Perioperative Pulmonary Atelectasis: Part II. Clinical Implications.
Humans
Intraoperative Complications
/ diagnostic imaging
Lung
/ diagnostic imaging
Manometry
/ methods
Obesity
/ diagnostic imaging
Perioperative Care
/ methods
Positive-Pressure Respiration
/ adverse effects
Pulmonary Atelectasis
/ diagnostic imaging
Respiration, Artificial
/ adverse effects
Risk Factors
Smoking
/ adverse effects
Journal
Anesthesiology
ISSN: 1528-1175
Titre abrégé: Anesthesiology
Pays: United States
ID NLM: 1300217
Informations de publication
Date de publication:
01 01 2022
01 01 2022
Historique:
pubmed:
29
10
2021
medline:
8
2
2022
entrez:
28
10
2021
Statut:
ppublish
Résumé
The development of pulmonary atelectasis is common in the surgical patient. Pulmonary atelectasis can cause various degrees of gas exchange and respiratory mechanics impairment during and after surgery. In its most serious presentations, lung collapse could contribute to postoperative respiratory insufficiency, pneumonia, and worse overall clinical outcomes. A specific risk assessment is critical to allow clinicians to optimally choose the anesthetic technique, prepare appropriate monitoring, adapt the perioperative plan, and ensure the patient's safety. Bedside diagnosis and management have benefited from recent imaging advancements such as lung ultrasound and electrical impedance tomography, and monitoring such as esophageal manometry. Therapeutic management includes a broad range of interventions aimed at promoting lung recruitment. During general anesthesia, these strategies have consistently demonstrated their effectiveness in improving intraoperative oxygenation and respiratory compliance. Yet these same intraoperative strategies may fail to affect additional postoperative pulmonary outcomes. Specific attention to the postoperative period may be key for such outcome impact of lung expansion. Interventions such as noninvasive positive pressure ventilatory support may be beneficial in specific patients at high risk for pulmonary atelectasis (e.g., obese) or those with clinical presentations consistent with lung collapse (e.g., postoperative hypoxemia after abdominal and cardiothoracic surgeries). Preoperative interventions may open new opportunities to minimize perioperative lung collapse and prevent pulmonary complications. Knowledge of pathophysiologic mechanisms of atelectasis and their consequences in the healthy and diseased lung should provide the basis for current practice and help to stratify and match the intensity of selected interventions to clinical conditions.
Identifiants
pubmed: 34710217
pii: 117846
doi: 10.1097/ALN.0000000000004009
pmc: PMC9885487
mid: NIHMS1738234
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
206-236Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL121228
Pays : United States
Organisme : NHLBI NIH HHS
ID : UG3 HL140177
Pays : United States
Organisme : NHLBI NIH HHS
ID : UH3 HL140177
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021, the American Society of Anesthesiologists. All Rights Reserved.
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