呼吸衰竭可能发生在围手术期或由低灌注引起。
围手术期呼吸衰竭通常由肺不张（肺组织塌陷并伴容积丧失）引起，并会增加肺炎风险（1）。(参见机械通气概述。）
对于腹胀所致的肺不张，应通过治疗病因予以缓解（如对腔内积气过多者行鼻胃管减压，对张力性腹水者行腹腔穿刺放液）。
预防或治疗肺不张的一般策略包括（2）：
诱发性肺量计检测
确保胸部和腹部切口充分镇痛
直立位
早期活动
任何原因所致的低灌注状态都可因呼吸肌氧供不足及呼吸肌过负荷而出现呼吸衰竭（如酸中毒、脓毒症）。机械通气可使血流从过度做功的呼吸肌重新分配至脑、肾和肠道等重要器官。
参考文献
1.Ko E, Yoo KY, Lim CH, Jun S, Lee K, Kim YH.Is atelectasis related to the development of postoperative pneumonia?a retrospective single center study. BMC Anesthesiol.2023;23(1):77.doi:10.1186/s12871-023-02020-4
2.Qaseem A, Snow V, Fitterman N, et al.Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians. Ann Intern Med.2006;144(8):575-580.doi:10.7326/0003-4819-144-8-200604180-00008
3.Eltorai AEM, Szabo AL, Antoci V Jr, et al.Clinical Effectiveness of Incentive Spirometry for the Prevention of Postoperative Pulmonary Complications. Respir Care.2018;63(3):347-352.doi:10.4187/respcare.05679
4.Odor PM, Bampoe S, Gilhooly D, Creagh-Brown B, Moonesinghe SR.Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis. BMJ.2020;368:m540.doi:10.1136/bmj.m540
5.Sullivan KA, Churchill IF, Hylton DA, Hanna WC.Use of Incentive Spirometry in Adults following Cardiac, Thoracic, and Upper Abdominal Surgery to Prevent Post-Operative Pulmonary Complications: A Systematic Review and Meta-Analysis. Respiration.2021;100(11):1114-1127.doi:10.1159/000517012
