Postoperative respiratory complications

    • Postoperative respiratory complications

Complications

Mechanisms

Manifestations

Interventions

Airway Obstruction

Tongue falling back

  • Muscular flaccidity associated with
  • decreased consciousness and muscle relaxants
  • Use of accessory muscles
  • Snoring respirations
  • Reduced Air movement
  • Patient stimulation
  • Head tilt, jaw thrust
  • Artificial airway

Retained thick secretions

  • Secretion stimulation by anesthetic agents
  • Dehydration of secretions
  • Noisy respirations
  • Coarse crackles
  • Suctioning
  • Deep breathing and coughing
  • IV hydration
  • Chest PT

Laryngospasm

  • Irritation from endotracheal tube, anesthetic gases, or gastric aspiration
  • Most likely to occur after removal of endotracheal tube
  • Inspiratory stridor (crowing respirations)
  • Sternal retraction
  • Acute respiratory distress
  • O2 therapy
  • Positive pressure ventilation
  • IV muscle relaxant
  • Lidocaine
  • Corticosteroids

Laryngeal edema

  • Allergic drug reaction
  • Mechanical irritation from intubation
  • Fluid overload
  • Similar to laryngospasm
  • O2 therapy
  • Antihistamines
  • Corticosteroids
  • Sedatives
  • Possible intubation

Hypoxemia

Atelectasis

  • Bronchial obstruction caused by retained secretions or decreased lung volumes
  • Decreased breath sounds
  • Decreased O2 saturation
  • Humidified O2 therapy
  • Deep breathing
  • Incentive spirometry
  • Early mobilization

Pulmonary edema

  • Fluid overload
  • Increased hydrostatic pressure
  • Decreased interstitial pressure
  • Increased capillary permeability
  • Decreased O2 saturation
  • Crackles
  • Infiltrates on chest x-ray
  • O2 therapy
  • Diuretics
  • Fluid restriction

Pulmonary embolism

  • Thrombus dislodged from peripheral venous system and lodged in pulmonary arterial system
  • Acute tachypnea
  • Dyspnea
  • Tachycardia
  • Hypotension
  • Decreased O2 saturation
  • Bronchospasm
  • O2 therapy
  • Cardiopulmonary support
  • Anticoagulant therapy

Aspiration

  • Inhalation of gastric contents into lungs
  • Unexplained tachypnea
  • Bronchospasm
  • Decreased O2 saturation
  • Atelectasis
  • Interstitial edema
  • Alveolar hemorrhage
  • Respiratory failure
  • O2 therapy
  • Cardiopulmonary support
  • Antibiotics

Bronchospasm

  • Increased smooth muscle tone with closure of small airways
  • Wheezing
  • Dyspnea
  • Tachypnea
  • Decreased O2 saturation
  • O2 therapy
  • Bronchodilators

Hypoventilation

Depression of central respiratory drive

  • Medullary depression from anesthetics, opioids, sedatives
  • Shallow respirations
  • Decreased respiratory rate, apnea
  • Decreased PaO2
  • Increased PaCO2
  • Initiate capnography or other technology supported respiratory monitoring
  • Stimulation
  • Reversal of opioids or benzodiazepines
  • Mechanical ventilation

Poor respiratory muscle tone

  • Neuromuscular blockade
  • Neuromuscular disease
  • Shallow respirations
  • Decreased respiratory rate, apnea
  • Decreased PaO2
  • Increased PaCO2
  • Reversal of paralysis
  • Mechanical ventilation

Mechanical restriction

  • Tight casts, dressings, abdominal binders
  • Positioning and obesity preventing lung expansion
  • Shallow respirations
  • Decreased respiratory rate, apnea
  • Decreased PaO2
  • Increased PaCO2
  • Elevate head of bed
  • Repositioning
  • Loosen dressings

Pain

  • Shallow breathing to prevent incisional pain
  • Increased respiratory rate
  • Hypotension
  • Hypertension
  • Decreased PaCO2
  • Decreased PaO2
  • Complaints of pain
  • Guarding behavior
  • Opioid analgesic drug therapy
  • Nonsteroidal anti-inflammatory drug therapy
  • Complementary and alternative therapies (e.g., music, imagery)