Abstract
Recent large prospective cohort study in non-cardiac surgery has demonstrated that the incidence of in-hospital mortality is relatively high as well as the incidence of postoperative respiratory/pulmonary complications (PPCs). PPCs are associated significantly with either type of surgery or anaesthesia. Furthermore, several risk factors such as age, recent respiratory tract infection, preoperative desaturation, etc., have been identified and included in the predictive scores of PPCs. As we know, many physicians have been trying to find the effective strategies for improving outcome. In this chapter, we aim to describe the current evidences associated with PPCs namely mechanism of PPCs, on-going studies that associated with outcome, and recently intervention for prevention and treatment PPCs.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
de Abreu MG, Pelosi P (2013) How can we prevent postoperative pulmonary complications? Curr Opin Anaesthesiol 26:105–106
Canet J, Gallart L, Gomar C et al (2010) Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology 113:1338–1350
Smetana GW (2009) Postoperative pulmonary complications: an update on risk assessment and reduction. Cleve Clin J Med 76(Suppl 4):S60–S65
Qaseem A, Snow V, Fitterman N et al (2006) Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American college of physicians. Ann Intern Med 144:575–580
Vargas MBI, Pelosi P (2013) Protective mechanical ventilation during general anesthesia. Trends Anaesth Crit Care 3: 77–81
Garcia AJ 3rd, Zanella S, Koch H et al (2011) Chapter 3–Networks within networks: the neuronal control of breathing. Prog Brain Res 188:31–50
Dahan A, Teppema LJ (2003) Influence of anaesthesia and analgesia on the control of breathing. Br J Anaesth 91:40–49
Wahba RW (1991) Perioperative functional residual capacity. Can J Anaesth 38:384–400
Hedenstierna G, Strandberg A, Brismar B et al (1985) Functional residual capacity, thoracoabdominal dimensions, and central blood volume during general anesthesia with muscle paralysis and mechanical ventilation. Anesthesiology 62:247–254
Krayer S, Rehder K, Beck KC et al (1987) Quantification of thoracic volumes by three-dimensional imaging. J Appl Physiol 62:591–598
Tusman G, Bohm SH, Warner DO et al (2012) Atelectasis and perioperative pulmonary complications in high-risk patients. Curr Opin Anaesthesiol 25:1–10
Milic-Emili J, Torchio R, D’Angelo E (2007) Closing volume: a reappraisal (1967-2007). Eur J Appl Physiol 99:567–583
Pelosi P, Goldner M, McKibben A et al (2001) Recruitment and derecruitment during acute respiratory failure: an experimental study. Am J Respir Crit Care Med 164:122–130
Pelosi P, Negrini D (2008) Extracellular matrix and mechanical ventilation in healthy lungs: back to baro/volotrauma? Curr Opin Crit Care 14:16–21
Rothen HU, Sporre B, Engberg G et al (1995) Influence of gas composition on recurrence of atelectasis after a reexpansion maneuver during general anesthesia. Anesthesiology 82:832–842
Hemmes SN, Abreu MG, Pelosi P et al (2013) ESA Clinical Trials Network 2012: LAS VEGAS - Local Assessment of ventilatory management during general anaesthesia for surgery and its effects on postoperative pulmonary complications: a prospective, observational, international, multicentre cohort study. Eur J Anaesthesiol 30:205–207
Serpa Neto A, Cardoso SO, Manetta JA et al (2012) Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis. JAMA 308:1651–1659
Force ADT, Ranieri VM, Rubenfeld GD et al (2012) Acute respiratory distress syndrome: the berlin definition. JAMA 307:2526–2533
Wrigge H, Uhlig U, Zinserling J et al (2004) The effects of different ventilatory settings on pulmonary and systemic inflammatory responses during major surgery. Anesth Analg 98: 775–781
Wrigge H, Uhlig U, Baumgarten G et al (2005) Mechanical ventilation strategies and inflammatory responses to cardiac surgery: a prospective randomized clinical trial. Intensive Care Med 31:1379–1387
Fernandez-Perez ER, Keegan MT, Brown DR et al (2006) Intraoperative tidal volume as a risk factor for respiratory failure after pneumonectomy. Anesthesiology 105:14–18
Wolthuis EK, Choi G, Dessing MC et al (2008) Mechanical ventilation with lower tidal volumes and positive end-expiratory pressure prevents pulmonary inflammation in patients without preexisting lung injury. Anesthesiology 108:46–54
Imberger G, McIlroy D, Pace NL et al (2010) Positive end-expiratory pressure (PEEP) during anaesthesia for the prevention of mortality and postoperative pulmonary complications. Cochrane Database Syst Rev: CD007922
