Location & Review
- Traditionally managed in a high dependency environment
- Immediate management on specialist thoracic ward increasingly recognised as safe for low-risk patients
Monitoring & Investigations
- Close monitoring required to allow early recognition of complications
Supportive Care
- Fluids should be restricted whilst avoiding hypovolaemia:
- Excess fluid independent risk factor for post-operative pulmonary oedema
- Fluid balance within the first 24 h should not exceed 20 ml/kg
- Fluid rate often limited to previous hour’s urine output plus 20 ml in the immediate postoperative period
- Ongoing analgesia to allow effective cough and secretion clearance:
- Opioid PCA
- Epidural or paravertebral catheters
- Adjunctive analgesics
- Early and intensive physiotherapy to promote secretion clearance and prevent atelectasis