The Aging Respiratory System: Anesthetic Strategies to Minimize Perioperative Pulmonary Complications

  • Rodrigo Cartin-Ceba
  • Juraj Sprung
  • Ognjen Gajic
  • David O. Warner


Because of increased life expectancy, the number of elderly individuals over the age of 65 is increasing all over the world, especially in developed countries. Although respiratory function is relatively well preserved in resting elderly patients, reduced respiratory reserve may lead to problems in the setting of acute illness or surgery. To anticipate and prevent potential problems that may result from reduced respiratory reserve, it is important to understand the effects of aging on respiratory function. Such changes may have particular significance during the perioperative period when numerous anesthetic and surgical factors, such as body positioning, residual effects of anesthetics on control of respiration, structural and functional disruption of respiratory muscles, and perioperative changes in lung fluid balance, may impose additional burdens on elderly patients with diminished pulmonary reserve. Indeed, postoperative respiratory complications account for approximately 40% of the perioperative deaths in patients over 65 years of age.1 In this chapter, we review the effects of aging on pulmonary function and the effects of anesthesia and surgery on this function.


Chronic Obstructive Pulmonary Disease Obstructive Sleep Apnea Continuous Positive Airway Pressure Pulmonary Complication Functional Residual Capacity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Zaugg M, Lucchinetti E. Respiratory function in the elderly. Anesthesiol Clin North Am 2000;18(1):47–58, vi.CrossRefGoogle Scholar
  2. 2.
    Pollock ML, Mengelkoch LJ, Graves JE, et al. Twenty-year follow-up of aerobic power and body composition of older track athletes. J Appl Physiol 1997;82(5):1508–1516.PubMedGoogle Scholar
  3. 3.
    McClaran SR, Babcock MA, Pegelow DF, Reddan WG, Dempsey JA. Longitudinal effects of aging on lung function at rest and exercise in healthy active fit elderly adults. J Appl Physiol 1995;78(5):1957–1968.PubMedGoogle Scholar
  4. 4.
    Kiyokawa H. Senescence and cell cycle control. Results Probl Cell Differ 2006;42:257–270.PubMedGoogle Scholar
  5. 5.
    Terman A, Gustafsson B, Brunk UT. Mitochondrial damage and intralysosomal degradation in cellular aging. Mol Aspects Med 2006;27(5–6):471–482.PubMedCrossRefGoogle Scholar
  6. 6.
    Campbell EJ, Lefrak SS. How aging affects the structure and function of the respiratory system. Geriatrics 1978; 33(6):68–74.PubMedGoogle Scholar
  7. 7.
    Janssens JP, Pache JC, Nicod LP. Physiological changes in respiratory function associated with ageing. Eur Respir J 1999;13(1):197–205.PubMedCrossRefGoogle Scholar
  8. 8.
    Turner JM, Mead J, Wohl ME. Elasticity of human lungs in relation to age. J Appl Physiol 1968;25(6):664–671.PubMedGoogle Scholar
  9. 9.
    Crapo RO. The aging lung. In: Mahler DA, ed. Pulmonary Disease in the Elderly Patient. New York: Marcel Dekker; 1993:1–21.Google Scholar
  10. 10.
    Larsson L. Histochemical characteristics of human skeletal muscle during aging. Acta Physiol Scand 1983;117(3):469–471.PubMedCrossRefGoogle Scholar
  11. 11.
    Enright P, Kronmal R, Manolio T, Schenker M, Hyatt R. Respiratory muscle strength in the elderly. Correlates and reference values. Cardiovascular Health Study Research Group. Am J Respir Crit Care Med 1994;149(2):430–438.PubMedGoogle Scholar
  12. 12.
    Arora NS, Rochester DF. Respiratory muscle strength and maximal voluntary ventilation in undernourished patients. Am Rev Respir Dis 1982;126(1):5–8.PubMedGoogle Scholar
  13. 13.
    Tolep K, Higgins N, Muza S, Criner G, Kelsen SG. Comparison of diaphragm strength between healthy adult elderly and young men. Am J Respir Crit Care Med 1995; 152(2):677–682.PubMedGoogle Scholar
  14. 14.
