[Intensive care of thoracic surgery patients]

An intensive treatment of patients undergoing thoracic surgery is important, foremost because of the extensity of the surgical procedures and the generally poor condition of the patients. As a first stage of preoperative preparation an evaluation of the functional capacity of the vital organs (heart, lungs and kidneys) is performed, and the most important infection's focci of the oro-pharynx, tracheobronchial tree, urinary tract and skin have to be detected and treated. Respiratory physiotherapy before the surgery improves the ventilatory function, enabling the patient to breath regularly and effectively cough, wherewith a bronchial spasm is prevented and bronchopulmonary infection limited. Before surgery any hypovolaemia, anaemia, hypoproteinemia and dysproteinaemia should also be corrected; in such patients the parenteral alimentation (hyperalimentation) through the central venous catheter, is also important. Immediately following the operation a continuous supervision of vital functions (usually managed by well-experienced surgical nurses) is very essential. Isothermia, isovolemia, a correct oxygenation and analgesia should be maintained permanently. To loose sight of hypoventilation and hypoxia can likely induce respiratory insufficiency. Symptoms indicating tracheal intubation and mechanical ventilation should be watched for and treated at the right moment. Following the surgery, prevention of pulmonary atelectasis and pneumonia, providing an effective thoracic drainage, and respiratory physiotherapy is of utmost importance. The prophylaxis of postoperative pulmonary embolism in particularly jeopardized patients consists in the administration of heparin. Antibiotics in accordance with antibiogram (material: samples taken by a catheter or by bronchoscope from the lung directly).