title: Pulmonary lobectomies for patients with cognitive impairment: the importance of postoperative respiratory care.
abstract: BACKGROUND
  Patients with cognitive impairment (CI) may have an increased risk of complications after major thoracic surgery. However, little is known about this risk and the corresponding management.
  
  
  METHODS
  Clinical data of patients who underwent pulmonary lobectomy via open thoracotomy between January 2006 and December 2008 in our institution were retrospectively reviewed.
  
  
  RESULTS
  Overall, 1,325 patients who underwent pulmonary lobectomy via open thoracotomy were analyzed retrospectively, in which five patients were diagnosed with CI. Sputum retention was common and led to significant hypoxemia in all five patients. Four patients were re-intubated due to severe respiratory dysfunction, and three underwent tracheotomy 7 days after intubation due to respiratory infection. Regarding to duration of chest tube placement, length of hospital stay, morbidity rate, and hospital cost, CI patients were significant higher compared with cognitively normal patients undergoing lobectomy via open thoracotomy.
  
  
  CONCLUSIONS
  Patients with CI may have difficulties in expectoration after pulmonary lobectomy, and develop multiple respiratory complications, thus increasing hospital stay. Efficacious sputum and airway clearance is critical in these patients.
authors.affiliation: 1 Department of Thoracic Surgery, Shanghai Chest Hospital of Shanghai Jiaotong University, Shanghai 200030, China ; 2 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China.
authors.forename: Yifeng
authors.initials: Y
authors.lastname: Sun
authors.affiliation: 1 Department of Thoracic Surgery, Shanghai Chest Hospital of Shanghai Jiaotong University, Shanghai 200030, China ; 2 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Gao
authors.affiliation: 1 Department of Thoracic Surgery, Shanghai Chest Hospital of Shanghai Jiaotong University, Shanghai 200030, China ; 2 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Zheng
authors.affiliation: 1 Department of Thoracic Surgery, Shanghai Chest Hospital of Shanghai Jiaotong University, Shanghai 200030, China ; 2 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China.
authors.forename: Gening
authors.initials: G
authors.lastname: Jiang
authors.affiliation: 1 Department of Thoracic Surgery, Shanghai Chest Hospital of Shanghai Jiaotong University, Shanghai 200030, China ; 2 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China.
authors.forename: Chang
authors.initials: C
authors.lastname: Chen
keywords: Cognitive impairment (CI); lobectomy; morbidity; thoracotomy