Restrictive Lung Disease 

 

 

Considerations

 

  • Potential difficult BMV & rapid desaturation (↓ FRC)

  • Altered respiratory physiology:

    • Hypoxemia (V/Q mismatch)

    • ↓ compliance & risk of barotrauma  pneumothorax

    • Pulmonary hypertension & cor pulmonale

  • ↑ risk of perioperative respiratory complications:

    • Pneumonia, pneumothorax, respiratory depression (sensitive to opioids), respiratory failure

    • Higher risk if VC < 15 ml/kg, FVC <50% or 500cc, or pCO2 >45 cmH2O

    • Cancel elective procedures if there is an acute & reversible process

  • Management may include the use of high performance ventilator, using small tidal volumes with rapid rates, may require post op ventilation & ICU care

  • Co-morbid disease/etiology:

    • Autoimmune disease, connective tissue disease, idiopathic pulmonary fibrosis, acute respiratory distress syndrome, malignancy, obesity, neuromuscular, drug effects

  • Medications:

    • Steroids, immunosuppressives, oxygen, pulmonary hypertension treatments

    • History of bleomycin, amiodarone use

 

 

Goals

 

  • Preoperative optimization (limited)

  • Minimally invasive (local anesthetic or regional) or maximum support (slow wean)

  • Lung protective ventilation:

    • ​Low tidal volume, fast respiratory rate, inverse ratio, pressure control, PEEP

  • Minimize exposure to oxygen if previous bleomycin use

  • Avoid precipitants of pulmonary hypertension (hypercarbia, hypoxia, acidosis, pain)

  • Excellent pain management to minimize risk of postoperative respiratory failure