Management of Postoperative Pulmonary Complications

Abstract

Pulmonary complications are major causes of morbidity and mortality during the postoperative period. They include atelectasis, bronchospasm, pneumonia and exacerbation of chronic lung disease. However, the list can be expanded to include acute upper airway obstruction, complications from obstructive sleep apnea, pleural effusions, chemical pneumonitis, pulmonary edema, hypoxemia due to abdominal compartment syndrome and tracheal laceration. Estimation of risk factors of Postoperative Pulmonary Complications (PPCs) is a necessary part of the preoperative evaluation. The risk factors may be grouped into patient-related, procedure-related and anesthesia-related. Procedure related factors are more important than patient related factors in predicting the risk of PPCs. Usually, in surgical procedures with no cavity opening or airway manipulation, the risk for PPCs is low. The rate of complication is inversely related to the distance of the surgical incision from the diaphragm. Patients undergoing upper abdominal and thoracic surgery have a decreased postoperative vital capacity which leads to VA/Q mismatch and contributes to development of hypoxemia. Thus, the rate is substantially higher for thoracic and upper abdominal surgeries than for lower abdominal surgery.