Bullous Lung Disease
Considerations
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Etiology with associated considerations:
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Chronic obstructive lung disease, congenital, carcinoma, infection/abscess
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Absolute indication for lung isolation due to pathophysiological sequelae:
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Bronchopleural fistula, infection/sepsis, obstructive lung physiology causing airspace expansion during PPV with risk of pneumothorax, restrictive lung physiology & mass effect
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Patient co-morbidities & limited physiological reserve
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Need for pre-op assessment as per 3-legged stool approach:
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Respiratory mechanics
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Gas exchange
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Cardio-respiratory interaction
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Goals & Conflicts
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Patients may present for non-thoracic surgery with lung cysts, blebs, bullae
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Use local & regional techniques if feasible
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Maintain spontaneous ventilation if feasible with supraglottic device or ETT
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If PPV required then employ lung isolation
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Lung isolation techniques:
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Options: double lumen ETT, bronchial blocker, endobronchial tube
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In a patient with marginal lung function, consider lobar/segmental isolation with a bronchial blocker
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Avoid PPV prior to lung isolation:
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RSI
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Awake fiberoptic intubation
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Inhalational induction
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Have a surgeon skilled in chest tube placement immediately available if the need arises, but do not place prophylactic chest tube