Bronchiectasis

 

 

Considerations

 

  • Etiology & co-existing disease: cystic fibrosis, COPD, TB, congenital

  • Risk of postoperative pulmonary complications:

    • Mixed restrictive & obstructive lung disease

    • Risk of intraoperative bronchospasm, pneumothorax, pulmonary tamponade

    • Recurrent pulmonary infections, mucus plugging

    • Hypoxemia, hypercarbia, V/Q  mismatch

    • Pulmonary hypertension, cor pulmonale

  • Potential need for lung isolation due to massive hemoptysis & active bronchial infection

  • Medications including need for steroid replacement

 

 

Goals & Conflicts

 

  • Maintain integrity of healthy lung in setting of infection & hemorrhage with lung isolation

  • Preoperative optimization of infection & bronchospasm with antibiotics, steroids, bronchodilators

  • Optimize intraoperative ventilation to avoid barotrauma, dynamic hyperinflation, pulmonary tamponade

  • Arrange for possibility of postoperative ventilation, high acuity care