    Niewohner D, Kleinerman J, Liotta L. Elastic behaviour of post-mortem human lungs: effects of aging and mild emphysema. J Appl Physiol 1975;25:664–671.Google Scholar
  15. 15.
    Verbeken E, Cauberghs M, Mertens I, Clement J, Lauweryns J, Van de Woestijne K. The senile lung. Comparison with normal and emphysematous lungs. 2. Functional aspects. Chest 1992;101(3):800–809.PubMedCrossRefGoogle Scholar
  16. 16.
    Levitzky MG. Effects of aging on the respiratory system. Physiologist 1984;27(2):102–107.PubMedGoogle Scholar
  17. 17.
    Crapo RO, Morris AH, Clayton PD, Nixon CR. Lung volumes in healthy nonsmoking adults. Bull Eur Physiopathol Respir 1982;18(3):419–425.PubMedGoogle Scholar
  18. 18.
    Knudson RJ, Clark DF, Kennedy TC, Knudson DE. Effect of aging alone on mechanical properties of the normal adult human lung. J Appl Physiol 1977;43(6):1054–1062.PubMedGoogle Scholar
  19. 19.
    Murray JF. Aging. In: Murray JF, ed. The Normal Lung. Philadelphia: WB Saunders; 1986:339–360.Google Scholar
  20. 20.
    Knudson RJ, Slatin RC, Lebowitz MD, Burrows B. The maximal expiratory flow-volume curve. Normal standards, variability, and effects of age. Am Rev Respir Dis 1976; 113(5):587–600.PubMedGoogle Scholar
  21. 21.
    Burrows B, Cline MG, Knudson RJ, Taussig LM, Lebowitz MD. A descriptive analysis of the growth and decline of the FVC and FEV1. Chest 1983;83(5):717–724.PubMedCrossRefGoogle Scholar
  22. 22.
    Brandstetter RD, Kazemi H. Aging and the respiratory system. Med Clin North Am 1983;67(2):419–431.PubMedGoogle Scholar
  23. 23.
    Griffith KA, Sherrill DL, Siegel EM, Manolio TA, Bonekat HW, Enright PL. Predictors of loss of lung function in the elderly: the Cardiovascular Health Study. Am J Respir Crit Care Med 2001;163(1):61–68.PubMedGoogle Scholar
  24. 24.
    Enright PL, Kronmal RA, Higgins M, Schenker M, Haponik EF. Spirometry reference values for women and men 65 to 85 years of age. Cardiovascular health study. Am Rev Respir Dis 1993;147(1):125–133.PubMedGoogle Scholar
  25. 25.
    Anthonisen N. Tests of mechanical function. In: Handbook of Physiology. Bethesda, MD: American Physiology Society; 1986:753–784.Google Scholar
  26. 26.
    Niewohner D, Kleinerman J. Morphologic basis of pulmonary resistance in human lung and effects of aging. J Appl Physiol 1974;36:412–418.Google Scholar
  27. 27.
    Fowler RW, Pluck RA, Hetzel MR. Maximal expiratory flow-volume curves in Londoners aged 60 years and over. Thorax 1987;42(3):173–182.PubMedGoogle Scholar
  28. 28.
    Sykes MK, McNicol MW, Campbell EJM. The mechanics of respiration. In: Sykes MK, McNicol MW, Campbell EJM, eds. Respiratory Failure. London: Blackwell Scientific Publications; 1976:3–30.Google Scholar
  29. 29.
    Hyatt RE, Flath RE. Influence of lung parenchyma on pressure-diameter behavior of dog bronchi. J Appl Physiol 1966;21(5):1448–1452.PubMedGoogle Scholar
  30. 30.
    Hyatt RE. Expiratory flow limitation. J Appl Physiol 1983; 55(1 Pt 1):1–7.PubMedGoogle Scholar
  31. 31.
    Babb TG, Rodarte JR. Mechanism of reduced maximal expiratory flow with aging. J Appl Physiol 2000;89(2):505–511.PubMedGoogle Scholar
  32. 32.
    Johnson BD, Badr MS, Dempsey JA. Impact of the aging pulmonary system on the response to exercise. Clin Chest Med 1994;15(2):229–246.PubMedGoogle Scholar
  33. 33.
