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Postoperative Care in Thoracic Surgery : A Comprehensive Guide.

By: Contributor(s): Material type: TextTextPublisher: Cham : Springer International Publishing AG, 2017Copyright date: ©2017Edition: 1st edDescription: 1 online resource (302 pages)Content type:
  • text
Media type:
  • computer
Carrier type:
  • online resource
ISBN:
  • 9783319199085
Subject(s): Genre/Form: Additional physical formats: Print version:: Postoperative Care in Thoracic SurgeryDDC classification:
  • 617.5401
LOC classification:
  • RD78.3-87.3
Online resources:
Contents:
Intro -- Preface -- Contents -- Contributors -- 1: What Happens to the Lung During Mechanical Ventilation and One-Lung Ventilation? -- 1.1 Introduction -- 1.2 Airway Closure -- 1.3 Formation of Atelectasis -- 1.4 Prevention of Atelectasis -- 1.5 Individual Lung Ventilation -- 1.6 One-Lung Ventilation -- References -- 2: Where Should I Send My Patient After the Operation? -- 2.1 Introduction -- 2.2 Risk Stratification -- 2.2.1 Patient-Related Risk Factors -- 2.2.1.1 General Risk Scores -- 2.2.1.2 Cardiovascular Risk Scores -- 2.2.1.3 Pulmonary Risk Scores -- 2.2.1.4 Lung Function Tests -- 2.2.1.5 Age and Frailty -- 2.2.2 Procedure-Related Risk Factors (Table 2.5) -- 2.2.2.1 Lung Resections -- 2.2.2.2 Other Thoracic Surgical Interventions -- 2.2.2.3 Additional Surgical Risk Factors -- 2.2.2.4 Anesthetic Management -- 2.3 Postoperative Selection of Patients for ICU, HDU, or PACU Admission -- 2.3.1 Scores and Guidelines -- 2.3.2 Local Specificities -- References -- 3: Does It Matter How I Ventilate the Patient During the Operation? -- 3.1 Introduction -- 3.2 The Protective Ventilation Was Born with ARDS -- 3.3 Is There a Rationale to Use Lung-Protective Ventilation in Patients with Normal Lungs? -- 3.4 What About Patients Ventilated During General Anesthesia? -- 3.5 The Role of PEEP -- 3.6 The Role of Oxygen -- 3.7 Alveolar Recruitment Maneuver -- 3.8 Pressure- or Volume-Controlled Two-Lung Ventilation -- 3.9 The "Baby Lung" During OLV -- 3.10 One-Lung Ventilation with Lessons from Two-Lung Ventilation? -- References -- 4: Can Postoperative Pulmonary Complications Be Objectively Evaluated? -- 4.1 Introduction -- 4.2 Definitions of Postoperative Pulmonary Complications -- 4.3 Postoperative Pulmonary Complications After Thoracic Surgery -- 4.4 Risk of Developing Postoperative Pulmonary Complications.
4.4.1 Risk Factors Related to the Patient's Condition -- 4.4.1.1 Age -- 4.4.1.2 Functional Dependence -- 4.4.1.3 Classification of the American Society of Anesthesiologists (ASA) -- 4.4.1.4 Smoking -- 4.4.1.5 Respiratory Symptoms -- 4.4.1.6 Peripheral Oxygen Saturation and Pulmonary Function Tests (PFTs) -- 4.4.1.7 Respiratory Infection Prior to Surgery -- 4.4.1.8 Preoperative Hypoalbuminemia, Weight Loss, and Body Mass Index (BMI) -- 4.4.1.9 Preoperative Anemia -- 4.4.1.10 Chronic Obstructive and Other Pulmonary Diseases -- 4.4.1.11 Congestive Heart Failure (CHF) -- 4.4.1.12 Renal Disease -- 4.4.1.13 Liver Disease -- 4.4.1.14 Obstructive Sleep Apnea (OSA) -- 4.4.1.15 Current Alcohol Use -- 4.4.1.16 Diabetes Mellitus -- 4.4.2 Procedure-Related and Intraoperative Risk Factors -- 4.4.2.1 Thoracotomy Versus Median Sternotomy -- 4.4.2.2 Video-Assisted Thoracoscopic Versus Open Thoracic Surgery -- 4.4.2.3 Extent of Lung Resection -- 4.4.2.4 Duration of Surgery -- 4.4.2.5 Volatile Versus Intravenous Anesthetics -- 4.4.2.6 Muscle Paralysis -- 4.4.2.7 Restrictive Versus Liberal Fluid Strategy -- 4.4.2.8 Transfusion of Blood and Blood Products -- 4.4.2.9 Mechanical Ventilation -- 4.5 Predictive Models of Postoperative Pulmonary Complications in Thoracic Surgery -- 4.5.1 The Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) -- 4.5.2 The Cardiopulmonary Risk Index (CPRI) -- 4.5.3 The Expiratory Volume Age Diffusion (EVÁD) Capacity Score -- 4.5.4 The Postoperative Respiratory Failure (PRF) and the Postoperative Pneumonia Risk (PPR) Index -- 4.5.5 The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) Score -- 4.5.6 Preoperative and Intraoperative Predictors of Postoperative Acute Respiratory Distress Syndrome -- 4.5.7 Further Scoring Systems Developed from Single-Center Databases.
