**Author details**

Anand Iyer and Sumit Yadav

Department of Cardiothoracic surgery, Townsville Hospital, Queensland, Australia

### **References**

day progresses, which may cause aspiration or impaired physiotherapy due to inability to cough effectively. A laryngoscopy is done to confirm the diagnosis and adduction of the affected vocal cord or sluggish motion will be absent. Treatment depends on whether the injury is temporary or permanent. A fibre optic evaluation is necessary to test swal‐ lowing and sensation. To assist with pulmonary physiotherapy and decrease the risk of aspiration, medialization laryngoplasty may be suggested [136]. This can be done as an office procedure with the aid of autologous fat, Gel foam, collagen, or polytetrafluoro‐

Infectious complications after pulmonary surgery include operative wound infection, em‐ pyema, and nosocomial pneumonia. Antibiotic prophylaxis should therefore be guided against these three entities. The incidence varies from 5% to 24.4%. They are responsible for increased hospital mortality to up to 19% as well as increased costs and length of hos‐ pital stay. In one study 53.6% of the germs identified were gram-negative bacteria, 39.3% gram-positive bacteria, and 7.1% were fungi [137]. These infections should be aggressive‐ ly treated with appropriate antibiotics after culture. Chest physiotherapy, pain control, bronchodilators, and early ambulation should be done for all patients but regardless of these pneumonia develops. Postoperative atelectasis after pulmonary surgery should be aggressively managed before it deteriorates into pneumonia. Our policy is to give Ticar‐ cillin Sodium and Potassium Clavulanate 3.1 g four times a day in divided doses till a

The incidence of empyema is dropping but could happen if there is prolonged air leak. Generally they are managed with antibiotics but may necessitate thoracotomy and wash out.

Other complications include pulmonary embolism, deep venous thrombosis, renal failure, strokes, major gastrointestinal bleed and late empyema. These complications should be recognised very early and aggressive management should be instituted if they are to be tackled

Thus postoperative care and management of postoperative complications is a team approach and good preoperative and intraoperative measures minimize the incidence of postoperative complications and early recognition and treatment is essential for successful outcomes.

Department of Cardiothoracic surgery, Townsville Hospital, Queensland, Australia

ethylene. [136]

74 Principles and Practice of Cardiothoracic Surgery

**7. Infections**

positive culture is obtained.

successfully.

**Author details**

Anand Iyer and Sumit Yadav


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**Chapter 4**

**Management of Malignant Pleural Effusion**

Pleural effusions can form basing on the disease of the pleural membranes themselves or thoracic or abdominal organs [1]. The pleura is also important to maintain local fluid homeo‐ stasis. The exact mechanisms of pleural fluid production and absorption are complex and not

The normal pleural space is approximately 18 to 20 μm in width, although it widens at its most dependent areas. It has been shown that the pleural membranes do not touch each other and

Classically described; pleural effusion is the accumulation of fluid in the pleural gap that may be caused by any reason [4]. If there is an evidence of invasion by the tumor or any malignant cells detected in this fluid, it is described as malignant pleural effusion. Although there has been no epidemiologic study with respect to pleural effusion yet, it is a common clinic problem which is estimated to be a million cases in the United States of America every year. Malignant diseases account for over 22% of all cases that means; approximately 220 000 new patients in

Primary tumours of the pleural space are less common [6]. Pleural metastasis may be caused by any organ. Malignant pleural effusions (MPE) are most frequently produced by carcinomas of the lung (37%), breast (25%), and ovary (10%). Other reasons include malignancies of the genitourinary (7%) or gastrointestinal tract (9%) and lymphoma (10%) [7]. Even today, in up

The incidence and prevalence of mesothelioma may vary from region to region. Interestingly, despite its grim reputation, mesothelioma whose curative treatments are not yet available, offers better survival than does metastatic pleural disease, with a median survival of less than

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© 2013 Esme and Calik; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

to 10% of the malignant pleural effusions, the origin of tumour is not identified [8].

Hidir Esme and Mustafa Calik

http://dx.doi.org/10.5772/54441

**1. Introduction**

fully understood [2, 3].

12 months [6].

Additional information is available at the end of the chapter

that the pleural space is a real gap, not a potential space [1].

the United States and 40 000 in the United Kingdom [5].

