Advanced research on respiratory rehabilitation for postoperative pulmonary complications after aortic dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHOU Nanxi ¹ , LUO Zeruxin ² , XIAO Zhenghua ³ , HE Jiayuan ⁴ , WEI Quan ² ,  YU Pengming ²

1. School of Clinical Medicine, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
3. Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
4. National Clinical Research Center for Geriatric, West China Hospital, Sichuan University, Chengdu, 610017, P. R. China;

Corresponding author：

YU Pengming, Email: 13438201451@126.com

Keywords：

Aortic dissection; postoperative pulmonary complications; respiratory rehabilitation; enhanced recovery after surgery; review

DOI：

10.7507/1007-4848.202412047

Video：

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Abstract Full text Figures/Tables Video References Cited by

Aortic dissection is a serious cardiovascular disease characterized by acute onset and high mortality rates. Although advancements in surgical techniques and anesthesia methods have significantly reduced surgical mortality, postoperative complications, particularly pulmonary complications, remain a challenge for the recovery of patients with aortic dissection. Existing studies indicate that respiratory rehabilitation plays a crucial role in preventing and alleviating postoperative pulmonary complications, and its application is gradually expanding. However, current understanding of respiratory rehabilitation treatment for patients with aortic dissection is still insufficient, and there is a lack of standardized protocols in clinical practice. This article aims to review the existing research evidence, comprehensively analyze common pulmonary complications after aortic dissection surgery, their pathogenesis, the latest advancements in perioperative respiratory rehabilitation, and the main challenges faced, in order to provide references for clinical practice and future research.

