Thoracic surgery in respiratory failure
Advanced Thoracic Surgery, Akademisyen Kitabevi, ss.33-40, 2021
- Yayın Türü: Kitapta Bölüm / Araştırma Kitabı
- Basım Tarihi: 2021
- Yayınevi: Akademisyen Kitabevi
- Sayfa Sayıları: ss.33-40
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
In this section, the topic of preoperative evaluation for thoracic surgery in patients with respiratory failure is discussed. Respiratory failure is a syndrome in which gas exchange is impaired due to dysfunction of one or more components of the respiratory system. Respiratory failure is divided into two main types: hypoxemic and hypercapnic. Hypoxemic respiratory failure is characterized by a PaO2 below 60 mmHg. Hypercapnic respiratory failure is characterized by a PaCO2 above 45 mmHg. Respiratory failure can be acute or chronic. Acute respiratory failure carries a higher mortality risk compared to chronic respiratory failure. Therefore, patients with acute respiratory failure should be treated until they are stable and then reevaluated for non-urgent surgeries. In patients with chronic respiratory failure, optimal control of underlying diseases such as COPD, asthma, restrictive lung diseases, and sleep apnea is important. Preoperative evaluation is performed to determine and reduce the risks of intra and postoperative complications. Chronic respiratory failure can occur due to various conditions, with COPD being the most common. Patients with COPD can reduce the risk of postoperative pulmonary complications to an acceptable level with a thorough preoperative evaluation and appropriate measures. Therefore, a detailed evaluation of lung function should be performed before considering patients as inoperable. The treatment of COPD patients with respiratory failure should include long and short-acting β2 agonists, anticholinergics, theophylline derivatives, and inhalation or systemic steroids to achieve complete symptom control. The first and most important step in the preoperative evaluation of high-risk patients is a detailed history and physical examination. In a known case of respiratory failure, new cough or dyspnea should be evaluated and treated accordingly. Pulmonary function tests (PFTs) are considered the next step in the evaluation of these patients and are mandatory in patients undergoing lung resection. These tests will help determine the severity of the disease, guide treatment and preventive measures, and also help predict post-resection lung function. PFTs have a specific role in thoracic and abdominal surgeries, but their value in determining the risk of postoperative pulmonary complications in extrathoracic surgery is uncertain. When evaluating the results of preoperative PFTs for thoracic surgery, the most important parameters to assess are respiratory function.