Articles: postoperative-complications.
-
Positive pressure at the end of expiration (PEEP) applied in spontaneous ventilation (CPAP) has the same ventilatory effects as in controlled ventilation without the harmful actions. Few studies have described the use of CPAP in severe isolated postoperative respiratory insufficiency. CPAP was applied in 16 patients free of chronic bronchopulmonary disease, aged between 22 and 82 years, and suffering after major thoracic and/or abdominal surgery from isolated acute respiratory insufficiency as defined by clinical, blood gas and rediological criteria. ⋯ Alveolar ventilation was assessed by capnography. Improvement was marked in six days : the PaO2/FIO2 ratio at nil PEEP fell from 129 +/- 3.2 to 3.73 +/- 6.5 (mean +/- SD), the score of interstitial and alveolar opacities from 25 to 4 and the atelectasis score from 10 to 1. These results show the efficacy of CPAP in the early treatment of isolated postoperative acute respiratory insufficiency.
-
In 14 patients with the respiratory distress syndrome it was demonstrated that this condition was caused by the administration of excessive volumes of fluid. In none of six patients examined post-mortem were any signs of thrombi or emboli observed in pulmonary vessels. Caution with the initial supply of fluids following major trauma and major surgery is recommended. By monitoring pulmonary arterial pressure, optimum volume replacement with 5% albumin solution for example can be achieved.
-
Four instances of severe anaphylactoid reaction occurring subsequent to cardiopulmonary bypass are described. These catastrophic reactions, from which 2 patients died, took place approximately an hour following administration of protamine and were characterized by marked peripheral vasodilatation, loss of capillary membrane integrity, and fulminant noncardiogenic pulmonary edema. ⋯ Differential diagnosis from other causes of acute cardiorespiratory dysfunction depended on early assessment of pulmonary artery and left ventricular filling pressures, cardiac output, respiratory mechanics, and arterial blood gases. Therapy was difficult; success in 1 of the patients seemed to have been effected in part by prompt administration of high-dose corticosteroids and maintenance of peripheral vascular tone with an alpha-adrenergic agonist.