1.	Mazzolai L, Teixido-Tura G, Lanzi S, et al. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J, 2024, 45(36): 3538-3700.
2.	中华医学会放射学分会介入学组. 中国StanfordB型主动脉夹层影像诊断和介入治疗临床指南. 中华放射学杂志, 2023, 57(5): 457-473.
3.	Yan Y, Zhang X, Yao Y, et al. Postoperative pulmonary complications in patients undergoing aortic surgery: A single-center retrospective study. Medicine (Baltimore), 2023, 102(39): e34668.
4.	Rodrigues SN, Henriques HR, Henriques MA. Effectiveness of preoperative breathing exercise interventions in patients undergoing cardiac surgery: A systematic review. Rev Port Cardiol (Engl Ed), 2021, 40(3): 229-244.
5.	Shahood H, Pakai A, Rudolf K, et al. The effect of preoperative chest physiotherapy on oxygenation and lung function in cardiac surgery patients: A randomized controlled study. Ann Saudi Med, 2022, 42(1): 8-16.
6.	Fang L, Cheng A, Zhu Z, et al. Effect of inspiratory muscle training on outcomes after cardiac surgery: A comprehensive meta-analysis of randomized controlled trials. J Cardiopulm Rehabil Prev, 2024, 44(5): 324-332.
7.	Katsura M, Kuriyama A, Takeshima T, et al. Preoperative inspiratory muscle training for postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery. Cochrane Database Syst Rev, 2015, 2015(10): CD010356.
8.	Wang X, Ma J, Lin D, et al. The risk factors of postoperative hypoxemia in patients with Stanford type A acute aortic dissection. Medicine (Baltimore), 2023, 102(33): e34704.
9.	Vlaar AP, Hofstra JJ, Determann RM, et al. The incidence, risk factors, and outcome of transfusion-related acute lung injury in a cohort of cardiac surgery patients: A prospective nested case-control study. Blood, 2011, 117(16): 4218-4225.
10.	Yao R, Liu X, He Y, et al. Low platelet count is a risk factor of postoperative pneumonia in patients with type A acute aortic dissection. J Thorac Dis, 2020, 12(5): 2333-2342.
11.	Zhang H, Liu Y, Meng X, et al. Effects of inhaled nitric oxide for postoperative hypoxemia in acute type A aortic dissection: A retrospective observational study. J Cardiothorac Surg, 2020, 15(1): 25.
12.	Wang D, Lu Y, Sun M, et al. Pneumonia After Cardiovascular Surgery: Incidence, Risk Factors and Interventions. Front Cardiovasc Med, 2022, 9: 911878.
13.	Quinton LJ, Walkey AJ, Mizgerd JP. Integrative Physiology of Pneumonia. Physiol Rev, 2018, 98(3): 1417-1464.
14.	BALLOTTA A B, KANDIL H, MONTGOMERY D G, et al. Acute respiratory failure after type A aortic dissection repair: data from the International Registry of Aortic Dissection (IRAD). Eur Heart J, 2019, 40: 3480-.
15.	Jammer I, Wickboldt N, Sander M, et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: A statement from the ESA-ESICM joint taskforce on perioperative outcome measures. Eur J Anaesthesiol, 2015, 32(2): 88-105.
16.	Liu N, Zhang W, Ma W, et al. Risk factors for hypoxemia following surgical repair of acute type A aortic dissection. Interact Cardiovasc Thorac Surg, 2017, 24(2): 251-256.
17.	Kurabayashi M, Okishige K, Azegami K, et al. Reduction of the PaO2/FiO2 ratio in acute aortic dissection – relationship between the extent of dissection and inflammation –. Circ J, 2010, 74(10): 2066-2073.
18.	Bossone E, Eagle KA. Epidemiology and management of aortic disease: Aortic aneurysms and acute aortic syndromes. Nat Rev Cardiol, 2021, 18(5): 331-348.
19.	Sayed A, Munir M, Bahbah EI. Aortic Dissection: A Review of the Pathophysiology, Management and Prospective Advances. Curr Cardiol Rev, 2021, 17(4): e230421186875.
20.	Girdauskas E, Kuntze T, Borger MA, et al. Acute respiratory dysfunction after surgery for acute type A aortic dissection. Eur J Cardiothorac Surg, 2010, 37(3): 691-696.
21.	Möller CM, Ellmauer PP, Zeman F, et al. Postoperative acute respiratory dysfunction and the influence of antibiotics after acute type A aortic dissection surgery: A retrospective analysis. PLoS One, 2021, 16(2): e0246724.
22.	Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA, 2012, 307(23): 2526-2533.
