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Crisis management during anaesthesia: pulmonary oedema

¹ Senior Staff Specialist, Intensive Care Unit, Royal Adelaide Hospital, and University of Adelaide, Adelaide, South Australia, Australia
² Associate Professor, University of New South Wales and Director of Research, Department of Intensive Care Medicine, The St George Hospital, Sydney, Australia
³ Senior Staff Specialist, Department of Anaesthesiology and Perioperative Medicine, North Shore Hospital, Auckland, New Zealand
⁴ Professor and Head, Department of Anaesthesia and Intensive Care, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia

Correspondence to:
Professor W B Runciman
President, Australian Patient Safety Foundation, GPO Box 400, Adelaide, South Australia 5001, Australia; research{at}apsf.net.au Background: Pulmonary oedema may complicate the perioperative period and the aetiology may be different from non-operative patients. Diagnosis may be difficult during anaesthesia and consequently management may be delayed.

Objectives: To examine the role of a previously described core algorithm "COVER ABCD–A SWIFT CHECK", supplemented by a specific sub-algorithm for pulmonary oedema, in its management occurring in association with anaesthesia.

Methods: The potential performance of this structured approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved.

Results: Pulmonary oedema was identified in 35 (<1%) of the first 4000 reports to AIMS. The most frequent presenting sign was hypoxia (46%) and the most specific sign was the presence of frothy sputum (23%). The core algorithm, although successful in the management of the initial physiological upset, was found to be inadequate for the ongoing management of pulmonary oedema. A specific sub-algorithm for the management of perioperative pulmonary oedema was devised, tested against the reports and would have been effective, if properly applied, in the management of all but one of the reported cases.

Conclusion: Successful recognition and management of perioperative pulmonary oedema is likely with the application of the structured algorithm and specific sub-algorithm approach outlined in this study.

Keywords: anaesthesia complications; pulmonary oedema; fluid overload; airway obstruction; crisis management; acute respiratory distress syndrome (ARDS)

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Crises in clinical care: an approach to management

W B Runciman and A F Merry
Qual. Saf. Health Care 2005 14: 156-163. [Abstract] [Full Text] [PDF]

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				W B Runciman, M T Kluger, R W Morris, A D Paix, L M Watterson, and R K Webb Crisis management during anaesthesia: the development of an anaesthetic crisis management manual Qual. Saf. Health Care, June 1, 2005; 14(3): e1 - e1. [Abstract] [Full Text] [PDF]