The postoperative airway: unique challenges?

作者：Pompei Livia^*; Della Rocca Giorgio

来源：Current Opinion in Critical Care, 2013, 19(4): 359-363.

DOI：10.1097/MCC.0b013e3283632ede

• difficult airway
• lung maneuvers
• noninvasive ventilation
• PEEP

Purpose of reviewThe review is focused on the challenge of managing airway and ventilation in the intraoperative and postoperative period.Recent findingsIn past years, a lot of attention was focused on tracheal intubation in difficult airway, whereas only in recent years extubation time of difficult airway is also covering an important role. Protective ventilation strategies have been studied in acute respiratory distress syndrome and then in general anesthesia, either for thoracic or bariatric surgery, whereas in general abdominal surgery, in healthy lung, few studies are present demonstrating the effective protective role of low tidal volume, lung recruitment maneuvers (LRM) and positive end-expiratory pressure (PEEP). In the early postoperative period, the role of noninvasive ventilation is growing as it reduces postoperative pulmonary complications, postoperative length of stay and costs.SummaryThe combination of planning extubation of predicted and unpredicted difficult airway, both intraoperative low tidal volume and low FiO(2) with LRM and PEEP at different points of surgery and postoperative noninvasive ventilation should be considered in patients undergoing surgery to decrease the rate of postoperative pulmonary complications and major fatal complications such as brain damage and death.

• 出版日期2013-8