Vetrugno Luigi, Deana Cristian, Colaianni-Alfonso Nicolas, Tritapepe Fabrizio, Fierro Carmen, Maggiore Salvatore Maurizio
Department of Medical, Oral and Biotecnological Science, "G. D'Annunzio" Chieti-Pescara University, Chieti, Italy.
Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy.
Front Med (Lausanne). 2024 Apr 17;11:1364475. doi: 10.3389/fmed.2024.1364475. eCollection 2024.
The application of preoperative noninvasive respiratory support (NRS) has been expanding with increasing recognition of its potential role in this setting as a physiological optimization for patients with a high risk of developing atelectasis and postoperative pulmonary complications (PPC). The increased availability of high-performance anesthesia ventilator machines providing an easy way for NRS support in patients with reduced lung function should not be under-evaluated. This support can reduce hypoxia, restore lung volumes and theoretically reduce atelectasis formation after general anesthesia. Therapeutic purposes should also be considered in the perioperative setting, such as preoperative NRS to optimize treatment of patients' pre-existing diseases, e.g., sleep-disordered breathing. Finally, the recent guidelines for airway management suggest preoperative NRS application before anesthesia induction in difficult airway management to prolong the time needed to secure the airway with an orotracheal tube. This narrative review aims to revise all these aspects and to provide some practical notes to maximize the efficacy of perioperative noninvasive respiratory support.
随着术前无创呼吸支持（NRS）在预防肺不张和术后肺部并发症（PPC）高风险患者生理状态优化方面的潜在作用得到越来越多的认可，其应用范围不断扩大。高性能麻醉呼吸机的普及为肺功能减退患者提供了便捷的NRS支持方式，这一点不容小觑。这种支持可以减轻缺氧、恢复肺容量，理论上还能减少全身麻醉后肺不张的形成。围手术期也应考虑治疗目的，例如术前NRS用于优化患者现有疾病（如睡眠呼吸障碍）的治疗。最后，最近的气道管理指南建议，在困难气道管理中，麻醉诱导前应用术前NRS，以延长经口气管插管确保气道安全所需的时间。本叙述性综述旨在对所有这些方面进行修订，并提供一些实用建议，以最大限度地提高围手术期无创呼吸支持的疗效。
