Perioperative Respiratory Failure

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Perioperative Respiratory Failure
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• Pulmonary Edema
• Atelectasis
• Alveolar Hypoventilation
• Aspiration

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Pulmonary Edema

• 1. Microvascular hydrostatic pressure
• Fluid overload
• Neurogenic edema
• 2. Pulmonary capillary permeability
• Sepsis

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Atelectasis

• Functional residual capacity (FRC)
  exceeds closing volums, lower airway patency is
  maintained. When FRC falls below the closing
  volume, airway closure begins.

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Risk Factors for Perioperative Atelectasis

• Obesity
• Somking
• Age
• Anesthesia

• Body position
• Incisional pain
• Diaphragm dysfunction

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Alveolar Hypoventilation

• Painful incisions
• CNS depression

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Aspiration

• Major cause of morbidity and mortality in
• the perioperative period.
• Supine position and depression of normal
• protective reflexes during general anesthesia
  
• predipose the surgical patient to gastric
  acid
• aspiration.

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The Treatment of Acid Aspiration

• rapid removal of debris
• placement of a nasogastric tube
• oxygen administration and mechanical
• ventation
• bronchodilator therapy
• maintenance of normovolemia
• treatment of pnemonia

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Predicting and PreventingPerioperative Lung
Dysfunction
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Treatment Principles (I)

• Maximization of the perioperative
• respiratory status.
• Aggressive physiotherapy and early
• ambulation.
• Adeguate treatment of sepsis and shock
• Judicious use of intravenous fluids to
• maintain adequate perfusion.

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Treatment Principles (II)

• Optimum use of analgesics
• The causes should be treated as
• specially as possible
• Preoperative pulmonary assessment
• Institution of mechanical ventilation
• when the above measures fail.