Table 2.

Prevention strategies for postoperative pulmonary complications.

	Options	Proposed mechanisms
Mechanical factors	Miniaturized CPB circuit	Decrease contact activation, decreased hemodilution
	Coated CPB circuit (heparin, PMEA)	Decrease contact activation
	Leukocyte filtration	Remove activated leukocytes, especially for longer CPB duration
	Retrograde autologous priming (RAP)	Decrease hemodilution
	Ultrafiltration (modified, zero-balance)	Hemoconcentration, filtration of mediators
	Normoxia on CPB	Reduce reperfusion injury with free oxygen radicals
Surgical technique	Avoid CPB if possible
	Reduce the duration of time on CPB	Reduction in time available for inflammation/ischemic injury to lungs
	Cardioprotection with cardioplegia	Prevent ischemia–reperfusion injury
	Minimize cardiotomy suction	Decrease blood–air contact; decrease activation of inflammatory response
	Transfusion-sparing techniques	Decrease inflammation/immune responses to transfusion
	Partial lung perfusion	Decrease ischemia to lungs, more complicated surgical procedure
Anesthesia factors	Intermittent ventilation	Prevent atelectasis
	Recruitment maneuver	Reduce atelectasis, improve respiratory mechanics, reduce volutrauma
	Low tidal volume ventilation	Prevent shear stress, various types of trauma to lungs: volutrauma, barotraumas, and atelectatrauma
	Volatile anesthesia-based
Medications	Steroids	Modulate immune response, potential negative impact on glucose control and wound healing
	Neutrophil elastase inhibitors	Inhibit neutrophil elastase and reduce leukocyte sequestration in the lungs
	Hypertonic saline	Decrease extravascular lung water, improve oxygenation
	Aprotonin	Decrease extravascular lung water, improve oxygenation, and reduce neutrophil sequestration