1912

Göğüs cerrahisi ameliyatları sonrası solunum yetmezliği ve yapay solunum desteği

Göğüs Cerrahisi ameliyatları sonrası en önemli komplikasyon, solunum yetmezliğidir. Ağır formlarında. ARDS tablosu ile kendini gösteren bu sorunun ameliyat öncesinde ön görülebilmesi, gerekli tedbirlerin önceden alınmasını sağlaması bakımından önemlidir; böylece sorun ortaya çıkmadan önlenmesi, daha sonra tedavi edilmesinden dalıa etkin ve daha kolay olabilir. Ameliyat sırasında ve sonrasında, akciğer koruyucu yöntemler, genel prensip olarak kabul edilmelidir. Postoperatif dönemde, noninvazif yapay solunum, özellikle hu hasta grubunda tercih edilmesi gereken bir yöntemdir. Bu derlemede, göğüs cerrahisi sonrası ortaya çıkan solunum yetmezliği tabloları, bunlar ile ilgili risk faktörleri, önleme yöntemleri ve uygulanan özgün yapay solunum yaklaşımları incelenmiştir.

Respiratory failure and support for artificial respiration after thoracic surgery

Respiratory failure is the most important complication after thoracic surgery. In its severe forms, the clinical presentation can have ARDS symptoms. The prediction of this complication can be helpful to prevent this complication, whereby the prevention is more effective and simple than its therapy. Lung protective strategies should be considered as the main principle during the intra- and postoperative periods. Non-invasive mechanical ventilation shold be the method of choice, spesifically in this group of patients. In this review, we aimed to explain the clinical presentations of the respiratory failure following thoracic surgery, the risk factors, preventive methods and the specific approaches of mechanical ventilation.