4.6 Summary -- References -- 5: Fluid Management During and After the Operation: Less Is More or More Is Less? -- 5.1 Introduction -- 5.2 Epidemiology and Impact of ALI/ARDS After Lung Resection Surgery -- 5.2.1 Fluid Administration as a Risk Factor -- 5.3 Pathophysiology -- 5.3.1 Revised Starling Equation and the Endothelial Glycocalyx -- 5.3.2 Pulmonary Endothelial Damage -- 5.3.3 Lymphatics and RV Dysfunction -- 5.4 Risks of Restrictive Approach: Tissue Hypoperfusion and AKI -- 5.5 Esophagectomy -- 5.6 Goal-Directed Approaches -- 5.6.1 Cardiac Index Estimation -- 5.6.2 Dynamic Variables: Stroke Volume Variation (SVV) and Pulse Pressure Variation (PVV) -- 5.6.3 Early Detection of Pulmonary Edema -- 5.7 Fluid Choice -- References -- 6: How to Organise the PACU? What to Treat in the PACU? -- 6.1 How to Organise the PACU? -- 6.1.1 PACU Location -- 6.1.2 Number of PACU Bed Slots -- 6.1.3 PACU Floor Plan -- 6.1.4 PACU Traffic -- 6.1.5 PACU Bed-Spaces -- 6.1.6 General Considerations of the PACU -- 6.1.6.1 Layout -- 6.1.6.2 Equipment and Drugs -- 6.1.6.3 PACU Lighting -- 6.1.6.4 PACU Environment -- 6.1.6.5 Electrical Power -- 6.1.6.6 Medical Gases -- 6.1.6.7 Central Equipment in the PACU -- 6.1.6.8 Essential Equipment for Each Bed-Space -- 6.1.6.9 Patient Monitoring -- 6.1.6.10 PACU Communications -- 6.1.7 Staff -- 6.1.8 PACU Discharge Criteria -- 6.2 What to Treat in PACU? -- 6.2.1 Early Postoperative Complications -- 6.2.1.1 Postoperative Nausea and Vomiting (PONV) -- 6.2.1.2 Postoperative Residual Curarisation (PORC) -- 6.2.1.3 Emergence Delirium and Postoperative Dysfunction -- 6.2.1.4 Anxiety in the PACU -- 6.2.1.5 Glycaemic Control -- 6.2.1.6 Pain in the PACU -- 6.2.1.7 Hypothermia in the PACU -- 6.2.1.8 Postoperative Care of the Chest Drains -- 6.2.1.9 Early Postoperative Hypoxemia and Oxygen Therapy.
