults with systemic lupus erythematosus. Pediatr Pulmonol. © 2005 Wiley-Liss, Inc. [source]

Pulmonary complications following hematopoietic stem cell transplantation: Diagnostic approaches

AMERICAN JOURNAL OF HEMATOLOGY, Issue 2 2005
Kasem Sirithanakul
Abstract Pulmonary complications are a significant cause of morbidity and mortality in hematopoietic stem cell transplant recipients. Pulmonary infiltrates in such patients pose a major challenge for clinicians because of the wide differential diagnosis of infectious and noninfectious conditions. It is rare for the diagnosis to be made by chest radiograph, and commonly these patients will need further invasive and noninvasive studies to confirm the etiology of the pulmonary infiltrates. This review describes the role of the different diagnostic tools available to reach a diagnosis in a timely manner in this patient population. Am. J. Hematol. 80:137,146, 2005. © 2005 Wiley-Liss, Inc. [source]

Pulmonary complications of immune reconstitution inflammatory syndromes in HIV-infected patients

RESPIROLOGY, Issue 4 2009
Kristina CROTHERS
ABSTRACT Immune reconstitution inflammatory syndrome (IRIS) describes a paradoxical worsening of clinical status related to recovery of the immune system, as can occur after the initiation of highly active antiretroviral therapy (HAART) in HIV-infected patients. Most commonly, IRIS results from opportunistic infections that can unmask or develop paradoxical worsening following HAART. Cancers, autoimmune conditions and sarcoidosis have also been associated with IRIS. Pulmonary complications may be frequently encountered. This article reviews the types and clinical presentation of IRIS, with a focus on the pulmonary manifestations. Management and outcome of IRIS are considered. [source]

RISK FACTORS FOR POSTOPERATIVE PULMONARY COMPLICATIONS IN UPPER ABDOMINAL SURGERY

Pulmonary complications in chronic lymphocytic leukemia

CANCER, Issue 9 2003
Shahid Ahmed M.D.
Abstract BACKGROUND Although pulmonary complications account for significant morbidity and mortality in patients with chronic lymphocytic leukemia (CLL), to the authors' knowledge there are sparse data available in published literature. The authors evaluated pulmonary complications in patients with CLL and identified prognostic variables that predict hospital mortality in these patients. METHODS Clinical data were analyzed retrospectively from patients with CLL who required hospitalization for a respiratory illness at a tertiary care institution from January 1993 to December 2001. A logistic regression analysis with a backward elimination procedure was carried out to determine prognostic variables that predict hospital mortality. RESULTS There were 110 patients who were admitted on 142 occasions with a pulmonary complication. The median age was 75 years (range, 43,97 years), and the male:female ratio was 1.7:1.0. Among 142 admissions, 68% were high risk according to the Rai criteria, 68% of patients admitted had received prior therapy for CLL, and 35% had received treatment within 3 months of admission. The most common pulmonary complications were pneumonias (75%), malignant pleural effusion/and or lung infiltrate due to CLL (9%), pulmonary leukostasis (4%), Richter transformation or nonsmall cell lung carcinoma (3%), and upper airway obstruction (2%). Forty-four of 110 patients (40%) died. In multivariate analysis, admission absolute neutrophil counts , 0.5 × 109/L (odds ratio, 4.6; 95% confidence interval [95% CI], 1.3,16.6) and blood urea nitrogen (BUN) levels , 20 mg/dL (odds ratio, 3.0; 95% CI, 1.1,8.3) were correlated significantly with mortality. CONCLUSIONS Pneumonia was the major pulmonary complication in hospitalized patients with CLL. Severe neutropenia and high BUN levels were correlated significantly with increased mortality. Cancer 2003. © 2003 American Cancer Society. [source]

Bronchiolitis obliterans following hematopoietic stem cell transplantation: a clinical update

