Lorenzo Ball1, Denise Battaglini, Paolo Pelosi. 1. Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy.
Abstract
PURPOSE OF REVIEW: Postoperative pulmonary complications (PPC) are a prominent determinant of postoperative morbidity, mortality, and increased use of healthcare resources. Several scores have been developed to identify patients at higher risk of PPC and have been proposed or validated as tools to predict postoperative respiratory disorders, stratify risk among patients requiring surgery, and to plan clinical studies. The aim of this review is to provide an update on the recent progresses in perioperative medicine concerning the risk assessment, prevention, and treatment of PPCs. RECENT FINDINGS: Efforts are being made to develop a uniform definition of PPCs; several scores have been developed and some of them externally validated. Their use can help the clinician to identify patients at higher risk, develop tailored strategies to mitigate the risk, and to perform a thoughtful allocation of healthcare resources. Intraoperative protective ventilation, with low tidal volume, low plateau pressure, low driving pressure and positive end expiratory pressure set at low-moderate levels titrated to avoid an increase in driving pressure and to achieve an acceptable gas exchange, can reduce the incidence of PPCs. Noninvasive positive pressure ventilation has an important role in the treatment of early stages of postoperative respiratory impairment, whereas not enough evidence is available concerning the use of routine prophylactic noninvasive continuous positive airway pressure postoperatively. SUMMARY: Several strategies can improve patients' outcome, including risk assessment, intraoperative protective ventilation and postoperative noninvasive ventilation.
PURPOSE OF REVIEW: Postoperative pulmonary complications (PPC) are a prominent determinant of postoperative morbidity, mortality, and increased use of healthcare resources. Several scores have been developed to identify patients at higher risk of PPC and have been proposed or validated as tools to predict postoperative respiratory disorders, stratify risk among patients requiring surgery, and to plan clinical studies. The aim of this review is to provide an update on the recent progresses in perioperative medicine concerning the risk assessment, prevention, and treatment of PPCs. RECENT FINDINGS: Efforts are being made to develop a uniform definition of PPCs; several scores have been developed and some of them externally validated. Their use can help the clinician to identify patients at higher risk, develop tailored strategies to mitigate the risk, and to perform a thoughtful allocation of healthcare resources. Intraoperative protective ventilation, with low tidal volume, low plateau pressure, low driving pressure and positive end expiratory pressure set at low-moderate levels titrated to avoid an increase in driving pressure and to achieve an acceptable gas exchange, can reduce the incidence of PPCs. Noninvasive positive pressure ventilation has an important role in the treatment of early stages of postoperative respiratory impairment, whereas not enough evidence is available concerning the use of routine prophylactic noninvasive continuous positive airway pressure postoperatively. SUMMARY: Several strategies can improve patients' outcome, including risk assessment, intraoperative protective ventilation and postoperative noninvasive ventilation.