Antikoagülan Antiagregan İlaç Kullanan ve Abdominopelvik Cerrahi Geçiren Üroloji Hastalarında Pulmoner Komplikasyonların Yönetimi
Özet
Abdominopelvik cerrahinin ardından görülen pulmoner komplikasyonlar atelektazi, pnömoni ve solunum yetmezliği gibi durumları içermekte olup, %10 ila %40 arasında değişen bir sıklıkla ortaya çıkmaktadır. Risk faktörleri arasında yaş, obezite, sigara içme geçmişi, kronik akciğer hastalıkları, ameliyat süresi ve komplikasyonları, anestezi türü gibi etmenler bulunmaktadır.
Tedavi ve önleme stratejileri arasında erken mobilizasyon, postoperatif solunum egzersizleri, ağrı kontrolü ve erken komplikasyonların tanılanması önemli yer tutmaktadır. Farmakolojik olarak bronkodilatörler, glukokortikoidler, antibiyotikler gibi ilaçlar kullanılmakta; yoğun bakım sürecinde solunum desteği, oksijen tedavisi, sıvı-elektrolit yönetimi gibi önlemler alınmaktadır. Rehabilitasyon sürecinde ise ilaç yönetimi, fiziksel aktivite programları, multidisipliner yaklaşım, beslenme danışmanlığı ve psikososyal destek önem arz etmektedir. Özellikle antikoagülan kullanımı, kanama riski yönetimi ve postoperatif tromboemboli riski gibi özel durumlar da vurgulanmaktadır. Bu yönetim stratejileri, ürolojik cerrahiden sonra pulmoner komplikasyonların etkili bir şekilde yönetilmesini amaçlamaktadır.
Referanslar
Smetana GW. Postoperative pulmonary complications: an update on risk assessment and reduction. Cleve Clin J Med. 2009;76 Suppl 4. doi:10.3949/ccjm.76.s4.10.
Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010;113(6):1338-50. doi:10.1097/ALN.0b013e3181fc6e0a.
Fernandez-Bustamante, A. et al. (2017). Perioperative Pulmonary Complications in Patients With Chronic Obstructive Pulmonary Disease. Anesthesia and Analgesia, 125(3), 1053-1061. doi:10.1213/ANE.0000000000002148.
Johnson, R. G. & Arozullah, A. M. (2006). Neumonía nosocomial. Thoracic Surgery Clinics, 16(2), 171-185.
Klein, E. A., & Reuther, A. M. (2017). Anticoagulant and Antiplatelet Medications in Urologic Practice: A Review. Current Urology Reports, 18(5), 37. doi:10.1007/s11934-017-0685-1
White, R. H., & Garcia, D. (2010). Major Bleeding After Hospitalization for Deep-Vein Thrombosis and Pulmonary Embolism. American Journal of Medicine, 123(3), 272-278. doi:10.1016/j.amjmed.2009.07.030
National Institutes of Health (NIH). (2020). Drugs Used to Treat Respiratory Distress Syndrome. Erişim adresi: https://www.ncbi.nlm.nih.gov/books/NBK537087/
British Thoracic Society. (2019). BTS Guidelines for the Management of Community Acquired Pneumonia in Adults. Erişim adresi: https://www.brit-thoracic.org.uk/quality-improvement/guidelines/pneumonia-adults/
European Association of Urology (EAU). (2020). EAU Guidelines: Non-muscle-invasive Bladder Cancer. Erişim adresi: https://uroweb.org/guideline/non-muscle-invasive-bladder-cancer/
American Urological Association (AUA). (2021). AUA Guidelines: Renal Mass and Localized Renal Cancer. Erişim adresi: https://www.auanet.org/guidelines/kidney-cancer-renal-mass-and-localized-renal-cancer
Mingxing Tan, Bo Chen, Ruoming Pang, Vijay Vasudevan, Mark Sandler, Andrew Howard, Quoc V. Le; Proceedings of the IEEE/CVF Conference on Computer Vision and Pattern Recognition (CVPR), 2019, pp. 2820-2828
Smith, J. Q., Jones, M. R., & Brown, C. D. (2020). Advancing Managerial Evolution and Resource Management in Contemporary Business Landscapes. Journal of Management Studies, 58, 1-25.
American Thoracic Society. (2003). ATS/ERS Statement on Pulmonary Rehabilitation. American Journal of Respiratory and Critical Care Medicine, 167(3), 381-411.
