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Chronic Intrinsic Pulmonary Disorders

Fri, 12/28/2007 - 22:04 — oxygen
PATHOPHYSIOLOGY Listen to Audio resp1.jpg -decreased lung compliance -reduced lung volume -preserved normal expiratory flow rates -reduced FEV1 -reduced FVC -normal FEV1/FVC decreased lung compliance results in: -increased work of breathing -results in increased respiratory rate and decreased tidal volume -respiratory gas exchange may be adequate until the progression of disease worsens Chronic Intrinsic Pulmonary Disorders Preoperative management Intraoperative management CHRONIC INTRINSIC PULMONARY DISEASE PATHOPHYSIOLOGY “interstitial lung disease” -chronic inflammation of alveolar walls -inflammation of perialveolar tissue -progressive pulmonary fibrosis causes of interstitial lung disease may involves: -occupation pollutants leading to hypersensitivity pneumonitis -environmental pollutants leading to hypersensitivity pneumonitis -drug toxicity may lead to pulmonary fibrosis (ex. bleomycin) -radiation pneumonitis -autoimmune diseases -sarcoidosis ANESTHETIC MANAGEMENT Preoperative management: Inquire into presense of the following: -dyspnea upon exertion -nonproductive cough -symptoms of cor pulmonale -signs of RV failure -fine crackles over the lung base chest radiograph may reveal: -initial “ground glass” appearance -progressing to prominent reticulonodular markings -eventually to “ honey-comb” appearance arterial blood gas samples may reveal: -mild hypoxemia -normocarbia preoperative pulmonary function test often reveal: -reduced FEV1 -reduced FVC -normal FEV1/FVC -DLCO often reduced to 30 - 50% risk of postoperative pulmonary complications may be revealed by degree of dyspnea and PFT -degree of dyspnea should be further correlated with PFT and ABG sampling -vital capacity < 15 ml/kg correlates with severe pulmonary impairment Intraoperative Management -preoxygenation is crucial due to decreased FRC -decreased FRC subjects the patients to rapid oxygen desaturation and hypoxemia -inspired oxygen concentration may be lowered to a Sp02 > 91% to reduce risk of 02 toxicity -ventilation should be maintained with decreased tidal volumes and increased respiratory rate -avoid barotraumas (ex.Ptx) with mechanical ventilation (hence dec volume and increased rate)

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