Pre-operative respiratory optimisation: an expert review.

Area of Science:

• Anesthesiology and Perioperative Medicine
• Pulmonary Medicine
• Surgical Critical Care

Background:

• Postoperative pulmonary complications (PPCs) are frequent, increasing mortality and hospital stay.
• Risk factors for PPCs include smoking, respiratory diseases (asthma, COPD, sleep apnea), low pre-operative oxygen saturation, and recent respiratory infections.

Purpose of the Study:

• To review evidence on pre-operative interventions for reducing PPCs.
• To identify effective strategies for optimizing patients before surgery.

Main Methods:

• Systematic review of studies on pre-operative interventions.
• Analysis of evidence for smoking cessation, exercise programs, and respiratory training.

Main Results:

• Pre-operative smoking cessation, particularly intensive programs, reduces PPCs; longer abstinence yields greater benefits.
• High-intensity interval training shows promise for improving fitness quickly (2 weeks) for surgical patients.
• Respiratory interventions like deep breathing exercises and inspiratory muscle training can be beneficial components of pre-operative care.

Conclusions:

• Optimizing patients pre-operatively through smoking cessation and targeted exercise (like interval training) or respiratory interventions can mitigate PPCs.
• These interventions are particularly recommended for major surgery or patients with low cardiorespiratory fitness.