RT Journal Article
SR Electronic
T1 Perioperative pulmonary complications and management of patients with COPD and esophageal malignancy
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP p538
VO 38
IS Suppl 55
A1 Yordanka Yamakova
A1 Rosen Petkov
A1 Georgi Yankov
A1 Emil Astrukov
A1 Danail Petrov
YR 2011
UL http://erj.ersjournals.com/content/38/Suppl_55/p538.abstract
AB The aim of this study was to determine the current incidence of pulmonary complications (PC) and to assess the optimal perioperative management in patients with COPD and esophageal malignancy.Methods: From 2006 to 2010 87 patients with esophageal cancer were investigated (mean age 62.2±1.5). According to FEV1 and FEV1/FVC ratio, we classified patients into three groups: COPD1 n= 37 with mild and moderate COPD, COPD2 n = 24 with severe COPD and WCOPD without COPD group n=26. We started the antibiotic treatment 24h before surgery in COPD groups. We conducted deep premedication, anesthesia with sevoflurane, fentanyl and pipecuronium. All patients were ventilated with PCV. Perioperatively arterial blood gases were tested. All patients were undergone overnight mechanical ventilation, postoperative analgesia, physiotherapy and early enteral therapeutic diet.Results: We didn't detect any differences in hemodynamic parameters and intraoperative blood gases analysis. The major PC (21/87=24.1%) included: pneumonia (n=6), atelectasis (n=3), pleural effusions requiring drainage (n=4) and the exacerbation of COPD (n=6). Patients with COPD had more PC (31.1%) than WCOPD (7.7%) p<0.025. Severe COPD2 group had more PC (54.2%) than COPD1 group (16.2%) p<0.01. Mean hospital length of stay was average 11 days for WCOPD and 16 days for COPD groups. The mortality in our study was 9.2% (8 patients) and was associated with the presence of severe COPD p<0.025.Conclusions: Severity of COPD affects the incidence rate of PC and mortality. Patients with COPD need to be under vigilant postoperative monitoring, complex therapy, managed by team of anesthesiologist, pulmonologist, surgeon and physiotherapist.