6.2.1.10 Cardiovascular Complications -- 6.2.1.11 Fluid Therapy and Acute Kidney Injury -- References -- 7: Should I Blame the Surgeon: Surgical Complications and Surgical Treatment of the Complications -- 7.1 Introduction -- 7.2 Postoperative Hemorrhage and Residual Hemothorax -- 7.3 Cardiac Herniation and Tamponade -- 7.4 Lobar torsion and gangrene -- 7.5 Air Leak and Subcutaneous Emphysema -- 7.6 Chylothorax -- 7.7 Nerve Injury -- 7.8 Right-to-Left Shunt -- 7.9 Atelectasis -- 7.10 Postsurgical Empyema -- 7.11 Bronchopleural Fistula -- 7.12 Complications After Lung Transplantation -- 7.12.1 Vascular Anastomotic Complications -- 7.12.2 Airway Complications -- 7.12.3 Necrosis and Dehiscence -- References -- 8: Should Every "Myasthenic Thymectomy" Be Sent to ICU? -- 8.1 Introduction -- 8.2 General Information -- 8.3 Diagnosis -- 8.4 Clinical Course -- 8.4.1 Comorbidities and Drug Interactions -- 8.4.2 The Myasthenic and the Cholinergic Crises -- 8.4.3 Therapy -- 8.5 Preoperative Evaluation -- 8.6 Perioperative Anesthetic Management -- 8.6.1 Juvenile MG -- 8.7 Postoperative Follow-Up -- References -- 9: How About Esophagectomies? -- 9.1 Indications of Esophagectomy -- 9.2 Types of Esophagectomy -- 9.3 Preoperative Preparation for Esophagectomy -- 9.4 Anesthesia for Esophagectomy -- 9.5 Postoperative Care After Esophagectomy -- 9.5.1 Timing of Extubation and Supplemental Oxygen Therapy -- 9.5.2 Analgesia -- 9.5.3 Fluid Management -- 9.5.4 Nutrition Considerations -- 9.5.5 Blood Administration -- 9.5.6 Deep Vein Thrombosis Prophylaxis -- 9.5.7 Management of Drainage Tubes -- 9.5.8 Physiotherapy -- 9.6 Management of Complications After Esophagectomy -- 9.6.1 Anastomotic Leak -- 9.6.2 Anastomotic Stricture -- 9.6.3 Conduit Ischemia -- 9.6.4 Functional Conduit Disorders -- 9.6.4.1 Postgastrectomy Syndrome.
9.6.4.2 Reflux -- 9.7 Summary -- References -- 10: Do the New Hemodynamic Monitoring Devices Make Sense Compared to the "Classical" Ones? -- 10.1 Introduction -- 10.2 Basic Hemodynamic Monitoring -- 10.3 Cardiac Output Monitoring -- 10.3.1 Pulmonary Artery Catheter: The "Classical" One -- 10.3.2 Other Cardiac Output Monitoring Devices: The "New" Ones -- 10.3.2.1 Pulse Contour Analysis -- Calibrated Devices -- Uncalibrated Devices (with No External Calibration) -- 10.3.2.2 Pitfalls in the Interpretation of Cardiac Output -- 10.3.2.3 How to Select the Best System? -- 10.4 Echocardiography -- 10.4.1 Ventricular Function -- 10.4.2 Intravascular Volume Status -- 10.4.3 Valvular Function -- 10.4.4 Pulmonary Embolism, Pericardial Effusion, and Thoracic Trauma -- 10.5 Fluid Management and Functional Hemodynamic Monitoring -- 10.5.1 Static Indicators of Preload -- 10.5.2 Functional Hemodynamic Parameters -- 10.5.3 Limitations -- 10.6 Venous Oxygen Saturation -- 10.7 Blood Lactate Concentrations -- 10.8 Management Strategies Based on Perioperative Monitoring -- References -- 11: What Are the Specific Challenges in the Postoperative Mechanical Ventilation After Thoracic Surgery? -- 11.1 Introduction -- 11.2 Ventilatory Support After Thoracic Surgery -- 11.3 Practical Hints -- 11.4 Protective Lung Ventilation -- 11.5 Permissive Hypercapnia -- 11.6 Inspired Oxygen Fraction -- 11.7 Ventilation Mode -- 11.8 Patients Requiring Mechanical Ventilation, but Having a Leak -- 11.9 High-Frequency Jet Ventilation (HFJV) After Thoracic Surgery -- 11.10 Differential Lung Ventilation -- 11.11 Weaning -- 11.12 Tracheostomy -- 11.13 Management of Chest Tubes -- References -- 12: Pros and Cons of Non-invasive Ventilation After Thoracic Surgery -- 12.1 Introduction -- 12.2 Non-invasive Positive Pressure Ventilation.
