Critical care challenges after thoracic surgery for carcinoma and pulmonary metastases – avoiding postoperative complications

PURPOSE OF REVIEW: Advanced radiological imaging techniques, modern minimal invasive surgical procedures and the implementation of high care postoperative care units (PACU) have resulted in a reduction of critical care unit admission following lung surgery. Diagnosis of lung cancer in earlier states, enabling defined surgery with less tissue trauma, shorter duration and reduced blood loss are reasons for this development. However, postoperative pulmonary complications (PPCs), necessitating critical care therapy, is still a major problem. RECENT FINDINGS: PPCs increase morbidity and mortality, reduce long term outcome, provoke critical care unit admission, raise costs of medical treatment and prevent timely hospital discharge. Pulmonary tissue inflammation and hypoxia represent an important underlying pathophysiological mechanism of PPCs and preventing them improves postoperative outcomes. In contrast to its relevance for outcome, evidence to guide perioperative and postoperative critical care therapy of PPCs after lung surgery is limited. It has become clear, that intertwined measures must be taken in the pre, intra- and postoperative phase to reduce PPCs and to enhance recovery after thoracic surgery. SUMMARY: This review gives an overview on recent advances of the perioperative and critical care prevention and therapy of postoperative pulmonary complications in patients with lung surgery.