Abstract
Postoperative pulmonary dysfunction (PPD) is a frequent and significant complication after cardiac surgery. It contributes to morbidity and mortality and increases hospitalization stay and its associated costs. Its pathogenesis is not clear but it seems to be related to the development of a systemic inflammatory response with a subsequent pulmonary inflammation. Many factors have been described to contribute to this inflammatory response, including surgical procedure with sternotomy incision, effects of general anesthesia, topical cooling, and extracorporeal circulation (ECC) and mechanical ventilation (VM). Protective ventilation strategies can reduce the incidence of atelectasis (which still remains one of the principal causes of PDD) and pulmonary infections in surgical patients. In this way, the open lung approach (OLA), a protective ventilation strategy, has demonstrated attenuating the inflammatory response and improving gas exchange parameters and postoperative pulmonary functions with a better residual functional capacity (FRC) when compared with a conventional ventilatory strategy. Additionally, maintaining low frequency ventilation during ECC was shown to decrease the incidence of PDD after cardiac surgery, preserving lung function.
Highlights
Postoperative pulmonary dysfunction (PPD) is a quite common complication after cardiac surgery [1]; 40% of patients readmitted into intensive care units (ICU) present respiratory failure [2], and the adequate therapeutic management that might reduce its incidence is still unknown.PPD pathophysiology is complex and its mechanisms are not clear (Table 1)
This systemic inflammatory response is associated with anomalies in gas exchange, such as an increased pulmonary shunt fraction [10], increased pulmonary vascular resistance [11], and intrapulmonary aggregation of leukocytes and platelets [12]; with alterations in lung mechanics, resulting in a reduced pulmonary compliance and reduced functional residual capacity (FRC) and vital capacity (VC) or both of them
Given that open lung approach (OLA) strategy reduces the incidence of hypoxemia and increases FRC on discharge, these results suggested that it might reduce the incidence of ICU readmission
Summary
Postoperative pulmonary dysfunction (PPD) is a quite common complication after cardiac surgery [1]; 40% of patients readmitted into intensive care units (ICU) present respiratory failure [2], and the adequate therapeutic management that might reduce its incidence is still unknown. Cardiac surgery produces a whole body inflammatory response that has been highly related with lung injury [9]. This systemic inflammatory response is associated with anomalies in gas exchange, such as an increased pulmonary shunt fraction [10], increased pulmonary vascular resistance [11], and intrapulmonary aggregation of leukocytes and platelets [12]; with alterations in lung mechanics, resulting in a reduced pulmonary compliance and reduced functional residual capacity (FRC) and vital capacity (VC) or both of them
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