Respiratory failure

Respiratory failure in the perioperative period is associated with significant morbidity and mortality. Underlying respiratory disease, as well as factors related to the patient, anaesthesia and surgery contribute to perioperative pulmonary complications and respiratory failure. The proven strategies to reduce the risk of postoperative pulmonary complications include optimizing management of chronic lung disease before surgery, lung expansion manoeuvres, and pain control. Postoperative respiratory failure usually results from dysfunction of alveolar gas exchange, but may also arise from problems with the respiratory pump (respiratory muscles, thoracic cage, abdomen), central respiratory drive or neuromuscular conduction. Treatment depends on the cause and includes measures to reverse atelectasis, mobilization and removal of secretions, bronchodilation, treatment of infections and, ultimately, mechanical ventilation. Heterogeneous causes and protean manifestations make diagnosis and management challenging.