Success of countermeasures against respiratory infection after digestive surgery by strict blood and fluid resuscitation.
This prospective controlled study included 5859 cases of digestive surgery from September 1987 to August 2002. The study was divided into six 2.5-year periods, A-F. During and after period B, cefazolin was used for surgery of the esophagus, stomach, and gall bladder, and cefotiam for colon resection, hepatectomy, and pancreatectomy. During period A, total parenteral nutrition (TPN) was administered for 6 (+/-4.6) days before surgery, on average. During and after period B, TPN was confined to patients who were incapable of oral intake. During thoracic esophageal cancer surgery, frozen plasma was administered at 10 ml/h, colloid osmotic pressure was maintained, and water was prevented from accumulating in the third space. Mechanical respiratory support was not needed during or after period B. The incidence rate of respiratory infection decreased to 1.7% during period A, and to 0.7%-1.1% during and after period B. During and after period B, in particular, early respiratory infection cases after surgery decreased significantly to 0.1%-0.3%. In period A, among the respiratory infectious bacteria isolated, MRSA was the most frequent, followed by Pseudomonas aeruginosa. After period B, P. aeruginosa was the most frequent bacterium isolated. Over all periods, there was no significant difference in resistant ratios in P. aeruginosa. Because of consistent infusion management during the perioperative period, artificial breathing became unnecessary and, as a result, the prevalence of early respiratory infection decreased significantly.
Kusachi
Shinya
S
Third Department of Surgery, Toho University Medical Center, Ohashi Hospital, 2-17-6 Ohashi, Meguro-ku, Tokyo 153-8515, Japan. mb560sel@nifty.com
Sumiyama
Yoshinobu
Y
Arima
Yoichi
Y
Yoshida
Yuichi
Y
Tanaka
Hidenori
H
Nakamura
Yoichi
Y
Nagao
Jiro
J
Saida
Yoshihisa
Y
Watanabe
Manabu
M
Watanabe
Ryohei
R
Sato
Junko
J
D019072:Antibiotic Prophylaxis / Q000379:methods; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005247:Feeding Behavior; D005440:Fluid Therapy; D006801:Humans; D009102:Multiple Organ Failure / Q000209:etiology / Q000517:prevention & control; D010289:Parenteral Nutrition, Total / Q000379:methods*; D019990:Perioperative Care / Q000379:methods; D017713:Platelet Transfusion; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000517:prevention & control; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D014882:Water-Electrolyte Balance / Q000502:physiology