Pulmonary Complications of Cardiac Surgery
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STATE OF THE ART REVIEW
Pulmonary Complications of Cardiac Surgery Tristan George Tanner1 · Mai O. Colvin1 Received: 6 October 2020 / Accepted: 31 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Cardiothoracic surgery posits an arrangement of large, significant hemodynamic, and physiologic alterations upon the human body, which predisposes a patient to develop pathology. The care of these patients in the postoperative realm requires an astute physician with deep understanding of the cardiopulmonary system, who is able to address subtle developing problems promptly, before the patient suffers further sequelae. In this review, we describe the presentation and management of an assortment of important complications which occur in the pulmonary system. In addition, we aim to shed better light upon how the physiology of a patient responds to the condition of cardiothoracic surgery. Keywords Cardiothoracic surgery · Postoperative complications · Complications · Cardiothoracic intensive care unit · Acute respiratory failure · Critical care
Introduction
Cardiopulmonary Bypass
Cardiac surgery is a high-risk field requiring specialized teams to manage patients in the perioperative and postoperative environment. The pulmonary system, exquisitely related in both spatial proximity and synergistic function, requires close attention and support during cardiac surgery’s acute stress. Pulmonary complications are common in patients who undergo cardiac surgery with outcomes such as pneumonia, pulmonary embolism, ventilation longer than 24 h, and pleural effusions necessitating drainage being reportable to the Society of Thoracic Surgeons [1]. Pulmonary complications after cardiac surgery result in prolonged hospital stay and increase in healthcare cost [2]. Patients prone to complications tend to have limited homeostatic reserve associated with chronic heart failure, pulmonary illness, multiple comorbidities, older age, or have completed more invasive and longer duration surgeries [3, 4]. As the field continues to advance medical acumen, we seek to protect the pulmonary system better.
Cardiac surgery commonly uses cardiopulmonary bypass (CPB), which provides advanced physiologic support with an extracorporeal circulatory device. Depending on the type of cardiac surgery, the lungs experience up to several hours of relative ischemia during bypass. Under normal physiology, blood is delivered to the lungs by both pulmonary and bronchial arterial systems which share collateral circulation. During bypass, perfusion is solely provided to the bronchial system, placing the lungs in a relative state of ischemia. Upon cessation of bypass, reperfusion of the lungs occurs after reinstatement of pulmonary arterial flow. In addition, bronchial arterial flow on bypass paradoxically decreases, contributing to worsening low flow ischemia, which normalizes after pulmonary arterial clamping ends [5]. This environment generates ischemia–reperfusion injury with a proinflammatory/proapoptotic state, charac
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