Respiratory failure can occur perioperatively or result from hypoperfusion.
Perioperative respiratory failure is usually caused by atelectasis (collapse of lung tissue with loss of volume), and increases the risk of pneumonia (1). (See also Overview of Mechanical Ventilation.)
Atelectasis caused by abdominal distention should be alleviated by treating the cause (eg, nasogastric suction for excessive intraluminal air, paracentesis to evacuate tense ascites).
General strategies for preventing or treating atelectasis include (2):
Incentive spirometry
Ensuring adequate analgesia for chest and abdominal incisions
Upright positioning
Early mobilization
Incentive spirometry is widely used but ineffective alone (3, 4, 5).
Hypoperfusion, regardless of cause, may result in respiratory failure through inadequate delivery of oxygen to respiratory muscles coupled with excess respiratory muscle load (eg, acidosis, sepsis). Mechanical ventilation can divert blood flow from overworked respiratory muscles to critical organs such as the brain, kidneys, and gut.
References
1. Ko E, Yoo KY, Lim CH, Jun S, Lee K, Kim YH. Is atelectasis related to the development of postoperative pneumonia? a retrospective single center study. BMC Anesthesiol. 2023;23(1):77. doi:10.1186/s12871-023-02020-4
2. Qaseem A, Snow V, Fitterman N, et al. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians. Ann Intern Med. 2006;144(8):575-580. doi:10.7326/0003-4819-144-8-200604180-00008
3. Eltorai AEM, Szabo AL, Antoci V Jr, et al. Clinical Effectiveness of Incentive Spirometry for the Prevention of Postoperative Pulmonary Complications. Respir Care. 2018;63(3):347-352. doi:10.4187/respcare.05679
4. Odor PM, Bampoe S, Gilhooly D, Creagh-Brown B, Moonesinghe SR. Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis. BMJ. 2020;368:m540. doi:10.1136/bmj.m540
5. Sullivan KA, Churchill IF, Hylton DA, Hanna WC. Use of Incentive Spirometry in Adults following Cardiac, Thoracic, and Upper Abdominal Surgery to Prevent Post-Operative Pulmonary Complications: A Systematic Review and Meta-Analysis. Respiration. 2021;100(11):1114-1127. doi:10.1159/000517012
