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Bullous Lung Disease 





  • Etiology with associated considerations:

    • Chronic obstructive lung disease, congenital, carcinoma, infection/abscess

  • Absolute indication for lung isolation due to pathophysiological sequelae:

    • Bronchopleural fistula, infection/sepsis, obstructive lung physiology causing airspace expansion during PPV with risk of pneumothorax, restrictive lung physiology & mass effect

  • Patient co-morbidities & limited physiological reserve

  • Need for pre-op assessment as per 3-legged stool approach:

    • ​Respiratory mechanics

    • Gas exchange

    • Cardio-respiratory interaction



Goals & Conflicts


  • Patients may present for non-thoracic surgery with lung cysts, blebs, bullae

  • Use local & regional techniques if feasible

  • Maintain spontaneous ventilation if feasible with supraglottic device or ETT

  • If PPV required then employ lung isolation

  • Lung isolation techniques:

    • Options: double lumen ETT, bronchial blocker, endobronchial tube

    • In a patient with marginal lung function, consider lobar/segmental isolation with a bronchial blocker

  • Avoid PPV prior to lung isolation:

    • RSI

    • Awake fiberoptic intubation

    • Inhalational induction

  • Have a surgeon skilled in chest tube placement immediately available if the need arises, but do not place prophylactic chest tube

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