Respiratory assessment post cardiac surgery

Dg Zuraini Sahadan
Sultan Idris Shah Hospital, Serdang, Selangor, Malaysia

Respiratory assessment after cardiac surgery is crucial to detect early signs of complications such as atelectasis, pleural effusion, chylothorax, pneumonia, pulmonary oedema and diaphragmatic paralysis, which are common due to factors like general anaesthesia, mechanical ventilation, chest incision and immobility.

Respiratory assessments involve monitoring respiratory rate, oxygen saturation, lung sounds, and chest X-rays, as well as evaluating the patient's ability to cough and clear secretions. Pulmonary function tests may also be used to assess lung capacity and function before and after surgery. In certain occasions flexible bronchoscopy is needed for airway assessment and pulmonary toileting.

Pulse oximetry is used to continuously monitor oxygen saturation levels. Arterial blood gas analysis may be required to assess oxygen and carbon dioxide levels, especially in cases of respiratory distress or unstable respiratory status. Respiratory rate and pattern are closely observed while End-tidal CO2 monitoring can provide information about ventilation. The work of breathing is assessed by observing the use of accessory muscles, nasal flaring, and chest retractions. Auscultation of the lungs for quality of breath sounds and adventitious sounds can help identify areas of consolidation, atelectasis, or secretions. Asymmetrical movement or paradoxical chest wall movement can indicate respiratory muscle weakness. lung collapse and diaphragmatic paralysis. Assessment of readiness for extubation includes evaluating respiratory muscle strength and assessing the endotracheal tube leak. 

In summary, recognizing these potential issues and providing prompt and appropriate care is vital for improving the respiratory outcome post cardiac surgery.