title: Preventing and managing perioperative pulmonary complications following cardiac surgery.
abstract: OBJECTIVE
  To provide an update of research findings on the mechanisms underlying respiratory complications after cardiac surgery, especially acute respiratory distress syndrome, transfusion-related lung injury and ventilation-associated pneumonia. The article will review some of the preventive and therapeutic measures that can be implemented to reduce these complications, focusing on the use of protective invasive ventilation and postextubation noninvasive ventilation.
  
  
  RESULTS
  The development of postoperative pulmonary complications is related to various perioperative factors. The most effective preventive measures are a correct preoperative preparation and an uneventful surgery. The implementation of nosocomial pneumonia prevention bundles, or early extubation in a fast-track program, has proven to be effective in reducing the complication rate. The application of protective invasive ventilation, with low tidal volumes, has been found to reduce lung injury and mortality in patients with lung injury or healthy lungs. The use of noninvasive ventilation as a preventive postextubation approach in patients at risk and rescue noninvasive ventilation in those developing respiratory failure remains under debate and is subject to ongoing research.
  
  
  CONCLUSIONS
  Postoperative pulmonary complications are common, but severe complications are infrequent. Their reduction requires measures to prevent infection and mechanical ventilation-associated lung injury through the use of low tidal volumes and early extubation. Noninvasive ventilation after extubation can be utilized to avoid reintubation and the associated increased morbidity and mortality. However, noninvasive ventilation should be done under rigorous conditions and by following strict criteria.
authors: aIntensive Care Unit, Hospital Universitario Virgen de las Nieves bIntensive Care Unit, Hospital Universitario San Cecilio, Granada, Spain.
authors: Manuel
authors: M
authors: García-Delgado
authors: Inés
authors: I
authors: Navarrete-Sánchez
authors: Manuel
authors: M
authors: Colmenero
mesh_terms: D055371:Acute Lung Injury / Q000517:prevention & control* / Q000628:therapy; D060666:Airway Extubation; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D026741:Physical Therapy Modalities; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control* / Q000628:therapy; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000517:prevention & control* / Q000628:therapy; D065227:Transfusion Reaction