2001 OPEN FORUM Abstracts
A Studyof Patients Who Developed Post-Operative Atelectasis An Outcome Measurement Perspective
George W. Lantz, B.S.,R.R.T., C.P.F.T., R.C.P. - Perinatal/Pediatric Specialist Director of Respiratory Care - ShrinersHospitals for Children, Chicago
Background:Pursuant to monitoring performance improvement indicators and clinical statisticsit was observed that there was an increasing incidence of post-operative atelectasis.A patient list was compiled covering a four-year period from 1997 through 2000to determine the degree of increase and if there was a cause and effect relationshipthat could be identified and treated. Atelectasis is determined by increasingoxygen requirements, tachypnea, hypercarbia, pulmonary congestion and/or fullor partial collapse of one or more lobes evidenced by radiological examination.
Findings: Itwas discovered that the incidence of atelectasis increased 16% in 1998, 166%in 1999 and 366% in 2000 compared to 1997. Of these patients all but one receivedspinal surgery. As there are several stages/types of spinal surgery each ofthese were investigated without any significant difference between them or ofthe number of procedures performed. However, due to the impressive number offoreign patients and patients who have varying degrees of cerebral palsy theseindicators were also investigated. 27% of the patients were foreign and54% of the patients had developmental impairments that affected their abilityto participate in their post-operative recovery. As these two indicators sharethe same outcome they were combined to reveal that 81% of all foreign/non-verbalpatients receiving spinal surgery developed post-operative alelectasis. Theresults of these findings suggest that any foreign/non-verbal patient receivingspinal surgery have an 81% chance of developing post-operative atelectasis.
Conclusion:From this information it was determined that a protocol should be developedto treat this patient population proactively, avoiding said post-operative respiratorycomplications and henceforth reducing the amount of time spent in P.I.C.U. andthe overall length of stay. Treatment options would include aggressive chestphysiotherapy combined with PEP therapy (EzPAP) or IPPB Q4 hours for48 hours then Q8 and prn for 48 hours then prn only for 48 hours.If the patient does not respond to the IPPB after 24 hours then considerationfor BiPAP at night would be considered. It was determined that our foreign/non-verbalpatient population who undergo all stages of spinal surgery are at the greatestrisk for developing post-operative atelectasis. By proactively managing thesepatients with aggressive pulmonary hygiene and lung expansion therapy, a reductionin the incidence and severity of pulmonary complications as well as the costsand length of stay can be realized. Additionally, enhanced patient comfort andcustomer satisfaction will also reflect an enhanced dimension of patient care.