Pulmonary Lobectomies For Patients With Cognitive Impairment: The Importance Of Postoperative Respiratory Care

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.