Incidencia de complicaciones y factores de riesgo asociados en pacientes intervenidos de neumonectomía / Incidence of complications and associated risk factors in patients undergoing pneumonectomy

Objetivo: conocer la incidencia de complicaciones e identificar los factores de riesgo asociados a complicaciones post-operatorias desarrolladas tras una neumonectomía.Método: se llevó a cabo un estudio observacional retrospectivo, cuya muestra se obtuvo del total de pacientes, mayores de 18 años, que estuvieron hospitalizados en el Servicio de Neumología y Cirugía Torácica del Hospital Universitario de Bellvitge (Barcelona), entre enero de 2016 y junio de 2020, que habían sido intervenidos de neumonectomía (derecha o izquierda). Variables de estudio: complicaciones durante la hospitalización, comorbilidades y factores de riesgo, además de otras variables demográficas y clínicas. Los datos se recogieron mediante una revisión de historias clínicas electrónicas. Se realizó análisis descriptivo y analítico. Se consideró significativa la diferencia si p< 0,05.Resultados: se incluyeron 24 pacientes, 75% varones (n=1 8). El 46% era fumador. La edad media (rango intercuatílico) fue de 66 (62-74) años. Las principales comorbilidades identificadas fueron: hipertensión arterial (46%; n= 11), diabetes mellitus (25%; n= 6) y EPOC (25%; n= 6). 83% (n= 20) intervenidos mediante toracotomía. 79% (n= 19) sometidos a neumonectomía izquierda y 42% (n= 10) con complicaciones post-operatorias. La complicación con mayor incidencia fue la arritmia cardiaca (17%; n= 4). La neumonectomía derecha se asoció con la aparición de complicaciones (p= 0,05). La media de días de estancia hospitalaria fue mayor en el grupo con complicaciones (9,5 frente a 7; p= 0,005).Conclusión: se detectaron complicaciones post-operatorias en cuatro de cada diez sujetos, siendo la más frecuente la arritmia cardiaca. La neumonectomía derecha se asoció significativamente a la aparición de complicaciones.(AU)

Objective: to understand the incidence of complications, and identify the risk factors associated with post-surgical complications developed after pneumonectomy.Method: a retrospective observational study was conducted; the sample was obtained from the group of >18-year-old patients hospitalized at the Pulmonology and Thoracic Surgery Unit of the Hospital Universitario de Bellvitge (Barcelona), between January, 2016 and June, 2020, who had undergone pneumonectomy (right or left). Study variables: complications during hospitalization, comorbidities and risk factors, besides other demographical and clinical variables. Data were collected through review of electronic clinical records. Descriptive and analytical analysis was conducted. The difference was considered significant if p< 0.05.Results: the study included 24 patients: 75% were male (n=1 8); 46% were smokers; and their mean age (interquartile range) was 66 (62-74) years. The main comorbidities detected were: hypertension (46%; n= 11), diabetes mellitus (25%; n= 6) and COPD (25%; n= 6); 83% (n= 20) underwent thoracotomy, and 79% (n= 19) underwent left pneumonectomy; 42% (n= 10) presented post-surgical complications. The complication with the highest incidence was cardiac arrythmia (17%; n= 4). Right pneumonectomy was associated with the development of complications (p= 0,05). The mean hospital stay was higher in the group with complications (9.5 vs. 7 days; p= 0.005).Conclusion: post-surgical complications were detected in 4 out of each ten subjects; the most frequent was cardiac arrythmia. Right pneumonectomy was significantly associated with the development of complications.(AU)

Nurse Coordinator Roles and Responsibilities for Bronchoscopic Lung Volume Reduction With Endobronchial Valves.

COPD may cause profound dyspnea, functional impairment, and reduced quality of life. Available pharmacologic therapy provides suboptimal symptom improvement in many patients. Bronchoscopic lung volume reduction (BLVR), achieved with endobronchial valve placement, can effectively improve dyspnea and functional status in appropriately selected patients. Operationalizing a safe and effective BLVR program requires appropriate oversight, which can be achieved by a BLVR nurse coordinator (NC). By identifying and developing screening practices, coordinating multidisciplinary diagnostic evaluation, and establishing safe efficient patient flow throughout the entire care process, a BLVR NC can optimize patient care, safety, experience, efficiency, and overall outcomes. This article details the role of our NC to facilitate extrapolation to other institutions.

ECMO-assisted resection of left main bronchial malignant tumor and left pneumonectomy with comprehensive nursing support: a case report.

