Postoperative pulmonary complications: risk assessment, prevention, and treatment
Stephen P. Hayden, MDAddress reprint requests to S.P.H., Department of General Internal Medicine, A91, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
Mark E. Mayer, MD
James K. Stoller, MD
Patients with pre-existing pulmonary disease and certain other conditions are at increased risk of postoperative pulmonary complications. This article surveys how internists can identify high-risk patients clinically, use pulmonary function studies, use specific therapy to reduce risk, and manage postoperative complications.KEY POINTS
Postoperative pulmonary complications occur more frequently in patients with chronic obstructive pulmonary disease, patients with higher American Society of Anesthesiologists (ASA) classification scores, and patients with upper abdominal and thoracic incisions.
Postoperative pulmonary complications can be reduced by stopping smoking, alleviating airflow obstruction before surgery, preventing aspiration and venous thromboembolic disease, and, in the case of resectional surgery, by careful patient selection.
Postoperative management of complications includes aggressively using lung-expansion techniques such as deep breathing, breath-holding, incentive spirometry, and, in selected cases, more complex respiratory therapies such as positive end-expiratory pressure (PEEP) or continuous positive airway pressure (CPAP).