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The risk of developing a pulmonary complication is highest in patients undergoing cardiac, thoracic, and upper abdominal surgery, with reported complication rates ranging from 9% to 19% The risk in patients undergoing lower abdominal or pelvic procedures ranges from 2% to 5%, and for extremity procedures the range is less than 1 3% The pulmonary complication rate for laparoscopic procedures appears to be much lower than that for open procedures In one series of over 1500 patients who underwent laparoscopic cholecystectomy, the pulmonary complication rate was less than 1% Three patient-specific factors have been repeatedly found to increase the risk of postoperative pulmonary complications: chronic lung disease, morbid obesity, and tobacco use Patients with chronic obstructive pulmonary disease (COPD) have a twofold to fourfold increased risk compared with patients without COPD In a single large prospective cohort of US military veterans, additional risk factors for the development of postoperative pneumonia included age over 60 years, dependent functional status, impaired sensorium, and prior stroke Several studies have found that a low serum albumin level is associated with a higher risk of pulmonary complications and overall mortality Patients with asthma are at increased risk for bronchospasm during tracheal intubation and extubation and during the postoperative period However, if patients are at their optimal pulmonary function (as determined by symptoms, physical examination, or spirometry) at the time of surgery, they do not appear to be at increased risk for other pulmonary complications Postoperative pneumonia is approximately twice as likely to develop in morbidly obese patients those weighing over 113 kg (250 lb) than in patients weighing less Mild to moderate obesity does not appear to increase the risk of clinically important pulmonary complications Several studies have shown that current cigarette smoking is associated with an increased risk of postoperative atelectasis In a single study, cigarette smoking was also found to double the risk of postoperative pneumonia, even when controlling for underlying lung disease A summary of the known risk factors for pulmonary complications is presented in Table 3 5.



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It is not possible to do this. Chrome currently meets the HTML standard as " print " generically means obtaining the page in some physical way, ...

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NOTE Students often wonder why two separate names exist for the same technology In reality, SONET and SDH vary a little in their signaling and frame type, but routers and other magic boxes on the Internet handle the interoperability between the standards The American National Standards Institute (ANSI) publishes the standard as SONET; the International Telecommunications Union (ITU) publishes the standard as SDH, but includes SONET signaling For simplicity s sake and because SONET is the more common term in the United States, this book uses SONET as the generic term for this technology All of these carriers, all adopting the same standard, created a world of simple interconnections between competing voice and data carriers This adoption defined the moment that truly made the Internet a universal network Before SONET, interconnections happened but they were outlandishly expensive, preventing the Internet from reaching many areas of the world SONET is the primary standard for long-distance, high-speed, fiber-optic transmission systems There is a high level of comparison of SONET to network standards like Ethernet because SONET defines interface standards at the Physical and Data Link layers of the OSI seven-layer model The physical aspect of SONET is partially covered by the Optical Carrier standards, but it also defines a ring-based topology that most SONET adopters now use SONET does not require a ring, but a SONET ring has extra survivability in case of line loss As a result, most of the big, long-distance optical pipes for the world s telecommunications networks are SONET rings EXAM TIP SONET is one of the most important standards for making all of our WAN interconnections and it s also the least likely standard you ll ever see because it s hidden away from all but the biggest networks The real beauty of SONET lies in its multiplexing capabilities A single SONET ring can combine multiple DS1, DS3, even European E1 signals and package them into single, huge SONET frames for transmission Clearly, for SONET to handle such large data rates it needs high-capacity fiber optics and that s where the Optical Carrier standards come into play! The Optical Carrier (OC) specification is used to denote the optical data carrying capacity (in Mbps) of fiber-optic cables in networks conforming to the SONET standard The OC standard is an escalating series of speeds, designed to meet the needs of medium-to-large corporations SONET establishes OCs from 518 Mbps (OC-1) to 398 Gbps (OC-768) SONET uses the Synchronous Transport Signal (STS) method The STS consists of two parts: the STS payload (which carries data), and the STS overhead (which carries the signaling and protocol information) When we talk about STS, we add a number to the end of STS to designate the speed of the signal For example, STS-1 is the 5185-Mbps signal that runs on an OC-1 line STS-3 runs at 15552 Mbps on OC-3 lines, and so on Table 14-2 describes the most common optical carriers.





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printThis - jQuery printing plugin
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However, you can easily print a PDF document directly from your web page using JavaScript . All you need is an iframe on your web page or you can create an ...

The majority of studies have shown that preoperative pulmonary function testing (PFT) in unselected patients is not

Upper abdominal or cardiothoracic surgery Prolonged anesthesia time (> 4 hours) Age > 60 years Chronic obstructive pulmonary disease Congestive heart failure Tobacco use (> 20 pack-years) Impaired cognition or sensorium Functional dependency or prior stroke Morbid obesity Low serum albumin level

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