Pre/Post-op Pulmonary Assessment and Management

Colice GL, Shafazand S, Griffin JP, et al. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: ACCP evidenced-based clinical practice guidelines (2nd Edition). Chest 2007; 132(3 Suppl):161S-77S. Updated summary of the use of PFTs, split function tests, and cardiopulmonary exercise tests in the assessment of lung resection candidates.    http://www.ncbi.nlm.nih.gov/pubmed/17873167?ordinalpos=8&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

Pollock M, Roa J, Benditt JO, et al. Estimation of ventilatory reserve by stair climbing: a study in patients with chronic airflow obstruction. Chest 1993;104:1378-83. Study found linear increases in VO2 and Ve with stair climbing. In order to reach a VO2 of 20ml/kg/min, subjects had to walk 4.6 flights of stairs, suggesting the tradition of walking patients up one or two flights is an inadequate stress to predict tolerance of surgery. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8222791

Thoren L. Post-operative pulmonary complication: observations on their prevention by means of physiotherapy. Acta Chir Scand 1954;193-205. Pioneering study on the prevention of post-op pulmonary complications found initiation of chest PT prior to surgery was superior to exclusively post-operative therapy, which in turn was better than no therapy. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=13188561&query_hl=22&itool=pubmed_DocSum

Squadrone V, Coha M, Cerutti E, et al.  Continuous positive airway pressure for treatment of postoperative hypoxemia: a randomized controlled trial.  JAMA. 2005; 293:589-95.  Multi-center,unblinded RCT with concealed allocation on 209 consecutive patients who developed severe hypoxemia after major elective abdominal surgery. Patients received oxygen vs. oxygen plus CPAP. Use of CPAP resulted in lower intubation rates, lower risk of pneumonia and sepsis, and shortened ICU stays. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15687314&query_hl=7&itool=pubmed_docsum