Management of Abnormal Respiratory Findings Post Cardiac Surgery

Assessment and Management

Non-invasive ventilation (NIV) should be used as the first-line treatment for patients with post-operative acute respiratory failure following cardiac surgery, as recommended by the European Respiratory Society 1
Systematic respiratory assessment should include monitoring of oxygen saturation, respiratory rate, work of breathing, and breath sounds, according to the American Thoracic Society 2
NIV reduces the risk of tracheal re-intubation within 7 days (33% vs 46% with standard oxygen therapy) and decreases the incidence of healthcare-associated infections (31% vs 49% with standard oxygen therapy), as reported by the European Respiratory Society 1
Early mobilization and respiratory physiotherapy should be implemented to prevent atelectasis and promote lung expansion, as recommended by the American Association for Respiratory Care 2
For patients requiring mechanical ventilation, a protective lung ventilation strategy with low tidal volumes (6-8 mL/kg ideal body weight) should be used, as recommended by the British Journal of Anaesthesia 2
Moderate positive end-expiratory pressure (PEEP) should be applied, and PEEP during cardiopulmonary bypass may protect the lungs, according to the British Journal of Anaesthesia 3, 4
High-dose dexamethasone (1 mg/kg) may be considered for lung protection in selected patients, reducing the incidence of prolonged ventilation (>24h) from 4.9% to 3.4% and postoperative pneumonia from 10.6% to 6%, as reported by the British Journal of Anaesthesia 3, 4

Biocompatible modifications of cardiopulmonary bypass circuits should be considered to protect lungs from inflammatory responses, as recommended by the European Association of Cardiothoracic Surgery 3, 4
Modified ultrafiltration (MUF) and selective pulmonary artery perfusion may improve postoperative respiratory function, according to the European Association of Cardiothoracic Surgery 3, 4
Avoid hyperoxia during cardiopulmonary bypass, as it is not recommended for lung protection, as stated by the American Heart Association 3, 4