Respiratory complications in postoperative patients.

OBJECTIVES: This study was conducted to see the extent of respiratory morbidity in the general surgical unit of a teritiary care teaching hospital and to look for probable factors that were responsible for them. METHODS: A prospective study was conducted over a six month period, of patients who underwent both elective and emergency surgeries. Patients were assessed pre-operatively, on the fifth post operative day and at the time of discharge for respiratory complications. RESULTS: Five hundred eighty four consecutive patients who underwent surgeries were studied. Eighty one of them (13.9%) had respiratory complications. Pneumonia was the most common complication (68%). The others included pleural effusion, empyema, pneumothorax and exacerbations of asthma and chronic obstructive pulmonary disease (COPD). One patient developed ARDS (Adult respiratory distress syndrome) and died. Patients who underwent upper abdominal surgery (both elective and emergency), those who had a stay in the surgical ICU for more than 24 hours and those who were on the ventilator for more than 24 hours had a higher incidence of respiratory complications (p < 0.001). CONCLUSION: Respiratory complications increase the morbidity in post operative patients. Pre-operative respiratory illnesses, upper abdominal surgery, ICU stay and mechanical ventilation in the post-operative period predispose patients to respiratory complications. Pre-operative respiratory assessment and treatment of any underlying respiratory disorder is necessary and may decrease the morbidity in surgical patients.

Prevalence of nosocomial infection in critically ill patients with abdominal pathology.

Bacterial infection is a problem in the intensive care unit (ICU). We conducted the present study in the surgical ICU over a period of 5 months to determine the prevalence of nosocomial infection. Our ICU has a bed strength of 7 with an average occupancy rate of 5.46 patients. Mechanical ventilation associated pneumonitis was the commonest nosocomial infection. Older patients, patients with organ system failure and patients with co-morbid conditions were at high risk of developing nosocomial infections. E. coli was the commonest and most resistant organism grown in our study.

Nutritional assessment of marginally nourished surgical patients.

BACKGROUND. Anthropometric indices are known to be good indicators of nutritional status in the long term. However, there are conflicting reports about their effectiveness in short term assessments. METHODS. In 45 patients undergoing elective operations, the mid-arm circumference, biceps and triceps skin fold thickness and arm muscle area were measured. These were compared with haematological indices of nutritional status such as serum albumin, total protein and haemoglobin. The patients were divided into two groups based on their body mass index (< or > 18.5) or weight (< or > 52 kg). In another 10 patients, anthropometric and blood indices were studied pre- and postoperatively along with changes in body composition. RESULTS. When patients were grouped according to weight or body mass index, the anthropometric indices studied showed significant differences between the two groups, i.e. weight < 52 kg v. > 52 kg (mid-arm circumference: 22 +/- 3.3 cm v. 10 +/- 1.8 cm, p < 0.01; triceps skin fold thickness: 5.6 +/- 1.4 mm v. 10 +/- 4.9 mm, p < 0.01) although there were no differences in the blood indices. The 10 patients studied longitudinally were on energy-deficient intakes in the first postoperative week and lost lean tissue and body fat (-43 g, -33 g and -19 g protein and -78 g, -88 g and -97 g fat on postoperative days 1, 4 and 8 respectively). There was a variable response in terms of weight and body water. The measured anthropometric indices, however, showed no significant differences. CONCLUSIONS. Our results suggest that anthropometric indices are useful measures of nutritional status on a cross-sectional basis, whereas blood indices are not. Weight changes and anthropometric indices are not reliable guides to the short term nutritional course after an operation.