Postoperative Respiratory Care

Postoperative Respiratory Care: Risks & Realities - Breathing After Bliss

Surgery & anesthesia significantly impact lung function, increasing postoperative pulmonary complication (PPC) risk.

• Physiological Insults:
  • ↓ Functional Residual Capacity (FRC) by 20-30% (most critical)
  • ↓ Tidal Volume (TV) & Vital Capacity (VC)
  • Impaired cough & mucociliary clearance
  • Diaphragmatic dysfunction
• Key Risk Factors (Illustrative, e.g., ARISCAT components):
  • Age >60 yrs
  • Pre-existing respiratory disease (COPD, asthma)
  • Smoking, Obesity (BMI >30 kg/m²)
  • Surgical site (thoracic/upper abdominal)
  • Surgery duration >2-3 hrs
  • Emergency surgery
  • Low preoperative SpO₂ <96%

⭐ The most common cause of early postoperative hypoxemia (first 24-48 hours) is atelectasis.

Postoperative Respiratory Care: PORCs Parade - When Breaths Go Bad

⭐ Atelectasis is the most common postoperative respiratory complication, typically occurring within 48 hours after surgery.

Common PORCs and their features:

• Risk Factors: Smoking, obesity, COPD, prolonged/thoracic/upper abdominal surgery.
• Prevention: 📌 I COUGH: Incentive spirometry, Coughing/deep breathing, Oral care, Understanding (patient education), Getting up (mobilization), Head elevation.
• Management: Treat cause; O2, physio; specific Rx (antibiotics, bronchodilators, anticoagulants).

Postoperative Respiratory Care: Preventive Playbook - Stop Trouble Starting

📌 LUNG SAFE approach: Lung expansion, Upright position, Non-invasive ventilation (if indicated), Good analgesia, Stop smoking/Secretions clear, Ambulation/Activity, Fluid balance, Early recognition.

• Pre-operative:
  • Smoking cessation: 4-8 weeks prior.
  • Patient education on Deep Breathing Exercises (DBE) & Incentive Spirometry (IS).
• Intra-operative:
  • Lung protective ventilation strategies.
• Post-operative:
  • Effective analgesia (e.g., epidural, nerve blocks).
  • Early mobilization & upright positioning.
  • Lung expansion maneuvers:
    • DBE, directed cough.
    • Incentive Spirometry: 5-10 breaths/hour while awake.
    • Chest Physiotherapy (CPT) for high-risk patients.
  • Humidified oxygen if $SpO_2 < \textbf{92}%$.
  • Consider CPAP/BiPAP for high-risk (e.g., OSA, COPD).

⭐ Adequate postoperative pain control, particularly with regional anesthesia or multimodal analgesia, is paramount for effective respiratory physiotherapy and prevention of Postoperative Respiratory Complications (PORCs).

Postoperative Respiratory Care: Response & Rescue - Fixing Faulty Flows

• Airway Patency: Head-tilt/chin-lift, jaw thrust. OPA/NPA. Suction. Consider LMA/ETT if refractory.
• Optimize Oxygenation: Titrate FiO₂ (Nasal cannula, Venturi, NRBM) to SpO₂ >92% (88-92% COPD). Consider CPAP/BiPAP for atelectasis/Type I failure.
• Support Ventilation: Address hypoventilation (reverse opioids/NMB). Mechanical ventilation if respiratory muscle fatigue/Type II failure.
• Specific Causes & Fixes:
  • Atelectasis: Chest physiotherapy, incentive spirometry.
  • Bronchospasm: Inhaled β₂-agonists.
  • Pulmonary edema: Diuretics, PEEP.
  • PE: Anticoagulation.
  • Pneumonia: Antibiotics.

⭐ For suspected postoperative pulmonary embolism, a Wells score followed by D-dimer or CT pulmonary angiography (CTPA) is the standard diagnostic pathway.

High‑Yield Points - ⚡ Biggest Takeaways

• Atelectasis: Most common postoperative pulmonary complication, typically within 24-48 hours.
• Prevention: Incentive spirometry, deep breathing exercises, and early mobilization are key.
• Hypoxemia (PaO2 < 60 mmHg or SpO2 < 90%) requires prompt oxygen and evaluation.
• Risk factors: Obesity, smoking, COPD, thoracic/upper abdominal surgery.
• Pulmonary embolism (PE): Suspect with sudden dyspnea, chest pain, and unexplained hypoxemia.
• Aspiration pneumonitis: High risk with impaired consciousness or delayed gastric emptying.