BACKGROUND: Patients with Extracorporeal Membrane Oxygenation (ECMO) undergoing primary bronchial malignancy resection and left pneumonectomy via bilateral thoracic approach are rare for there exist few reports available to date. And the nursing experience about this disease is rare reported. CASE PRESENTATION: This study reported a 50-year-old man with adenoid cystic carcinoma in left main bronchus by computed tomography (CT), fiberoptic bronchoscopy, and puncture biopsy. The case is the first report about operation method and the comprehensive nursing care, including conventional nursing, airway management, fluid management, nutritional support, and psychosocial support for patients undergoing primary bronchial malignancy resection and left pneumonectomy. After multidisciplinary treatment and comprehensive care, the patient was cured and discharged on the 17th day after surgery. CONCLUSION: This study reported a rare case with bronchial malignancy resection and left pneumonectomy and discussed its nursing care. A skilled management of ECMO, intraoperative position transformation, and prevention, as well as control of pulmonary complications are fundamental in caring patients with bronchial tumors. Monitoring of pulmonary function and blood pressure, adequate nutrition, and psychological support could be contributing factors for successful treatment during the postoperative stage.

Results of Postdischarge Nursing Telephone Assessments: Persistent Symptoms Common Among Pulmonary Resection Patients.

BACKGROUND: After hospital discharge, patients may have questions or complaints that surface or remain inadequately addressed. However, the dominant concerns and indications for further intervention among recently discharged patients after pulmonary resection have not been well described. The aims of this study were to characterize dominant concerns of pulmonary resection patients after discharge and to elucidate any relevant risk factors for their development. METHODS: A single-institution, retrospective review was conducted of all patients who underwent pulmonary resection over a 12-month period and included records of standardized, nurse-initiated follow-up phone calls to discharged patients. Records of postdischarge telephone calls were reviewed, and data collected pertaining to complaints requiring counseling over the phone or escalation to higher care level. Demographic, operative, and hospital data were examined by multivariate analyses to assess predictors of need for counseling or escalation of care. RESULTS: In all, 523 patients underwent pulmonary resection during the study, and 245 (46.8%) had nursing-documented telephone conversations at 4.6 days (±0.18) days after discharge. Among those reached, 81 (33.1%) had problems requiring counseling during the call; 31 (12.7%) reported concerns requiring escalation of care, handled by subsequent telephone call for 7 (22.6%), clinic appointment for 22 (71.0%), or emergency room referral for 2 (6.5%). Age, sex, race, and residential proximity to the hospital did not predict need for counseling nor escalation of care. CONCLUSIONS: Patient complaints after pulmonary resection were frequent, with most problems resolved by telephone counseling. Despite highly prevalent concerns, predictors of need for counseling or care escalation were not identified, suggesting ongoing utility in the practice of telephoning all patients. Further, this study serves as a needs assessment, highlighting the importance of patient education and discharge planning.

La prueba de escaleras. En búsqueda de la necesaria simplicidad / No disponible

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Cuidados enfermeros del paciente con resección pulmonar / Nursing care of patients who have undergone lung resection

La cirugía de pulmón representa un importante riesgo quirúrgico, con una mortalidad entre el 5 y el 20%, ya que la apertura de la cavidad torácica constituye por si sola un intervención con repercusión sistémica. Con el propósito de mejorar los resultados de los pacientes que pasan por este proceso y facilitar la adaptación a la nueva vida de la persona operada,se ha elaborado un plan de cuidados enfermeros que contempla el estado físico, emocional y la necesidad de aprendizaje educacional.Se especifican y fundamentan los cuidados enfermeros en las fases de preoperatorio y postoperatorio y se describe y fundamenta la importancia de la valoración y control de signos y síntomas, drenajes y catéteres, para la prevención de complicaciones o en su caso para la detección precoz de las mismas.Se incluye un apartado específico sobre la importancia del tratamiento del dolor en los pacientes durante el postoperatorio y su asociación con las complicaciones potenciales del proceso quirúrgico, se especifican las recomendaciones al alta hospitalaria (AU)

Lung surgery entails an important surgical risk, with mortality ranging between 5% and 20%, due to the fact that the opening of the thoracic cavity,in itself, constitutes and intervention with systemic repercussions.In order to improve the outcome in patients who have undergone this procedure and to facilitate adjustment to their new life after the operation,a nursing care plan has been elaborated. This plan takes into account the physical and emotional state of the patient and the need for educational learning.Nursing care guidelines and principles during the preoperative and postoperative stages as well as the importance of assessing and controlling signs and symptoms, drainage lines, and catheters are described for the prevention and early detection of complications.The paper includes a specific section on the relevance of pain management during the postoperative course and its association with potential complications of the surgical procedure as well as postoperative instructions for the patient to follow at the time of discharge (AU)

The nursing of a patient following lung volume reduction surgery.