CLINICAL TRANSPLANTATION, Issue 3 2010
Chirag M. Pandya
Pandya CM, Soubani AO. Bronchiolitis obliterans following hematopoietic stem cell transplantation: a clinical update. Clin Transplant 2010: 24: 291,306. © 2009 John Wiley & Sons A/S. Abstract:, Hematopoietic stem cell transplantation (HSCT) is an established treatment for a variety of malignant and non-malignant conditions. Pulmonary complications, infectious and non-infectious, are a major cause of morbidity and mortality in these patients. The recent advances in prophylaxis and treatment of infectious complications increased the significance of late non-infectious pulmonary conditions. Currently, bronchiolitis obliterans is one of the most challenging pulmonary complications facing clinicians who are taking care of HSCT recipients. This report provides a clinical update of the incidence, risk factors, pathogenesis, clinical characteristics, and management of bronchiolitis obliterans following HSCT. [source]

Assessment of physical fitness for esophageal surgery, and targeting interventions to optimize outcomes

DISEASES OF THE ESOPHAGUS, Issue 7 2010
C. Feeney
SUMMARY This review examines how higher levels of physiological reserve and fitness can help the patient endure the demands of esophageal surgery. Lung function, body composition, cardiac function, inflammatory mediators and exercise performance are all determinants of fitness. Physical fitness, both as an independent risk factor and through its effect on other risk factors, has been found to be significantly associated with the risk of developing postoperative pulmonary complications (PPCs) in patients following esophagectomy. Respiratory dysfunction preoperatively poses the dominant risk of developing complications, and PPCs are the most common causes of morbidity and mortality. The incidence of PPCs is between 15 and 40% with an associated 4.5-fold increase in operative mortality leading to approximately 45% of all deaths post-esophagectomy. Cardiac complications are the other principal postoperative complications, and pulmonary and cardiac complications are reported to account for up to 70% of postoperative deaths after esophagectomy. Risk reduction in patients planned for surgery is key in attaining optimal outcomes. The goal of this review was to discuss the risk factors associated with the development of postoperative pulmonary complications and how these may be modified prior to surgery with a specific focus on the pulmonary complications associated with esophageal resection. There are few studies that have examined the effect of modifying physical fitness pre-esophageal surgery. The data to date would indicate a need to develop targeted interventions preoperatively to increase physical function with the aim of decreasing postoperative complications. [source]

Salvage esophagectomy after definitive chemoradiotherapy for synchronous double cancers of the esophagus and head-and-neck

DISEASES OF THE ESOPHAGUS, Issue 1 2010
R. Yoshida
SUMMARY Head-and-neck cancer is frequently associated with esophageal cancer. Because the operative procedures for these synchronous double cancers are too invasive, definitive chemoradiotherapy tends to be applied as an initial treatment. A salvage esophagectomy for either recurrent or residual disease after definitive chemoradiotherapy in patients with such double cancer has never been reported. We reviewed 21 patients with esophageal cancer who underwent a salvage esophagectomy after definitive chemoradiotherapy. Among them, the treatment course of five patients who underwent a salvage esophagectomy for patients with synchronous double cancers of the esophagus and head-and-neck region was analyzed. Because head-and-neck cancer was well controlled after chemoradiotherapy in all five patients, a salvage esophagectomy was indicated for either recurrent or residual esophageal cancer after definitive chemoradiotherapy. Anastomotic leakage developed in four patients; however, no other complications including pulmonary complications were recognized. All of them were discharged to home and three of them are still alive without any recurrence for 20,43 months. A salvage esophagectomy should be considered as a treatment option for either recurrent or residual esophageal cancer with well-controlled head-and-neck cancer after definitive chemoradiotherapy when complete resection of the esophagus is expected. [source]

ACQUIRED CARDIOVASCULAR DISEASE Original Articles: A Prospective Observational Study to Compare Conventional Coronary Artery Bypass Grafting Surgery with Off-Pump Coronary Artery Bypass Grafting on Basis of EuroSCORE