    DeLorey DS, Babb TG. Progressive mechanical ventilatory constraints with aging. Am J Respir Crit Care Med 1999;160(1):169–177.PubMedGoogle Scholar
  34. 34.
    Wagner PD, Laravuso RB, Uhl RR, West JB. Continuous distributions of ventilation-perfusion ratios in normal subjects breathing air and 100 per cent O2. J Clin Invest 1974; 54(1):54–68.PubMedCrossRefGoogle Scholar
  35. 35.
    Wagner PD, Saltzman HA, West JB. Measurement of continuous distributions of ventilation-perfusion ratios: theory. J Appl Physiol 1974;36(5):588–599.PubMedGoogle Scholar
  36. 36.
    Craig DB, Wahba WM, Don HF, Couture JG, Becklake MR. “Closing volume” and its relationship to gas exchange in seated and supine positions. J Appl Physiol 1971;31(5): 717–721.PubMedGoogle Scholar
  37. 37.
    Sorbini CA, Grassi V, Solinas E, Muiesan G. Arterial oxygen tension in relation to age in healthy subjects. Respiration 1968;25(1):3–13.PubMedGoogle Scholar
  38. 38.
    Raine JM, Bishop JM. A-a difference in O2 tension and physiological dead space in normal man. J Appl Physiol 1963;18:284–288.PubMedGoogle Scholar
  39. 39.
    Wahba WM. Influence of aging on lung function—clinical significance of changes from age twenty. Anesth Analg 1983; 62(8):764–776.PubMedCrossRefGoogle Scholar
  40. 40.
    Cerveri I, Zoia MC, Fanfulla F, et al. Reference values of arterial oxygen tension in the middle-aged and elderly. Am J Respir Crit Care Med 1995;152(3):934–941.PubMedGoogle Scholar
  41. 41.
    Guenard H, Marthan R. Pulmonary gas exchange in elderly subjects. Eur Respir J 1996;9(12):2573–2577.PubMedCrossRefGoogle Scholar
  42. 42.
    Thurlbeck WM, Angus GE. Growth and aging of the normal human lung. Chest 1975;67(2 Suppl):3S–6S.PubMedCrossRefGoogle Scholar
  43. 43.
    Grimby G, Saltin B. Physiological effects of physical training. Scand J Rehabil Med 1971;3(1):6–14.PubMedGoogle Scholar
  44. 44.
    Mahler DA, Cunningham LN, Curfman GD. Aging and exercise performance. Clin Geriatr Med 1986;2(2):433–452.PubMedGoogle Scholar
  45. 45.
    Poulin MJ, Cunningham DA, Paterson DH, Rechnitzer PA, Ecclestone NA, Koval JJ. Ventilatory response to exercise in men and women 55 to 86 years of age. Am J Respir Crit Care Med 1994;149(2 Pt 1):408–415.PubMedGoogle Scholar
  46. 46.
    Krumpe PE, Knudson RJ, Parsons G, Reiser K. The aging respiratory system. Clin Geriatr Med 1985;1(1):143–175.PubMedGoogle Scholar
  47. 47.
    Mahler DA, Rosiello RA, Loke J. The aging lung. Part 1. Loss of elasticity. Clin Geriatr Med 1986;2(2):215–225.PubMedGoogle Scholar
  48. 48.
    Peterson DD, Pack AI, Silage DA, Fishman AP. Effects of aging on ventilatory and occlusion pressure responses to hypoxia and hypercapnia. Am Rev Respir Dis 1981; 124(4):387–391.PubMedGoogle Scholar
  49. 49.
    Kronenberg RS, Drage CW. Attenuation of the ventilatory and heart rate responses to hypoxia and hypercapnia with aging in normal men. J Clin Invest 1973;52(8):1812–1819.PubMedCrossRefGoogle Scholar
  50. 50.
    Brischetto MJ, Millman RP, Peterson DD, Silage DA, Pack AI. Effect of aging on ventilatory response to exercise and CO2. J Appl Physiol 1984;56(5):1143–1150.PubMedGoogle Scholar
  51. 51.
