The Trajectory of Postoperative Pulmonary Dysfunction in Adults After Cardiac Surgery

CHEST Journal ◽  
2011 ◽  
Vol 140 (4) ◽  
pp. 507A
Author(s):  
Rochelle Wynne ◽  
Mari Botti ◽  
James Tatoulis
Keyword(s):  
Cardiac Surgery ◽  
Pulmonary Dysfunction ◽  
Postoperative Pulmonary Dysfunction

scholarly journals Postoperative Pulmonary Dysfunction and Mechanical Ventilation in Cardiac Surgery

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Rafael Badenes ◽  
Angels Lozano ◽  
F. Javier Belda
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Inflammatory Response ◽  
Pulmonary Inflammation ◽  
Protective Ventilation ◽  
Pulmonary Dysfunction ◽  
Gas Exchange Parameters ◽  
Ventilatory Strategy ◽  
Protective Ventilation Strategy ◽  
Postoperative Pulmonary Dysfunction

Postoperative pulmonary dysfunction (PPD) is a frequent and significant complication after cardiac surgery. It contributes to morbidity and mortality and increases hospitalization stay and its associated costs. Its pathogenesis is not clear but it seems to be related to the development of a systemic inflammatory response with a subsequent pulmonary inflammation. Many factors have been described to contribute to this inflammatory response, including surgical procedure with sternotomy incision, effects of general anesthesia, topical cooling, and extracorporeal circulation (ECC) and mechanical ventilation (VM). Protective ventilation strategies can reduce the incidence of atelectasis (which still remains one of the principal causes of PDD) and pulmonary infections in surgical patients. In this way, the open lung approach (OLA), a protective ventilation strategy, has demonstrated attenuating the inflammatory response and improving gas exchange parameters and postoperative pulmonary functions with a better residual functional capacity (FRC) when compared with a conventional ventilatory strategy. Additionally, maintaining low frequency ventilation during ECC was shown to decrease the incidence of PDD after cardiac surgery, preserving lung function.

Pulmonary Protection During Cardiac Surgery: Systematic Literature Review

2008 ◽  
Vol 16 (6) ◽  
pp. 503-507 ◽  
Author(s):  
Enisa MF Carvalho ◽  
Edmo A Gabriel ◽  
Tomas A Salerno
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Literature Review ◽  
Heart Surgery ◽  
Ischemia Reperfusion Injury ◽  
Current Knowledge ◽  
Ischemia Reperfusion ◽  
Pulmonary Dysfunction ◽  
Pulmonary Protection ◽  
Postoperative Pulmonary Dysfunction

Ischemia-reperfusion injury occurs during heart surgery in which cardiopulmonary bypass is used. Current knowledge of the factors contributing to postoperative pulmonary dysfunction and the measures to avoid it are reviewed.

Postoperative Pulmonary Dysfunction in Adults After Cardiac Surgery With Cardiopulmonary Bypass: Clinical Significance and Implications for Practice

2004 ◽  
Vol 13 (5) ◽  
pp. 384-393 ◽  
Author(s):  
Rochelle Wynne ◽  
Mari Botti
Keyword(s):  
Cardiac Surgery ◽  
Pulmonary Complications ◽  
Surgical Patients ◽  
Future Research ◽  
Pulmonary Dysfunction ◽  
Postoperative Pulmonary Complications ◽  
Management Interventions ◽  
Clinical Nursing ◽  
Postoperative Pulmonary Dysfunction ◽  
The Continuum

Postoperative pulmonary complications are the most frequent and significant contributor to morbidity, mortality, and costs associated with hospitalization. Interestingly, despite the prevalence of these complications in cardiac surgical patients, recognition, diagnosis, and management of this problem vary widely. In addition, little information is available on the continuum between routine postoperative pulmonary dysfunction and postoperative pulmonary complications. The course of events from pulmonary dysfunction associated with surgery to discharge from the hospital in cardiac patients is largely unexplored. In the absence of evidence-based practice guidelines for the care of cardiac surgical patients with postoperative pulmonary dysfunction, an understanding of the pathophysiological basis of the development of postoperative pulmonary complications is fundamental to enable clinicians to assess the value of current management interventions. Previous research on postoperative pulmonary dysfunction in adults undergoing cardiac surgery is reviewed, with an emphasis on the pathogenesis of this problem, implications for clinical nursing practice, and possibilities for future research.

