Abstract
Perioperative Lung Protective Strategies
Highlights
The incidence of postoperative pulmonary complications (PPC) far outnumbers cardiovascular complications [1]
Most of the patients undergoing cardiothoracic or abdominal operations present some degree of hypoxemia and diffuse micro-atelectasis that will barely impact on the postoperative clinical course
Implementation of a bundle of scientifically based perioperative interventions represents an integral component of quality control and improved clinical care
Summary
The incidence of postoperative pulmonary complications (PPC) far outnumbers cardiovascular complications [1]. In patients of higher surgical risk (major abdominal, thoracic and cardiac surgery), a protective ventilation” strategy (VT 4-6 ml/kg PBW, PEEP with or without RM) was associated with a reduced expression of alveolar/ systemic inflammatory markers, reduced procoagulant activity in the bronchoalveolar fluid, better respiratory mechanical properties (dynamic compliance, airway resistance) and stable or improved oxygenation indices. In three of these RCTs, better clinical postoperative outcomes were reported in the group treated with the protective approach [80,84,85]. During the resolution phase of lung disease, spontaneous breathing during mechanical ventilation has been shown to improve gas exchange by redistribution of ventilation to dependent, juxtadiaphragmatic lung regions and thereby it promotes alveolar
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