    Tack M, Altose MD, Cherniack NS. Effect of aging on respiratory sensations produced by elastic loads. J Appl Physiol 1981;50(4):844–850.PubMedGoogle Scholar
  52. 52.
    Tack M, Altose MD, Cherniack NS. Effect of aging on the perception of resistive ventilatory loads. Am Rev Respir Dis 1982;126(3):463–467.PubMedGoogle Scholar
  53. 53.
    Manning H, Mahler D, Harver A. Dyspnea in the elderly. In: Mahler D, ed. Pulmonary Disease in the Elderly Patient. New York: Marcel Dekker; 1993:81–111.Google Scholar
  54. 54.
    Hoch CC, Reynolds CF 3rd, Monk TH, et al. Comparison of sleep-disordered breathing among healthy elderly in the seventh, eighth, and ninth decades of life. Sleep 1990;13(6): 502–511.PubMedGoogle Scholar
  55. 55.
    Epstein CD, El-Mokadem N, Peerless JR. Weaning older patients from long-term mechanical ventilation: a pilot study. Am J Crit Care 2002;11(4):369–377.PubMedGoogle Scholar
  56. 56.
    Ancoli-Israel S, Coy T. Are breathing disturbances in elderly equivalent to sleep apnea syndrome? Sleep 1994; 17(1):77–83.PubMedGoogle Scholar
  57. 57.
    Krieger J, Sforza E, Boudewijns A, Zamagni M, Petiau C. Respiratory effort during obstructive sleep apnea: role of age and sleep state [see comment]. Chest 1997;112(4): 875–884.PubMedCrossRefGoogle Scholar
  58. 58.
    Marik PE, Kaplan D. Aspiration pneumonia and dysphagia in the elderly. Chest 2003;124(1):328–336.PubMedCrossRefGoogle Scholar
  59. 59.
    Rosenthal RA, Kavic SM. Assessment and management of the geriatric patient. Crit Care Med 2004;32(4 Suppl): S92–105.PubMedCrossRefGoogle Scholar
  60. 60.
    McCormick KA, Cummings MA, Kovner C. The role of the Agency for Health Care Policy and Research (AHCPR) in improving outcomes of care. Nurs Clin North Am 1997;32(3):521–542.PubMedGoogle Scholar
  61. 61.
    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.PubMedGoogle Scholar
  62. 62.
    Wightman JA. A prospective survey of the incidence of postoperative pulmonary complications. Br J Surg 1968; 55(2):85–91.PubMedCrossRefGoogle Scholar
  63. 63.
    Lawrence VA, Dhanda R, Hilsenbeck SG, Page CP. Risk of pulmonary complications after elective abdominal surgery. Chest 1996;110(3):744–750.PubMedCrossRefGoogle Scholar
  64. 64.
    Smetana GW, Lawrence VA, Cornell JE. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med 2006;144(8):581–595.PubMedGoogle Scholar
  65. 65.
    Lawrence VA, Hilsenbeck SG, Noveck H, Poses RM, Carson JL. Medical complications and outcomes after hip fracture repair. Arch Intern Med 2002;162(18):2053–2057.PubMedCrossRefGoogle Scholar
  66. 66.
    Pedersen T, Eliasen K, Henriksen E. A prospective study of risk factors and cardiopulmonary complications associated with anaesthesia and surgery: risk indicators of cardiopulmonary morbidity. Acta Anaesthesiol Scand 1990; 34(2):144–155.PubMedGoogle Scholar
  67. 67.
    Smetana GW. Preoperative pulmonary assessment of the older adult. Clin Geriatr Med 2003;19(1):35–55.PubMedCrossRefGoogle Scholar
  68. 68.
    McAlister FA, Khan NA, Straus SE, et al. Accuracy of the preoperative assessment in predicting pulmonary risk after nonthoracic surgery. Am J Respir Crit Care Med 2003;167(5):741–744.PubMedCrossRefGoogle Scholar
  69. 69.
    Arozullah AM, Daley J, Henderson WG, Khuri SF. Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. The National Veterans Administration Surgical Quality Improvement Program. Ann Surg 2000;232(2):242–253.PubMedCrossRefGoogle Scholar
  70. 70.
