Rhonchi

Summary for patients. Those Incentive Spirometry orders stand!

Preoperative Pulmonary Risk Stratification for Noncardiothoracic Surgery: Systematic Review for the American College of Physicians — Smetana et al. 144 (8): 581 — Annals of Internal Medicine
The authors found good evidence that the following patient factors increase the chances of pulmonary complications: older age, American Society of Anesthesiologists class II or higher, chronic obstructive pulmonary disease, dependence on others for help with daily activities, and congestive heart failure. The authors also found good evidence that pulmonary complications are most common with aortic aneurysm repair, thoracic surgery, abdominal surgery, neurosurgery, vascular surgery, head and neck surgery, surgery lasting for more than 3 hours, emergency surgery, and general anesthesia. The only laboratory test result that predicted pulmonary complications was low serum albumin level (blood test that indicates poor nutritional status). The authors found good evidence that strategies to expand the lungs after surgery, such as deep breathing exercises, reduce the risk for pulmonary complications. They found fair evidence that selective use of a nasogastric tube (a tube passed through the nose to the stomach) for nausea, vomiting, or abdominal distention only reduces pulmonary complications after abdominal surgery. They found insufficient evidence to draw firm conclusions about the effectiveness of other strategies to reduce pulmonary complications.