This review focuses on the pulmonary protection strategies during the cooperative period in cardiothoracic surgery. By deeply analyzing the psychophysiology mechanism of pulmonary injury during the cooperative period, it comprehensively sorts out the pulmonary protection strategies and their research progress in key areas covered in current clinical practice, including optimizing mechanical ventilation strategies, drug intervention, fluid management, and respiratory function exercise. The study systematically interprets the advantages and application limitations of existing strategies and prospectively looks forward to the innovative directions of future pulmonary protection strategies. It aims to provide an evidence-based medical reference with theoretical depth and practical value for improving the refined management level of pulmonary function of patients undergoing cardiothoracic surgery during the cooperative period.
References
[1]
Song, Y.J. and Li, Q.G. (2024) Research Progress on the Pathogenesis of Acute Respiratory Distress Syndrome in Patients after Cardiac Surgery with Cardiopulmonary Bypass. Journal of Cardiovascular and Pulmonary Diseases, 43, 1337-1340.
[2]
Xu, Y., Zhuo, L. and Guo, G.W. (2021) Research Progress of Endothelial Glycocalyx and Perioperative Pulmonary Injury in Cardiothoracic Surgery. Journal of Cardiovascular and Pulmonary Diseases, 40, 397-400.
[3]
Luo, M.Z., Zhang, X.R., Sun, C.Y., et al. (2024) Research Progress on the Abnormal Mechanical Behavior of Airway Smooth Muscle Cells in Mechanical Ventilation-induced Airway Collapse. Journal of Medical Biomechanics, 39, 998-1004.
[4]
Ak, A.K. and Anjum, F. (2025) Ventilator-Induced Lung Injury (VILI). StatPearls.
[5]
Hamacher, J., Hadizamani, Y., Huwer, H., Moehrlen, U., Bally, L., Stammberger, U., et al. (2023) Characteristics of Inflammatory Response and Repair after Experimental Blast Lung Injury in Rats. PLOS ONE, 18, e0281446. https://doi.org/10.1371/journal.pone.0281446
[6]
Ward, P.A. (2010) Oxidative Stress: Acute and Progressive Lung Injury. Annals of the New York Academy of Sciences, 1203, 53-59. https://doi.org/10.1111/j.1749-6632.2010.05552.x
[7]
Rezoagli, E., Ichinose, F., Strelow, S., Roy, N., Shelton, K., Matsumine, R., et al. (2017) Pulmonary and Systemic Vascular Resistances after Cardiopulmonary Bypass: Role of Hemolysis. Journal of Cardiothoracic and Vascular Anesthesia, 31, 505-515. https://doi.org/10.1053/j.jvca.2016.06.009
[8]
Souza, M.F.S., Penha, J.G., Maeda, N.Y., Galas, F.R.B.G., Abud, K.C.O., Carvalho, E.S., et al. (2022) Postoperative Pulmonary Hemodynamics and Systemic Inflammatory Response in Pediatric Patients Undergoing Surgery for Congenital Heart Defects. Mediators of Inflammation, 2022, Article ID: 3977585. https://doi.org/10.1155/2022/3977585
[9]
Vlastos, D., Zeinah, M., Ninkovic-Hall, G., Vlachos, S., Salem, A., Asonitis, A., et al. (2022) The Effects of Ischaemic Conditioning on Lung Ischaemia-Reperfusion Injury. Respiratory Research, 23, Article No. 351. https://doi.org/10.1186/s12931-022-02288-z
[10]
Wang, L., Li, J., Zhu, Y. and Zha, B. (2022) Low Tidal Volume Ventilation Alleviates Ventilator-Induced Lung Injury by Regulating the NLRP3 Inflammasome. Experimental Lung Research, 48, 168-177. https://doi.org/10.1080/01902148.2022.2104409
[11]
Briel, M., Meade, M., Mercat, A., Brower, R.G., Talmor, D., Walter, S.D., et al. (2010) Higher vs Lower Positive End-Expiratory Pressure in Patients with Acute Lung Injury and Acute Respiratory Distress Syndrome: Systematic Review and Meta-Analysis. JAMA, 303, 865-873. https://doi.org/10.1001/jama.2010.218
[12]
Meade, M.O., Cook, D.J., Guyatt, G.H., Slutsky, A.S., Arabi, Y.M., Cooper, D.J., et al. (2008) Ventilation Strategy Using Low Tidal Volumes, Recruitment Maneuvers, and High Positive End-Expiratory Pressure for Acute Lung Injury and Acute Respiratory Distress Syndrome: A Randomized Controlled Trial. JAMA, 299, 637-645. https://doi.org/10.1001/jama.299.6.637
[13]
Albers, G.J., Amouret, A., Ciupka, K., Montes-Cobos, E., Feldmann, C. and Reichardt, H.M. (2023) Glucocorticoid Nanoparticles Show Full Therapeutic Efficacy in a Mouse Model of Acute Lung Injury and Concomitantly Reduce Adverse Effects. International Journal of Molecular Sciences, 24, Article 16843. https://doi.org/10.3390/ijms242316843
[14]
