To the Editor Fernandez-Bustamante et al1 show that postoperative pulmonary complications occur in one-third of noncardiothoracic surgical patients with severe systemic disease despite current intraoperative ventilation practices considered to be protective. During general anesthesia, the combination of reduced functional residual capacity, airway closure, and a high inspiratory oxygen fraction are the main factors implicated in the development of atelectasis. The study by Fernandez-Bustamante et al1 raises attention once more to the occurrence of atelectasis as well as the prolonged oxygen therapy requirement. Notwithstanding that both have been considered mild postoperative pulmonary complications, they might also play a role as triggering factors in a potentially hazardous chain of events.
Borges JB, Amato MBP, Hedenstierna G. The Increasing Call for Protective Ventilation During Anesthesia. JAMA Surg. 2017;152(9):893–894. doi:10.1001/jamasurg.2017.1614
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