Intraoperative management of the patient with severe lung disease

Abstract

Of all perioperative complications, respiratory difficulties represent the greatest cost to the healthcare system. Patients undergoing cardiac, thoracic, gastrointestinal and orofacial surgery are particularly at risk. However, the highest 30-day mortality for pulmonary complications follows abdominal surgery. Patients with chronic obstructive pulmonary disease (COPD), decreased preoperative SpO₂, and recent respiratory infections are at increased risk. Epidural analgesia improves outcomes in thoracic, abdominal and orthopaedic patients. Chest physiotherapy, including respiratory muscle training and smoking cessation, can reduce risks in high-risk patients. Intraoperative management strategies in patients with COPD need to consider the potential presence of CO₂ retention, right ventricular dysfunction, bullae and auto-positive end-expiratory pressure.