Skip to main content
SpringerLink
Log in

Perioperative pulmonale Komplikationen in der Thoraxchirurgie

Perioperative pulmonary complications in thoracic surgery

  • Leitthema
  • Published:
Der Pneumologe Aims and scope

Zusammenfassung

Bronchopulmonale Komplikationen in der Thoraxchirurgie erfordern häufig ein interdisziplinäres Management. Dazu gehören die perioperative Hypoxämie mit Ausbildung eines Lungenödems und eines ALI / ARDS („acute lung injury“ /“acute respiratory distress syndrome“), Infektionen (nosokomiale Pneumonie, Beatmungspneumonie sowie das Früh- und Spätempyem), die Lungenembolie, lokale oder diffuse Nachblutungen, Medikamentennebenwirkungen, sowie Komplikationen bei Infusionen und Transfusionen, die Bronchusstumpfinsuffizienz und persistierende Fisteln, Atelektasen, die Herniation des Herzens (nach Perikarderöffnung und Pneumonektomie), ein (Spannungs-)Pneumothorax, der auch unter liegender Thoraxdrainage auftreten kann, das Postpneumonektomiesyndrom, das Postthorakotomiesyndrom, sowie die Verschlechterung vorbestehender bronchopulmonaler Erkrankungen. Der Artikel gibt eine Übersicht über Diagnostik und Therapie dieser Komplikationen.

Abstract

Bronchopulmonary complications in thoracic surgery often necessitate an interdisciplinary approach. These complications include perioperative hypoxemia with pulmonary edema and ALI / ARDS (acute lung injury / acute respiratory distress syndrome), infections (hospital-acquired pneumonia, ventilator associated pneumonia, as well as early and late pleural empyema), pulmonary embolism, localized or diffuse postoperative bleeding, side effects of drug therapy, as well as complications of infusion therapy, insufficiency of the bronchial stump, atelectasis, herniation of the heart, pneumothorax, postpneumonectomy syndrome, post-thoracotomy syndrome, as well as worsening of preexisting bronchopulmonary disorders. This article summarizes diagnostics and therapy of these complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Abbas Ael-S, Deschamps C (2002) Postpneumonectomy empyema. Curr Opin Pulm Med 8(4):327–333

    Article  Google Scholar 

  2. Ahmed A, Page RD (2008) The utility of intrapleural instillation of autologous blood for prolonged air leak after lobectomy. Curr Opin Pulm Med 14(4):343–347

    Article  PubMed  Google Scholar 

  3. Arozullah AM, Daley J, Henderson WG et al (2000) Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. The national veterans administration surgical quality improvement program. Ann Surg (United States) 232(2):242–253

    Google Scholar 

  4. Artigas A, Bernard GR, Carlet J et al (1998) The American-European Consensus Conference on ARDS, part 2: Ventilatory, pharmacologic, supportive therapy, study design strategies, and issues related to recovery and remodeling. Acute respiratory distress syndrome. Am J Respir Crit Care Med 157(4 Pt 1):1332–1347

    CAS  PubMed  Google Scholar 

  5. Bedard EL, Uy K, Keshavjee S (2007) Postpneumonectomy syndrome: a spectrum of clinical presentations. Ann Thorac Surg 83(3):1185–1188

    Article  PubMed  Google Scholar 

  6. Boffa DJ, Allen MS, Grab JD et al (2008) Data from the society of thoracic surgeons general thoracic surgery database: the surgical management of primary lung tumors. J Thorac Cardiovasc Surg 135(2):247–254

    Article  PubMed  Google Scholar 

  7. Brunelli A, Monteverde M, Borri A et al (2004) Predictors of prolonged air leak after pulmonary lobectomy. Ann Thorac Surg 77(4):1205–1210

    Article  PubMed  Google Scholar 

  8. Cassivi SD, Allen MS, Vanderwaerdt GD et al (2008) Patient-centered quality indicators for pulmonary resection. Ann Thorac Surg 86(3):927–932

    Article  PubMed  Google Scholar 

  9. Chung SA, Yuan H, Chung F (2008) A systemic review of obstructive sleep apnea and its implications for anesthesiologists. Anesth Analg (United States) 107(5):1543–1546

    Google Scholar 

  10. Cooper WA, Miller JI (2001) Management of bronchopleural fistula after lobectomy. Semin Thorac Cardiovasc Surg (United States) 13(1):8–12

    Google Scholar 

  11. Dulu A, Pastores SM, Park B et al (2006) Prevalence and mortality of acute lung injury and ARDS after lung resection. Chest 130(1):73–78

    Article  PubMed  Google Scholar 

  12. Ferguson ND, Kacmarek RM, Chiche JD et al (2004) Screening of ARDS patients using standardized ventilator settings: influence on enrollment in a clinical trial. Intensive Care Med (United States) 30(6):1111–1116

    Article  Google Scholar 

  13. Gothard J (2006) Lung injury after thoracic surgery and one-lung ventilation. Curr Opin Anaesthesiol (United States) 19(1):5–10