23.	Matthay MA, Arabi Y, Arroliga AC, et al. A New Global Definition of Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med, 2024, 209(1): 37-47.
24.	Yamada Y, Tanno J, Nakano S, et al. Clinical implications of pleural effusion in patients with acute type B aortic dissection. Eur Heart J Acute Cardiovasc Care, 2016, 5(7): 72-81.
25.	Looney MR, Gropper MA, Matthay MA. Transfusion-related acute lung injury: A review. Chest, 2004, 126(1): 249-258.
26.	Yu Y, Lian Z. Update on transfusion-related acute lung injury: An overview of its pathogenesis and management. Front Immunol, 2023 May 12: 14: 1175387.
27.	Zeng C, Lagier D, Lee JW, et al. Perioperative Pulmonary Atelectasis: Part I. Biology and Mechanisms. Anesthesiology, 2022, 136(1): 181-205.
28.	Wang Y, Luo Z, Huang W, et al. Comparison of Tools for Postoperative Pulmonary Complications After Cardiac Surgery. J Cardiothorac Vasc Anesth, 2023, 37(8): 1442-1448.
29.	PAJARES M A, MARGARIT J A, GARCíA-CAMACHO C, et al. Guidelines for enhanced recovery after cardiac surgery. Consensus document of Spanish Societies of Anesthesia (SEDAR), Cardiovascular Surgery (SECCE) and Perfusionists (AEP) [J]. Rev Esp Anestesiol Reanim (Engl Ed), 2021, 68(4): 183-231.
30.	Salzmann S, Salzmann-Djufri M, Wilhelm M, et al. Psychological Preparation for Cardiac Surgery. Curr Cardiol Rep, 2020, 22(12): 172.
31.	Kilic A, Ohkuma R, Grimm JC, et al. A novel score to estimate the risk of pneumonia after cardiac surgery. J Thorac Cardiovasc Surg, 2016, 151(5): 1415-1420.
32.	Rhee R, Gupta A, Vechvitvarakul S, et al. Risk factors predictive of unfavorable distal aortic remodeling after surgical repair of type A thoracic aortic dissection. J Cardiovasc Surg (Torino), 2020, 61(3): 323-331.
33.	Lumb AB. Pre-operative respiratory optimisation: An expert review. Anaesthesia, 2019 Jan: 74 Suppl 1: 43-48.74-71.
34.	Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology, 2010, 113(6): 1338-1350.
35.	García Sánchez F, Mudarra García N. Evaluation of postoperative results after a presurgical optimisation programme. Perioper Med (Lond), 2024, 13(1): 73.
36.	CEREDA M, NELIGAN P J, REED A J. Noninvasive respiratory support in the perioperative period. Curr Opin Anaesthesiol, 2013, 26(2): 134-40.
37.	Carron M, Freo U, BaHammam AS, et al. Complications of non-invasive ventilation techniques: A comprehensive qualitative review of randomized trials. Br J Anaesth, 2013, 110(6): 896-914.
38.	Spence EA, Rajaleelan W, Wong J, et al. The Effectiveness of High-Flow Nasal Oxygen During the Intraoperative Period: A Systematic Review and Meta-analysis. Anesth Analg, 2020, 131(4): 1102-1110.
39.	Rochwerg B, Granton D, Wang DX, et al. High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: A systematic review and meta-analysis. Intensive Care Med, 2019, 45(5): 563-572.
40.	Hol L, Nijbroek SGLH, Schultz MJ. Perioperative Lung Protection: Clinical Implications. Anesth Analg, 2020, 131(6): 1721-1729.
41.	Young CC, Harris EM, Vacchiano C, et al. Lung-protective ventilation for the surgical patient: international expert panel-based consensus recommendations. Br J Anaesth, 2019, 123(6): 898-913.
42.	Petrucci N, De Feo C. Lung protective ventilation strategy for the acute respiratory distress syndrome. Cochrane Database Syst Rev, 2013, 2013(2): CD003844.
43.	Ferrando C, Soro M, Unzueta C, et al. Individualised perioperative open-lung approach versus standard protective ventilation in abdominal surgery (iPROVE): A randomised controlled trial. Lancet Respir Med, 2018, 6(3): 193-203.
44.	Constantin JM, Jabaudon M, Lefrant JY, et al. Personalised mechanical ventilation tailored to lung morphology versus low positive end-expiratory pressure for patients with acute respiratory distress syndrome in France (the LIVE study): A multicentre, single-blind, randomised controlled trial. Lancet Respir Med, 2019, 7(10): 870-880.