    Freye E, Levy JV. Use of opioids in the elderly—pharmacokinetic and pharmacodynamic considerations [German]. Anasthesiol Intensivmed Notfallmed Schmerzther 2004; 39(9):527–537.PubMedCrossRefGoogle Scholar
  71. 71.
    Warner DO. Preventing postoperative pulmonary complications: the role of the anesthesiologist. Anesthesiology 2000;92(5):1467–1472.PubMedCrossRefGoogle Scholar
  72. 72.
    Gunnarsson L, Tokics L, Gustavsson H, Hedenstierna G. Influence of age on atelectasis formation and gas exchange impairment during general anaesthesia. Br J Anaesth 1991;66(4):423–432.PubMedCrossRefGoogle Scholar
  73. 73.
    Holland J, Milic-Emili J, Macklem PT, Bates DV. Regional distribution of pulmonary ventilation and perfusion in elderly subjects. J Clin Invest 1968;47:81–92.PubMedGoogle Scholar
  74. 74.
    Gunnarsson L, Tokics L, Lundquist H, et al. Chronic obstructive pulmonary disease and anaesthesia: formation of atelectasis and gas exchange impairment. Eur Respir J 1991;4(9):1106–1116.PubMedGoogle Scholar
  75. 75.
    Sekizawa K, Ujiie Y, Itabashi S, Sasaki H, Takishima T. Lack of cough reflex in aspiration pneumonia. Lancet 1990;335(8699):1228–1229.PubMedCrossRefGoogle Scholar
  76. 76.
    Smithard DG, O’Neill PA, Parks C, Morris J. Complications and outcome after acute stroke. Does dysphagia matter? Stroke 1996;27(7):1200–1204.PubMedGoogle Scholar
  77. 77.
    Nelson R, Tse B, Edwards S. Systematic review of prophylactic nasogastric decompression after abdominal operations. Br J Surg 2005;92(6):673–680.PubMedCrossRefGoogle Scholar
  78. 78.
    Lawrence VA, Cornell JE, Smetana GW. Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med 2006;144(8): 596–608.PubMedGoogle Scholar
  79. 79.
    Trayner E Jr, Celli BR. Postoperative pulmonary complications. Med Clin North Am 2001;85(5):1129–1139.PubMedCrossRefGoogle Scholar
  80. 80.
    Smetana GW. Preoperative pulmonary evaluation [see comment]. N Engl J Med 1999;340(12):937–944.PubMedCrossRefGoogle Scholar
  81. 81.
    Wong DH, Weber EC, Schell MJ, Wong AB, Anderson CT, Barker SJ. Factors associated with postoperative pulmonary complications in patients with severe chronic obstructive pulmonary disease. Anesth Analg 1995;80(2): 276–284.PubMedCrossRefGoogle Scholar
  82. 82.
    Tarhan S, Moffitt EA, Sessler AD, Douglas WW, Taylor WF. Risk of anesthesia and surgery in patients with chronic bronchitis and chronic obstructive pulmonary disease. Surgery 1973;74(5):720–726.PubMedGoogle Scholar
  83. 83.
    Moulton MJ, Creswell LL, Mackey ME, Cox JL, Rosenbloom M. Obesity is not a risk factor for significant adverse outcomes after cardiac surgery. Circulation 1996;94 (9 Suppl): II87–92.PubMedGoogle Scholar
  84. 84.
    Gerson MC, Hurst JM, Hertzberg VS, Baughman R, Rouan GW, Ellis K. Prediction of cardiac and pulmonary complications related to elective abdominal and noncardiac thoracic surgery in geriatric patients. Am J Med 1990;88(2): 101–107.PubMedCrossRefGoogle Scholar
  85. 85.
    Williams-Russo P, Charlson ME, MacKenzie CR, Gold JP, Shires GT. Predicting postoperative pulmonary complications. Is it a real problem? Arch Intern Med 1992;152(6): 1209–1213.PubMedCrossRefGoogle Scholar
  86. 86.
    Beard K, Jick H, Walker AM. Adverse respiratory events occurring in the recovery room after general anesthesia. Anesthesiology 1986;64(2):269–272.PubMedCrossRefGoogle Scholar
  87. 87.
