[Considerations for Perioperative Management of Patients with Complicated Respiratory Dysfunction]

Area of Science:

• Pulmonology and Thoracic Surgery
• Critical Care Medicine

Context:

• Chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD), particularly idiopathic pulmonary fibrosis (IPF), represent significant challenges in respiratory dysfunction.
• These conditions are leading causes of respiratory impairment, impacting surgical patient outcomes.
• Postoperative mortality in Japan is significantly influenced by acute exacerbation of IPF.

Purpose:

• To outline perioperative complications associated with COPD and ILD/IPF.
• To describe risk assessment methodologies for surgical patients with these respiratory diseases.
• To present strategies for optimal perioperative management to mitigate surgical risks.

Summary:

• Key pulmonary function tests, including forced expiratory volume in one second (FEV1) and pulmonary diffusing capacity (DLCO), are vital for COPD assessment, with established algorithms.
• Risk factors for acute exacerbation of IPF, a major cause of postoperative mortality, are under investigation.
• Effective perioperative management involves thorough risk assessment, judicious surgical strategy selection, and meticulous planning.

Impact:

• Improved understanding of perioperative risks in COPD and IPF patients.
• Guidance on implementing comprehensive risk assessment and management plans.
• Potential reduction in postoperative complications and mortality for patients with severe respiratory diseases.