Elsevier

Thoracic Surgery Clinics

Volume 16, Issue 3, August 2006, Pages 235-241
Thoracic Surgery Clinics

Postoperative Respiratory Failure

https://doi.org/10.1016/j.thorsurg.2006.05.002Get rights and content

Section snippets

“Pure” respiratory failure

Pure or primary respiratory failure (pneumonia, aspiration, and ARDS) is different from the other (secondary) types of respiratory failure in significant ways (Fig. 1). Many patients who are sick will require intubation even though they have no pulmonary illnesses. Most patients who are sick from sepsis, ketoacidosis, and renal failure may require intubation owing to an increased acid load. They require an increased minute ventilation to clear this increased acid load but otherwise have

Prevention or prediction of respiratory failure

A Medline search to identify articles on the prevention of postoperative respiratory failure yielded one citation [7]. This finding fits with the mind-set many of us were taught, that is, respiratory failure “just happens” after thoracic surgery and is difficult to prevent. A similar search on the prediction of postoperative respiratory failure/mortality yielded more than 200 articles.

The literature has focused on identifying patients with enough respiratory reserve to recover from an episode

Pain

Many of the life-threatening complications in patients undergoing thoracic surgery result from poor pain management. Patients may have insufficient treatment for pain, fail to cough, and experience pneumonia from slow clearance of secretions. On the other hand, patients may be overtreated for pain, become too sedated, experience an ileus, fail to protect their airway during vomiting, and experience aspiration. Of course, this premise ignores all of the nonpulmonary causes of postoperative

Background

ARDS or acute lung injury (ALI) is a well-known factor in postoperative mortality after surgery of any type in adult patients [11]. Manuscripts on ARDS sometimes sound like ghost stories or vampire movies; they are dangerous, and you cannot see them coming or going [12]. Bayadi and coworkers [13] described ARDS in two patients who underwent limited wedge resection and could identify no cause; these patients almost surely aspirated. Many agents (bleomycin [14]) and processes (hypotension, blood

Summary of literature about prediction of respiratory failure

Lung volumes, diffusing capacity, and exercise oximetry can all be used to predict which patients will be more likely to have respiratory failure. Of these modalities, diffusing capacity may be the most accurate. Nevertheless, all of these factors are poor predictors in that most patients dying after thoracic surgery are not identified by these predictors. Most of the causes of death cannot be identified by preoperative or perioperative factors; therefore, we need to look for other factors (eg,

Prevention

Methods designed to prevent perioperative death should focus on respiratory failure (pneumonia, aspiration, and ARDS), cardiac disease, and pulmonary disease. Most physicians attempt to prevent pulmonary emboli with subcutaneous heparin and sequential devices and give perioperative antibiotics to prevent wound infection but do nothing to prevent respiratory failure and cardiac failure in patients undergoing lung surgery, except to refuse to do surgery. Although preventing cardiac failure is not

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