Prevention of Postoperative Acute Lung Injury (ALI) - The Anaesthetist Role

Postoperative pulmonary complications such as Pneumonia, Acute Lung Injury (ALI), Acute Respiratory Distress Syndrome (ARDS) substantially increases the risk of morbidity, mortality, length of hospitalisation and financial burden. Risk factors can be broadly categorized into patient related, procedure related, anaesthesia related and post procedural care related. The prevention of postoperative ALI requires a comprehensive approach that includes preoperative risk stratification and optimizations, intraoperative lung protective strategies that includes lung protective ventilation, regional analgesia technique, avoiding excessive fluid, minimising blood and blood product transfusion, control oxygen therapy. Postoperative part is equally important and required multidisciplinary multi-model approach that includes- fast tracking protocol for enhanced recovery, good analgesia using multimodel therapy to minimised systemic opioid, vigilance monitoring, physiotherapy and lung expansion manoeuvres including use of non-invasive ventilation in selected patients and other supportive care such as nutritional support, glycemic control, selective nasogastric drainage, thrombo- prophylaxis and early empirical antibiotic therapy in suspected infection and sepsis.