Pre-operative patient optimization to prevent postoperative pulmonary complications—Insights and roles for the respiratory therapist: A narrative review

Abstract

Background: The preoperative period has gained recognition as a crucial time to identify and manage preoperative medical conditions for preventing perioperative complications. Consequently, preoperative clinics have now become an essential component of perioperative care at many large hospitals. As the prevalence of preoperative clinics continues to grow, and the field of perioperative medicine progresses, respiratory therapists (RTs) will inevitably find a growing role to participate in preoperative patient optimization to mitigate pulmonary complications. Methods: Keyword searches on perioperative pulmonary complications were conducted on the Medline database via PubMed and identified over 2000 candidate articles for review. Articles were included if they were English only and resulted with one or more of the following search terms; pulmonary complications, postoperative complications, postoperative pulmonary complications (PPCs), prehabilitation, incentive spirometry, smoking cessation, noninvasive ventilation. Preference was given for meta-analyses, randomized controlled trials, and systematic reviews. Publications within the past two decades were given additional preference toward final inclusion. The authors discussed eligible articles in group meetings over the span of multiple years to assess relevance and quality of data for narrowing eligible articles to the final selection of publications for the review. Findings: The following narrative review examines preoperative optimization strategies to prevent PPCs and highlight areas where RTs may play a key role. After examining challenges in defining PPCs, the review examines key risk models available to predict PPCs and their implications for subsequent discussion on preventive measures that RTs may assist with in a multidisciplinary team. Conclusion: RTs can reduce the health care burden of PPCs by assisting fellow perioperative clinicians in providing respiratory care for patients with premorbid conditions. While much of our review focused on pre-existing pulmonary pathologies and both the pharmacological and nonpharmacological optimization of these pathologies, there are other factors contributing to PPCs deserving future exploration.

Risk factors for postoperative pulmonary complications in elderly patients undergoing video-assisted thoracoscopic surgery lobectomy under general anesthesia: a retrospective study

“…For thoracic surgery, PPCs are the most common complications that pose a threat to patients’ perioperative safety and affect their prognosis. Previous study has identified advanced age as a significant risk factor for the development of PPCs [ 18 , 19 ]. Specifically, elderly patients who undergo more invasive surgical procedures like lobectomy are at a heightened risk of experiencing PPCs.…”

Penggunaan Video Interaktif sebagai Upaya Optimalisasi Edukasi Persiapan Operasi oleh Perawat Setting Rawat Jalan

“…Namun dalam implementasinya ditemukan peningkatan data penjadwalan ulang atau pembatalan tindakan operasi akibat beberapa hal diantaranya kondisi pasien tidak layak operasi akibat persiapan operasi yang tidak optimal sebanyak 5.6% dalam 3 bulan terakhir. Waktu pelayanan yang cepat dan tepat serta load pasien yang tinggi menyebabkan pemberian edukasi persiapan operasi di rawat jalan menjadi tantangan bagi perawat (Schwartz et al, 2020). Berdasarkan hal tersebut, dibutuhkan penelitian yang memberikan gambaran perihal implementasi edukasi preoperatif di rumah sakit serta upaya solusi alternatif yang dapat memberikan dampak positif pada kepuasan pasien.…”

Programa De Reabilitação Respiratória Na Pessoa Submetida a Cirurgia

“…De entre as complicações pós-operatórias mais frequentes, as complicações do foro pulmonar assumem uma prevalência entre 1% a 23% (Miskovic & Lumb, 2017;Odor et al, 2020). Caracterizam-se como disfunções não intencionais na função pulmonar no período pós-operatório, que influenciam a recuperação da pessoa submetida a cirurgia e são mais comuns em cirurgias aos segmentos torácico e abdominal (Liu et al, 2020;Lohiya et al, 2018;Lumb, 2019;Schwartz et al, 2020). Mais frequentemente manifestam-se por hipoxemia, atelectasia, pneumonia, broncospasmo, derrame pleural, embolia pulmonar, edema pulmonar, pneumotórax, falência respiratória e infeções (Ávila & Fenili, 2017;Kendall et al, 2018;Schwartz et al, 2020).…”