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Postoperative Pulmonary Complications Br J Anaesth. 2017;118(3):317-334. Changes to the respiratory system occur immediately on induction of general anaesthesia: respiratory drive and muscle function are altered, lung volumes reduced, and atelectasis develops in > 75% of patients receiving a neuromuscular blocking drug..The respiratory system may take 6 weeks to return to its preoperative state after general anaesthesia for major surgery. clinicians should be aware of non-modifiable and modifiable factors in order to recognize those at risk and optimize their care.Preventative measures include preoperative optimization of co-morbidities, smoking cessation, and correction of anaemia, in addition to intraoperative protective ventilation strategies and appropriate management of neuromuscular blocking drugs. Protective ventilation includes low tidal volumes, which must be calculated according to the patient's ideal body weight. the most beneficial level of PEEP is required,
Bronchoscopic Lung Cryobiopsy Increases Diagnostic Confidence in the Multidisciplinary Diagnosis of Idiopathic Pulmonary Fibrosis American Journal of Respiratory and Critical Care Medicine Volume 193 Number 7 | April 1 2016 BLC is a new biopsy method that has a meaningful impact on diagnostic confidence in the multidisciplinary diagnosis of interstitial lung disease and may prove useful in the diagnosis of IPF.
COPD (Chronic obstructive pulmonary diseases or chronic bronchitis) Assessment of the risk of death in this patients depend on their BODE Index B stand for BMI, O- Obstruction depending on FEV1, D - Shortness of breath OR dyspnea using MMRC scale , E - Exercise capacity, measured by 6 minutes walk test 6MWT.This index calculated using a scale of 0 to 3 for each parameter, depending on severity. except BMI scale different < 21 is 0 and more than >21 is 1. BODE score of 7 to 10 falls in the higher chance of mortality. Other factors have also been associated with increased moribidity and mortality in COPD , For example : acute exacerbation of COPD, Hospitalization, cardiac comorbidities Survival benefit are smoking cessation and lung volume reduction surgery in selected patients .Oxygen is beneficial who are hypoxemic on room air. None of the medications consistently demonstrated to prolong life.
COPD patients significant effects on survival have been shown for several interventions , including. high-frequency neuromuscular electrical stimulation should initiated as the main training modality during his Pulmonary rehabilitation programme, weight gain in underweight patients , non-invasive positive pressure ventilation in chronic hypercapnic patients and lung volume reduction surgery or endobronchial valve treatment in patients with upper-lobe predominant emphysema and poor exercise capacity
An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome For all patients with ARDS, the recommendation is strong for mechanical ventilation using lower tidal volumes (4–8 ml/kg predicted body weight) and lower inspiratory pressures (plateau pressure , 30 cm H2O) (moderate confidence in effect estimates). For patients with severe ARDS, the recommendation is strong for prone positioning for more than 12 h/d (moderate confidence in effect estimates). For patients with moderate or severeARDS, the recommendation is strong against routine use of high-frequency oscillatory ventilation (high confidence in effect estimates) and conditional for higher positive end-expiratory pressure (moderate confidence in effect estimates) and recruitment maneuvers (low confidence in effect estimates). Additional evidence is necessary to make a definitive recommendation for or against the use of extracorporeal membrane oxygenation in patients with severe ARDS.
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