    Warner DO, Warner MA, Offord KP, Schroeder DR, Maxson P, Scanlon PD. Airway obstruction and perioperative complications in smokers undergoing abdominal surgery. Anesthesiology 1999;90(2):372–379.PubMedCrossRefGoogle Scholar
  88. 88.
    Warner DO. Helping surgical patients quit smoking: why, when, and how. Anesth Analg 2005;101(2):481–487.PubMedCrossRefGoogle Scholar
  89. 89.
    Warner DO. Perioperative abstinence from cigarettes: physiologic and clinical consequences. Anesthesiology 2006;104(2):356–367.PubMedCrossRefGoogle Scholar
  90. 90.
    Moller AM, Villebro N, Pedersen T, Tonnesen H. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet 2002; 359(9301):114–117.PubMedCrossRefGoogle Scholar
  91. 91.
    Garibaldi RA, Britt MR, Coleman ML, Reading JC, Pace NL. Risk factors for postoperative pneumonia. Am J Med 1981;70(3):677–680.PubMedCrossRefGoogle Scholar
  92. 92.
    Valentine SJ, Marjot R, Monk CR. Preoxygenation in the elderly: a comparison of the four-maximal-breath and three-minute techniques. Anesth Analg 1990;71(5): 516–519.PubMedCrossRefGoogle Scholar
  93. 93.
    Berg H, Roed J, Viby-Mogensen J, et al. Residual neuromuscular block is a risk factor for postoperative pulmonary complications. Aprospective, randomised, and blinded study of postoperative pulmonary complications after atracurium, vecuronium and pancuronium. Acta Anaesthesiol Scand 1997;41(9):1095–1103.PubMedGoogle Scholar
  94. 94.
    Eichenberger A, Proietti S, Wicky S, et al. Morbid obesity and postoperative pulmonary atelectasis: an underestimated problem. Anesth Analg 2002;95(6):1788–1792.PubMedCrossRefGoogle Scholar
  95. 95.
    Bindslev L, Hedenstierna G, Santesson J, Norlander O, Gram I. Airway closure during anaesthesia, and its prevention by positive end expiratory pressure. Acta Anaesthesiol Scand 1980;24(3):199–205.PubMedGoogle Scholar
  96. 96.
    Rothen HU, Sporre B, Engberg G, Wegenius G, Hedenstierna G. Reexpansion of atelectasis during general anaesthesia may have a prolonged effect. Acta Anaesthesiol Scand 1995;39(1):118–125.PubMedGoogle Scholar
  97. 97.
    Rothen HU, Sporre B, Engberg G, Wegenius G, Hedenstierna G. Re-expansion of atelectasis during general anaesthesia: a computed tomography study. Br J Anaesth 1993; 71(6):788–795.PubMedCrossRefGoogle Scholar
  98. 98.
    Whalen FX, Gajic O, Thompson GB, et al. The effects of the alveolar recruitment maneuver and positive end-expiratory pressure on arterial oxygenation during laparoscopic bariatric surgery. Anesth Analg 2006;102(1):298–305.PubMedCrossRefGoogle Scholar
  99. 99.
    Lachmann B. Open up the lung and keep the lung open. Intensive Care Med 1992;18(6):319–321.PubMedCrossRefGoogle Scholar
  100. 100.
    Rodgers A, Walker N, Schug S, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 2000;321(7275):1493.PubMedCrossRefGoogle Scholar
  101. 101.
    Myles PS, Power I, Jamrozik K. Epidural block and outcome after major surgery. Med J Aust 2002;177(10):536–537.PubMedGoogle Scholar
  102. 102.
    Jayr C, Thomas H, Rey A, Farhat F, Lasser P, Bourgain JL. Postoperative pulmonary complications. Epidural analgesia using bupivacaine and opioids versus parenteral opioids. Anesthesiology 1993;78(4):666–676; discussion 22A.PubMedCrossRefGoogle Scholar
  103. 103.
    Norris EJ, Beattie C, Perler BA, et al. Double-masked randomized trial comparing alternate combinations of intraoperative anesthesia and postoperative analgesia in abdominal aortic surgery. Anesthesiology 2001;95(5): 1054–1067.PubMedCrossRefGoogle Scholar
  104. 104.
