Respiratory Maneuvers to Prevent Postoperative Pulmonary Complications

TLDR

Significant pulmonary complications occur in 20% to 40% of patients after abdominal or thoracic operations, making them the largest cause of postoperative morbidity and mortality, and various respiratory maneuvers and devices are employed to prevent atelectasis, tachypnea, hypoxia, fever, and pneumonitis. This report reviews the altered physiology of the postoperative period and describes the respiratory maneuvers required to reverse that pathophysiology. It examines reports of specific maneuvers and devices used to achieve these physiological reversals. Postoperative patients experience major changes in lung volume, mechanics, and gas exchange.

Abstract

Significant pulmonary complications occur in 20% to 40% of patients following abdominal or thoracic operations,^1-3making pulmonary complications the single largest cause of morbidity and mortality in the postoperative period.⁴The desire of the surgeon and the inhalation therapist to prevent the familiar progression of atelectasis, tachypnea, hypoxia, fever, and pneumonitis has led to a wide variety of practices to prevent pulmonary complications. The prophylactic respiratory maneuver is one of many aspects of postoperative care that are intended to minimize pulmonary complications. Various respiratory maneuvers and devices to encourage those maneuvers are used in different centers. The purpose of this report is to review the altered physiology of the postoperative period, describe what respiratory maneuvers must be carried out to reverse that pathophysiology, and to examine the reports of specific maneuvers and devices. <h3>Pulmonary Physiology in the Postoperative Patient</h3> Major changes in lung volume, mechanics, and gas exchange