Severgnini P, Selmo G, Lanza C et al (2013) Protective mechanical ventilation during general anesthesia for open abdominal surgery improves postoperative pulmonary function. Anesthesiology
Wittmann M, Matot I, Hoeft A (2013) ESA clinical trials network 2012. Eur J Anaesthesiol 30:208–210
Pearse RM, Moreno RP, Bauer P et al (2012) Mortality after surgery in Europe: a seven day cohort study. Lancet 380:1059–1065
Canet J, Hardman J, Sabate S et al (2011) Periscope study: predicting post-operative pulmonary complications in Europe. Eur J Anaesthesiol 28:459–461
Hemmes SN, Severgnini P, Jaber S et al (2011) Rationale and study design of PROVHILO—a worldwide multicenter randomized controlled trial on protective ventilation during general anesthesia for open abdominal surgery. Trials 12:111
University Hospital, C.-F. Intraoperative protective ventilation in abdominal surgery (IMPROVE Study). In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000, 2013 May 2].Available from: URL of the record NLM Identifier: NCT01282996
Haynes AB, Weiser TG, Berry WR et al (2009) A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 360:491–499
Arozullah AM, Daley J, Henderson WG et al (2000) Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. The national veterans administration surgical quality improvement program. Ann Surg 232:242–253
Arozullah AM, Khuri SF, Henderson WG et al (2001) Development and validation of a multifactorial risk index for predicting postoperative pneumonia after major noncardiac surgery. Ann Intern Med 135:847–857
Kor DJ, Warner DO, Alsara A et al (2011) Derivation and diagnostic accuracy of the surgical lung injury prediction model. Anesthesiology 115:117–128
Pelosi P, Gama de Abreu M (2011) Lung injury prediction models to improve perioperative management: let’s hit the bull’s-eye! Anesthesiology 115:10–11
Gupta H, Gupta PK, Fang X et al (2011) Development and validation of a risk calculator predicting postoperative respiratory failure. Chest 140:1207–1215
Pedersen T, Moller AM, Hovhannisyan K (2009) Pulse oximetry for perioperative monitoring. Cochrane Database Syst Rev: CD002013
McCormack JG, Kelly KP, Wedgwood J et al (2008) The effects of different analgesic regimens on transcutaneous CO2 after major surgery. Anaesthesia 63:814–821
Pelosi P, Croci M, Ravagnan I et al (1998) The effects of body mass on lung volumes, respiratory mechanics, and gas exchange during general anesthesia. Anesth Analg 87:654–660
Pelosi P, Ravagnan I, Giurati G et al (1999) Positive end-expiratory pressure improves respiratory function in obese but not in normal subjects during anesthesia and paralysis. Anesthesiology 91:1221–1231
Pelosi P, Vargas M (2012) Mechanical ventilation and intra-abdominal hypertension: beyond good and evil. Crit Care 16:187
Ueda K, Ahmed W, Ross AF (2011) Intraoperative pneumothorax identified with transthoracic ultrasound. Anesthesiology 115:653–655
Baldi G, Gargani L, Abramo A et al (2013) Lung water assessment by lung ultrasonography in intensive care: a pilot study. Intensive Care Med 39:74–84
Via G, Storti E, Gulati G et al (2012) Lung ultrasound in the ICU: from diagnostic instrument to respiratory monitoring tool. Minerva Anestesiol 78:1282–1296
Guldner A, Pelosi P, de Abreu MG (2013) Nonventilatory strategies to prevent postoperative pulmonary complications. Curr Opin Anaesthesiol 26:141–151
Lobo SM, Ronchi LS, Oliveira NE et al (2011) Restrictive strategy of intraoperative fluid maintenance during optimization of oxygen delivery decreases major complications after high-risk surgery. Crit Care 15:R226
Blum JM, Stentz MJ, Dechert R et al (2013) Preoperative and intraoperative predictors of postoperative acute respiratory distress syndrome in a general surgical population. Anesthesiology 118:19–29
Futier E, Constantin JM, Petit A et al (2010) Conservative vs restrictive individualized goal-directed fluid replacement strategy in major abdominal surgery: A prospective randomized trial. Arch Surg 145:1193–1200
Carvalho CR, Paisani DM, Lunardi AC (2011) Incentive spirometry in major surgeries: a systematic review. Rev Bras Fisioter 15:343–350
Hulzebos EH, Smit Y, Helders PP et al (2012) Preoperative physical therapy for elective cardiac surgery patients. Cochrane Database Syst Rev 11: CD010118
Bobbio A, Chetta A, Ampollini L et al (2008) Preoperative pulmonary rehabilitation in patients undergoing lung resection for non-small cell lung cancer. Eur J Cardiothorac Surg 33:95–98
Morano MT, Araujo AS, Nascimento FB et al (2013) Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection: a pilot randomized controlled trial. Arch Phys Med Rehabil 94:53–58