45.	Wang J, Zeng J, Zhang C, et al. Optimized ventilation strategy for surgery on patients with obesity from the perspective of lung protection: A network meta-analysis. Front Immunol, 2022 Oct 18: 13: 1032783.
46.	Sankarganesh A, Abathsagayam K, Ravisankar NP, et al. Lung Expansion Therapy for the Potential Populations: A Literature Review. Cureus, 2023, 15(11): e49283.
47.	SANTOS E D C D, SILVA J D S D, ASSIS FILHO M T T D, et al. Use of lung expansion techniques on drained and non-drained pleural effusion: survey with 232 physiotherapists. Fisioterapia em Movimento, 2020, 33: e003305.
48.	Rowley DD, Malinowski TP, Di Peppe JL, et al. A randomized controlled trial comparing two lung expansion therapies after upper abdominal surgery. Respir Care, 2019, 64(10): 1181-1192.
49.	Chatwin M, Toussaint M, Gonçalves MR, et al. Airway clearance techniques in neuromuscular disorders: A state of the art review. Respir Med, 2018, 136: 98-110.
50.	Spinou A, Hererro-Cortina B, Aliberti S, et al. Airway clearance management in people with bronchiectasis: data from the European Bronchiectasis Registry (EMBARC). Eur Respir J, 2024, 63(6): 2301689.
51.	Polverino E, Goeminne PC, McDonnell MJ, et al. European Respiratory Society guidelines for the management of adult bronchiectasis. Eur Respir J, 2017, 50(3): 1700629.
52.	Priya V, Sen J, Ninave S. A Comprehensive Review of Prone Ventilation in the Intensive Care Unit: Challenges and Solutions. Cureus, 2024, 16(3): e57247.
53.	Liao X, Meng L, Zeng Z. Prone position ventilation for the relief of acute respiratory distress syndrome through improved pulmonary ventilation: Efficacy and safety. Nurs Crit Care, 2024, 29(2): 255-273.
54.	Ding F, Zhang Z, Qiao G, et al. Early Prone Position Ventilation in the Efficacy for Severe Hypoxemia and Neurological Complications Following Acute Type A Aortic Dissection (TAAD) Surgery. Int J Neurosci, 2024 Mar 21: 1-9.
55.	Thijssen CGE, Bons LR, Gökalp AL, et al. Exercise and sports participation in patients with thoracic aortic disease: A review. Expert Rev Cardiovasc Ther, 2019, 17(4): 251-266.
56.	Lin Y, Liang T, Zhang X, et al. Early goal-directed mobilization in patients with acute type A aortic dissection: A randomized controlled trial. Clin Rehabil, 2023, 37(10): 1311-1321.
57.	Ren J, Li Z, He Y, et al. Systematic review and meta-analysis of breathing exercises effects on lung function and quality of life in postoperative lung cancer patients. J Thorac Dis, 2024, 16(7): 4295-4309.
58.	Gomes Neto M, Martinez BP, Reis HF, et al. Pre- and postoperative inspiratory muscle training in patients undergoing cardiac surgery: systematic review and meta-analysis. Clin Rehabil, 2017, 31(4): 454-464.
59.	Araújo CO, Araújo Alves CC, Dos Santos FRA, et al. Inspiratory Muscle Training in Phase 1 and 2 Postoperative Cardiac Rehabilitation Following Coronary Artery Bypass Graft Surgery: Systematic Review With Meta-Analysis. Phys Ther, 2024, 104(7): pzae061.
60.	Xiang Y, Zhao Q, Luo T, et al. Inspiratory muscle training to reduce risk of pulmonary complications after coronary artery bypass grafting: A systematic review and meta-analysis. Front Cardiovasc Med, 2023 Jul 24: 10: 1223619.
61.	Yang M. Acute Lung Injury in aortic dissection : new insights in anesthetic management strategies. J Cardiothorac Surg, 2023, 18(1): 147.
62.	Liu Q, Guan Y, Yang X, et al. Perioperative oxygenation impairment related to type a aortic dissection. Perfusion, 2025, 40(1): 49-60.
63.	Yu W, Liang Y, Gao J, et al. Study on risk factors and treatment strategies of hypoxemia after acute type a aortic dissection surgery. J Cardiothorac Surg, 2024, 19(1): 273.
64.	Samuel R, Alfadhel M, McAlister C, et al. Cardiac rehabilitation following coronary artery dissection: recommendations and patient considerations. Expert Rev Cardiovasc Ther, 2021, 19(11): 1005-1012.
65.	Li Y, Jiang H, Xu H, et al. Impact of a Higher Body Mass Index on Prolonged Intubation in Patients Undergoing Surgery for Acute Thoracic Aortic Dissection. Heart Lung Circ, 2020, 29(11): 1725-1732.

