Overview of the management of postoperative pulmonary complications
- Michelle V Conde, MD
Michelle V Conde, MD
- Clinical Professor of Medicine
- University of Texas Health Science Center
- San Antonio
- Sandra G Adams, MD, MS
Sandra G Adams, MD, MS
- Professor of Medicine
- Department of Internal Medicine, Division of Pulmonary Diseases and Critical
- Section Editors
- Scott Manaker, MD, PhD
Scott Manaker, MD, PhD
- Section Editor — Critical Care
- Professor of Medicine
- University of Pennsylvania School of Medicine
- Roberta Hines, MD
Roberta Hines, MD
- Editor-in-Chief — Anesthesiology
- Section Editor — Anesthesia with Comorbid Cardiovascular/Pulmonary Conditions
- Professor and Chair, Department of Anesthesiology
- Yale School of Medicine
Pulmonary complications are a major cause of morbidity and mortality during the postoperative period . The reported incidence of postoperative pulmonary complications ranges from 5 to 80 percent, depending upon the patient population and the criteria used to define a complication . The incidence also varies across hospitals, with one study reporting lower rates of complications in hospitals with a high volume of patients than in hospitals with a lower volume following esophagectomy, pancreatectomy, and intact abdominal aortic aneurysm repair .
Traditional definitions of postoperative pulmonary complications 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 or rupture. Recognition and management of these postoperative pulmonary complications are reviewed here. Their prevention is discussed separately. (See "Strategies to reduce postoperative pulmonary complications in adults".)
Atelectasis is one of the most common postoperative pulmonary complications, particularly following abdominal and thoracoabdominal procedures . Measures to prevent atelectasis have become an integral part of routine postoperative care, as described separately. (See "Strategies to reduce postoperative pulmonary complications in adults", section on 'Lung expansion'.) This section focuses on the management of postoperative atelectasis.
Clinical presentation — Postoperative atelectasis can be asymptomatic or it may manifest as increased work of breathing and hypoxemia. The onset of hypoxemia due to postoperative atelectasis tends to occur after the patient has left the post-anesthesia care unit. It typically becomes most severe during the second postoperative night and continues through the fourth or fifth postoperative night [5,6].
Hypoxemia that develops earlier (ie, in the post-anesthesia care unit) should prompt the consideration of postoperative complications other than atelectasis, such as hypoventilation due to residual anesthetic effects and upper airway obstruction due to airway tissue edema. The latter may be due to the accumulation of pharyngeal secretions, prolapse of the tongue posteriorly, or tongue edema due to either surgical manipulation or an allergic reaction .
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- Clinical presentation
- - Few respiratory secretions
- - Abundant respiratory secretions
- Clinical presentation
- ACUTE UPPER AIRWAY OBSTRUCTION
- EXACERBATION OF OBSTRUCTIVE SLEEP APNEA
- PLEURAL EFFUSION
- CHEMICAL PNEUMONITIS
- PULMONARY EDEMA
- PULMONARY EMBOLISM
- ABDOMINAL COMPARTMENT SYNDROME
- TRACHEAL LACERATION OR RUPTURE
- POSTOPERATIVE RESPIRATORY FAILURE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS