Postoperative care of patients undergoing lung resection

Abstract

Due to frequent pre-existing comorbidities and variable impairment of postoperative respiratory function thoracic surgical patients still encounter various complications which in high risk individuals may contribute to poor outcome. Postoperative management of patients undergoing lung resection may vary from simple and transient monitoring of vital functions in the recovery room to the highly specialized therapeutic approach that requires direct admission to the ICU. Proper care of these patients focuses on obtaining an early recovery from anesthesia and mechanical ventilation, achieving optimal pain control, preventing postoperative pulmonary complications, and facilitating early mobilization. The early post-operative period following extensive surgical resection is a crucial time when major cardiac and respiratory adverse events may significantly affect both the hemodynamic response and "residual" lung performance. Among the worst complications an early onset of acute hypoxemia, usually identified as post-resectional ALI or ARDS, has always been considered an ominous sign. This severe pulmonary edema, unrelated to cardiac failure and accompanied with endothelial damage and radiographic pulmonary infiltrates, has been shown to be the leading cause of death in patients undergoing lung surgery. In severe postoperative lung dysfunction conventional mechanical ventilation with protective ventilatory settings is needed to improve gas exchange; in less serious disease noninvasive ventilatory strategies may be safe and effective. Other potentially useful treatments for unresponsive hypoxia include the administration of inhaled pulmonary vasodilators, ventilatory support in the prone position, and the application of extracorporeal membrane oxygenation (ECMO). A multidisciplinary management of high risk patients undergoing lung surgery, focused on adequate preoperative "pulmonary rehabilitation", intraoperative lung protective strategies, postoperative optimization of analgesia and incentivation of cough effectiveness, is essential for a positive outcome. © 2012 Feltracco P, et al.