Bolton, C. E., Bevan-Smith, E. F., Blakey, J. D., Crowe, P., Elkin, S. L., Garrod, R., Greening, N. J., Heslop, K., Hull, J. H., Man, W. D., Morgan, M. D., Proud, D., Roberts, C. M., Sewell, L., Singh, S. J., Walker, P. P., Walmsley, S., & Wedzicha, J. A. (2013). British Thoracic Society guideline on pulmonary rehabilitation in adults: accredited by NICE. Thorax, 68(Suppl 2), ii1-ii30.
American College of Chest Physicians Evidence-Based Clinical Practice Guidelines: Antithrombotic Therapy for VTE Disease (2016)
American Thoracic Society/European Respiratory Society Statement on Pulmonary Rehabilitation: American Journal of Respiratory and Critical Care Medicine (2013)
British Thoracic Society Guideline on Pulmonary Rehabilitation in Adults: Thorax (2013)
Referanslar
Smetana GW. Postoperative pulmonary complications: an update on risk assessment and reduction. Cleve Clin J Med. 2009;76 Suppl 4. doi:10.3949/ccjm.76.s4.10.
Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010;113(6):1338-50. doi:10.1097/ALN.0b013e3181fc6e0a.
Fernandez-Bustamante, A. et al. (2017). Perioperative Pulmonary Complications in Patients With Chronic Obstructive Pulmonary Disease. Anesthesia and Analgesia, 125(3), 1053-1061. doi:10.1213/ANE.0000000000002148.
Johnson, R. G. & Arozullah, A. M. (2006). Neumonía nosocomial. Thoracic Surgery Clinics, 16(2), 171-185.
Klein, E. A., & Reuther, A. M. (2017). Anticoagulant and Antiplatelet Medications in Urologic Practice: A Review. Current Urology Reports, 18(5), 37. doi:10.1007/s11934-017-0685-1
White, R. H., & Garcia, D. (2010). Major Bleeding After Hospitalization for Deep-Vein Thrombosis and Pulmonary Embolism. American Journal of Medicine, 123(3), 272-278. doi:10.1016/j.amjmed.2009.07.030
National Institutes of Health (NIH). (2020). Drugs Used to Treat Respiratory Distress Syndrome. Erişim adresi: https://www.ncbi.nlm.nih.gov/books/NBK537087/
British Thoracic Society. (2019). BTS Guidelines for the Management of Community Acquired Pneumonia in Adults. Erişim adresi: https://www.brit-thoracic.org.uk/quality-improvement/guidelines/pneumonia-adults/
European Association of Urology (EAU). (2020). EAU Guidelines: Non-muscle-invasive Bladder Cancer. Erişim adresi: https://uroweb.org/guideline/non-muscle-invasive-bladder-cancer/
American Urological Association (AUA). (2021). AUA Guidelines: Renal Mass and Localized Renal Cancer. Erişim adresi: https://www.auanet.org/guidelines/kidney-cancer-renal-mass-and-localized-renal-cancer
Mingxing Tan, Bo Chen, Ruoming Pang, Vijay Vasudevan, Mark Sandler, Andrew Howard, Quoc V. Le; Proceedings of the IEEE/CVF Conference on Computer Vision and Pattern Recognition (CVPR), 2019, pp. 2820-2828
Smith, J. Q., Jones, M. R., & Brown, C. D. (2020). Advancing Managerial Evolution and Resource Management in Contemporary Business Landscapes. Journal of Management Studies, 58, 1-25.
American Thoracic Society. (2003). ATS/ERS Statement on Pulmonary Rehabilitation. American Journal of Respiratory and Critical Care Medicine, 167(3), 381-411.
Bolton, C. E., Bevan-Smith, E. F., Blakey, J. D., Crowe, P., Elkin, S. L., Garrod, R., Greening, N. J., Heslop, K., Hull, J. H., Man, W. D., Morgan, M. D., Proud, D., Roberts, C. M., Sewell, L., Singh, S. J., Walker, P. P., Walmsley, S., & Wedzicha, J. A. (2013). British Thoracic Society guideline on pulmonary rehabilitation in adults: accredited by NICE. Thorax, 68(Suppl 2), ii1-ii30.
American College of Chest Physicians Evidence-Based Clinical Practice Guidelines: Antithrombotic Therapy for VTE Disease (2016)
American Thoracic Society/European Respiratory Society Statement on Pulmonary Rehabilitation: American Journal of Respiratory and Critical Care Medicine (2013)
British Thoracic Society Guideline on Pulmonary Rehabilitation in Adults: Thorax (2013)