JOURNAL OF CARDIAC SURGERY, Issue 5 2010
Pawan Singhal M.Ch.
Off-pump coronary bypass (OPCAB) surgery has become a widely used technique during recent years. EuroSCORE risk scale is the most rigorously evaluated scoring system in cardiac surgery to preoperatively quantify the risk of death and other serious postoperative complications. The aim of this prospective observational study was to compare the mortality and morbidity between OPCAB and conventional CABG in three major preoperative groups as assessed by EuroSCORE. Material and Method: All consecutive patients undergoing isolated coronary artery bypass surgery between January 2003 and December 2004 at Wellington Hospital were included. In this period, 347 patients had conventional CABG and 254 patients had OPCAB. Data were prospectively collected according to Australasian Society of Cardiothoracic Surgeons' cardiac surgery data set. The preoperative additive EuroSCORE was computed in each patient and the patients were divided into three risk groups. Results of OPCAB and conventional CABG were compared on basis of EuroSCORE group. Results: OPCAB surgery is preferably performed in patients with low-risk. OPCAB group had lesser number of grafts per patient. When adjusted with risk score, there was no statistically significant difference in mortality in any of the three groups. No significant difference was found for stroke, renal dysfunction, atrial fibrillation, re-exploration for bleeding, deep sternal wound infection, or pulmonary complications in either of three groups. However, inotropic requirement and requirements of blood products were less in OPCAB group. Conclusion: OPCAB does not offer any significant advantage in terms of mortality and morbidity over conventional CABG.,(J Card Surg 2010;25:495-500) [source]

Comparison between intubation and the laryngeal mask airway in moderately obese adults

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2009
M. ZOREMBA
Background: Obesity is a well-established risk factor for perioperative pulmonary complications. Anaesthetic drugs and the effect of obesity on respiratory mechanics are responsible for these pathophysiological changes, but tracheal intubation with muscle relaxation may also contribute. This study evaluates the influence of airway management, i.e. intubation vs. laryngeal mask airway (LMA), on postoperative lung volumes and arterial oxygen saturation in the early postoperative period. Methods: We prospectively studied 134 moderately obese patients (BMI 30) undergoing minor peripheral surgery. They were randomly assigned to orotracheal intubation or LMA during general anaesthesia with mechanical ventilation. Premedication, general anaesthesia and respiratory settings were standardized. While breathing air, we measured arterial oxygen saturation by pulse oximetry. Inspiratory and expiratory lung function was measured preoperatively (baseline) and at 10 min, 0.5, 2 and 24 h after extubation, with the patient supine, in a 30° head-up position. The two groups were compared using repeated-measure analysis of variance (ANOVA) and t -test analysis. Statistical significance was considered to be P<0.05. Results: Postoperative pulmonary mechanical function was significantly reduced in both groups compared with preoperative values. However, within the first 24 h, lung function tests and oxygen saturation were significantly better in the LMA group (P<0.001; ANOVA). Conclusions: In moderately obese patients undergoing minor surgery, use of the LMA may be preferable to orotracheal intubation with respect to postoperative saturation and lung function. [source]

Living liver donor death related to complications of myeloma

LIVER TRANSPLANTATION, Issue 3 2009
Emmanuel Melloul
We report a donor death after right hepatectomy for living donor transplantation due to an undiagnosed myeloma. The 47-year-old donor, who was the 147th case performed in our department, was in excellent health without any abnormalities in the preoperative investigations. Despite an uneventful right hepatectomy without transfusion, the patient developed a partial thrombus of the inferior vena cava with a right proximal pulmonary trunk embolism on postoperative day 6. Subsequently, he developed multiorgan dysfunction leading to a coagulopathy, respiratory distress, and renal failure requiring hemodialysis and mechanical ventilation. This clinical scenario led us to suspect a hematological disorder. Immune electrophoresis showed a monoclonal peak of immunoglobulin G (8.7 g/L), a myelogram revealed an abnormally high level of dystrophic plasmocytes (more than 7%), and biopsies of salivary glands confirmed the diagnosis of immunoglobulin G kappa myeloma. The patient progressively deteriorated because of simultaneous hemorrhagic and infectious pulmonary complications resulting in septic shock. Despite an adequate combination of antimicrobial therapy and pleural drainage, the donor died on postoperative day 57 from multiple organ failure. This unusual cause of donor death after right hepatectomy reinforces the need for an extensive preoperative assessment. We advocate the addition of urinary protein loss and electrophoresis to the standard donor assessment protocol. Liver Transpl 15:326,329, 2009. © 2009 AASLD. [source]

