Pregledni rad
https://doi.org/10.26800/LV-145-supl4-20
Postoperative pulmonary complications after bypass surgery in a patient with COPD and bullous emphysema
Brankica Vuković
; Specijalna bolnica „Centar za srce KM“ Sarajevo
Aleksandra Cvetković
; Specijalna bolnica „Centar za srce KM“ Sarajevo
Mirsad Kacila
Sažetak
One of the more frequent problems after open heart surgery are pulmonary complications associated with prolonged stay in the ICU, increased incidence of morbidity and mortality. The frequency of these complications ranges from three to fifty percent, on average about twenty percent. Patients more prone to complications usually have limited homeostatic reserve due to chronic heart failure, pulmonary disease, multiple comorbidities, older age, or have undergone invasive and long-term surgery. For perioperative risk assessment in cardiac surgery, the European Cardiac Operative Risk Assessment System (EuroSCORE) includes chronic lung disease as an independent prognostic factor for surgical mortality. Many patients with COPD undergoing CABG with a cardiopulmonary bypass pump are at increased risk of postoperative complications such as pneumonia, respiratory failure, repeated intubations, need for prolonged mechanical ventilation, stroke, infection, renal failure, and require longer stay in the intensive care unit and in the hospital after surgery. Our paper contains a case report of a 72- old patient with COPD who underwent surgical revascularization of the myocardium of a higher degree of urgency due to three-vessel heart disease with left main stenosis 85%. The patient has fatigue, dyspnea and anginal complaints for a long time. The existence of multiple bullous changes in the lungs is verified intraoperatively. The patient’s postoperative condition is complicated by the development of subcutaneous emphysema and bilateral infiltrates in the lungs. After placement of a thoracic drain, the presence of an active fistula was observed. Due to the development of respiratory insufficiency, the patient is intubated and placed on mechanical ventilation. During hospitalization, the patient’s condition is further complicated by the sudden onset of a massive pneumothorax and the development of septic shock, despite appropriate antibiotic treatment.
Ključne riječi
COPD; BULLOUS EMPHYSEMA; CABG SURGERY; POSTOPERATIVE PULMONARY COMPLICATIONS
Hrčak ID:
310283
URI
Datum izdavanja:
20.11.2023.
Posjeta: 1.256 *