Recent advances in understanding and managing postoperative respiratory problems [version 1; peer review: 2 approved]

• Published in: F1000 research Vol. 8; p. 197
• Main Authors: Eikermann, Matthias, Santer, Peter, Ramachandran, Satya-Krishna, Pandit, Jaideep
• Format: Journal Article
• Language: English
• Published: England Faculty of 1000 Ltd 2019; F1000 Research Limited; F1000 Research Ltd
• Subjects: Anesthesia; Anesthetics; Continuous positive airway pressure; Extubation; Laparoscopy; Mechanical ventilation; Mortality; Opioids; Patients; Pressure; Respiration; Respiratory therapy; Respiratory tract; Review; Surgery; Ventilators; United Kingdom > UK; hypoxia; respiration; hypercapnia; ventilation
• ISSN: 2046-1402; 2046-1402
• DOI: 10.12688/f1000research.16687.1

Postoperative respiratory complications increase healthcare utilization (e.g. hospital length of stay, unplanned admission to intensive care or high-dependency units, and hospital readmission), mortality, and adverse discharge to a nursing home. Furthermore, they are associated with significant costs. Center-specific treatment guidelines may reduce risks and can be guided by a local champion with multidisciplinary involvement. Patients should be risk-stratified before surgery and offered anesthetic choices (such as regional anesthesia). It is established that laparoscopic surgery improves respiratory outcomes over open surgery but requires tailored anesthesia/ventilation strategies (positive end-expiratory pressure utilization and low inflation pressure). Interventions to optimize treatment include judicious use of intensive care, moderately restrictive fluid therapy, and appropriate neuromuscular blockade with adequate reversal. Patients' ventilatory drive should be kept within a normal range wherever possible. High-dose opioids should be avoided, while volatile anesthetics appear to be lung protective. Tracheal extubation should occur in the reverse Trendelenburg position, and postoperative continuous positive airway pressure helps prevent airway collapse. In combination, all of these interventions facilitate early mobilization.