Perioperative anaesthetic management of patients with or at risk of acute distress respiratory syndrome undergoing emergency surgery

Abstract

Patients undergoing emergency surgery may present with the acute respiratory distress syndrome (ARDS) or develop this syndrome postoperatively. The incidence of ARDS in the postoperative period is relatively low, but the impact of ARDS on patient outcomes and healthcare costs is relevant [1]. The development of ARDS as a postoperative pulmonary complication (PPC) is associated with prolonged hospitalisation, longer duration of mechanical ventilation, increased intensive care unit length of stay and high morbidity and mortality [2]. In order to mitigate the risk of ARDS after surgery, the anaesthetic management and protective mechanical ventilation strategies play an important role. In particular, a careful integration of general anaesthesia with neuraxial or locoregional techniques might promote faster recovery and reduce opioid consumption. In addition, the use of low tidal volume, minimising plateau pressure and titrating a low-moderate PEEP level based on the patient’s need can improve outcome and reduce intraoperative adverse events. Moreover, perioperative management of ARDS patients includes specific anaesthesia and ventilator settings, hemodynamic monitoring, moderately restrictive fluid administration and pain control. The aim of this review is to provide an overview and evidence- and opinion-based recommendations concerning the management of patients at risk of and with ARDS who undergo emergency surgical procedures.

Pediatric lower respiratory tract infection: Considerations for the anesthesiologist

“…Most of these patients are on noninvasive or mechanical ventilation have concomitant septic shock and multi-organ failure. Supportive management with moderate fluid restriction and lung-protective mechanical ventilation is recommended.Lung-protective mechanical ventilation reduce24,25 ventilator-induced lung injury with low tidal volume ventilation, minimizing the increase of plateau pressure >30 cm H2O and the use adequate PEEP. Both intravenous and inhalational anesthetics are safe in PARDS.…”

“…Viral respiratory infection is the most common underlying condition causing PARDS. The management is usually supportive including lungprotective mechanical ventilation, appropriate fluid management, and treatment of underlying conditions 24,25. For emergency procedures, preoperative risk stratification based on PARDS severity is important.…”