Abstract 17199: Airway Mucociliary Clearance is Impaired After Infant Congenital Cardiac Surgery

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Phillip S Adams ◽  
Timothy Corcoran ◽  
Michael Czachowski ◽  
Al Saville ◽  
Ivy Lin ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Period ◽  
Mucociliary Clearance ◽  
Sulfur Colloid ◽  
Congenital Cardiac Surgery ◽  
Icu Length Of Stay ◽  
Quantitative Measurements ◽  
First Time ◽  
Ciliary Dyskinesia ◽  
Postoperative Pulmonary Dysfunction

Introduction: A link between congenital heart disease and airway ciliary dyskinesia has been identified. Postoperative pulmonary dysfunction is highly prevalent after cardiac surgery and contributes to morbidity, mortality, and healthcare costs. We hypothesized that respiratory mucociliary clearance (MCC) would be impaired in the immediate postoperative period after infant congenital cardiac surgery. Methods: 41 infants from 5-254 days old underwent MCC scans using nebulized technetium-99m sulfur colloid either immediate postoperative or later postoperative periods after congenital cardiac surgery. Physiologic variables and medications at the time of scan were recorded. Results: There was no significant correlation between MCC and age, gender, race or any of the of the physiologic variables, such as temperature, SpO2, or FiO2, at the time of the MCC scan. MCC was lowest on the first 2 postoperative days, increased at days 3-7, and highest beyond postoperative day 7 (Fig1). Fentanyl (p=0.023) and paralytics agents (p=0.018) were significantly associated with lower MCC, while benzodiazepines (p=0.447) and dexmedetomidine (p=0.675) showed no measurable impact (Table 1). Conclusion: We show for the first time, with quantitative measurements, the near absence of infant MCC in the immediate postoperative period after congenital cardiac surgery. This may be exacerbated by opioid exposure, which should be minimized. Our results further suggest sedative alternatives such as benzodiazepines and dexmedetomidine are preferable to help optimize infant airway clearance. This may reduce ICU length of stay and improve outcomes after cardiac surgery.

Nurse-Led Preoperative Screening and Targeted Optimization of Pulmonary Dysfunction in Patients Undergoing Cardiac Surgery

2007 ◽  
Vol 84 (2) ◽  
pp. 683-685 ◽  
Author(s):  
Sivakumar Sivalingam ◽  
Sridhar Rathinam ◽  
Adam Ajis ◽  
Christopher M.R. Satur
Keyword(s):  
Cardiac Surgery ◽  
Pulmonary Dysfunction ◽  
Preoperative Screening

scholarly journals Pulmonary Protection Strategies in Cardiac Surgery: Are We Making Any Progress?

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Emad Al Jaaly ◽  
Mustafa Zakkar ◽  
Francesca Fiorentino ◽  
Gianni D. Angelini
Keyword(s):  
Cardiac Surgery ◽  
Pulmonary Dysfunction ◽  
Common Complication ◽  
Level Of Evidence ◽  
The Poor ◽  
Wide Acceptance ◽  
Protection Strategies ◽  
Multistep Process ◽  
Pulmonary Protection ◽  
And Oxidative Stress

Pulmonary dysfunction is a common complication of cardiac surgery. The mechanisms involved in the development of pulmonary dysfunction are multifactorial and can be related to the activation of inflammatory and oxidative stress pathways. Clinical manifestation varies from mild atelectasis to severe respiratory failure. Managing pulmonary dysfunction postcardiac surgery is a multistep process that starts before surgery and continues during both the operative and postoperative phases. Different pulmonary protection strategies have evolved over the years; however, the wide acceptance and clinical application of such techniques remain hindered by the poor level of evidence or the sample size of the studies. A better understanding of available modalities and/or combinations can result in the development of customised strategies for the different cohorts of patients with the potential to hence maximise patients and institutes benefits.

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