Haemodynamics in leptospirosis: Effects of plasmapheresis and continuous venovenous haemofiltration

NEPHROLOGY, Issue 1 2005
TONGPRAKOB SIRIWANIJ
SUMMARY: Background: Haemodynamics in leptospirosis may differ from that of sepsis because of frequently obeserved myocarditis and severe cholestatic jaundice. A haemodynamic study was therefore made in 10 patients with severe leptospirosis. Methods and Results: All patients had pulmonary complications with a chest X-ray showing either pulmonary oedema or infiltration. Renal failure was present in nine patients. Three patterns of haemodynamics were revealed. The first pattern was observed in six patients who showed increased cardiac index, decreased systemic vascular resistance, normal pulmonary capillary wedge pressure, normal pulmonary vascular resistance and hypotension. The pattern resembled that of sepsis. The second pattern shown in two patients with haemoptysis consisted of a normal cardiac index, normal systemic vascular resistance, normal blood pressure, normal pulmonary capillary wedge pressure and increased pulmonary vascular resistance. The third pattern was observed in two patients with severe jaundice who had hypotension, a relatively low cardiac index, increased systemic vascular resistance and normal pulmonary capillary wedge pressure, and pulmonary vascular resistance. Plasmapheresis performed in two patients and continuous venovenous haemofiltration performed in two patients improved systemic haemodynamics and normalized blood pressure with a resolution of lung signs. [source]

The risks and benefits of long-term use of hydroxyurea in sickle cell anemia: A 17.5 year follow-up,,§¶,,,,,§§

AMERICAN JOURNAL OF HEMATOLOGY, Issue 6 2010
Martin H. Steinberg
A randomized, controlled clinical trial established the efficacy and safety of short-term use of hydroxyurea in adult sickle cell anemia. To examine the risks and benefits of long-term hydroxyurea usage, patients in this trial were followed for 17.5 years during which they could start or stop hydroxyurea. The purpose of this follow-up was to search for adverse outcomes and estimate mortality. For each outcome and for mortality, exact 95% confidence intervals were calculated, or tests were conducted at , = 0.05 level (P -value <0.05 for statistical significance). Although the death rate in the overall study cohort was high (43.1%; 4.4 per 100 person-years), mortality was reduced in individuals with long-term exposure to hydroxyurea. Survival curves demonstrated a significant reduction in deaths with long-term exposure. Twenty-four percent of deaths were due to pulmonary complications; 87.1% occurred in patients who never took hydroxyurea or took it for <5 years. Stroke, organ dysfunction, infection, and malignancy were similar in all groups. Our results, while no longer the product of a randomized study because of the ethical concerns of withholding an efficacious treatment, suggest that long-term use of hydroxyurea is safe and might decrease mortality. Am. J. Hematol. 2010. © 2010 Wiley-Liss, Inc. [source]

Bronchiolitis Obliterans: A Rare Chronic Pulmonary Complication Associated with Stevens-Johnson Syndrome

PEDIATRIC DERMATOLOGY, Issue 4 2007
Arzu Bakirtas M. D.
We report two boys with bronchiolitis obliterans following the acute phase of Stevens-Johnson syndrome and discuss the clinical picture and treatment of persistent pulmonary complications with reference to earlier reports. [source]

Use of intrapulmonary percussive ventilation (IPV) in the management of pulmonary complications of an infant with osteogenesis imperfecta

