Postoperative Management of Respiratory Failure: Extracorporeal Ventilatory Therapy

  • Vera von Dossow
  • Maria Deja
  • Bernhard Zwissler
  • Claudia Spies


Post-thoracotomy acute lung injury is one of the leading causes of mortality after thoracic surgery. Several trigger factors have been identified such as preoperative conditions, surgery-associated inflammation, fluid overload, ventilator-induced lung injury, one-lung ventilation, as well as transfusions. In severe cases the clinical presentation is an acute respiratory distress syndrome in adult patients with a high mortality rate. In the last decade, the concept of lung-“protective” ventilation strategies has been gaining importance in thoracic surgery.

However, in a case of severe post-thoracotomy acute lung injury refractory to maximal conservative treatment, the use of extracorporeal ventilatory therapy might be indicated representing the concept of “lung rest.”


Postoperative acute lung injury (PALI) Acute respiratory distress syndrome (ARDS) Lung-protective ventilation strategies Extracorporeal membrane oxygenation (ECMO) 



Activated clotting time


Activated partial thromboplastin time


Acute respiratory distress syndrome


Bi-level positive airway pressure


Cardiac output


Carbon dioxide


Continuous positive airway pressure


Double-lumen single bicaval cannula


Extracorporeal carbon dioxide removal


Extracorporeal membrane oxygenation


Inspiratory oxygen concentration


High-frequency oscillation ventilation


Heparin-induced thrombocytopenia


Left ventricular


Post-thoracotomy acute lung injury


Predicted body weight


Positive end-expiratory pressure




Renin-angiotensin system


Right ventricular




Vena jugularis interna



Supplementary material


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Vera von Dossow
    • 1
    • 2
  • Maria Deja
    • 3
  • Bernhard Zwissler
    • 1
  • Claudia Spies
    • 3
  1. 1.Department of AnesthesiologyLudwig-Maximilians Universität München, Klinikum GroßhadernMunichGermany
  2. 2.Heart and Diabetes Center Bad Oeynhausen, Ruhr-University BochumBochumGermany
  3. 3.Department of Anesthesiology and Intensive Care MedicineCharité-University Medicine BerlinBerlinGermany

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