Abstract
Postoperative pulmonary complications (PPC) are a major cause of perioperative morbidity and mortality. The definitions of PPC include several major categories of clinically significant complications, including atelectasis, respiratory infection, postoperative respiratory failure and exacerbation of chronic lung disease. To prevent PPC, intraoperative lung protective ventilation, a postoperative lung expansion maneuver, a high flow nasal cannula (HFNC) and noninvasive positive pressure ventilation (NPPV) can be applied. Regarding lung protective ventilation, low tidal volume ventilation (LTVV) with moderate PEEP and the lung recruitment maneuver are more effective for preventing PPC than LTVV alone. Early mobilization, chest physiotherapy, and an oral hygiene bundle approach can reduce PPC. Although HFNC has a good tolerability, it should not be considered a standard measure to prevent PPC in high-risk patients because the PEEP effect attributable to HFNC is not sufficient to re-expand the collapsed lung. The benefit from applying NPPV is the lung recruitment effect, thereby reducing the risk of reintubation and pneumonia in high-risk patients. However, NPPV is difficult to use for long periods of time because of its poor tolerability. Close monitoring of the patient’s respiratory status during the use of HFNC or NPPV for postoperative respiratory failure to avoid delayed reintubation.