PEDIATRIC PULMONOLOGY, Issue 11 2009
Gustavo Nino MD
Abstract Osteogenesis imperfecta (OI) is a genetic disorder characterized by abnormal collagen formation and short stature. These patients present with frequent vertebral, rib, and long bone fractures. There are many respiratory complications associated with OI including pneumonia, the most common cause of mortality in the severe forms of the disease. We present a case of an infant with OI (type III/IV) and significant tracheobronchomalacia who had required multiple hospitalizations for recurrent atelectasis and respiratory failure in the setting of acute respiratory infections. External chest percussion and vibration were avoided because of the risk of rib fractures. intrapulmonary percussive ventilation (IPV) was initiated during an acute illness with good effect, and continued successfully after discharge from hospital. We conclude that IPV represents a safe and effective alternative to airway clearance in infants with OI. Pediatr Pulmonol. 2009; 44:1151,1154. ©2009 Wiley-Liss, Inc. [source]

Airway reactivity in children before and after stem cell transplantation

Rituximab (B-cell depleting antibody) associated lung injury (RALI): A pediatric case and systematic review of the literature

PEDIATRIC PULMONOLOGY, Issue 9 2009
Martin Bitzan MD
Abstract Introduction Pulmonary toxicity of delayed onset is a rare complication of B-lymphocyte depleting antibody therapy and has been almost exclusively reported in older patients with B-cell malignancies. Aims To describe a pediatric patient with rituximab-associated lung injury (RALI), to systematically analyze previous reports of pulmonary complications, and to summarize common clinico-pathological features, treatment, and outcome. Results A teenage boy with focal segmental glomerulosclerosis (FSGS) presented with progressive dyspnea, fever, hypoxemia and fatigue 18 days after the completion of a second course of rituximab infusions for calcineurin inhibitor-dependent nephrotic syndrome. Respiratory symptoms started while he received high-dose prednisone for persistent proteinuria. Bilateral, diffuse ground-glass infiltrates corresponded to the presence of inflammatory cells in the bronchioalveolar lavage fluid. Empiric antibiotic treatment including clarithromycin was given, but the microbiological work-up remained negative. Serum IgE, C3, and C4 concentrations were normal. He recovered within 3 weeks after onset. We systematically reviewed 23 reports describing 30 additional cases of rituximab-associated lung disease. Twenty eight patients had received rituximab for B-cell malignancies, one for graft-versus-host disease and one for immune thrombocytopenia. Median age was 64 years (interquartile range [IQR] 58,69 years). Seventy one percent received concomitant chemotherapy. Time to onset from the last rituximab dose was 14 days (IQR 11,22 days). Eleven of 31 patients required mechanical ventilation, and 9 died (29%). Ventilation was a significant predictor of fatal outcome (odds ratio 46.7; confidence interval 9.5,229.9). High dose glucocorticoid therapy did not improve survival or prevent severe lung disease or death. Conclusions With the expanding use of rituximab for novel indications, additional cases of RALI affecting younger age groups are expected to emerge. Mechanical ventilation predicts poor outcome. Glucocorticoids may not be protective. Pediatr Pulmonol. 2009; 44:922,934. © 2009 Wiley-Liss, Inc. [source]

Asthma management: Reinventing the wheel in sickle cell disease,

AMERICAN JOURNAL OF HEMATOLOGY, Issue 4 2009
Claudia R. Morris
Asthma is a common comorbidity in sickle cell disease (SCD) with a reported prevalence of 30,70%. The high frequency of asthma in this population cannot be attributed to genetic predisposition alone, and likely reflects in part, the contribution of overlapping mechanisms shared between these otherwise distinct disorders. There is accumulating evidence that dysregulated arginine metabolism and in particular, elevated arginase activity contributes to pulmonary complications in SCD. Derangements of arginine metabolism are also emerging as newly appreciated mechanism in both asthma and pulmonary hypertension independent of SCD. Patients with SCD may potentially be at risk for an asthma-like condition triggered or worsened by hemolysis-driven release of erythrocyte arginase and low nitric oxide bioavailability, in addition to classic familial asthma. Mechanisms that contributed to asthma are complex and multifactorial, influenced by genetic polymorphisms as well as environmental and infectious triggers. Given the association of asthma with inflammation, oxidative stress and hypoxemia, factors known to contribute to a vasculopathy in SCD, and the consequences of these factors on sickle erythrocytes, comorbid asthma would likely contribute to a vicious cycle of sickling and subsequent complications of SCD. Indeed a growing body of evidence documents what should come as no surprise: Asthma in SCD is associated with acute chest syndrome, stroke, pulmonary hypertension, and early mortality, and should therefore be aggressively managed based on established National Institutes of Health Guidelines for asthma management. Barriers to appropriate asthma management in SCD are discussed as well as strategies to overcome these obstacles in order to provide optimal care. Am. J. Hematol., 2009. © 2008 Wiley-Liss, Inc. [source]

