Complications respiratoires après chirurgie de résection pulmonaire : nouveautés dans la prévention et la prise en charge périopératoire

Pulmonary complications are the main cause of postoperative complications after thoracic surgery. Risk factors are: old age, male, extent of pulmonary resection, severity of preoperative dyspnea, and major impairment in preoperative respiratory function. Gastric content inhalation, postoperative diaphragmatic dysfunction and pulmonary mechanical stress favor the occurrence of pulmonary complications. Management of patients in centres having developed a special expertise is mandatory. Prevention of respiratory complications is based on smoking cessation, preoperative renutrition and respiratory physiotherapy, protective ventilation during surgery (decrease in tidal volume) and restriction of intravenous fluid administration. Postoperatively, patient may benefit of epidural analgesia or paravertebral block for pain control and non-invasive ventilation when the risk is high.