Restrictive Lung Disease
Considerations
-
Potential difficult BMV & rapid desaturation (↓ FRC)
-
Altered respiratory physiology:
-
Hypoxemia (V/Q mismatch)
-
↓ compliance & risk of barotrauma → pneumothorax
-
Pulmonary hypertension & cor pulmonale
-
-
↑ risk of perioperative respiratory complications:
-
Pneumonia, pneumothorax, respiratory depression (sensitive to opioids), respiratory failure
-
Higher risk if VC < 15 ml/kg, FVC <50% or 500cc, or pCO2 >45 cmH2O
-
Cancel elective procedures if there is an acute & reversible process
-
-
Management may include the use of high performance ventilator, using small tidal volumes with rapid rates, may require post op ventilation & ICU care
-
Co-morbid disease/etiology:
-
Autoimmune disease, connective tissue disease, idiopathic pulmonary fibrosis, acute respiratory distress syndrome, malignancy, obesity, neuromuscular, drug effects
-
-
Medications:
-
Steroids, immunosuppressives, oxygen, pulmonary hypertension treatments
-
History of bleomycin, amiodarone use
-
Goals
-
Preoperative optimization (limited)
-
Minimally invasive (local anesthetic or regional) or maximum support (slow wean)
-
Lung protective ventilation:
-
Low tidal volume, fast respiratory rate, inverse ratio, pressure control, PEEP
-
-
Minimize exposure to oxygen if previous bleomycin use
-
Avoid precipitants of pulmonary hypertension (hypercarbia, hypoxia, acidosis, pain)
-
Excellent pain management to minimize risk of postoperative respiratory failure