12.2.1 NPPV in the Perioperative Period.
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Intro -- Preface -- Contents -- Contributors -- 1: What Happens to the Lung During Mechanical Ventilation and One-Lung Ventilation? -- 1.1 Introduction -- 1.2 Airway Closure -- 1.3 Formation of Atelectasis -- 1.4 Prevention of Atelectasis -- 1.5 Individual Lung Ventilation -- 1.6 One-Lung Ventilation -- References -- 2: Where Should I Send My Patient After the Operation? -- 2.1 Introduction -- 2.2 Risk Stratification -- 2.2.1 Patient-Related Risk Factors -- 2.2.1.1 General Risk Scores -- 2.2.1.2 Cardiovascular Risk Scores -- 2.2.1.3 Pulmonary Risk Scores -- 2.2.1.4 Lung Function Tests -- 2.2.1.5 Age and Frailty -- 2.2.2 Procedure-Related Risk Factors (Table 2.5) -- 2.2.2.1 Lung Resections -- 2.2.2.2 Other Thoracic Surgical Interventions -- 2.2.2.3 Additional Surgical Risk Factors -- 2.2.2.4 Anesthetic Management -- 2.3 Postoperative Selection of Patients for ICU, HDU, or PACU Admission -- 2.3.1 Scores and Guidelines -- 2.3.2 Local Specificities -- References -- 3: Does It Matter How I Ventilate the Patient During the Operation? -- 3.1 Introduction -- 3.2 The Protective Ventilation Was Born with ARDS -- 3.3 Is There a Rationale to Use Lung-Protective Ventilation in Patients with Normal Lungs? -- 3.4 What About Patients Ventilated During General Anesthesia? -- 3.5 The Role of PEEP -- 3.6 The Role of Oxygen -- 3.7 Alveolar Recruitment Maneuver -- 3.8 Pressure- or Volume-Controlled Two-Lung Ventilation -- 3.9 The "Baby Lung" During OLV -- 3.10 One-Lung Ventilation with Lessons from Two-Lung Ventilation? -- References -- 4: Can Postoperative Pulmonary Complications Be Objectively Evaluated? -- 4.1 Introduction -- 4.2 Definitions of Postoperative Pulmonary Complications -- 4.3 Postoperative Pulmonary Complications After Thoracic Surgery -- 4.4 Risk of Developing Postoperative Pulmonary Complications.

4.4.1 Risk Factors Related to the Patient's Condition -- 4.4.1.1 Age -- 4.4.1.2 Functional Dependence -- 4.4.1.3 Classification of the American Society of Anesthesiologists (ASA) -- 4.4.1.4 Smoking -- 4.4.1.5 Respiratory Symptoms -- 4.4.1.6 Peripheral Oxygen Saturation and Pulmonary Function Tests (PFTs) -- 4.4.1.7 Respiratory Infection Prior to Surgery -- 4.4.1.8 Preoperative Hypoalbuminemia, Weight Loss, and Body Mass Index (BMI) -- 4.4.1.9 Preoperative Anemia -- 4.4.1.10 Chronic Obstructive and Other Pulmonary Diseases -- 4.4.1.11 Congestive Heart Failure (CHF) -- 4.4.1.12 Renal Disease -- 4.4.1.13 Liver Disease -- 4.4.1.14 Obstructive Sleep Apnea (OSA) -- 4.4.1.15 Current Alcohol Use -- 4.4.1.16 Diabetes Mellitus -- 4.4.2 Procedure-Related and Intraoperative Risk Factors -- 4.4.2.1 Thoracotomy Versus Median Sternotomy -- 4.4.2.2 Video-Assisted Thoracoscopic Versus Open Thoracic Surgery -- 4.4.2.3 Extent of Lung Resection -- 4.4.2.4 Duration of Surgery -- 4.4.2.5 Volatile Versus Intravenous Anesthetics -- 4.4.2.6 Muscle Paralysis -- 4.4.2.7 Restrictive Versus Liberal Fluid Strategy -- 4.4.2.8 Transfusion of Blood and Blood Products -- 4.4.2.9 Mechanical Ventilation -- 4.5 Predictive Models of Postoperative Pulmonary Complications in Thoracic Surgery -- 4.5.1 The Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) -- 4.5.2 The Cardiopulmonary Risk Index (CPRI) -- 4.5.3 The Expiratory Volume Age Diffusion (EVÁD) Capacity Score -- 4.5.4 The Postoperative Respiratory Failure (PRF) and the Postoperative Pneumonia Risk (PPR) Index -- 4.5.5 The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) Score -- 4.5.6 Preoperative and Intraoperative Predictors of Postoperative Acute Respiratory Distress Syndrome -- 4.5.7 Further Scoring Systems Developed from Single-Center Databases.

