When the Critically Ill Patient Requires Surgery: A Review of Perioperative Considerations for the Surgical Patient With ALI/ARDS

Abstract

Patients with acute lung injury or acute respiratory distress syndrome present many challenges in the perioperative setting. Maintaining oxygenation and hemodynamic stability requires a comprehensive plan for both transport and intraoperative management. Many factors are important to consider when choosing a mechanical ventilation strategy, including tidal volume, ventilation mode, and maintenance of positive end-expiratory pressure. The goals of care include maintenance of lung protective strategies during surgery and avoidance of adverse events during transport. Considerations for ventilation unique to the intraoperative setting and situations requiring use of a transport ventilator or an ICU ventilator are discussed. Overall, providing safe and high-quality perioperative care to a critically ill patient requires communication and collaboration among a multidisciplinary team.