Prevention of Postoperative Pulmonary Complications

Incidência e fatores de complicações pulmonares pós-operatórias em pacientes submetidos à cirurgias de tórax e abdome

“…The presence of COPD is a commonly identified risk factor for PCP, being one of the most cited, with a risk greater than 18%, and varying with disease severity 5 . This factor was significantly associated with PPC in this study.…”

“…On the other hand, obese patients present physiological changes such as decreased ventilation-perfusion ratio due to under-ventilation and to high tissue perfusion. They also present a decrease in pulmonary complacency and chest movement secondary to the accumulation of adipose tissue in the thoracic wall 5 and abdominal cavity, hampering the diaphragmatic mobility 10 . In addition, obese patients are more difficult to mobilize during the postoperative period, which implies greater risk of deep venous thrombosis and, consequently, pulmonary thromboembolism 5 .…”

“…We cannot state that video surgeries act as protective factors because it was not possible to measure the risks involved in the different procedures performed by video or open. However, it is known that patients submitted to video-surgeries present smaller incisions, less systemic inflammatory responses, reduced postoperative pain and better pulmonary function, which emphasizes the option for this type of surgical access 5 . The degree of contamination was also associated with a higher occurrence of PPC in this study, and patients submitted to infected surgeries had a ninefold greater risk of developing such complications.…”

“…Smokers also present physiological changes that may alter the responses to surgical procedures, contributing to the increase in postoperative morbidity due to the high risk of developing respiratory, cardiovascular and healing complications 15 . One of the main alterations implicated in smoking is damage to the cilia of the tracheobronchial mucosa and increased mucus production with high consistency, in addition to an increased susceptibility to alveolar collapse, leading to a higher chance of infection in the lower airways and prolonged mechanical ventilation 5 . We conclude that postoperative pulmonary complications were frequent in our study and are associated with higher morbidity and mortality.…”

“…Risk factors for PPC are congestive heart failure, surgical risk classification by the American Society of Anesthesiologists (ASA) II or greater, functional dependence and advanced age, reduction of peripheral oxygen saturation, respiratory infection in the month preceding the surgical procedure, anemia (hemoglobin= 10g/dL), surgical incision near the diaphragm, surgery long duration and emergency surgery 5 .…”