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lungprotective perioperative care

Epidemiology:
  • risk factors (1): length of surgery >2h -> x4

Treatment:

  • Tooth brushing or chlorhexidine for several days before surgery of heart, lung and upper gastrointestinal tract (1).
  • Lubrification of double lumen tubes for prevention of leakage through folds in the cuff (2).
  • Semi-recumbent position after extubation.
  • Controll pressure cuff -> adequate is 20-30 cmH2O (especially after moving head for example in ICU settings).
  • Use PEEP (5-8 cmH2O)
  • Cuff design -> taperguard PVC is better.

References:

  1. Lecture "lungprotective perioperative care". SGAR-Kongress 2013.
  2. The effect of gel lubrication on cuff leakage of double lumen tubes during thoracic surgery. Anaesthesia. 2006; 61: pp 133-7: abstract.