4.6 Summary -- References -- 5: Fluid Management During and After the Operation: Less Is More or More Is Less? -- 5.1 Introduction -- 5.2 Epidemiology and Impact of ALI/ARDS After Lung Resection Surgery -- 5.2.1 Fluid Administration as a Risk Factor -- 5.3 Pathophysiology -- 5.3.1 Revised Starling Equation and the Endothelial Glycocalyx -- 5.3.2 Pulmonary Endothelial Damage -- 5.3.3 Lymphatics and RV Dysfunction -- 5.4 Risks of Restrictive Approach: Tissue Hypoperfusion and AKI -- 5.5 Esophagectomy -- 5.6 Goal-Directed Approaches -- 5.6.1 Cardiac Index Estimation -- 5.6.2 Dynamic Variables: Stroke Volume Variation (SVV) and Pulse Pressure Variation (PVV) -- 5.6.3 Early Detection of Pulmonary Edema -- 5.7 Fluid Choice -- References -- 6: How to Organise the PACU? What to Treat in the PACU? -- 6.1 How to Organise the PACU? -- 6.1.1 PACU Location -- 6.1.2 Number of PACU Bed Slots -- 6.1.3 PACU Floor Plan -- 6.1.4 PACU Traffic -- 6.1.5 PACU Bed-Spaces -- 6.1.6 General Considerations of the PACU -- 6.1.6.1 Layout -- 6.1.6.2 Equipment and Drugs -- 6.1.6.3 PACU Lighting -- 6.1.6.4 PACU Environment -- 6.1.6.5 Electrical Power -- 6.1.6.6 Medical Gases -- 6.1.6.7 Central Equipment in the PACU -- 6.1.6.8 Essential Equipment for Each Bed-Space -- 6.1.6.9 Patient Monitoring -- 6.1.6.10 PACU Communications -- 6.1.7 Staff -- 6.1.8 PACU Discharge Criteria -- 6.2 What to Treat in PACU? -- 6.2.1 Early Postoperative Complications -- 6.2.1.1 Postoperative Nausea and Vomiting (PONV) -- 6.2.1.2 Postoperative Residual Curarisation (PORC) -- 6.2.1.3 Emergence Delirium and Postoperative Dysfunction -- 6.2.1.4 Anxiety in the PACU -- 6.2.1.5 Glycaemic Control -- 6.2.1.6 Pain in the PACU -- 6.2.1.7 Hypothermia in the PACU -- 6.2.1.8 Postoperative Care of the Chest Drains -- 6.2.1.9 Early Postoperative Hypoxemia and Oxygen Therapy.