PDF

___

1. Martin J. Ginsberg RJ. Abolhoda A, et al. Morbidity and mortality after neoadjuvan therapy for lung cancer: the risks of right pneumonectomy. AnnThorac Surg 2001:72(4): 1149-54.
2. Wright CD. Wain JC. Malheson DJ. et al. Postpneumonectomy bronchoplevral fistula after sutured bronchial closure: incidence, risk factors, and management. J Thorac Cardiovasc Surg 1996: 112(5): 1367-71.
3. Fry DE, Pine M. Jones BL, Meimban RJ. Adverse outcomes in surgery: redefinition of postoperative complications. Am J Surg 2009:197(4):479-84.
4. Licker M, Spiliopoulos A. Frey JG. el al. Management and outcome of patients undergoing thoracic surgery in a regional chest medical centre. Eur J Anaesthesiol 2001;18(8):540-7.
5. Slinger P. Update on anesthetic management for pneumonectomy. Curr Opin Anaesthesiol 2009:22( 1 ):31-7.
6. Slinger P, Johnston M. Preoperative assessment for lung cancer surgery. Progress in thoracic anesthesia (Chapter I) pp. 1-27. Society of Cardiovascular Anesthesiologists Monograpgh, 2004 Lippincott Williams and Wilkins. Baltimore.
7. Zwissler B, Reiüıer A. Preoperative abstinence from smoking. An outdated dogma in dogma in anaesthesia? Anaesthesist 2005; 54(691:550-9.
X. Licker M. de Perrot M. Spiliopoulos A. et al. Risk factors for acute lung injury after thoracic surgery for lung cancer. Aııesth Analg 2003:97(6): 1558-65.
9. Griclınik KP. D'Amico TA. Acute lung injury and acute respiratory distress syndrome after pulmonary resection. Semin Cardiothorac Vase Anesth 2004;8(4):317-34.
10. Misthos P. Katsaragakis S, Theodorou D, et al. The degree of oxidative stress is associated with major adverse effects after lung resection: a prospective study. Eur J Cardiothorac Surg 2006: 29(4):59l-5.
11. Şentürk M. Major Key Topics concerning one-lung ventilation. Clinical and therapeutic implications. İn: Yearbook Respiratory Care Clinics and Applied Technologies. Ed. A. Esquinas ISBN: 978-84-612-5901-4: 2008. Pp. 221-8.
12. Van der Houwen HK. Heijmans PJ. et al. Postpneumonectomy pulmonary edema. A retrospective analysis of incidence and possible risk factors. Chest 1997:111 (5): 1278-84.
13. Şentürk M. New concepts of the management of one-lung ventilation. Curr Opin Anaesthesiol 2006; 19( I): 1 -4.
14. Slinger PD. Perioperative fluid management for thoracic surgery: the puzzle of postpneumonectomy pulmonary edema. J Cardiothorac Vase Anesth I995;9(4):442-51.
15. Sünger P, Shennib H. Wilson S. Postthoracotomy pulmonary function: a comparison of epidural versus intravenous meperidine infusions. J Cardiothorac Vase Anesth 1995;9(2):I28-34
16. Zeldin RA. Normandin D. Landtwing D. Peters RM. Postpncumonectomy pulmonary edema. J Thorae Cardiovasc Surg l984;87(3):359-65.
17. Slinger P. Fluid management during pulmonary resection. Ann Card Anaesth 2002:5(2):220-4.
18. Duggan M. McCaul C'L.. McNamarâ PJ. et al. Atelectasis causes vascular leak and lethal right ventricular failure in uninjured ral lungs. Am J Respir Crit Care Med 2003; I67( 12): 1633-40.
19. Van Kaam AH. Laclunann RA, I lening H, et al. Reducing atelectasis attenuates bacterial growth and translocation in experimental pneumonia. Am J Respir Crit Care Med 2(X>4: 169(9): 1046-53.
20. Femândez-Perez ER, Keegan MT. Brown DR. et al. Intraoperative tidal volume as a risk factor for respiratory failure after pneumonectomy. Anesthesiology 2006; 105( 1 ):14-8.
21. Lases EC. Duurkens VA. Gerritsen VVB, Haas FJ. Oxidative stress after lung resection therapy: A pilot study. Chest 2000; 117(4): 999-1003.
22. Tenling A, Hachenberg T. Tydıfn H. et al. Atelectasis and gas exchange after cardiac surgery. Anesthesiology 1998;89(2):37l-8.
23. Demhinski R. Henzler D. Bensberg R. et al. Ventilalion-perfusion distribution related to different inspiratory flow patterns in experimental lung injury. Anesth Analg 2004:98( l):2lI-9.
24. Sentürk NM. Dilek A. Camci E. et al. Effects of positive end-expiratory pressure on ventilatory and oxygenation parameters during pressure-controlled one-lung ventilation. J Cardiothorac Vase Anesth. 2005; 19(1 ):71-5. 25. Gama de Abreu M, Heintz. M, Heller A, et al. One-lung ventilation with high tidal volumes and zero positive end-expiratory pressure is injurious in the isolated rabbit lung model. Anesth Analg 2003:96( I ):220-8.
26. Tusınan G. Böhm SH. Sipmann FS. Maisch S. Lung recruitment improves tlx* efficiency of ventilation and gas exchange during one-lung ventilation anesthesia. Anesth Analg 2004;98(6): 1604-9.
27. Dikmen Y. Aykac B. Erolçay 11. Unilateral high frequency jet ventilation during one-lung ventilation. Eur J Anaesthesiol 1997; 14(3)123943.
28. Lucangelo U. Antonaglia V. Zin WA. ct al. High-frequency percussive ventilation improves perioperatively clinical evolution in pulmonary resection. Crit Care Med 2009:37(5): 1663-9.
29. N Çakar. S Tuğrul, E Şentürk. ve ark. Mekanik ventilasyonun oluşturduğu akciğer hasarında hiperkarbiniı» koruyucu rolü. Türk Anest Rean Der Dergisi 2003:31:402-8.
30. Anantham D. Jagadesan R. Tiew PE. Clinical review: Independent lung ventilation in critical care. Crit Care 2005:9(6):594-600.
31. Fischer S, Hoeper MM, Bein T. et al. Interventional lung assist: a new concept of protective ventilation in bridge to lung transplantation. ASAIO J 2008:54(1 ):3-l0.
32. Neumann P. Wrigge H. Zinserling J, et al. Spontaneous breathing affects the spatial ventilation and perfusion distribution during mechanical ventilatory support.Crit Care Med 2005:33(5): 1090-5.
33. Beck J. Brander L. Slulsky AS, et al. Non-invasive neurally adjusted ventilatory assist in rabbits with acute lung injury. Intensive Care Med. 2008:34(2):316-23.
34. Auriant 1, Jallot A, Herve P, el al. Noninvasive ventilation reduces mortality in acute respiratory failure following lung resection. Am J Respir Crit Care Med 2001; 164(7): 1231-5.