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Hi
Does anyone know of any good literature I can get hold of regarding the use of mobilisation on postoperative abdominal patients. I am trying to justify its use in an essay question I have for a patient who has atelectasis and possible pneumonia post-surgery. Any ideas please??
Thank you
Atelectasis may be the result of a blocked airway or of pressure from outside the lung. It is observed in almost everyone who undergoes surgery, it is caused because of the use of anesthesia. To improve the patient's condition, following techniques must be employed:
- Make him Inhale bronchodilators as it opens the bronchial tubes of the lungs, making breathing easier.
- Use medication to thin mucus and make it easier to cough up.
I have to respectfully disagree with this advice. Atelectasis post-operatively is due to a reduced functional residual capacity to below the closing capacity level of the lungs. This results in early airways closure, and resultant atelectasis. Also, the anaesthesia will contribute by causing respiratory muscle dysfunction with inhibition of the phrenic nerve. Also, lack of sighs whilst ventilated with reduce surfactant production, and therefore reduce compliance of the lungs, also contributing to the atelectatic state post-operatively. Areas of atelectasis provide an ideal area for the growth of bacteria, due to the reduced airflow in combination with the dark, warm, and moist environment. This is why pneumonia can result from post-op atelectasis. The most effective treatment is to improve lung volumes by positioning and mobility. FRC is significantly higher in the upright position, and lung volumes are further increased with the increased ventilation demands resultant from mobility. This will in turn increase expiratory airflow, which will facilitate secretion clearance from the lungs. There is significant literature to support the use of mobility to prevent post-operative pulmonary complications, which can be found in any of the health databases (CINAHL, AMED, or even Google Scholar). Try a search of prevention of post-operative pulmonary complications AND abdominal surgery - it is sure to get plenty of hits....
Almost all the abdominal surgeries involves certain amount of gastric swelling due to raw wound and excessive gastric fluid collection in the stomach as the patient tend to be NBM atleast for couple of days. The patients tend to lie flat or propped up atmost to 30 degrees if they can tolerate pain. It is very typical to observe basal atelectasis when u look at the anterior chest x-ray in these cases than any other parts of lungs.Main reason being the huge abdominal contents compressing the dome of diaphragm upward and subsequently compressing the basal areas of lungs bilaterally.Quote:
Originally Posted by Ryan82
Early SOEB or SOOB especially POD1 and Regular intermittent NG suctioning to clear gastric fluids will help to avoid this common post op complication. Incentive spirometry with Voldyne or Coach would compliment recovery when done at regular intervals.Thanks.
Look under MEDLARS for EBM articles.
Hi Brosnan,
that's interesting - do Physios in Singapore do NG suctioning of gastric contents?
Could you please explain and also write out your abbreviations? Thanks ever so much!
Fyzzio