Preemptive gastrointestinal tract management reduces aspiration and respiratory failure after thoracic operations

John R. Roberts, Yu Shyr, Karla R. Christian, Davis Drinkwater, Walter Merrill

研究成果: Article同行評審

14 引文 斯高帕斯(Scopus)

摘要

Objectives: Respiratory failure is the major mode of death after general thoracic operations. However, respiratory failure may develop from two very different mechanisms: aspiration, often caused by ileus, and pneumonia, which often results from poor pain control. Epidural catheters help control pain and prevent pneumonia but contribute to ileus and may increase aspiration. We report a decrease in the incidence of aspiration after changing postoperative care to include gastrointestinal tract management. Methods: All patients undergoing elective thoracotomy by a single surgeon were evaluated for hospital mortality and morbidity. For the first 21 months, patients did not receive an intraoperative nasogastric tube and were prescribed an 'advance as tolerated' diet after the operation (n = 125). For the second period, nasogastric tubes were placed intraoperatively and patients received nothing by mouth the day of operation, clear liquids the first day, and a regular diet the second day (n = 153). Pneumonia was considered to have developed if infiltrates developed in a single lobe or two adjoining lobes and culture of the sputa grew a dominant organism. Patients were considered to have aspirated if diffuse infiltrates developed or cultures grew multiple organisms. Significance of results was determined by χ2 testing. Results: A total of 278 patients underwent elective lung resection over a 3 1/2 -year period, 125 with ad libitum dietary management and 153 with intensive management of the gastrointestinal tract. Six patients (4.84%) aspirated before the institution of gastrointestinal tract management, whereas none (0.0%) aspirated after the change. This difference was significant (P = .01). Respiratory mortality was eliminated in the group with gastrointestinal tract management (P = .04). Conclusions: Aspiration and its subsequent respiratory failure and mortality can be decreased with preemptive gastrointestinal tract management.

原文English
頁(從 - 到)449-452
頁數4
期刊Journal of Thoracic and Cardiovascular Surgery
119
發行號3
DOIs
出版狀態Published - 2000

All Science Journal Classification (ASJC) codes

  • 手術
  • 肺和呼吸系統醫學
  • 心臟病學與心血管醫學

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