Postoperative pulmonary complications.

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Thoracic Surgery

Background:

• Postoperative pulmonary complications (PPCs) are frequent, expensive, and increase patient mortality.
• General anesthesia significantly alters respiratory function, leading to reduced lung volumes and atelectasis in most patients.
• The respiratory system may require up to six weeks to recover to its preoperative state after major surgery.

Purpose of the Study:

• To review the risk factors, clinical prediction models, and preventative strategies for postoperative pulmonary complications (PPCs).
• To highlight the importance of recognizing and managing modifiable and non-modifiable risk factors for PPCs.
• To provide an evidence-based overview of current and future preventative measures for PPCs.

Main Methods:

• Literature review of risk factors, prediction models, and preventative strategies for PPCs.
• Analysis of intraoperative protective ventilation techniques, including tidal volumes and PEEP.
• Evaluation of postoperative care bundles, such as mobilization and physiotherapy.

Main Results:

• Numerous risk factors for PPCs exist, but clinical consensus on risk prediction models remains inadequate.
• Preoperative optimization, protective ventilation (low tidal volumes based on ideal body weight), and appropriate neuromuscular blockade management are key preventative measures.
• Postoperative interventions including avoiding nasogastric tubes, optimizing analgesia, mobilization, chest physiotherapy, and oral hygiene bundles reduce PPCs.

Conclusions:

• Clinicians must be aware of PPC risk factors to optimize patient care.
• While risk prediction models exist, clinical implementation is limited; focus should be on preventative strategies.
• A multimodal approach combining preoperative optimization, intraoperative protective measures, and postoperative care bundles is essential for reducing PPCs.