1. Mazzolai L, Teixido-Tura G, Lanzi S, et al. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J, 2024, 45(36): 3538-3700.
2. 中华医学会放射学分会介入学组. 中国StanfordB型主动脉夹层影像诊断和介入治疗临床指南. 中华放射学杂志, 2023, 57(5): 457-473.
3. Yan Y, Zhang X, Yao Y, et al. Postoperative pulmonary complications in patients undergoing aortic surgery: A single-center retrospective study. Medicine (Baltimore), 2023, 102(39): e34668.
4. Rodrigues SN, Henriques HR, Henriques MA. Effectiveness of preoperative breathing exercise interventions in patients undergoing cardiac surgery: A systematic review. Rev Port Cardiol (Engl Ed), 2021, 40(3): 229-244.
5. Shahood H, Pakai A, Rudolf K, et al. The effect of preoperative chest physiotherapy on oxygenation and lung function in cardiac surgery patients: A randomized controlled study. Ann Saudi Med, 2022, 42(1): 8-16.
6. Fang L, Cheng A, Zhu Z, et al. Effect of inspiratory muscle training on outcomes after cardiac surgery: A comprehensive meta-analysis of randomized controlled trials. J Cardiopulm Rehabil Prev, 2024, 44(5): 324-332.
7. Katsura M, Kuriyama A, Takeshima T, et al. Preoperative inspiratory muscle training for postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery. Cochrane Database Syst Rev, 2015, 2015(10): CD010356.
8. Wang X, Ma J, Lin D, et al. The risk factors of postoperative hypoxemia in patients with Stanford type A acute aortic dissection. Medicine (Baltimore), 2023, 102(33): e34704.
9. Vlaar AP, Hofstra JJ, Determann RM, et al. The incidence, risk factors, and outcome of transfusion-related acute lung injury in a cohort of cardiac surgery patients: A prospective nested case-control study. Blood, 2011, 117(16): 4218-4225.
10. Yao R, Liu X, He Y, et al. Low platelet count is a risk factor of postoperative pneumonia in patients with type A acute aortic dissection. J Thorac Dis, 2020, 12(5): 2333-2342.
11. Zhang H, Liu Y, Meng X, et al. Effects of inhaled nitric oxide for postoperative hypoxemia in acute type A aortic dissection: A retrospective observational study. J Cardiothorac Surg, 2020, 15(1): 25.
12. Wang D, Lu Y, Sun M, et al. Pneumonia After Cardiovascular Surgery: Incidence, Risk Factors and Interventions. Front Cardiovasc Med, 2022, 9: 911878.
13. Quinton LJ, Walkey AJ, Mizgerd JP. Integrative Physiology of Pneumonia. Physiol Rev, 2018, 98(3): 1417-1464.
14. BALLOTTA A B, KANDIL H, MONTGOMERY D G, et al. Acute respiratory failure after type A aortic dissection repair: data from the International Registry of Aortic Dissection (IRAD). Eur Heart J, 2019, 40: 3480-.
15. Jammer I, Wickboldt N, Sander M, et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: A statement from the ESA-ESICM joint taskforce on perioperative outcome measures. Eur J Anaesthesiol, 2015, 32(2): 88-105.
16. Liu N, Zhang W, Ma W, et al. Risk factors for hypoxemia following surgical repair of acute type A aortic dissection. Interact Cardiovasc Thorac Surg, 2017, 24(2): 251-256.
17. Kurabayashi M, Okishige K, Azegami K, et al. Reduction of the PaO2/FiO2 ratio in acute aortic dissection – relationship between the extent of dissection and inflammation –. Circ J, 2010, 74(10): 2066-2073.
18. Bossone E, Eagle KA. Epidemiology and management of aortic disease: Aortic aneurysms and acute aortic syndromes. Nat Rev Cardiol, 2021, 18(5): 331-348.
19. Sayed A, Munir M, Bahbah EI. Aortic Dissection: A Review of the Pathophysiology, Management and Prospective Advances. Curr Cardiol Rev, 2021, 17(4): e230421186875.
20. Girdauskas E, Kuntze T, Borger MA, et al. Acute respiratory dysfunction after surgery for acute type A aortic dissection. Eur J Cardiothorac Surg, 2010, 37(3): 691-696.
21. Möller CM, Ellmauer PP, Zeman F, et al. Postoperative acute respiratory dysfunction and the influence of antibiotics after acute type A aortic dissection surgery: A retrospective analysis. PLoS One, 2021, 16(2): e0246724.
22. Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA, 2012, 307(23): 2526-2533.