Lung volume reduction surgery (LVRS) is an experimental surgical procedure that aims to alleviate the symptoms of breathlessness for patients with end-stage chronic emphysema. Emphysema (from the Greek for 'puff up') is a progressive chronic obstructive pulmonary disease (COPD) and risk factors include smoking and chronic infections. The disease causes the alveoli of the lung to over-expand and lose their elasticity (Schedel and Connolly, 1999). Advanced emphysema causes severe dyspnoea that significantly reduces the patient's quality of life.

Lung volume reduction with video assisted thoracic surgery.

This article aims to describe lung volume reduction (LVR) and some aspects of perioperative care. LVR is a surgical treatment for emphysema. An understanding of the operation and the patient's pre-existing medical condition is important for skilled and appropriate care, particularly in anaesthetic and recovery rooms.

Surgical therapies for lung carcinomas.

Lung cancer is the leading cause of cancer-related death for men and women in the world today. Surgical resection of early stage non-small cell lung cancer is the recommended treatment option and offers the patient the best chance for survival. Nurses are instrumental in lung cancer prevention, early detection, delivery of quality perioperative care, and maximizing long-term patient survival.

Lung volume reduction surgery: new hope for emphysema patients.

Lung volume reduction is a new surgical procedure for patients with severe emphysema. The hyperinflated portion of the lung or lungs is removed so the patient's chest wall and diaphragm can return to normal positions, easing breathing. This article describes the patient criteria, surgical procedure, and nursing problems and interventions related to the care of the lung volume reduction patient.

A surgical approach for patients with endstage emphysema.

For patients with emphysema who experience deteriorating lung function and concomitant comorbidity, there has been little to offer apart from best supportive care and more recently pulmonary rehabilitation. The early promise of lung transplantation for these patients has failed to materialize--a shortage of donors has meant that younger patients are more likely to receive donor lungs. A renewed interest in lung volume reduction surgery (LVRS) appears to offer hope for selected patients. This article looks at the history of LVRS and illustrates its benefits with a case study. However, if LVRS is a clinically significant approach to the treatment of emphysemic patients, then it requires careful clinical trials so that its benefits and costs can be fully evaluated.

Volume lung reduction surgery: a review.

Emphysema, along with other chronic obstructive lung diseases, affects 13.5 million Americans and is the fastest-growing cause of morbidity and mortality in the United States. Despite excellent medical management, there are many patients who become unresponsive to therapy. The current surgical options include lung transplantation and lung volume reduction surgery. It is important for nurses to be current with these new surgical techniques. This article reviews the current surgical procedure, postoperative complications, and patient outcomes.

Lung volume reduction surgery: an overview.

Lung volume reduction surgery, originally used in the 1950s, has reemerged as a technique that may help some individuals with end-stage emphysema breathe more easily. The goal of the surgery is to enhance elastic recoil of the lung and to restore diaphragmatic function. The surgery is still in the experimental stages, but early outcome data are encouraging. The purpose of this study was to discuss the pathology of emphysema and the rationale for lung volume reduction. The patient selection criteria for the operation are discussed, and information is provided regarding the preoperative and postoperative management and rehabilitation of these patients by physicians, nurses, respiratory therapists, and physical therapists.

Nursing care of the thoracoscopic lung volume reduction patient.

BACKGROUND: Several methods to surgically enhance pulmonary function and improve the quality of life in patients with bullous emphysema are currently being evaluated. One of these methods, lung volume reduction, is performed in patients with bullous emphysema that can no longer be well managed with medical therapy. OBJECTIVES: The focus of this article is to review bullectomy via unilateral thoracoscopy with an endoscopic stapler in the management of end-stage pulmonary emphysema, and to discuss nursing care of these patients. METHODS: An experimental study was used, including review of the literature and analysis of clinical experience using chi-square and t test analyses of pre- and postoperative variables. RESULTS: At 3-month follow-up there were significant improvements in forced expiratory volume in 1 second, forced vital capacity, minute volume ventilation, partial pressure of oxygen, residual volume, and 6-minute walk when pre- and postoperative parameters were compared. Operative mortality was 4%, with the most common complication being prolonged air leak, occurring in 30% of patients studied. CONCLUSIONS: There is now consistent preliminary information to support the concept that lung volume reduction improves pulmonary function and quality of life in a significant percentage of patients.