Postoperative Respiratory Failure
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
References (51)
- et al.
Use of Medicare claims data to evaluate outcomes in elderly patients undergoing lung resection for lung cancer
Chest
(1991) - et al.
Patterns of surgical care of lung cancer patients
Ann Thorac Surg
(2005) - et al.
Patient and hospital characteristics related to in-hospital mortality after lung cancer resection
Chest
(1992) - et al.
Recent results of postoperative mortality for surgical resections in lung cancer
Ann Thorac Surg
(2004) - et al.
Modern thirty-day operative mortality for surgical resections in lung cancer
J Thorac Cardiovasc Surg
(1983) - et al.
Intraoperative and postoperative risk factors for respiratory failure after coronary bypass
Ann Thorac Surg
(2003) - et al.
Random versus predictable risks of mortality after thoracotomy for lung cancer
J Thorac Cardiovasc Surg
(1986) - et al.
Effect of postoperative epidural analgesia on morbidity and mortality following surgery in Medicare patients
Reg Anesth Pain Med
(2004) - et al.
Failure of serial chest radiographs to predict recovery from respiratory distress syndrome
Am J Obstet Gynecol
(1978) - et al.
Elective pulmonary lobectomy: factors associated with morbidity and operative mortality
Ann Thorac Surg
(1985)
Prediction of postoperative respiratory failure in patients undergoing lung resection for lung cancer
Ann Thorac Surg
Elective pneumonectomy: factors associated with morbidity and operative mortality
Ann Thorac Surg
Diffusing capacity predicts morbidity and mortality after pulmonary resection
J Thorac Cardiovasc Surg
Impact of interstitial lung disease on surgical morbidity and mortality for lung cancer: analyses of short-term and long-term outcomes
J Thorac Cardiovasc Surg
POSSUM scoring system as an instrument of audit in lung resection surgery: physiological and operative severity score for the enumeration of mortality and morbidity
Ann Thorac Surg
Determinants of perioperative morbidity and mortality after pneumonectomy
Ann Thorac Surg
Prognostic models of thirty-day mortality and morbidity after major pulmonary resection
J Thorac Cardiovasc Surg
Pneumonectomy for malignant disease: factors affecting early morbidity and mortality
J Thorac Cardiovasc Surg
Risk factors for early mortality and major complications following pneumonectomy for non-small cell carcinoma of the lung
Chest
Morbidity and mortality after neoadjuvant therapy for lung cancer: the risks of right pneumonectomy
Ann Thorac Surg
Lung resection for non-small-cell lung cancer in patients older than 70: mortality, morbidity, and late survival compared with the general population
Ann Thorac Surg
Exercise tolerance test in lung cancer patients: the relationship between exercise capacity and postthoracotomy hospital mortality
Ann Thorac Surg
Inability to perform bicycle ergometry predicts increased morbidity and mortality after lung resection
Chest
Preemptive gastrointestinal tract management reduces aspiration and respiratory failure after thoracic operations
J Thorac Cardiovasc Surg
Resection rates and postoperative mortality in 7899 patients with lung cancer
Eur Respir J
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2021, European Journal of Cardio-thoracic SurgeryThoracoscopic esophagectomy using prone positioning
2013, Annals of Thoracic and Cardiovascular Surgery