Rusu Gabriel- General Medicine

 Major interventions significantly affects the functions of more systems such as respiratory one, increasing the risk of pulmonary postoperative complications.  Atelectasis, pneumonia, respiratory failure are frequently.  Personal pathological status plays an important role in developing those, such as: COPD, chronic smoking, cardiovascular or renal disease.  Surgical positions on the operative room and the duration of intervention influence the morbidity through pulmonary complications.  General anaesthesia reduces functional residual capacity, that will lead to atelectasis.

 Non-invasive ventilation is increasingly used in the treatment of acute respiratory failure  It is addressed to hypoxemia, preventing atelectasis, improving gas exchange and decreasing the respiratory labor.  More indications: acute COPD, pulmonary edema (cardiogenic or non-cardiogenic), acute respiratory failure.  The patient is breathing spontaneous through a pressurized system against a resistance that maintain a default positive pressure.  Although many studies have shown the ability of CPAP to reduce atelectasis, none of them have shown that the rate of intubation it is actually reduced.

 The connection between respiratory physiotherapy and improvement of acid-base parameters and oxygenation of the critic surgical patient in the first 24 hours postoperative.  Parameters: PH, PO2, PCO2, Alveolar-arterial gradient, SO2  Right after physiotherapy there are no changes in the PH and neither after 15 minutes.  PCO2 decreases after the procedure, but after 15 minutes the average value rises again, without reaching statistical significance.  It is noticed an improvement of PO2 after the CPAP, but no significant statistical difference occurred.  A-a gradient has a stationary evolution.  SO2 rises immediately after procedure, but also after 15 minutes the average value decreases.

Twenty consenting patients of which: 55% men and 45% women, hemodynamic stable, spontaneous respirations.  Respiratory therapy with nebulizer 1. Saline solution (0,9% or 5,85% in 1:1 dilution) 2. The patient had to breath deeply and rare, in order to maximize the effects. 3. Followed by the clearing of mucus and relief of the cough.  Non-invasive ventilation(CPAP) 1. Parameters: PEEP: 5, FiO2: 0,35, ASB: 12. Duration: 15 minutes. 2. Three blood gas analysis(ASTRUP): before, after and also 15 minutes after.  Thoracic tapotement 1. Purpose: clearing of mucus from lower respiratory tract to the superior one. 2. Each lung was massaged from the base to the apex. The patient had to cough in order to eliminate the mucus.

 After the procedures, 15 of the 20 patients had improvements, and 5 of them didn’t, because of postoperative pain and lack of compliance.  Average value of PH before was: After the procedures was 7.39 and 15 minutes from them was  Between these values there is no statistical difference (U-Mann Whitney Test, p=0.72 for (1) moment and p=0.1 for (2) towards (0)) PH evolution

 Average value of PCO2 before the procedures was 38.3 mmHg. Right after them turns 37.7 mmHg and 15 minutes after 39.7mmHg.  It has been observed the decrease of the average value of PCO2, right after the CPAP, but 15 minutes after, the value rises again also with no significantly statistical difference between the moments( p=0.17, and p=0.6) PCO2 evolution

 Before: 80.7mmHg, after: 84.9 mmHg and 15 minutes after the procedures: 84 mmHg  It was observed an improvement of the values right after the CPAP and nebulization, however there is no significantly statistical difference(p=0.1 and p=0.51) PO2 evoluton

 Before the CPAP average value was: 96%, after: 96.6% and 15 minutes after 96.1%.  There has been an increase of the SO2 value after the CPAP, but the moment (2) shows us that the value of SO2 is decreasing, also with no significantly statistical difference(p=0.4 and p=0.9) SO2 evolution

 Average value of the gradient before CPAP was 94.9 mmHg, it has increased immediately after at mmHg and after 15 minutes reached 93mmHg  It is a stationary evolution of the values between the moments (0),(1) and (3). Gradient A-a evolution

 Analyzing the whole group of patients, I concluded that there were no significantly changes in the values of: PH, PCO2, PO2, SO2 and A- a gradient.  Five of the patients actually show worsening of the parameters, because of postoperative pain that decreases the compliance of the patients to the procedures.  To the fifteen compliant patients, to which have been observed improvements, the only significantly change was of the PCO2, the lung collapsing quickly after the PEEP ended.  Patient monitoring was short, so that we cannot reach a definite conclusion among the impact of prophylactic respiratory physiotherapy in those patients where the characteristic changes of pulmonary shunt are not present.  Postoperative pulmonary complications are often seen in ICU after major surgery and are needed more prospective studies to show the prophylactic benefits of the procedures.