    Sprung J, Gajic O, Warner DO. Review article: age related alterations in respiratory function—anesthetic considerations [Article de synthese: Les modifications de fonction respiratoire liees a l’age—considerations anesthesiques]. Can J Anaesth 2006;53(12):1244–1257.PubMedGoogle Scholar
  105. 105.
    Turnheim K. When drug therapy gets old: pharmacokinetics and pharmacodynamics in the elderly. Exp Gerontol 2003;38(8):843–853.PubMedCrossRefGoogle Scholar
  106. 106.
    Celli BR, Rodriguez KS, Snider GL. A controlled trial of intermittent positive pressure breathing, incentive spirometry, and deep breathing exercises in preventing pulmonary complications after abdominal surgery. Am Rev Respir Dis 1984;130(1):12–15.PubMedGoogle Scholar
  107. 107.
    Castillo R, Haas A. Chest physical therapy: comparative efficacy of preoperative and postoperative in the elderly. Arch Phys Med Rehabil 1985;66(6):376–379.PubMedGoogle Scholar
  108. 108.
    Brooks-Brunn JA. Postoperative atelectasis and pneumonia. Heart Lung 1995;24(2):94–115.PubMedCrossRefGoogle Scholar
  109. 109.
    Pasquina P, Tramer MR, Granier JM, Walder B. Respiratory physiotherapy to prevent pulmonary complications after abdominal surgery: a systematic review. Chest 2006; 130(6):1887–1899.PubMedCrossRefGoogle Scholar
  110. 110.
    Pennock BE, Kaplan PD, Carlin BW, Sabangan JS, Magovern JA. Pressure support ventilation with a simplified ventilatory support system administered with a nasal mask in patients with respiratory failure. Chest 1991;100(5): 1371–1376.PubMedCrossRefGoogle Scholar
  111. 111.
    Gust R, Gottschalk A, Schmidt H, Bottiger BW, Bohrer H, Martin E. Effects of continuous (CPAP) and bi-level positive airway pressure (BiPAP) on extravascular lung water after extubation of the trachea in patients following coronary artery bypass grafting. Intensive Care Med 1996; 22(12):1345–1350.PubMedCrossRefGoogle Scholar
  112. 112.
    Matte P, Jacquet L, Van Dyck M, Goenen M. Effects of conventional physiotherapy, continuous positive airway pressure and non-invasive ventilatory support with bilevel positive airway pressure after coronary artery bypass grafting. Acta Anaesthesiol Scand 2000;44(1):75–81.PubMedCrossRefGoogle Scholar
  113. 113.
    Aguilo R, Togores B, Pons S, Rubi M, Barbe F, Agusti AG. Noninvasive ventilatory support after lung resectional surgery. Chest 1997;112(1):117–121.PubMedCrossRefGoogle Scholar
  114. 114.
    Kindgen-Milles D, Buhl R, Gabriel A, Bohner H, Muller E. Nasal continuous positive airway pressure: a method to avoid endotracheal reintubation in postoperative high-risk patients with severe nonhypercapnic oxygenation failure. Chest 2000;117(4):1106–1111.PubMedCrossRefGoogle Scholar
  115. 115.
    Squadrone V, Coha M, Cerutti E, et al. Continuous positive airway pressure for treatment of postoperative hypoxemia: a randomized controlled trial. JAMA 2005;293(5):589–595.PubMedCrossRefGoogle Scholar
  116. 116.
    Esteban A, Frutos-Vivar F, Ferguson ND, et al. Noninvasive positive-pressure ventilation for respiratory failure after extubation. N Engl J Med 2004;350(24):2452–2460.PubMedCrossRefGoogle Scholar
  117. 117.
    Brochard L, Mancebo J, Wysocki M, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 1995;333(13):817–822.PubMedCrossRefGoogle Scholar
  118. 118.
    Brochard L. Non-invasive ventilation for acute exacerbations of COPD: a new standard of care. Thorax 2000;55(10): 817–818.PubMedCrossRefGoogle Scholar
  119. 119.
