[Diagnosis, prevention and therapy of pulmonary complications in heart surgery interventions]

Abstract

Pulmonary complications after cardiac surgery may be caused by preexisting disorders of the respiratory system, common risk factors (e.g., smoking), kind and duration of the surgical procedure, and the anesthesia performed. Preoperative lung function measurements do not allow a valid assessment of the frequency and severity of postoperative complications. However, the efficacy of the peroperative management with bronchodilating agents (beta 2-agonists, theophylline, corticosteroids) in patients with airflow limitation should be based on repeated lung-function testing. After coronary artery surgery, the internal mammary artery grafting produces a greater impairment of lung function than does saphenous vein grafting. In patients with mitral valve disease and pulmonary congestion without increased pulmonary vascular resistance lung-function may be improved by mitral valve replacement. Atelectasis and gas-exchange disturbances during anesthesia can be treated by ventilation with PEEP. An adequate and immediate management of postoperative pulmonary complications (atelectasis, respiratory failure, pneumonia) improves the outcome of patients after cardiac surgery. The role of perioperative physiotherapy for the reduction of pulmonary complications after cardiac surgery is not well established.