Perioperative lung protection

Abstract

Perioperative pulmonary complications are known to be a major cause of morbidity and mortality, and as such, contribute a large burden to the health care system globally. Anesthesiologists have an important role during the perioperative period to identify patients at risk of these complications and intervene in order to reduce them. After describing perioperative pulmonary complications and risk factors for such, this article will address preoperative, intraoperative, and postoperative lung protective strategies to try and reduce the risk of these complications.

Intraoperative Anesthetic Management of Patients with Chronic Obstructive Pulmonary Disease to Decrease the Risk of Postoperative Pulmonary Complications after Abdominal Surgery

“…Suboptimal baseline lung function contributes to an increased risk of postoperative pulmonary complications (PPCs) in patients with COPD [1,2]. Even mild PPCs such as atelectasis or pleural effusion can worsen the clinical course and increase the risk of prolonged hospital stay; therefore, upon intensive care unit admission, as well as hospital readmission [3][4][5], anesthesiologists use various strategies-mechanical ventilation [6][7][8], fluid therapy [9], and neuromuscular blockade and its reversal [10,11]-to prevent PPCs. We hypothesized that there is a possibility of reducing PPCs using these strategies based on clinical evidence from patients who did not have COPD and who responded differently from patients with COPD due to the difference in lung physiology.…”

Effect of dexmedetomidine on lung function and prognosis a systematic review and meta-analysis

“…There are many ways for perioperative lung protection. Several preoperative methods were proven to be useful for lung protection such as smoking cessation, rehabilitation and optimization of respiratory status (7). Useful intraoperative interventions include lung protective mechanical ventilation, appropriate uid management and enough analgesia (7).…”

“…The possible mechanism is through reducing atelectasis (3,9). Fluid overload may damage pulmonary endothelial which results in the damage of capillary and causes pulmonary edema (7,10). But restrictive uid management may decrease organ perfusion.…”

“…The current trend of uid management is individualization (7,10). It has been reported that when the patients receiving thoracotomy were free to cough and felt mild pain of the thorax, the less pulmonary dysfunction and complications would occur (7). Postoperative lung protection that aims to expand the lung have shown to signi cantly reduce perioperative pulmonary complications.…”

“…Respiratory physiotherapy includes a series of movements such as deep breathing, postural drainage, cough and vibration (7). But, some of these interventions still have con icting evidences, several studies have reported that after major surgeries there is no difference in outcomes in patients undergoing preoperative exercise program (11).…”