The physiotherapy management of patients undergoing thoracic surgery: a survey of current practice in Australia and New Zealand

PHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 2 2007
Julie Reeve
Abstract Background and Purpose.,Physiotherapy is considered an essential component of the management of patients after thoracotomy, yet the type of interventions utilized, and evidence for their efficacy, has not been established. The aim of the present study was to ascertain the current physiotherapy management of patients undergoing thoracotomy and the factors influencing practice among different providers.,Method.,A purpose-designed postal questionnaire was distributed to senior physiotherapists in all thoracic surgical units throughout Australia and New Zealand (n = 57).,Results.,A response rate of 81% was obtained (n = 46). Pre-operatively, 16 respondents (35%) reported assessing all thoracotomy patients. The majority of respondents (n = 44; 96%) indicated that all patients were seen by physiotherapists after surgery, with 29 respondents (63%) performing prophylactic physiotherapy interventions to prevent post-operative pulmonary complications. Respondents reported that physiotherapy treatment was usually commenced on day one post-operatively (n = 37; 80%) with the most commonly used treatment interventions being deep breathing exercises, the active cycle of breathing techniques, cough, forced expiration techniques and sustained maximal inspirations. Most respondents reported that patients first sat out of bed (n = 41; 89%), commenced shoulder range of movement (n = 23; 50%) and walking (n = 32; 70%) on day one post-operatively. The majority of respondents reported that they offered no post-operative pulmonary rehabilitation (n = 25; 54%), outpatient follow-up (n = 43; 94%) or post-thoracotomy pain management (n = 40; 87%). Respondents indicated that personal experience, literature recommendations and established practice were the factors which most influenced physiotherapy practice.,Conclusion.,Most patients after thoracotomy receive physiotherapy assessment and/or treatment in the immediate post-operative period, but only one-third were routinely seen pre-operatively and relatively few were reviewed following discharge from hospital. Further studies are required to guide physiotherapists in determining the efficacy of their practices for patients undergoing thoracotomy. Copyright © 2007 John Wiley & Sons, Ltd. [source]

HIV-associated opportunistic pneumonias

RESPIROLOGY, Issue 4 2009
Laurence HUANG
ABSTRACT Among the HIV-associated pulmonary complications, opportunistic pneumonias are major causes of morbidity and mortality. The spectrum of HIV-associated opportunistic pneumonias is broad and includes bacterial, mycobacterial, fungal, viral and parasitic pneumonias. Bacterial pneumonia is the most frequent opportunistic pneumonia in the United States and Western Europe while tuberculosis is the dominant pathogen in sub-Saharan Africa. With the use of combination antiretroviral therapy and prophylaxis, the incidence of Pneumocystis pneumonia (PCP) has declined. Nevertheless, PCP continues to occur in persons who are unaware of their HIV infection, those who fail to access medical care, and those who fail to adhere to antiretroviral therapy or prophylaxis. Although pneumonias due to Cryptococcus neoformans, Histoplasma capsulatum, Coccidioides immitis, cytomegalovirus and Toxoplasma gondii are less frequent, their presence in the lung is often indicative of disseminated disease and is associated with significant mortality. [source]

Preoperative maximal exercise oxygen consumption test predicts postoperative pulmonary morbidity following major lung resection