    Google Scholar 

  14. Grichnik KP, D’Amico TA (2004) Acute lung injury and acute respiratory distress syndrome after pulmonary resection. Semin Cardiothorac Vasc Anesth (United States) 8(4):317–334

    Article  Google Scholar 

  15. Gross JB, Bachenberg KL, Benumof JL et al (2006) Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology (United States) 104(5):1081–1093

    Google Scholar 

  16. Hachenberg T (2007) Management respiratorischer Komplikationen. Anasthesiol Intensivmed Notfallmed Schmerzther 42(5):368–369

    Article  PubMed  Google Scholar 

  17. Hofer S, Plachky J, Fantl R et al (2006) Postoperative pulmonale Komplikationen: Prophylaxe nach nichtkardiochirurgischen Eingriffen. Anaesthesist 55(4):473–484

    Article  CAS  PubMed  Google Scholar 

  18. Hollaus PH, Lax F, el-Nashef BB et al (1997) Natural history of bronchopleural fistula after pneumonectomy: a review of 96 cases. Ann Thorac Surg (United States) 63(5):1391–1396

    Article  Google Scholar 

  19. Jeon K, Yoon JW, Suh GY et al (2009) Risk factors for post-pneumonectomy acute lung injury/acute respiratory distress syndrome in primary lung cancer patients. Anaesth Intensive Care 37(1):14–19

    CAS  PubMed  Google Scholar 

  20. Kalluri M, Sahn SA, Highland KB (2008) Chronic dyspnea and severe obstruction after pneumonectomy: postpneumonectomy syndrome. Am J Med Sci 336(6):530–531

    Article  PubMed  Google Scholar 

  21. Koch C, Li L, Figueroa P et al (2009) Transfusion and pulmonary morbidity after cardiac surgery. Ann Thorac Surg 88(5):1410–1418

    Article  PubMed  Google Scholar 

  22. Kozian A, Schilling T, Hachenberg T (2005) Non-analgetic effects of thoracic epidural anaesthesia. Curr Opin Anaesthesiol 18(1):29–34

    Article  PubMed  Google Scholar 

  23. Kozian A, Schilling T, Strang C et al (2006) Anesthetic considerations in patients with previous thoracic surgery. Curr Opin Anaesthesiol 19(1):26–33

    Article  PubMed  Google Scholar 

  24. Licker M, Fauconnet P, Villiger Y, Tschopp JM (2009) Acute lung injury and outcomes after thoracic surgery. Curr Opin Anaesthesiol 22(1):61–67

    Article  PubMed  Google Scholar 

  25. MacCallum NS, Evans TW (2005) Epidemiology of acute lung injury. Curr Opin Crit Care 11(1):43–49

    Article  PubMed  Google Scholar 

  26. Mussi A, Lucchi M, Davini F et al (2000) Gastropleural fistula as complication of postpneumonectomy empyema. J Cardiovasc Surg 41(1):147–149

    CAS  Google Scholar 

  27. Ozpolat B (2010) Autologous blood patch pleurodesis in the management of prolonged air leak. Thorac Cardiovasc Surg 58(1):52–54

    Article  CAS  PubMed  Google Scholar 

  28. Ruffini E, Parola A, Papalia E et al (2001) Frequency and mortality of acute lung injury and acute respiratory distress syndrome after pulmonary resection for bronchogenic carcinoma. Eur J Cardiothorac Surg 20(1):30–36

    Article  CAS  PubMed  Google Scholar 

  29. Schilling T, Kozian A, Huth C et al (2005) The pulmonary immune effects of mechanical ventilation in patients undergoing thoracic surgery. Anesth Analg 101(4):957–965

    Article  PubMed  Google Scholar 

  30. Schreiber J (2009) Medikamenteninduzierte Lungenerkrankungen. Pneumologe 6:113–124

    Article  Google Scholar 

  31. Silliman CC, Ambruso DR, Boshkov LK (2005) Transfusion-related acute lung injury. Blood 105(6):2266–2267

    Article  CAS  PubMed  Google Scholar 

  32. Villar J, Perez-Mendez L, Kacmarek RM (1999) Current definitions of acute lung injury and the acute respiratory distress syndrome do not reflect their true severity and outcome. Intensive Care Med 25(9):930–935

    Article  CAS  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Fachbereich für Pneumologie, Universitätsklinikum der Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland

    J. Schreiber

  2. Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum der Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland

    C. Huth

  3. Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum der Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland

    T. Hachenberg

Authors
  1. J. Schreiber
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Huth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. Hachenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Schreiber.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schreiber, J., Huth, C. & Hachenberg, T. Perioperative pulmonale Komplikationen in der Thoraxchirurgie. Pneumologe 7, 272–278 (2010). https://doi.org/10.1007/s10405-009-0362-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10405-009-0362-9

Schlüsselwörter

Keywords

Search

Navigation