TY - CHAP M1 - Book, Section TI - Pulmonary Physiology, Function Tests, and Bronchoscopic Techniques A1 - Yarmus, Lonny A1 - Feller-Kopman, David J. A2 - Yuh, David D. A2 - Vricella, Luca A. A2 - Yang, Stephen C. A2 - Doty, John R. PY - 2014 T2 - Johns Hopkins Textbook of Cardiothoracic Surgery AB - EpidemiologyPulmonary complications occur in 5 to 10 percent of all surgical patients and have been shown to prolong hospital stay by 1 to 2 weeks. Approximately 25 percent of deaths within the first week after surgery are due to pulmonary complications.PathophysiologyPneumonia occurs in 10 to 40 percent of patients after major surgery and is associated with a mortality rate of 30 to 45 percent. General anesthesia can decrease lung volumes by 30 to 40 percent, and this decrease may persist for 1 to 2 weeks postoperatively.Clinical featuresCardiothoracic surgery is associated with the highest frequency of pulmonary complications. Risk factors include the type of surgery, general anesthesia, length of surgery and general anesthesia, smoking, chronic obstructive pulmonary disease, age, obesity, functional status, and a history of dyspnea.DiagnosticsPreoperative evaluation should include a directed history and physical examination to identify those patients at particular risk for pulmonary complications. Pulmonary function tests with spirometry and arterial blood gases (ABGs) should be obtained for any patient undergoing lung resection. For further risk stratification, cardiopulmonary exercise testing (CPET) is indicated in high-risk patients who do not have adequate predicted postoperative lung function. Alternatives to CPET include the shuttle-walk or stair-climb test.Bronchoscopy is an essential tool in the preoperative work for diagnosis, staging, and surgical planning.TreatmentInhaled bronchodilators may successfully reverse some cases of obstructive pulmonary disease.OutcomesPreoperative pulmonary function evaluation can stratify patients for risk, thus identifying those who can safely undergo major cardiothoracic surgery and minimizing the risk of significant morbidity and mortality.Appropriate nodal staging is essential in the workup of lung cancer patients and essential for surgical planning. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accesssurgery.mhmedical.com/content.aspx?aid=1104584072 ER -