Authors: Pensier J et al.
Anaesthesia Critical Care & Pain Medicine, 2025. | DOI: 10.1016/j.accpm.2025.101554
This review article addresses postoperative pulmonary complications (PPCs), which affect more than 10% of surgical patients, particularly after abdominal, thoracic, or cardiac surgeries. PPCs result from alterations in respiratory mechanics, including reduced lung volumes, atelectasis, diaphragmatic dysfunction, and hypoxemia, which can progress to acute respiratory failure (ARF) requiring reintubation and invasive mechanical ventilation.
The authors propose the Peri-Operative Positive Pressure (POP) Ventilation concept, which integrates a comprehensive strategy from preoperative positive pressure pre-oxygenation to intraoperative lung-protective ventilation and postoperative noninvasive respiratory support tailored to high-risk populations. While intraoperative lung-protective strategies, such as low-to-moderate tidal volumes, PEEP, and careful recruitment maneuvers, have demonstrated efficacy in reducing PPCs, the optimal role of noninvasive ventilation (NIV) versus high-flow nasal oxygenation (HFNO) in the postoperative setting remains uncertain. Current evidence supports NIV as the gold standard for treating postoperative ARF, though HFNO may still have a role in specific patient populations.
The article emphasizes that while respiratory function impairment is an expected consequence of surgery and anesthesia, targeted perioperative interventions can significantly reduce morbidity. The future of PPC prevention hinges on individualized risk stratification and tailored application of ventilation strategies.
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Authors: Pensier J et al. 2025.
Anaesthesia Critical Care & Pain Medicine. doi:10.1016/j.accpm.2025.101554
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