23. Matthay MA, Arabi Y, Arroliga AC, et al. A New Global Definition of Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med, 2024, 209(1): 37-47.
24. Yamada Y, Tanno J, Nakano S, et al. Clinical implications of pleural effusion in patients with acute type B aortic dissection. Eur Heart J Acute Cardiovasc Care, 2016, 5(7): 72-81.
25. Looney MR, Gropper MA, Matthay MA. Transfusion-related acute lung injury: A review. Chest, 2004, 126(1): 249-258.
26. Yu Y, Lian Z. Update on transfusion-related acute lung injury: An overview of its pathogenesis and management. Front Immunol, 2023 May 12: 14: 1175387.
27. Zeng C, Lagier D, Lee JW, et al. Perioperative Pulmonary Atelectasis: Part I. Biology and Mechanisms. Anesthesiology, 2022, 136(1): 181-205.
28. Wang Y, Luo Z, Huang W, et al. Comparison of Tools for Postoperative Pulmonary Complications After Cardiac Surgery. J Cardiothorac Vasc Anesth, 2023, 37(8): 1442-1448.
29. PAJARES M A, MARGARIT J A, GARCíA-CAMACHO C, et al. Guidelines for enhanced recovery after cardiac surgery. Consensus document of Spanish Societies of Anesthesia (SEDAR), Cardiovascular Surgery (SECCE) and Perfusionists (AEP) [J]. Rev Esp Anestesiol Reanim (Engl Ed), 2021, 68(4): 183-231.
30. Salzmann S, Salzmann-Djufri M, Wilhelm M, et al. Psychological Preparation for Cardiac Surgery. Curr Cardiol Rep, 2020, 22(12): 172.
31. Kilic A, Ohkuma R, Grimm JC, et al. A novel score to estimate the risk of pneumonia after cardiac surgery. J Thorac Cardiovasc Surg, 2016, 151(5): 1415-1420.
32. Rhee R, Gupta A, Vechvitvarakul S, et al. Risk factors predictive of unfavorable distal aortic remodeling after surgical repair of type A thoracic aortic dissection. J Cardiovasc Surg (Torino), 2020, 61(3): 323-331.
33. Lumb AB. Pre-operative respiratory optimisation: An expert review. Anaesthesia, 2019 Jan: 74 Suppl 1: 43-48.74-71.
34. Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology, 2010, 113(6): 1338-1350.
35. García Sánchez F, Mudarra García N. Evaluation of postoperative results after a presurgical optimisation programme. Perioper Med (Lond), 2024, 13(1): 73.
36. CEREDA M, NELIGAN P J, REED A J. Noninvasive respiratory support in the perioperative period. Curr Opin Anaesthesiol, 2013, 26(2): 134-40.
37. Carron M, Freo U, BaHammam AS, et al. Complications of non-invasive ventilation techniques: A comprehensive qualitative review of randomized trials. Br J Anaesth, 2013, 110(6): 896-914.
38. Spence EA, Rajaleelan W, Wong J, et al. The Effectiveness of High-Flow Nasal Oxygen During the Intraoperative Period: A Systematic Review and Meta-analysis. Anesth Analg, 2020, 131(4): 1102-1110.
39. Rochwerg B, Granton D, Wang DX, et al. High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: A systematic review and meta-analysis. Intensive Care Med, 2019, 45(5): 563-572.
40. Hol L, Nijbroek SGLH, Schultz MJ. Perioperative Lung Protection: Clinical Implications. Anesth Analg, 2020, 131(6): 1721-1729.
41. Young CC, Harris EM, Vacchiano C, et al. Lung-protective ventilation for the surgical patient: international expert panel-based consensus recommendations. Br J Anaesth, 2019, 123(6): 898-913.
42. Petrucci N, De Feo C. Lung protective ventilation strategy for the acute respiratory distress syndrome. Cochrane Database Syst Rev, 2013, 2013(2): CD003844.
43. Ferrando C, Soro M, Unzueta C, et al. Individualised perioperative open-lung approach versus standard protective ventilation in abdominal surgery (iPROVE): A randomised controlled trial. Lancet Respir Med, 2018, 6(3): 193-203.
44. Constantin JM, Jabaudon M, Lefrant JY, et al. Personalised mechanical ventilation tailored to lung morphology versus low positive end-expiratory pressure for patients with acute respiratory distress syndrome in France (the LIVE study): A multicentre, single-blind, randomised controlled trial. Lancet Respir Med, 2019, 7(10): 870-880.
45. Wang J, Zeng J, Zhang C, et al. Optimized ventilation strategy for surgery on patients with obesity from the perspective of lung protection: A network meta-analysis. Front Immunol, 2022 Oct 18: 13: 1032783.
