Perioperative Lung Protective Strategies

Marc Aldenkortt John Diaper

doi:10.4172/2161-105x.s2-002

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

Introduction

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

62 Cardiac 25 Cardiac 40 Post-cardiac 44 Cardiac 103 General

52 Oesophagectomy

Findings

Conclusions and Practice Points