The development of pulmonary atelectasis is common in the surgical patient. Pulmonary atelectasis can cause various degrees of gas exchange and respiratory mechanics impairment during and after surgery. In its most serious presentations, lung collapse could contribute to postoperative respiratory insufficiency, pneumonia, and worse overall clinical outcomes. A specific risk assessment is critical to allow clinicians to optimally choose the anesthetic technique, prepare appropriate monitoring, adapt the perioperative plan, and ensure the patient’s safety. Bedside diagnosis and management have benefited from recent imaging advancements such as lung ultrasound and electrical impedance tomography, and monitoring such as esophageal manometry. Therapeutic management includes a broad range of interventions aimed at promoting lung recruitment. During general anesthesia, these strategies have consistently demonstrated their effectiveness in improving intraoperative oxygenation and respiratory compliance. Yet these same intraoperative strategies may fail to affect additional postoperative pulmonary outcomes. Specific attention to the postoperative period may be key for such outcome impact of lung expansion. Interventions such as noninvasive positive pressure ventilatory support may be beneficial in specific patients at high risk for pulmonary atelectasis (e.g., obese) or those with clinical presentations consistent with lung collapse (e.g., postoperative hypoxemia after abdominal and cardiothoracic surgeries). Preoperative interventions may open new opportunities to minimize perioperative lung collapse and prevent pulmonary complications. Knowledge of pathophysiologic mechanisms of atelectasis and their consequences in the healthy and diseased lung should provide the basis for current practice and help to stratify and match the intensity of selected interventions to clinical conditions.
Perioperative Pulmonary Atelectasis: Part II. Clinical Implications
Submitted for publication April 22, 2021. Accepted for publication August 26, 2021.
Martin J. London, M.D., served as Handling Editor for this article.
Acknowledgments: The authors thank Laurent Zieleskiewicz, M.D., Ph.D. (Aix-Marseille University, Marseille, France), Christian Putensen, M.D., Ph.D. (University of Bonn, Bonn, Germany), and Jean-Michel Constantin, M.D., Ph.D. (Paris Sorbonne University, Paris, France), for providing graphic material. Figures were made in BioRender (BioRender.com, Toronto, Ontario, Canada).
Research Support: This work was funded by National Institutes of Health–National Heart, Lung, and Blood Institute (Bethesda, Maryland) grant Nos. R01 HL121228 to Dr. Vidal Melo and UH3 HL140177 to Drs. Vidal Melo and Fernandez-Bustamante. Dr. Lagier received research grants from Societe Francaise d’Anesthesie Reanimation (Paris, France), European Association of CardioThoracic Anaesthesiologists (Rome, Italy), and Fondation Monahan (Paris, France).
Competing Interests:Dr. Fernandez-Bustamante reports financial relationships with Merck Sharp & Dohme Corp. (Kenilworth, New Jersey) and the U.S. Department of Defense (Arlington, Virginia). The other authors declare no competing interests.
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David Lagier, Congli Zeng, Ana Fernandez-Bustamante, Marcos F. Vidal Melo; Perioperative Pulmonary Atelectasis: Part II. Clinical Implications. Anesthesiology Newly Published on October 28, 2021. doi: https://doi.org/10.1097/ALN.0000000000004009
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