Perioperative pulmonary complications

Abstract

POPCs are common and lead to significant resource utilization. Optimal POPC risk mitigation must span all phases of surgical care. Preoperative assessment may identify patients at risk and effectively lower their risk by identifying targeted interventions. Intra-operative strategies impact postoperative outcome. POPCs continue to be a concern for several days postoperatively. We review the current literature on this broad subject with a focus on implementable interventions for the clinician.

Addressing the Global Burden of Trauma in Major Surgery

“…An unappreciated fact is that pulmonary perioperative complications may equal or outnumber cardiac complications ( 206 – 208 ). Postoperative lung dysfunction occurs in 3–10% of patients after elective abdominal surgery ( 209 ), 2–7% after thoracic surgery ( 210 ), and 30–50% in patients after cardiac surgery ( 211 ).…”

The usefulness of a classification and regression tree algorithm for detecting perioperative transfusion‐related pulmonary complications

“…33 In addition, site of surgery such as upper abdomen or thorax results in the reduction of functional residual capacity and atelectasis, pneumonia, and pneumothorax, which are associated with mechanical ventilation, lead to perioperative pulmonary complications. 34,35 Consequently, the results of this study suggest that the CART algorithm may have limited diagnostic value in the perioperative period rather than in all clinical settings. Therefore, for a high validation of the algorithm and generalization of study population, prospective observational studies are needed that include all transfused recipients who were continuously monitored for development of TRALI by clinical, radiographic evidence with laboratory test and by the CART algorithm simultaneously.…”

“…Early postoperative hypoxemia is caused by anesthetic factors including residual anesthetic agents and neuraxial blockade . In addition, site of surgery such as upper abdomen or thorax results in the reduction of functional residual capacity and atelectasis, pneumonia, and pneumothorax, which are associated with mechanical ventilation, lead to perioperative pulmonary complications . Consequently, the results of this study suggest that the CART algorithm may have limited diagnostic value in the perioperative period rather than in all clinical settings.…”

Mechanical Ventilation After Injury

“…Perioperative reintubations are primarily related to excess opioid, excess benzodiazepine, or inadequate NMB reversal, and less so to negative pressure pulmonary edema or infection. 32 In the ICU, a panel of weaning parameters has been described and includes ventilator parameters coupled with an assessment of level of consciousness, the ability to participate in care, the ability to protect the airway, secretion volume and character as well as (controversially) the presence of a cuff leak of gas when the cuff is deflated. Since some of the parameters are based upon patient effort (such as negative inspiratory force and vital capacity), some advocate against using any parameter other than the RSBI.…”