Preemptive gastrointestinal tract management reduces @entity1173 and XXXX after thoracic operations.

@entity1 @entity55 @entity1576 @entity158 @entity204 @entity1173
OBJECTIVES: @entity1576 is the major mode of @entity204 after general thoracic operations. However, @entity1576 may develop from two very different mechanisms: @entity1173 , often caused by ileus, and @entity55 , which often results from poor @entity158 control. Epidural catheters help control @entity158 and prevent @entity55 but contribute to ileus and may increase @entity1173 . We report a decrease in the incidence of @entity1173 after changing postoperative care to include gastrointestinal tract management. METHODS: All @entity1 undergoing elective thoracotomy by a single surgeon were evaluated for hospital mortality and morbidity. For the first 21 months, @entity1 did not receive an intraoperative nasogastric tube and were prescribed an "advance as tolerated" diet after the operation (n = 125). For the second period, nasogastric tubes were placed intraoperatively and @entity1 received nothing by mouth the day of operation, clear liquids the first day, and a regular diet the second day (n = 153). @entity55 was considered to have developed if infiltrates developed in a single lobe or two adjoining lobes and culture of the sputa grew a dominant organism. @entity1 were considered to have aspirated if diffuse infiltrates developed or cultures grew multiple organisms. Significance of results was determined by chi(2) testing. RESULTS: A total of 278 @entity1 underwent elective lung resection over a 3(1/2)-year period, 125 with ad libitum dietary management and 153 with intensive management of the gastrointestinal tract. Six @entity1 (4.84%) aspirated before the institution of gastrointestinal tract management, whereas none (0.0%) aspirated after the change. This difference was significant (P =.01). Respiratory mortality was eliminated in the group with gastrointestinal tract management (P =.04). CONCLUSIONS: Aspiration and its subsequent @entity1576 and mortality can be decreased with preemptive gastrointestinal tract management.
