Noninvasive respiratory support in the perioperative period

Pulmonary complications ranging from atelectasis to acute respiratory failure are common causes of poor perioperative outcomes. As the surgical population becomes increasingly at risk for pulmonary dysfunction due to increasing age and weight, development of an approach toward respiratory compromise in these patients is becoming ever more important. Given the utility of noninvasive respiratory support (NRS) in acute respiratory failure, it is likewise likely to also be important in the perioperative period.

NRS is evaluated from preoperative risk assessment to its use in prevention and treatment of acute respiratory failure. Data supporting intraoperative use of NRS including preinduction continuous positive airway pressure and postextubation NRS for high-risk individuals and surgeries are examined. Timing and duration of NRS is also addressed. Finally, NRS is proposed for treatment for postoperative acute respiratory failure as an alternative to invasive rescue maneuvers.

Noninvasive respiratory support should be considered an important adjunct in perioperative pulmonary care. Usage should be individually tailored in regard to timing and application modality specific to patient and surgical circumstances. More studies are needed, however, to determine the relationship demonstrated between short-term improvements in lung function and long-term outcomes.