Pulmonary Pathophysiology and Lung Mechanics in Anesthesiology

Abstract

The induction and maintenance of anesthesia, surgical requirements, and patients’ unique pathophysiology all combine to create a setting in which our accumulated knowledge of respiratory physiology and lung mechanics take on immediate and central importance in patient management. In this review we will take a case-based approach to illustrate how the complex interactions between anesthesia, surgery, and patient disease impact patient care with respect to pulmonary pathophysiology and clinical decision-making. We will examine two disparate scenarios: a patient with chronic obstructive pulmonary disease undergoing a lung resection, and a patient with coronary artery disease undergoing cardiopulmonary bypass. In each example we will illustrate how important concepts in pulmonary physiology and respiratory mechanics impact clinical management decisions.

Assessment of lung ultrasound for early detection of respiratory complications in thoracic surgery

“… 3 , 11 On the ventilated side, barotrauma and volutrauma secondary to OLV, aggravated using the block, and the use of high FiO2s favoring oxidative stress are incriminated. 12 , 13 These factors explain that we observed B lines as soon as we left the operating room on both lungs.…”

Pulmonary Protection Strategies in Cardiac Surgery: Are We Making Any Progress?

“…Pulmonary vascular endothelial cells dysfunction and activated neutrophils sequestration into lungs parenchyma during period of reperfusion can increase lung tissue permeability and elevate vascular resistance and pulmonary surfactant changes leading to alveolar protein accumulation and pulmonary oedema and driving more ROS and cytokines production [ 26 – 28 ]. This will be manifested as abnormal gas exchange, poor lung mechanics, increased pulmonary shunt fraction and reduced functional residual capacity, and carbon monoxide transfer factor [ 28 – 30 ] ( Figure 1 ).…”

Effect of knee-chest, semi-sitting, and right lateral position on preterm neonates with respiratory distress syndrome

“…strategy usually prevents recourse to longer, overwhelming, or exhausting techniques. Positioning improves gas exchange and reduces pathology; several patients with respiration difficulties mechanically adopt a posture that facilitates their respiration(Vidal Melo, Musch, & Kaczka, 2012).The semi-sitting position where the patient bed has a 30 to 45-degree angle to the horizontal. Other physiological impacts, like cardiovascular and respiratory changes, can be caused by various physical states, mostly due to gravity's effects on the bloodstream and its distribution in the venous, pulmonary, and arterial systems.…”