Dashti-Khavidaki, S., Saidi, R. and Lu, H. (2021) Current Status of Glucocorticoid Usage in Solid Organ Transplantation. World Journal of Transplantation, 11, 443-465. https://doi.org/10.5500/wjt.v11.i11.443
[15]
Zhong, Y., Xia, S., Wang, G., Liu, Q., Ma, F., Yu, Y., et al. (2024) The Interplay between Mitophagy and Mitochondrial ROS in Acute Lung Injury. Mitochondrion, 78, Article ID: 101920. https://doi.org/10.1016/j.mito.2024.101920
[16]
Sang, W., Chen, S., Lin, L., Wang, N., Kong, X. and Ye, J. (2022) Antioxidant Mitoquinone Ameliorates EtOH-LPS Induced Lung Injury by Inhibiting Mitophagy and NLRP3 Inflammasome Activation. Frontiers in Immunology, 13, Article 973108. https://doi.org/10.3389/fimmu.2022.973108
[17]
Mokra, D., Porvaznik, I. and Mokry, J. (2025) N-Acetylcysteine in the Treatment of Acute Lung Injury: Perspectives and Limitations. International Journal of Molecular Sciences, 26, Article 2657. https://doi.org/10.3390/ijms26062657
[18]
Uchiyama, M., Tojo, K., Yazawa, T., Ota, S., Goto, T. and Kurahashi, K. (2015) Edaravone Prevents Lung Injury Induced by Hepatic Ischemia-Reperfusion. Journal of Surgical Research, 194, 551-557. https://doi.org/10.1016/j.jss.2014.11.011
[19]
Zhao, X. and Bie, M. (2022) Preoperative Acute Lung Injury and Oxygenation Impairment Occurred in the Patients with Acute Aortic Dissection. BMC Cardiovascular Disorders, 22, Article No. 129. https://doi.org/10.1186/s12872-022-02579-9
[20]
Leng, Y. (2014) Ulinastatin for Acute Lung Injury and Acute Respiratory Distress Syndrome: A Systematic Review and Meta-analysis. World Journal of Critical Care Medicine, 3, 34-41. https://doi.org/10.5492/wjccm.v3.i1.34
[21]
Bignami, E., Guarnieri, M. and Gemma, M. (2017) Fluid Management in Cardiac Surgery Patients: Pitfalls, Challenges and Solutions. Minerva Anestesiologica, 83, 638-651. https://doi.org/10.23736/s0375-9393.17.11512-9
[22]
Katsura, M., Kuriyama, A., Takeshima, T., Fukuhara, S. and Furukawa, T.A. (2015) Preoperative Inspiratory Muscle Training for Postoperative Pulmonary Complications in Adults Undergoing Cardiac and Major Abdominal Surgery. Cochrane Database of Systematic Reviews, No. 10, CD010356. https://doi.org/10.1002/14651858.cd010356.pub2
[23]
Hegazy, F.A., Mohamed Kamel, S.M., Abdelhamid, A.S., Aboelnasr, E.A., Elshazly, M. and Hassan, A.M. (2021) Effect of Postoperative High Load Long Duration Inspiratory Muscle Training on Pulmonary Function and Functional Capacity after Mitral Valve Replacement Surgery: A Randomized Controlled Trial with Follow-Up. PLOS ONE, 16, e0256609. https://doi.org/10.1371/journal.pone.0256609
[24]
Aquino, T.N.d., Prado, J.P., Crisafulli, E., Clini, E.M. and Galdino, G. (2024) Efficacy of Respiratory Muscle Training in the Immediate Postoperative Period of Cardiac Surgery: A Systematic Review and Meta-Analysis. Brazilian Journal of Cardiovascular Surgery, 39, e20220165. https://doi.org/10.21470/1678-9741-2022-0165
[25]
Chiang, X. and Lin, M. (2021) Converting to Intubation during Non-Intubated Thoracic Surgery: Incidence, Indication, Technique, and Prevention. Frontiers in Surgery, 8, Article 769850. https://doi.org/10.3389/fsurg.2021.769850
[26]
Ersöz, H., Ağababaoğlu, İ., Taylan, İ., Çakır, E., Aksun, S. and Güneli, E. (2020) Do Oral Amino Acid Supplements Facilitate the Healing of Rat Lung Injuries? European Journal of Cardio-Thoracic Surgery, 58, 983-990. https://doi.org/10.1093/ejcts/ezaa206
[27]
Habet, V., Li, N., Qi, J., Peng, G., Charkoftaki, G., Vasiliou, V., et al. (2023) Integrated Analysis of Tracheobronchial Fluid from before and after Cardiopulmonary Bypass Reveals Activation of the Integrated Stress Response and Altered Pulmonary Microvascular Permeability. The Yale Journal of Biology and Medicine, 96, 23-42. https://doi.org/10.59249/kfyz8002
[28]
Li, J.W., Wei, L., Han, Z. and Chen, Z. (2019) Mesenchymal Stromal Cells-Derived Exosomes Alleviate Ischemia/Reperfusion Injury in Mouse Lung by Transporting Anti-Apoptotic miR-21-5p. European Journal of Pharmacology, 852, 68-76. https://doi.org/10.1016/j.ejphar.2019.01.022
[29]
Peng, W., Qi, H., Zhu, W., Tong, L., Rouzi, A., Wu, Y., et al. (2023) Lianhua Qingke Ameliorates Lipopolysaccharide-Induced Lung Injury by Inhibiting Neutrophil Extracellular Traps Formation and Pyroptosis. Pulmonary Circulation, 13, e12295. https://doi.org/10.1002/pul2.12295