6.2.1.10 Cardiovascular Complications -- 6.2.1.11 Fluid Therapy and Acute Kidney Injury -- References -- 7: Should I Blame the Surgeon: Surgical Complications and Surgical Treatment of the Complications -- 7.1 Introduction -- 7.2 Postoperative Hemorrhage and Residual Hemothorax -- 7.3 Cardiac Herniation and Tamponade -- 7.4 Lobar torsion and gangrene -- 7.5 Air Leak and Subcutaneous Emphysema -- 7.6 Chylothorax -- 7.7 Nerve Injury -- 7.8 Right-to-Left Shunt -- 7.9 Atelectasis -- 7.10 Postsurgical Empyema -- 7.11 Bronchopleural Fistula -- 7.12 Complications After Lung Transplantation -- 7.12.1 Vascular Anastomotic Complications -- 7.12.2 Airway Complications -- 7.12.3 Necrosis and Dehiscence -- References -- 8: Should Every "Myasthenic Thymectomy" Be Sent to ICU? -- 8.1 Introduction -- 8.2 General Information -- 8.3 Diagnosis -- 8.4 Clinical Course -- 8.4.1 Comorbidities and Drug Interactions -- 8.4.2 The Myasthenic and the Cholinergic Crises -- 8.4.3 Therapy -- 8.5 Preoperative Evaluation -- 8.6 Perioperative Anesthetic Management -- 8.6.1 Juvenile MG -- 8.7 Postoperative Follow-Up -- References -- 9: How About Esophagectomies? -- 9.1 Indications of Esophagectomy -- 9.2 Types of Esophagectomy -- 9.3 Preoperative Preparation for Esophagectomy -- 9.4 Anesthesia for Esophagectomy -- 9.5 Postoperative Care After Esophagectomy -- 9.5.1 Timing of Extubation and Supplemental Oxygen Therapy -- 9.5.2 Analgesia -- 9.5.3 Fluid Management -- 9.5.4 Nutrition Considerations -- 9.5.5 Blood Administration -- 9.5.6 Deep Vein Thrombosis Prophylaxis -- 9.5.7 Management of Drainage Tubes -- 9.5.8 Physiotherapy -- 9.6 Management of Complications After Esophagectomy -- 9.6.1 Anastomotic Leak -- 9.6.2 Anastomotic Stricture -- 9.6.3 Conduit Ischemia -- 9.6.4 Functional Conduit Disorders -- 9.6.4.1 Postgastrectomy Syndrome.

9.6.4.2 Reflux -- 9.7 Summary -- References -- 10: Do the New Hemodynamic Monitoring Devices Make Sense Compared to the "Classical" Ones? -- 10.1 Introduction -- 10.2 Basic Hemodynamic Monitoring -- 10.3 Cardiac Output Monitoring -- 10.3.1 Pulmonary Artery Catheter: The "Classical" One -- 10.3.2 Other Cardiac Output Monitoring Devices: The "New" Ones -- 10.3.2.1 Pulse Contour Analysis -- Calibrated Devices -- Uncalibrated Devices (with No External Calibration) -- 10.3.2.2 Pitfalls in the Interpretation of Cardiac Output -- 10.3.2.3 How to Select the Best System? -- 10.4 Echocardiography -- 10.4.1 Ventricular Function -- 10.4.2 Intravascular Volume Status -- 10.4.3 Valvular Function -- 10.4.4 Pulmonary Embolism, Pericardial Effusion, and Thoracic Trauma -- 10.5 Fluid Management and Functional Hemodynamic Monitoring -- 10.5.1 Static Indicators of Preload -- 10.5.2 Functional Hemodynamic Parameters -- 10.5.3 Limitations -- 10.6 Venous Oxygen Saturation -- 10.7 Blood Lactate Concentrations -- 10.8 Management Strategies Based on Perioperative Monitoring -- References -- 11: What Are the Specific Challenges in the Postoperative Mechanical Ventilation After Thoracic Surgery? -- 11.1 Introduction -- 11.2 Ventilatory Support After Thoracic Surgery -- 11.3 Practical Hints -- 11.4 Protective Lung Ventilation -- 11.5 Permissive Hypercapnia -- 11.6 Inspired Oxygen Fraction -- 11.7 Ventilation Mode -- 11.8 Patients Requiring Mechanical Ventilation, but Having a Leak -- 11.9 High-Frequency Jet Ventilation (HFJV) After Thoracic Surgery -- 11.10 Differential Lung Ventilation -- 11.11 Weaning -- 11.12 Tracheostomy -- 11.13 Management of Chest Tubes -- References -- 12: Pros and Cons of Non-invasive Ventilation After Thoracic Surgery -- 12.1 Introduction -- 12.2 Non-invasive Positive Pressure Ventilation.

12.2.1 NPPV in the Perioperative Period.

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