46. Sankarganesh A, Abathsagayam K, Ravisankar NP, et al. Lung Expansion Therapy for the Potential Populations: A Literature Review. Cureus, 2023, 15(11): e49283.
47. SANTOS E D C D, SILVA J D S D, ASSIS FILHO M T T D, et al. Use of lung expansion techniques on drained and non-drained pleural effusion: survey with 232 physiotherapists. Fisioterapia em Movimento, 2020, 33: e003305.
48. Rowley DD, Malinowski TP, Di Peppe JL, et al. A randomized controlled trial comparing two lung expansion therapies after upper abdominal surgery. Respir Care, 2019, 64(10): 1181-1192.
49. Chatwin M, Toussaint M, Gonçalves MR, et al. Airway clearance techniques in neuromuscular disorders: A state of the art review. Respir Med, 2018, 136: 98-110.
50. Spinou A, Hererro-Cortina B, Aliberti S, et al. Airway clearance management in people with bronchiectasis: data from the European Bronchiectasis Registry (EMBARC). Eur Respir J, 2024, 63(6): 2301689.
51. Polverino E, Goeminne PC, McDonnell MJ, et al. European Respiratory Society guidelines for the management of adult bronchiectasis. Eur Respir J, 2017, 50(3): 1700629.
52. Priya V, Sen J, Ninave S. A Comprehensive Review of Prone Ventilation in the Intensive Care Unit: Challenges and Solutions. Cureus, 2024, 16(3): e57247.
53. Liao X, Meng L, Zeng Z. Prone position ventilation for the relief of acute respiratory distress syndrome through improved pulmonary ventilation: Efficacy and safety. Nurs Crit Care, 2024, 29(2): 255-273.
54. Ding F, Zhang Z, Qiao G, et al. Early Prone Position Ventilation in the Efficacy for Severe Hypoxemia and Neurological Complications Following Acute Type A Aortic Dissection (TAAD) Surgery. Int J Neurosci, 2024 Mar 21: 1-9.
55. Thijssen CGE, Bons LR, Gökalp AL, et al. Exercise and sports participation in patients with thoracic aortic disease: A review. Expert Rev Cardiovasc Ther, 2019, 17(4): 251-266.
56. Lin Y, Liang T, Zhang X, et al. Early goal-directed mobilization in patients with acute type A aortic dissection: A randomized controlled trial. Clin Rehabil, 2023, 37(10): 1311-1321.
57. Ren J, Li Z, He Y, et al. Systematic review and meta-analysis of breathing exercises effects on lung function and quality of life in postoperative lung cancer patients. J Thorac Dis, 2024, 16(7): 4295-4309.
58. Gomes Neto M, Martinez BP, Reis HF, et al. Pre- and postoperative inspiratory muscle training in patients undergoing cardiac surgery: systematic review and meta-analysis. Clin Rehabil, 2017, 31(4): 454-464.
59. Araújo CO, Araújo Alves CC, Dos Santos FRA, et al. Inspiratory Muscle Training in Phase 1 and 2 Postoperative Cardiac Rehabilitation Following Coronary Artery Bypass Graft Surgery: Systematic Review With Meta-Analysis. Phys Ther, 2024, 104(7): pzae061.
60. Xiang Y, Zhao Q, Luo T, et al. Inspiratory muscle training to reduce risk of pulmonary complications after coronary artery bypass grafting: A systematic review and meta-analysis. Front Cardiovasc Med, 2023 Jul 24: 10: 1223619.
61. Yang M. Acute Lung Injury in aortic dissection : new insights in anesthetic management strategies. J Cardiothorac Surg, 2023, 18(1): 147.
62. Liu Q, Guan Y, Yang X, et al. Perioperative oxygenation impairment related to type a aortic dissection. Perfusion, 2025, 40(1): 49-60.
63. Yu W, Liang Y, Gao J, et al. Study on risk factors and treatment strategies of hypoxemia after acute type a aortic dissection surgery. J Cardiothorac Surg, 2024, 19(1): 273.
64. Samuel R, Alfadhel M, McAlister C, et al. Cardiac rehabilitation following coronary artery dissection: recommendations and patient considerations. Expert Rev Cardiovasc Ther, 2021, 19(11): 1005-1012.
65. Li Y, Jiang H, Xu H, et al. Impact of a Higher Body Mass Index on Prolonged Intubation in Patients Undergoing Surgery for Acute Thoracic Aortic Dissection. Heart Lung Circ, 2020, 29(11): 1725-1732.

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