One of the most important issues that requires continuous observation and proper management is the satisfaction of the patient’s respiratory needs. The regulation of postoperative analgesia is an additional variable that must be managed efficiently. It is well-recognized that, as long as postoperative pain is correctly regulated, the patient’s respiration is carried out without relative complications (e.g., pulmonary atelectasis). We must not forget that every case has a unique medical history, with greater respiratory and recovery needs according to its complexity and seriousness [2].

Postoperative respiratory needs notably depend on the type of the operation procedure and the type of excision of the pulmonary parenchyma. Lung excisions include single or multiple wedge resections, segmentectomy, lobectomy or bilobectomy, and radical pneumonectomy. The wide variety of thoracic procedures includes lung, pleural, mediastinal, or lymph node biopsies. A necessary preoperative control via spirometry provides an indicative image of pulmonary functionality. Emergency cases, such as pulmonary empyema, a tension pneumothorax, or a traumatic hemothorax are, of course, excluded, as their intraoperative process depends on the degree of damage. According to the latest guidelines, the following spirometry measures indicate the maximum degree of excision that a patient can bear postoperatively without presenting a permanent respiratory disorder. If the FEV₁ measurement is above 2.00, the patient is capable of receiving a radical pneumonectomy; if it is above 1.80, a lobectomy can be performed; and readings below 1.60 allow only the performance of a lung biopsy. Lower readings, for example, below 1.00, show a poor performance status, which makes an eventual procedure impossible.

The aggravation of the patient’s respiratory functionality is clinically manifested via sudden desaturation, the inability for independent respiration with the analog effect over the patient’s respiratory index, blood gas, disturbance of pO₂, pCO₂, PaO₂/FiO₂, and so on.

A novel indication for noninvasive mechanical ventilation (NIV) is its use during other invasive procedures, such as bronchoscopy, particularly in patients with a high risk of endotracheal intubation (e.g., immune-compromised patients). The use of NIV during bronchoscopy should be considered as an alternative to avoid the complications related to intubation and mechanical ventilation in patients with severe conditions, particularly in those with chronic obstructive pulmonary disease with a tendency to develop hypercapnia.

Other indications include transesophageal echocardiography, interventional cardiology, and pulmonology. NIV may reduce the need for deep sedation or general anesthesia, preventing the respiratory depression that results from it.

Esophageal surgery may not be an absolute contraindication for NIV or noninvasive positive pressure ventilation (NPPV), although it is considered an effective treatment option in many cases because it can minimize trauma to these patients [3].

A common and serious complication sometimes evolves as a result of the development of a pulmonary infection during the postoperative period in the intensive care unit (ICU), which may clinically result in acute respiratory failure (ARF). ARF may also be triggered by acute heart failure or pulmonary fibrosis. This serious clinical disorder may require immediate endotracheal intubation (ETI) and mechanical ventilation for its management [4].

Acute respiratory distress syndrome (ARDS) is another serious clinical complex and is characterized by alveolar capillary injury arising from various extra- and intrapulmonary contributing factors. This severe stage of acute lung injury is clinically presented as increased respiratory rate and respiratory distress, progressive hypoxemia, and diffuse infiltrations on chest X-ray [5].