Analysis of the current state of the postoperative pulmonary complications issue in abdominal surgery
DOI:
https://doi.org/10.14739/2310-1210.2019.4.173360Keywords:
postoperative complications, mechanical ventilation, prevention of pulmonary complicationsAbstract
Purpose: based on the analysis of the scientific literature data, to determine the relevance of postoperative pulmonary complications (PPCs) issue in abdominal surgery, as well as to examine the causes and modern methods of their development prevention in patients with unaffected lungs.
Conclusions. Indicators of PPCs in abdominal surgery range from 17 % to 88 %, and their development leads to an increase in lethality, the cost of treatment, and the length of stay in a medical institution. Mechanical ventilation (MV) is non-physiological and can cause ventilator-associated lung injury (VALI), adversely affects the respiratory muscles, as well as non-respiratory lung function. The above factors are prominent in PPCs development causing an increase in morbidity and mortality in the postoperative period. Extensive open abdominal operations, especially upper abdominal surgical procedures, increase the risk of PPCs development. In the analysis of modern studies, there has been a clear “paradigm shift” from the prevention of death and complications of lung damage to the prevention of respiratory complications development itself. To date, the risk factors have been identified and scales have been developed that allow predicting PPCs development in a timely and reliable manner, one of which is the ARISCAT scale. There are various measures to prevent VALI and PPCs development and the main ones include low respiratory volume, the use of positive end-expiratory pressure (PEEP) and alveolar recruitment maneuvers. The combination of these measures has been termed “protective ventilation”. It has been proved that protective MV during abdominal surgery in patients with unaffected lungs can reduce the risk of PPCs development.
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