Mechanical ventilation for respiratory failure postthoracotomy

Abstract

Although the exact incidence of postthoracotomy respiratory failure is unknown, it can be estimated to lie between 5% and 15%, given that many of these patients suffer from comorbid cardiopulmonary disease. Preoperative assessment is essential to more accurately predict those patients at increased risk for the development of respiratory failure. Efforts to minimize these risks include the aggressive use of analgesics. In the event of respiratory failure, the clinician must have a clear understanding of the underlying cardiopulmonary pathology, if any, and of the impact of the anesthetic and surgical procedures on cardiopulmonary performance. The twin goals of mechanical ventilation should be to provide inspiratory muscle assistance and rest while preventing the onset of muscle atrophy. To that extent, the limitations of the various modes of mechanical ventilation must be appreciated as to their impact on patient ventilatory performance. Weaning, which should be regarded simply as an extension of mechanical ventilation, should be approached with an appreciation of the pathophysiologic basis underlying ventilatory failure, the factors responsible, and a rational approach to their repair.