Postoperative Pulmonary Complications

Postoperative pulmonary complications (PPCs) are a common outcome of cardiothoracic surgery. When allowed to progress, PPCs can result in serious sequelae, such as respiratory failure, pulmonary embolism, acute lung injury, or acute respiratory distress syndrome. The prevention of PPCs requires a comprehensive approach that includes assessment of preoperative risk, smoking cessation, and attention to a number of factors before, during and after surgery. In this article, Dr. Grooms addresses several preventive measures such as intraoperative and postoperative anesthetic/analgesic technique, the use of laparoscopic surgery, selective nasogastric tube decompression, lung expansion modalities, oxygen therapy, deep breathing exercises, physical therapy, and the use of subglottic suction endotracheal tubes. Clinical trials in this area are needed to guide practice, but in the absence of evidence, minimally studied or unproven therapies may still provide clinical benefit if used judiciously.