RESPIROLOGY, Issue 4 2007
Ahmet Sami BAYRAM
Background and objective: Pulmonary resection carries a significant morbidity and mortality. The utility of maximal oxygen uptake test (VO2max) to predict cardiopulmonary complications following major pulmonary resection was evaluated. Methods: Following standard preoperative work-up and VO2max testing, 55 patients (49 male; mean age 59 years, range 20,74) underwent major pulmonary surgery: lobectomy (n = 31), bilobectomy (n = 6) and pneumonectomy (n = 18). An investigator blinded to the preoperative assessment prospectively collected data on postoperative cardiopulmonary complications. Patients were divided into two groups according to preoperative VO2max and also according to FEV1. The frequency of postoperative complications in the groups was compared. Results: Complications were observed in 19 (34.5%) patients, 11 of which were pulmonary (20%). There were two deaths (3.6%), both due to respiratory failure. Preoperative FEV1 failed to predict postoperative respiratory complications. Five of 36 patients with a preoperative FEV1 > 2 L suffered pulmonary complications, compared with six of 19 patients with FEV1 < 2 L. Cardiopulmonary complications were not observed in patients with VO2max > 15 mL/kg/min (n = 27); however, 11 patients with VO2max < 15 mL/kg/min (n = 28) suffered cardiopulmonary complications (P < 0.05). Conclusion: VO2max predicts postoperative pulmonary complications following major lung resection, and the risk of complications increases significantly when the preoperative VO2max is less than 15 mL/kg/min. [source]

Lobar torsion following thoraco-abdominal oesophagogastrectomy

ANAESTHESIA, Issue 10 2009
V. Felmine
Summary Following thoraco-abdominal oesophagogastrectomy for an adenocarcinoma of the lower oesophagus, an 81-year-old female with no pre-existing respiratory disease could not be weaned from mechanical ventilation. Right upper and middle lobe torsion were found at thoracotomy on the 14th postoperative day. Both lobes were resected. The patient was discharged from hospital after several postoperative complications. Pulmonary torsion is a rare, potentially life-threatening complication of thoraco-abdominal oesophagogastrectomy. Differentiation from the more common postoesophagectomy pulmonary complications can be difficult. Early post-thoracotomy lung opacification, in the absence of the expected degree of hypoxaemia, should trigger a suspicion of pulmonary torsion. [source]

RISK FACTORS FOR POSTOPERATIVE PULMONARY COMPLICATIONS IN UPPER ABDOMINAL SURGERY

Expectant management of early onset, severe pre-eclampsia: perinatal outcome

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 10 2000
D. R. Hall Consultant
Objective To evaluate the perinatal outcome of expectant management of early onset, severe pre-eclampsia. Design Prospective case series extending over a five-year period. Setting Tertiary referral centre. Population All women (n= 340) presenting with early onset, severe pre-eclampsia, where both mother and the fetus were otherwise stable. Methods Frequent clinical and biochemical monitoring of maternal status with careful blood pressure control. Fetal surveillance included six-hourly heart rate monitoring, weekly Doppler and ultrasound evaluation of the fetus every two weeks. All examinations were carried out in a high care obstetric ward. Main outcome measures Prolongation of gestation, perinatal mortality rate, neonatal survival and major complications. Results A mean of 11 days were gained by expectant management. The perinatal mortality rate was 24/1000 (, 1000 g/7 days) with a neonatal survival rate of 94%. Multivariate analysis showed only gestational age at delivery to be significantly associated with neonatal outcome. Chief contributors to neonatal mortality and morbidity were pulmonary complications and sepsis. Three pregnancies (0.8%) were terminated prior to viability and only two (0.5%) intrauterine deaths occurred, both due to placental abruption. Most women (81.5%) were delivered by caesarean section with fetal distress the most common reason for delivery. Neonatal intensive care was necessary in 40.7% of cases, with these babies staying a median of six days in intensive care. Conclusion Expectant management of early onset, severe pre-eclampsia and careful neonatal care led to high perinatal and neonatal survival rates. It also allowed the judicious use of neonatal intensive care facilities. Neonatal sepsis remains a cause for concern. [source]