14 - Post-Op Respiratory Care

identifying at-risk patients

• prevent complications

  • postpone surgery if needed

  • stop smoking 8 weeks before surgery

  • optimize pulmonary function

• history

• patient education

risk factors for post-op complications

• age

• smoking

• lung disease

• cardiac disease

• obesity

• OSA

• anesthesia (ASA)

• nutrition

• patient education

pre-op assessment

• H&P

• lab tests

  • EKG

  • CXR

  • ABG

  • PFT

intra-op risks

• surgical site

• surgical duration

• type of ASA

• monitoring during ASA

• fluid management

• ventilator settings

post-op management

• hypoxemia

• hypercapnia

• nutrition

• pain management

• patient temperature

• muscle strength

• lung expansion

post-op atelectasis

• demographics

• 90% of anesthetized patients

• 20-25% at lung bases

• 15-20% at LLL (abdominal surgery)

post-op atelectasis

• risks

• small V_T

• inadequate distention

• obstruction with gas absorption

• decreased surfactant

• interference with generating pleural pressure

• retained secretions

• intra-op aspiration

post-op atelectasis

• manifestations

• late inspiratory crackles

• diminished breath sounds

• bronchial breath sounds

• increased HR and RR

• dyspnea

• hypoxemia

post-op atelectasis

• diagnosis

• CXR

• PFT

• ABG

post-op atelectasis

• management

• prevention!!!

• bronchoscopy

• lung expansion (incentive spirometry)

• mechanical ventilation (rare)

other post-op complications

• PE/DVT

• pneumonia

  • 18% develop HAP/VAP