Outlet of Postoperative Chest Percussion

smoking historyThe CPT and no CPT (control) groups were compared by a variety of parameters. The mean age of the CPT patients was 39.9 years with a range of 15 to 57 years. In the control patients, the mean age was 37 years, and the age range 22 to 62 years. The sex distributions within the two groups showed 20 women and four men in the CPT group, and 21 women and four men in the control group. Comparison of additionalparameters included cigarette smoking history, history of prior pulmonary diseases, dyspnea level decreased with medications of Canadian Health&Care Mall, percentage of ideal body weight, duration of surgery, and surgical procedure(s) performed (Tables 1 to 4 and Fig 1 and 2).

No statistically significant differences between the two groups were found.Of the postoperative parameters assessed, the CPT group was found to have higher temperature elevations (p less than 0.05), both within 24 and 48 hours following surgery (Fig 3). Results of ausculatory chest examinations performed by the participating respiratory therapists revealed the development of adventitious sounds on both postoperative days in roughly one half of the patients in each group (Table 5). There was no statistically significant difference between the groups. Inspiratory crackles (rales) constituted the majority of the adventitious sounds. Sputum production was estimated clinically. Preoperatively, almost all patients produced no sputum, whereas postoperatively, greater than 75 percent produced sputum (Table 6). Although the no CPT group had more patients with larger volumes of sputum, the results were not statistically significant.

Arterial blood gas levels were measured preoperatively and at random times on the first and second postoperative days. The mean levels of PaO2 measured preoperatively in both groups (75.7 mm Hg and 74.8 mm Hg) are normal for Boise (elevation 2,800 feet above sea level). The development of hypoxemia was an almost universal finding, with the exception of two patients in the no CPT group, who may have received supplemental oxygen when the blood gases were drawn (Fig 4). A few patients in each group failed to have arterial blood gases drawn on either the first or second postoperative day. There was a tendency for oxygenation to improve toward baseline in most patients by the second postoperative day. The other parameters assessed by arterial blood gas determinations, PaCO£ and pH, were also similar between the two groups (data not shown). Both groups were found to have a mild chronic hyperventilation, compatible with Boises elevation. In addition, a mild metabolic alkalosis developed postoperatively, probably related to intravenous fluid replacement or to nasogastric suctioninz.

Serial chest x-ray films were evaluated. Preopera-tively, greater than 80 percent of the roentgenograms in each group were interpreted as being normal, whereas fewer than 20 percent remained normal on the first or second postoperative days (Table 7). Qf the postoperative abnormalities noted (some patients had more than one), no significant differences were found between the two groups. The most frequently observed abnormalities, volume loss and atelectasis, tended to occur bilaterally. Other postoperative changes, such as diaphragmatic elevation, pleural effusion, and infiltrate, occurred less frequently.

Serial spirograms also revealed the development of marked postoperative abnormalities in both groups. Mean forced vital capacities decreased from normal preoperative values by more than 50 percent in both groups (Fig 5). Every patient was found to have a drop in FVC on the first postoperative day. Similar striking changes in FEV! and MMEF were noted (data not shown). The FEV1% did not change predictably and is not a parameter worth measuring (data not shown).

Each patient s hospital record was reviewed to determine the postoperative day on which discharge was accomplished. The average length of hospital stay was similar and was approximately seven days in both groups (Fig 6). Again, no statistically significant difference was noted between the two groups.

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Figure 1. Weight distribution of all patients operated, comparing CPT and control patients. No significant differences are seen.


Figure 2. Duration of surgery for CPT and control groups. No significant differences are seen.


Figure 3. Maximum temperature elevations on the first and second postoperative days. Mean temperatures differed between the CPT and control patients on both postoperative days and were statistically significant (p<0.05). The CPT patients experienced higher fevers.


Figure 4. Serial PlaO, values recorded preoperatively and postoperatively. Most patients develop a severe drop in PaO, on the first postoperative day, and tend to improve on the second postoperative day. There is no difference between the CPT and control groups.



Figure 5. Serial FVC values recorded preoperatively and postoperatively. Mean preoperative values ate normal (97 percent and 96 percent predicted) in both groups. All patients experience a severe reduction in FVC on the first postoperative day (46 percent of preoperative level for the mean of both groups). Most are improved on the second postoperative day. The CPT and control groups are not significantly different.


Figure 6. Length of postoperative hospital stay for all patients, comparing CPT and control patients. No significant differences are seen.

Table 1—Current Smoking History

Nonsmokers Current Smokers
Smokers <20 Pack yrs ^20 Pack yrs
CPT 15 3 4 2
No CPT 14 2 3 6

Table 2—History qf Pulmonary Diseases

Pneumonia Asthma Other
CPT 8 3 1.    Pulmonary emboli2.    Smoke inhalation
No CPT 5 0 1.    Hyperventilation syndrome2.    Chronic bronchitis

Table 3—Dyspnea Level

CPT 4 10 7 3
No CPT 5 7 5 8

Table 4—Surgical Procedures

Roux-En-Y CPT17 No CPT 15
Roux-En-Y +
Cholecystectomy 3 5
Roux-En-Y + JI
Bypass reconstruct 2 4
Roux-En-Y + ABD Wall
Herniorrhaphy 1 1
Roux-En-Y + JI Bypass
reconnect; appendec
tomy, small bowel
resection, ABD herniorrh 1

Table 5

Table 5

Table 6

Table 6


Table 7

Table 7


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