Pathogenesis and management of respiratory insufficiency following pulmonary resection

Scott K. Alpard, Alexander Duarte, Akhil Bidani, Joseph B. Zwischenberger

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

The underlying principle of the surgical treatment of non-small-cell lung cancer (NSCLC) is complete removal of the local/regional disease within the thorax. Pulmonary resection should be as conservative as possible without compromising the adequacy of tumor removal. A multitude of factors influence the incidence and severity of complications following pulmonary resection including the pre-operative physical and psychological status of the patient, the pathologic process requiring resection, the physiologic impact of the procedure, and the addition of pre-operative or postoperative adjuvant therapy. The insidious onset of interstitial changes on chest X-ray (CXR) 1 to 2 days after pulmonary resection forewarns of respiratory distress; however, the pathophysiology of adult respiratory distress syndrome (ARDS) with progression to respiratory failure requiring mechanical ventilation and advanced critical care often unfolds. Management of patients with severe respiratory failure remains primarily supportive. 'Good critical care' is the mainstay of therapy: this includes gentle mechanical ventilation to avoid ventilator-induced barotrauma and over-extension of remaining functional alveoli, diuresis, infection identification and management, and nutritional support. New therapeutic strategies that may impact on outcomes in the adult population include pressure-limited ventilation (permissive hypercapnia), inverse ratio ventilation, high-frequency jet ventilation, high-frequency oscillatory ventilation, intratracheal pulmonary ventilation, and prone position ventilation. In addition, alternative therapies such as partial liquid ventilation, inhaled nitric oxide, and extracorporeal techniques including extracorporeal membrane oxygenation (ECMO), extracorporeal carbon dioxide removal (ECCO2R), intravascular oxygenation (IVOX), and arteriovenous carbon dioxide removal (AVCO2R), provide additional modalities. A component of some or all of these strategies is finding a role in clinical practice. (C) 2000 Wiley-Liss, Inc.

Original languageEnglish (US)
Pages (from-to)183-196
Number of pages14
JournalSeminars in Surgical Oncology
Volume18
Issue number2
DOIs
StatePublished - Mar 2000

Fingerprint

Respiratory Insufficiency
Ventilation
Lung
Critical Care
Artificial Respiration
Carbon Dioxide
Thorax
Liquid Ventilation
High-Frequency Jet Ventilation
Barotrauma
High-Frequency Ventilation
Pulmonary Ventilation
Prone Position
Extracorporeal Membrane Oxygenation
Nutritional Support
Hypercapnia
Diuresis
Adult Respiratory Distress Syndrome
Population Dynamics
Pathologic Processes

Keywords

  • Adult respiratory distress syndrome
  • Barotrauma
  • Carbon dioxide
  • Extracorporeal membrane oxygenation
  • High-frequency ventilation
  • Lung neoplasms
  • Membrane oxygenators
  • Morbidity
  • Mortality
  • Nitric oxide
  • Non-small-cell lung carcinoma
  • Pneumonectomy
  • Postoperative complications
  • Preoperative care
  • Pulmonary edema
  • Respiratory insufficiency
  • Survival rate

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Pathogenesis and management of respiratory insufficiency following pulmonary resection. / Alpard, Scott K.; Duarte, Alexander; Bidani, Akhil; Zwischenberger, Joseph B.

In: Seminars in Surgical Oncology, Vol. 18, No. 2, 03.2000, p. 183-196.

Research output: Contribution to journalArticle

Alpard, Scott K. ; Duarte, Alexander ; Bidani, Akhil ; Zwischenberger, Joseph B. / Pathogenesis and management of respiratory insufficiency following pulmonary resection. In: Seminars in Surgical Oncology. 2000 ; Vol. 18, No. 2. pp. 183-196.
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