Concept of prevention of complications zislin
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THE CONCEPT OF PREVENTION OF POSTOPERATIVE RESPIRATORY
COMPLICATIONS IN LUNG SURGERY
M. Kontorovich, B. Zislin
Yekaterinburg Russian Federation
Ural Reaserch Institute for Phtiziopulmonology
translated by Alexander Postoev
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Postoperative pulmonary complications (PPC) account for about 50% of the total number of non-surgical complications.
After lobectomy the frequency of respiratory complications is 7.2%-36.5% , after combined pneumonectomy is 70%.
Magnusson l., Spahn D.R. New concepts of atelectasis during general anaesthesia // British J. of Anaesthesia , 2003. Vol. 91 (1). P. 61–72.
Saratov Journal of Medical Scientific Research // 2010. Vol. 6, № 3
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Postoperative pulmonary complications (PPC) are the most frequently observed complications following lung resection, of which pneumonia and atelectasis are the most common. PPCs have a significant clinical and economic impact associated with increased observed number of deaths, morbidity, length of stay and associated cost.
Thirty-four of 234 subjects (14.5%) had clinical evidence of PPC.
P. Agostini, H. Cieslik, S. Rathinam et al. Postoperative pulmonary complications following thoracic surgery…/Thorax 2010;65:815-818
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Postoperative pulmonary complications are reported in the range of 2% – 39%, and include atelectasis, pneumonia and respiratory failure.
Ruben D. Restrepo, Richard Wettstein, Leo Wittnebel, Michael TracyAARC Clinical Practice Guideline: Incentive Spirometry // 2011
Pulmonary complications have been reported in 20% to 70% of patients undergoing thoracic operations compared with a 4% incidence of pulmonary complications after urologic or orthopedic surgery.
Ramona L. Doyle. Assessing and Modifying the Risk of Postoperative Pulmonary Complications // Chest 1999-115; S.77-81
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Atelectasis makes up 90 percent of PPC.
Colleen M. Kigin. Chest Physical Therapy for the Postoperative or Traumatic Injury Patient / PHYSICAL THERAPY , 1981 Vol. 61, № 12
Emergence of bilateral mikroatelektasis the early postoperative period after cardiac and pulmonary operation in the 30% - 70% noted.
A.N.Kuzovlev, A.V.Vlasenko, A.I.Yaroshetsky et al., A.A.Romanov et al., Yu.A.Zorin et al. - Reports of the All-Russian Congress dedicated to the
100th anniversary of acad. V.A.Negovsky, Moscow, March 2009
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HFJVCMV
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HFJV EFFECTS
RESPIRATORY PHYSIOLOGY Rodney A. Rhoades, Ph.D., George A. Tanner, Ph.D., 2006
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Copyright 2005, Elsevier Inc. with changes
PHFJV
CMV
Atelectasis zone
Hyperinflation zone
V
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P
T
HFJV
CMVHyperinflation zone
Atelectasis zone
Copyright 2005, Elsevier Inc. with changes
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ZISLINE JV-100
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ZISLINE JV-110
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CMV HFJV Р*
Patients (total) 313 310Postoperative atelectasis 62 (19,8%) 18 (5,8%) =0,000
sexm 48 (77%) 10 (55%)f 14 (23% 8 (45%)total 62 (100%) 18 (100%)
Age (M±SD) 41,3±13,1 47,3±14,0
Diagnosis
tuberculosis 44 (70,1%) 6 (33,3%) =0,008cancer 12 (19%) 8 (44,4%)_ =0,059прочие 6 (10,9%) 4 (22,2%)total 62 (100%) 18 (100%)
Operation
pneumonectomy 2 (0,1%) =0,042lobectomy 10 (16%) 5 (27,8%)segmentectomy 41 (66,1%) 7 (38,9)thoracotomy 11 (17,9%) 4 (33,2%) =0,026
*criterion Z
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0
20
40
60
80 62
18
CMV (n=313)HFJV(n=310)
THE INCIDENCE OF ATELECTASIS
19,8%5,8%
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INCENTIVE SPIROMETRY,EXPIRATORY TRAINING
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NON-INVASIVE HFJV (СРАРHF)
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THE CONCEPT OF PREVENTION OF POSTOPERATIVE RESPIRATORY COMPLICATIONS
AFTER LUNG SURGERY INCLUDES:
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HFJV CMV
Thank
you
translated by Alexander Postoev
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