Bronchiectasis
Considerations
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Etiology & co-existing disease: cystic fibrosis, COPD, TB, congenital
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Risk of postoperative pulmonary complications:
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Mixed restrictive & obstructive lung disease
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Risk of intraoperative bronchospasm, pneumothorax, pulmonary tamponade
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Recurrent pulmonary infections, mucus plugging
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Hypoxemia, hypercarbia, V/Q mismatch
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Pulmonary hypertension, cor pulmonale
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Potential need for lung isolation due to massive hemoptysis & active bronchial infection
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Medications including need for steroid replacement
Goals & Conflicts
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Maintain integrity of healthy lung in setting of infection & hemorrhage with lung isolation
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Preoperative optimization of infection & bronchospasm with antibiotics, steroids, bronchodilators
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Optimize intraoperative ventilation to avoid barotrauma, dynamic hyperinflation, pulmonary tamponade
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Arrange for possibility of postoperative ventilation, high acuity care