PT - JOURNAL ARTICLE AU - Muhammad Sameed AU - Humberto Choi AU - Moises Auron AU - Eduardo Mireles-Cabodevila TI - Preoperative Pulmonary Risk Assessment AID - 10.4187/respcare.09154 DP - 2021 Jul 01 TA - Respiratory Care PG - 1150--1166 VI - 66 IP - 7 4099 - http://rc.rcjournal.com/content/66/7/1150.short 4100 - http://rc.rcjournal.com/content/66/7/1150.full AB - Postoperative pulmonary complications have a significant impact on perioperative morbidity and mortality and contribute substantially to health care costs. Surgical stress and anesthesia lead to changes in respiratory physiology, altering lung volumes, respiratory drive, and muscle function that can cumulatively increase the risk of postoperative pulmonary complications. Preoperative medical evaluation requires a structured approach to identify patient-, procedure-, and anesthesia-related risk factors for postoperative pulmonary complications. Validated risk prediction models can be used for risk stratification and to help tailor the preoperative investigation. Optimization of pulmonary comorbidities, smoking cessation, and correction of anemia are risk-mitigation strategies. Lung-protective ventilation, moderate PEEP application, and conservative use of neuromuscular blocking drugs are intra-operative preventive strategies. Postoperative early mobilization, chest physiotherapy, oral care, and appropriate analgesia speed up recovery. High-risk patients should receive inspiratory muscle training prior to surgery, and there should be a focus to minimize surgery time.