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Overview of the Perioperative Management of Lung Volume Reduction Surgery Patients

¹ Division of Pulmonary and Critical Care Medicine, Baylor College of Medicine, and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; ² Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cedars-Sinai Medical Center, and David Geffen School of Medicine at UCLA, Los Angeles, California; ³ Department of Pulmonary, Allergy, and Critical Care Medicine, Cleveland Clinic, Cleveland, Ohio; and ⁴ Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

Correspondence and requests for reprints should be addressed to Amir Sharafkhaneh, M.D., F.C.C.P., Division of Pulmonary and Critical Care Medicine, HVAMC, Bldg 100 (111i), 2002 Holcombe Boulevard, Houston, TX 77030. E-mail: amirs{at}bcm.tmc.edu

ABSTRACT

This article reviews management strategies that may improve the outcome of thoracic surgery and particularly lung volume reduction surgery (LVRS) in patients with severe emphysema. Maximal preoperative pharmacologic therapy includes bronchodilators and inhaled corticosteroids to attain peak lung function at the time of surgery. Nonpharmacologic measures include smoking cessation and pulmonary rehabilitation. Mechanical ventilation during the perioperative period should ensure adequate oxygenation, while avoiding dynamic hyperinflation. Keys to successful postoperative care include close monitoring while in the intensive care unit, early extubation, adequate pain control, chest physiotherapy and appropriate chest tube management. Aggressive management of early postoperative complications, including air leaks, respiratory failure, arrhythmias, and hemorrhage, can also be expected to improve outcomes.

Key Words: emphysema • lung resection • perioperative complications

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