Chapter 25 - Management of post-operative respiratory problems

Summary

Lung separation techniques are generally unnecessary in the post-operative period and are usually replaced by a single lumen endotracheal tube if continued mechanical ventilation is required. Single lumen tubes are preferable as double lumen tubes (DLTs) are more likely to cause airway trauma and edema due to their size. Non-invasive positive pressure ventilation as management of acute hypoxemic respiratory insufficiency after lung resection has been shown to reduce the requirement for endotracheal intubation and invasive ventilation and to potentially reduce associated mortality. Acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) is one of the main causes of mortality following surgery for lung resection. A strategy for fluid administration during lung resection surgery might include a restrictive policy of replacing losses and avoiding hypovolemia. Administration of fluid may be guided by the measurement of central venous pressure and urinary output.