Mechanical ventilation can be anticipated for at least 12 to 48 hours postoperatively. Weaning can commence once relative hemodynamic stability can be maintained, coagulation status corrected, and the patient begins mobilizing interstitial fluid with reduced airway edema and improved oxygenation.

Respiratory failure after TAAA repair remains one of the most commonly reported complications, with reported rates of postoperative tracheostomy as high as 8.5%. The large thoracoabdominal incision, diaphragmatic incision, and need for lung isolation all predispose the patient to pulmonary dysfunction. The diaphragmatic incision may lead to hemidiaphragm dysfunction or paralysis. Preoperative pulmonary dysfunction, tobacco use, postoperative cardiac complications, and postoperative renal complications are independent risk factors for postoperative respiratory failure.

References

• Chatterjee S, Casar JG, LeMaire SA, Preventza O, Coselli JS. Perioperative care after thoracoabdominal aortic aneurysm repair: The Baylor College of Medicine experience. Part 2: postoperative management. J Thorac Cardiovasc Surg. 2021;161:699-705.
• Khan FM, Naik A, Hameed I, et al. Open repair of descending thoracic and thoracoabdominal aortic aneurysms: a meta-analysis. Ann Thorac Surg. 2020;110:1941-1949.