Hulzebos EH, Helders PJ, Favie NJ et al (2006) Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial. JAMA 296:1851–1857
Kodric M, Trevisan R, Torregiani C et al (2013) Inspiratory muscle training for diaphragm dysfunction after cardiac surgery. J Thorac Cardiovasc Surg 145:819–823
Paulus F, Binnekade JM, Vroom MB et al (2012) Benefits and risks of manual hyperinflation in intubated and mechanically ventilated intensive care unit patients: a systematic review. Crit Care 16:R145
Grams ST, Ono LM, Noronha MA et al (2012) Breathing exercises in upper abdominal surgery: a systematic review and meta-analysis. Rev Bras Fisioter 16:345–353
Lunardi AC, Cecconello I, Carvalho CR (2011) Postoperative chest physical therapy prevents respiratory complications in patients undergoing esophagectomy. Rev Bras Fisioter 15:160–165
Gosselink R, Schrever K, Cops P et al (2000) Incentive spirometry does not enhance recovery after thoracic surgery. Crit Care Med 28:679–683
Orman J, Westerdahl E (2010) Chest physiotherapy with positive expiratory pressure breathing after abdominal and thoracic surgery: a systematic review. Acta Anaesthesiol Scand 54:261–267
Coussa M, Proietti S, Schnyder P et al (2004) Prevention of atelectasis formation during the induction of general anesthesia in morbidly obese patients. Anesth Analg 98: 1491–1495
Gander S, Frascarolo P, Suter M et al (2005) Positive end-expiratory pressure during induction of general anesthesia increases duration of nonhypoxic apnea in morbidly obese patients. Anesth Analg 100:580–584
Bagan P, Bouayad M, Benabdesselam A et al (2011) Prevention of pulmonary complications after aortic surgery: evaluation of prophylactic noninvasive perioperative ventilation. Ann Vasc Surg 25:920–922
Neligan PJ, Malhotra G, Fraser M et al (2009) Continuous positive airway pressure via the boussignac system immediately after extubation improves lung function in morbidly obese patients with obstructive sleep apnea undergoing laparoscopic bariatric surgery. Anesthesiology 110:878–884
Wong DT, Adly E, Ip HY et al (2011) A comparison between the boussignac continuous positive airway pressure mask and the venturi mask in terms of improvement in the PaO2/F(I)O2 ratio in morbidly obese patients undergoing bariatric surgery: a randomized controlled trial. Can J Anaesth 58:532–539
Perrin C, Jullien V, Venissac N et al (2007) Prophylactic use of noninvasive ventilation in patients undergoing lung resectional surgery. Respir Med 101:1572–1578
Liao G, Chen R, He J (2010) Prophylactic use of noninvasive positive pressure ventilation in post-thoracic surgery patients: a prospective randomized control study. J Thorac Dis 2:205–209
Cereda M, Neligan PJ, Reed AJ (2013) Noninvasive respiratory support in the perioperative period. Curr Opin Anaesthesiol 26:134–140
Mariani J, Macchia A, Belziti C et al (2011) Noninvasive ventilation in acute cardiogenic pulmonary edema: a meta-analysis of randomized controlled trials. J Card Fail 17:850–859
Zarbock A, Mueller E, Netzer S et al (2009) Prophylactic nasal continuous positive airway pressure following cardiac surgery protects from postoperative pulmonary complications: a prospective, randomized, controlled trial in 500 patients. Chest 135:1252–1259
Narita M, Tanizawa K, Chin K et al (2010) Noninvasive ventilation improves the outcome of pulmonary complications after liver resection. Intern Med 49:1501–1507
Auriant I, Jallot A, Herve P et al (2001) Noninvasive ventilation reduces mortality in acute respiratory failure following lung resection. Am J Respir Crit Care Med 164:1231–1235
Antonelli M, Conti G, Bufi M et al (2000) Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial. JAMA 283:235–241
Garcia-Delgado M, Navarrete I, Garcia-Palma MJ et al (2012) Postoperative respiratory failure after cardiac surgery: use of noninvasive ventilation. J Cardiothorac Vasc Anesth 26:443–447
Author information
Authors and Affiliations
Corresponding authors
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer-Verlag Italia
About this paper
Cite this paper
Vargas, M., Sutherasan, Y., Pelosi, P. (2014). Postoperative Respiratory Complications. In: Gullo, A. (eds) Anaesthesia, Pharmacology, Intensive Care and Emergency A.P.I.C.E.. Springer, Milano. https://doi.org/10.1007/978-88-470-5516-2_8
Download citation
DOI: https://doi.org/10.1007/978-88-470-5516-2_8
Published:
Publisher Name: Springer, Milano
Print ISBN: 978-88-470-5515-5
Online ISBN: 978-88-470-5516-2
eBook Packages: MedicineMedicine (R0)