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Respiratory Complications and Management After Adult Cardiac Surgery

  • Michael Nurok
  • Oren Friedman
  • Erik R. Dong
Chapter

Abstract

The respiratory system’s primary function is to exchange oxygen and carbon dioxide as part of metabolism. This is accomplished by moving blood and air into approximation in the alveoli through mass action driven by the heart and lung. The physical properties of the heart and lung dictate how the respiratory system functions and can dysfunction in pathologic states. These principles inform evidence-based strategies for mechanical ventilation and the rationale for treating frequently encountered respiratory complications following cardiac surgery.

Keywords

Respiratory physiology and pathophysiology Respiratory mechanics Gas exchange Ventilation and perfusion Cardiopulmonary interactions Pulmonary response to general anesthesia and cardiac surgery Risk factors for postoperative respiratory failure Mechanical ventilation Indications for mechanical ventilation Complications of mechanical ventilation Direct consequences Indirect consequences Complications of mechanical ventilation Reducing postoperative respiratory failure Preoperative risk stratification Intraoperative management to reduce respiratory failure Postoperative strategies to reduce respiratory failure Ventilation modes Volume control ventilation Pressure control ventilation Pressure support Alternative modes Noninvasive ventilation Positive end-expiratory pressure Auto-i-PEEP Oxygen and ventilation goals Work of breathing on mechanical ventilation Discontinuation of mechanical ventilation Readiness for spontaneous breathing trial (SBT) Performing spontaneous breathing trials High-flow oxygen Mechanical ventilation in specific scenarios ARDS Mechanical ventilation during VV ECMO for ARDS Strategies for managing specific perioperative disease states Pleural effusion Acute respiratory distress syndrome Pneumothorax/hemothorax Pulmonary edema Obstructive airway disease Pneumonia and ventilator-associated events Pulmonary hypertension 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Cardiac Surgery Intensive Care UnitCedars-Sinai Medical CenterLos AngelesUSA
  2. 2.Critical Care Medicine, Pulmonary Medicine, Cardiothoracic Surgery and Transplant Team, Cedars-Sinai Medical CenterLos AngelesUSA
  3. 3.Critical Care Cardiology, Heart Institute, Cedars-Sinai Medical CenterLos AngelesUSA

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