Complications of Esophageal Surgery and Trauma
Stephen M. Cohn, Matthew O. Dolich in Complications in Surgery and Trauma, 2014
Pulmonary complications are the most common cause of morbidity and mortality after esophageal resection. The most common respiratory complications continue to be pneumonia, ventilator dependence, and acute respiratory distress syndrome (ARDS). Patients who developed a postoperative pneumonia had an almost sevenfold increase in mortality (20.0% vs. 3.1%) [40]. Risk factors that increase the incidence of respiratory complications include advanced age, smoking, chronic obstructive pulmonary disease (COPD), malnutrition, neoadjuvant chemotherapy, recurrent laryngeal nerve injury, loss of more than 1 L of blood during the procedure, and immobility due to pain or malnutrition. Preoperative intervention aimed at optimizing pulmonary hygiene and function can prevent and decrease the incidence of pulmonary complications.
The Pancreas and the Periampullary Area
E. George Elias in CRC Handbook of Surgical Oncology, 2020
The preoperative preparation of the patient for the Whipple procedure or total pancreatectomy is of utmost importance. The patient should be carefully evaluated and blood elements should be given to the patient for replacements. Albumin and fresh frozen plasma may be administered if so needed. The patient should be well hydrated and the serum electrolytes should be corrected. The serum creatinine and blood urea nitrogen should be checked to ensure good functioning kidneys. Fat soluble vitamins should be given freely as these patients are usually deficient in this category. In addition, cardiac status should be evaluated and pulmonary hygiene instituted in preparation for a major surgery. Large bowel prep is essential in case the tumor extends and involves a segment of the large bowel or one of its vessels such as the middle colic. The availability of percutaneous cholangiography and drainage either intraduodenally or externally is of great value. It has been shown that patients who have elevated serum bilirubin to 10 mg percent have a 12% mortality rate due to renal failure, sepsis, and hemorrhage. In addition, patients with a serum bilirubin of 20 mg percent have double the morbidity and mortality rates.10 Therefore, percutaneous drainage during preoperative preparation is ideal in the severely jaundiced patient.
Pulmonary Disease in the Geriatric Population
K. Rao Poduri in Geriatric Rehabilitation, 2017
Rehabilitation in the older patient with bronchiectasis should focus not only on improving exercise capacity, but also on maintaining good pulmonary hygiene with airway clearance techniques described above. An effort should be made to clear the airways as able prior to the onset of exercise, although exertion itself is often a powerful stimulus for mucous clearance. Dynamic hyperinflation should be minimized using breathing techniques, self-pacing, and a short-acting bronchodilator prior to exercise if bronchospastic. On the basis of the above evidence, inspiratory muscle training may have a role. The educational component should center around recognizing early signs of exacerbation, using airway clearance techniques, and maintaining good nutrition (Figures 21.13 and 21.14).
Community exercise for individuals with spinal cord injury with inspiratory muscle training: A pilot study
Published in The Journal of Spinal Cord Medicine, 2021
Jessica M. Leathem, Martha Macht-Sliwinski, Sarah Boak, Aubrey Courville, Michelle Dearwater, Sneha Gazi, Allison Scott
In addition to regular exercise, IMT can provide additional benefit for individuals with SCI.8,9,15 To decrease risk for respiratory complications, resistive respiratory training (RRT) can be included in an exercise program to potentially decrease secondary health complications.20 RRT has been shown to be effective when included in inpatient rehabilitation for improving respiratory function in patients with SCI,21,22 and other neuromuscular disorders.23–25 This is important, as people with impaired neuromuscular control of respiratory muscles have more difficulty maintaining pulmonary hygiene.26–28 Changes that occur with SCI can impact inspiratory and expiratory neuromuscular control resulting in altered inspiration mechanics,28,29 paradoxical breathing patterns,30,31 and increased reliance on accessory muscles.31,32 Impaired efficiency of respiration increases the risk for respiratory complications13,22,32 supporting the need for continued RRT through the continuum of care. IMT specifically targets inspiratory muscles, providing progressive resistance to the diaphragm, intercostals, and accessory muscles to improve lung volume utilization,33–35 and can improve cardiovascular health, blood pressure regulation,34 and overall respiratory health.36–39
Best practices protocol for the evaluation of bulbar dysfunction: summary recommendations from the NEALS bulbar subcommittee symposium
Published in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 2018
Gary L. Pattee, Emily K. Plowman, Benjamin R. Brooks, James D. Berry, Nazem Atassi, Jennifer L. Chapin, Kendrea Garand, Yana Yunusova, Courtney E. Mcilduff, Eufrosina Young, John M. Costello, Eric A. Macklin, Eduardo R. Locatelli, Vincenzo Silani, Daragh Heitzman, James Wymer, Stephen A. Goutman, Deborah F. Gelinas, Richard Smith, Bridget Perry, Paige Nalipinski, Kaila Stipancic, Meghan O'Brien, Stacey L. Sullivan, Jordan Green
The Augmentative communication assessment should focus on communication participation across a variety of functions, proactive introduction of voice and message banking, early consideration of low tech/quick access strategies, and exploring functional use of telephone, texting, keyboarding, internet access, including standard methods of face to face and distance communication. The Swallowing section advocated objective assessment in each of the following upper aerodigestive domains: dietary/oral intake, airway defense physiologic capacity, swallow safety screen, patient-reported swallow-related outcomes, oral sensorimotor exam, and pulmonary function. Specific objective testing and outcome suggestions for each domain were established. Important practice parameters included patient education concerning: dietary modifications, compensatory swallow strategies, oral hygiene, feeding tubes, pulmonary hygiene with airway clearance, and basic life saving techniques. Defining the use and optimal timing of instrumental assessment of swallowing physiology (e.g. videofluoroscopy) remains underway.
Mycobacterium scrofulaceum disease: experience from a tertiary medical centre and review of the literature
Published in Infectious Diseases, 2019
John W. Wilson, Anil C. Jagtiani, Nancy L. Wengenack
The presence of chronic lung disease is not a novel characteristic of M. scrofulaceum lung infection, as pulmonary infection caused by other NTM species have also been associated with chronic structural lung disease including bronchiectasis and cystic fibrosis [19,20]. Management of NTM lung infections can be hindered by suboptimal pulmonary hygiene measures with reduced endobronchial mucous clearance.
Related Knowledge Centers
- Mucociliary Clearance
- Mucus
- Pulmonary Shunt
- Respiratory Tract
- Respiratory Tract Infection
- Secretion
- Atelectasis
- Lung
- Hygiene
- Pulmonary Alveolus