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Respiratory complications after major surgery

Ferreyra, Gabriela; Long, Yun; Ranieri, Vito Marco

Current Opinion in Critical Care: August 2009 - Volume 15 - Issue 4 - p 342–348
doi: 10.1097/MCC.0b013e32832e0669
Postoperative problems: Edited by Jukka Takala

Purpose of review To discuss the recent literature concerning the significance of respiratory complications as a determining factor in postoperative complications after major surgery. Although many studies have identified risk factors focusing on the prevention of respiratory complications, these complications continue to be a significant cause of morbidity and mortality. Here, we will examine the diagnosis, contributing factors, consequences, and early treatment of respiratory complications.

Recent findings General anesthesia and surgery are the main causes of postoperative respiratory complications. Atelectasis, a common respiratory complication, may contribute to pneumonia and acute respiratory failure. Recently, it has been shown that activation of abdominal muscles during the induction of anesthesia contributes to a reduction of lung capacity, leading to a higher degree of atelectasis. Additionally, long-term mortality at 5 and 10 years has recently been shown to remain significantly increased in patients with respiratory complications. Prevention or early therapy of respiratory complications may, therefore, be beneficial in improving outcome in postoperative patients.

Summary Postoperative respiratory complications may have significant deleterious consequences. Increasing the understanding of the underlying causes of respiratory complications and developing early treatment strategies will likely provide improved benefits. To date, early treatment with prophylactic or therapeutic continuous positive airway pressure has proved beneficial in an abdominal surgical patient population; however, the efficacy in a general population remains unclear.

Department of Anesthesia and Intensive Care Medicine, San Giovanni Battista Hospital, Torino, Italy

Correspondence to Professor Vito Marco Ranieri, MD, Department of Anesthesia and Intensive Care Medicine, San Giovanni Battista Hospital, University of Turin, Corso Dogliotti 14, 10126 Torino, Italy Tel: +39 011 633 4001; fax: +39 011 696 0448; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.