    Ebeo CT, Benotti PN, Byrd RP Jr, Elmaghraby Z, Lui J. The effect of bi-level positive airway pressure on postoperative pulmonary function following gastric surgery for obesity. Respir Med 2002;96(9):672–676.PubMedCrossRefGoogle Scholar
  120. 120.
    Joris JL, Sottiaux TM, Chiche JD, Desaive CJ, Lamy ML. Effect of bi-level positive airway pressure (BiPAP) nasal ventilation on the postoperative pulmonary restrictive syndrome in obese patients undergoing gastroplasty. Chest 1997;111(3):665–670.Google Scholar
  121. 121.
    Angus DC, Kelley MA, Schmitz RJ, White A, Popovich J Jr. Caring for the critically ill patient. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population? JAMA 2000; 284(21):2762–2770.PubMedCrossRefGoogle Scholar
  122. 122.
    Rice DP, Fineman N. Economic implications of increased longevity in the United States. Annu Rev Public Health 2004;25:457–473.PubMedCrossRefGoogle Scholar
  123. 123.
    Sevransky JE, Haponik EF. Respiratory failure in elderly patients. Clin Geriatr Med 2003;19(1):205–224.PubMedCrossRefGoogle Scholar
  124. 124.
    Sloane PJ, Gee MH, Gottlieb JE, et al. A multicenter registry of patients with acute respiratory distress syndrome. Physiology and outcome. Am Rev Respir Dis 1992;146(2): 419–426.PubMedGoogle Scholar
  125. 125.
    Luhr OR, Karlsson M, Thorsteinsson A, Rylander C, Frostell CG. The impact of respiratory variables on mortality in non-ARDS and ARDS patients requiring mechanical ventilation. Intensive Care Med 2000;26(5):508–517.PubMedCrossRefGoogle Scholar
  126. 126.
    Ely EW, Evans GW, Haponik EF. Mechanical ventilation in a cohort of elderly patients admitted to an intensive care unit. Ann Intern Med 1999;131(2):96–104.PubMedGoogle Scholar
  127. 127.
    Groeger JS, Guntupalli KK, Strosberg M, et al. Descriptive analysis of critical care units in the United States: patient characteristics and intensive care unit utilization. Crit Care Med 1993;21(2):279–291.PubMedCrossRefGoogle Scholar
  128. 128.
    Thompson LF. Failure to wean: exploring the influence of age-related pulmonary changes. Crit Care Nurs Clin North Am 1996;8(1):7–16.PubMedGoogle Scholar
  129. 129.
    Kleinhenz ME, Lewis CY. Chronic ventilator dependence in elderly patients. Clin Geriatr Med 2000;16(4):735–756.PubMedCrossRefGoogle Scholar
  130. 130.
    Gajic O, Dara SI, Mendez JL, et al. Ventilator-associated lung injury in patients without acute lung injury at the onset of mechanical ventilation. Crit Care Med 2004;32(9): 1817–1824.PubMedCrossRefGoogle Scholar
  131. 131.
    Fernandez-Perez ER, Keegan MT, Brown DR, Hubmayr RD, Gajic O. Intraoperative tidal volume as a risk factor for respiratory failure after pneumonectomy. Anesthesiology 2006;105(1):14–18.PubMedCrossRefGoogle Scholar
  132. 132.
    Choi G, Wolthuis EK, Bresser P, et al. Mechanical ventilation with lower tidal volumes and positive end-expiratory pressure prevents alveolar coagulation in patients without lung injury. Anesthesiology 2006;105(4):689–695.PubMedCrossRefGoogle Scholar
  133. 133.
    Michelet P, D’Journo XB, Roch A, et al. Protective ventilation influences systemic inflammation after esophagectomy: a randomized controlled study. Anesthesiology 2006; 105(5):911–919.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Rodrigo Cartin-Ceba
    • 1
  • Juraj Sprung
    • 2
  • Ognjen Gajic
    • 3
  • David O. Warner
    • 2
  1. 1.Critical Care Medicine Fellow Department of Critical Care ServiceMayo ClinicRochesterUSA
  2. 2.Department of AnesthesiologyMayo Clinic College of MedicineRochesterUSA
  3. 3.Department of Internal MedicineMayo Clinic College of MedicineRochesterUSA

Personalised recommendations