Risk factors for postoperative pulmonary complications

Patient characteristics	Preoperative testing	Surgery	Anesthetic management
Age	Low albumin	Open thoracic surgery	General anesthesia
Male sex	Low SpO₂ (≤95%)	Cardiac surgery	High respiratory driving pressure (≥13 cm H₂O)
ASA class ≥3	Anemia (Hb <10 g/dL)	Open upper abdominal surgery	High inspiratory oxygen fraction
Previous respiratory infection		Major vascular surgery	High volume of crystalloid administration
Functional dependency		Neurosurgery	Erythrocyte transfusion
Congestive heart failure		Urology	Residual neuromuscular blockade
COPD		Duration of surgery >2 hours	Nasogastric tube use
Smoking		Emergent surgery
Renal failure
Gastroesophageal reflux disease
Weight loss

Respiratory driving pressure is defined as inspiratory plateau airway pressure minus positive end-expiratory pressure.

ASA: American Society of Anesthesiologists; COPD: chronic obstructive pulmonary disease; Hb: hemoglobin concentration; SpO₂: oxygen saturation as measured by pulse oximetry.

From: Güldner A, Kiss T, Serpa Neto A, et al. Intraoperative protective mechanical ventilation for prevention of postoperative pulmonary complications: a comprehensive review of the role of tidal volume, positive end-expiratory pressure, and lung recruitment maneuvers. Anesthesiology 2015; 123(3):692-713. DOI: 10.1097/ALN.0000000000000754. Copyright © 2015 American Society of Anesthesiologists. Reproduced with permission from Lippincott Williams & Wilkins. Unauthorized reproduction of this material is prohibited.

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Risk factors for postoperative pulmonary complications