Postoperative Care for Lung Lobectomy

Core Recommendations

The American College of Surgeons recommends implementing an Enhanced Recovery After Surgery (ERAS) program, including multimodal pain management, early mobilization, multimodal respiratory physiotherapy, and selective use of non-invasive ventilation for respiratory complications, for patients undergoing lung lobectomy 1, 2

The American Society of Anesthesiologists recommends continuous paravertebral block as the first-line treatment for pain management after lung lobectomy, due to its equivalent analgesic effect to thoracic epidural anesthesia but with fewer side effects 3
The American Society of Anesthesiologists also recommends the use of NSAIDs for short-term improvement of pain control and shoulder function recovery, but with strict evaluation of contraindications 3, 4

The American Thoracic Society strongly recommends implementing a multimodal respiratory physiotherapy program, including early mobilization, breathing exercises, supportive cough techniques, and pain management education, to reduce the incidence of pulmonary complications 1, 5
The use of non-invasive ventilation (NIV) or high-flow oxygen therapy (HFO) is recommended for patients with postoperative hypoxemia or respiratory distress, to reduce the rate of reintubation and mortality 2, 5, 6

The American College of Surgeons recommends early mobilization as a core component of the ERAS program, to reduce the incidence of pulmonary complications and hospital stay 2, 5, 6

The American College of Surgeons does not recommend routine admission to the intensive care unit (ICU) after lung lobectomy, but rather selective admission to intermediate care units based on comorbidities and intraoperative events 1
The mortality rate after lung lobectomy should be controlled below 4% 8