Perioperative “remote” acute lung injury: recent update

Abstract

Perioperative acute lung injury (ALI) is a syndrome characterised by hypoxia and chest radiograph changes. It is a serious post-operative complication, associated with considerable mortality and morbidity. In addition to mechanical ventilation, remote organ insult could also trigger systemic responses which induce ALI. Currently, there are limited treatment options available beyond conservative respiratory support. However, increasing understanding of the pathophysiology of ALI and the biochemical pathways involved will aid the development of novel treatments and help to improve patient outcome as well as to reduce cost to the health service. In this review we will discuss the epidemiology of peri-operative ALI; the cellular and molecular mechanisms involved on the pathological process; the clinical considerations in preventing and managing perioperative ALI and the potential future treatment options.

Protective effect of clotrimazole on lung injury in an experimental model of ruptured abdominal aortic aneurysm

“…19 Temporary clamping of the aorta or its major visceral branches at the infradiaphragmatic segment can cause damage to organs that are directly exposed to ischemia, including the bowel and kidney, and to the distant target organs, particularly the lungs. 7 Total body hypoperfusion due to hemorrhagic shock or lower body ischemia due to aortic clamping alone does not cause sufficient organ damage and increased mortality. 6,[23][24][25] Due to these 2 crucial ischemic conditions and subsequent reperfusion in RAAA operations, mortality remains high, and multiple organ failures occur.…”

“…6,[23][24][25] Due to these 2 crucial ischemic conditions and subsequent reperfusion in RAAA operations, mortality remains high, and multiple organ failures occur. 5,7 Although many physiopathological factors that cause shock and I/R injury are considered, the main factor is free oxygen radicals that appear in the reperfusion phase. The main source of free radicals that are held responsible for reperfusion injury are neutrophils that are activated both in shock and in ischemia and reperfusion phases.…”

“…5,6 Activated neutrophils accumulate in the subendothelial space, releasing reactive oxygen species (ROS) and oxidative damage. 7 Ischemia causes an increase in calcium permeability by promoting its entry into cells. The intracellular accumulation of calcium ions (Ca ++ ) because of changes in the permeability of the plasma membrane and the decrease in its active ATP-depended transport results in the activation of phospholipases and proteases.…”

Efficacy of human immunoglobulin injection and effects on serum inflammatory cytokines in neonates with acute lung injury

“…The primary clinical manifestations of ALI are progressive hypoxemia and respiratory distress. ALI may lead to multiple organ dysfunction syndrome, multiple system organ failure and other life-threatening complications ( 2 ). Acute respiratory distress syndrome (ARDS) is a severe form of ALI ( 3 ).…”

<p>Comprehensive Pulmonary Rehabilitation is an Effective Way for Better Postoperative Outcomes in Surgical Lung Cancer Patients with Risk Factors: A Propensity Score-Matched Retrospective Cohort Study</p>

“…In the Chinese expert consensus statement on multidisciplinary peri-operative airway management (2016 version), 7 comprehensive pulmonary rehabilitation (CPR), including physical exercise and pharmacotherapy (inhaled corticosteroid (ICS) and bronchodilator), was recommended for patients during peri-operation because it plays a vital role in enhancing cardiopulmonary capacity and subsequently decreasing PPC rates. [8][9][10] Clinical experiments have demonstrated the effectiveness and feasibility of pulmonary rehabilitation (PR) as a costeffective intervention for preoperative conditioning, especially for patients with high risks of PPCs due to limited lung function. 11,12 However, the appropriate rehabilitation regimen, duration, and intensity remain unclear.…”