Chronic obstructive pulmonary disease surgery: Difference between revisions

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__NOTOC__
{{Chronic obstructive pulmonary disease}}
{{Chronic obstructive pulmonary disease}}
{{CMG}}; '''Associate Editors-In-Chief:''' {{CZ}}, [[Priyamvada Singh|Priyamvada Singh, MBBS]] [mailto:psingh13579@gmail.com]
{{CMG}}; '''Associate Editors-In-Chief:''' {{CZ}}, [[Priyamvada Singh|Priyamvada Singh, MBBS]] [mailto:psingh13579@gmail.com]
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* Patients who are symptomatic and have an FEV1 of less than 50% of the predicted value have a better outcome after bullectomy.
* Patients who are symptomatic and have an FEV1 of less than 50% of the predicted value have a better outcome after bullectomy.
* Postoperative bronchopleural air leak is the major complication.
* Postoperative bronchopleural air leak is the major complication.
===Resectional surgery===
===Resectional Surgery===
* The ICSI 2011 COPD guidelines state that lung reduction surgery may be an option for patients with severe symptoms that are not responding to maximal medical therapy.
* The ICSI 2011 COPD guidelines state that lung reduction surgery may be an option for patients with severe symptoms that are not responding to maximal medical therapy.


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** Pneumonia
** Pneumonia
** Prolonged air leaks
** Prolonged air leaks
===Lung transplantation===
===Lung Transplantation===
* [[Lung transplantation]] is still not very popular around the world. It is undertaken mostly at tertiary centers.
* [[Lung transplantation]] is still not very popular around the world. It is undertaken mostly at tertiary centers.
* It is primarily done for improvement of symptoms and quality of life. Large scale trials are still needed to show its effect on survival.
* It is primarily done for improvement of symptoms and quality of life. Large scale trials are still needed to show its effect on survival.
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[[Category:Intensive care medicine]]
[[Category:Intensive care medicine]]
[[Category:Mature chapter]]
[[Category:Mature chapter]]
[[Category:Primary care]]

Revision as of 20:44, 26 February 2013

Chronic obstructive pulmonary disease Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Chronic obstructive pulmonary disease from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

Echocardiography or Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Future or Investigational Therapies

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Ongoing Trials at Clinical Trials.gov

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CDC on Chronic obstructive pulmonary disease surgery

Chronic obstructive pulmonary disease surgery in the news

Blogs on Chronic obstructive pulmonary disease surgery

Directions to Hospitals Treating Chronic obstructive pulmonary disease

Risk calculators and risk factors for Chronic obstructive pulmonary disease surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Cafer Zorkun, M.D., Ph.D. [2], Priyamvada Singh, MBBS [3]

Overview

Patients with emphysema may have big bullae ranging from 1-4 cm and may occupy 1/3rd of lung space. These bullae can cause compromise to vetilation and perfusion. Bullaectomy is the surgical removal of these bullae. It is commonly done in patients with FEV1 < 50% of predicted and who are symptomatic. Bullaectomy helps in re-expansion of the lung tissue.

Surgery

Bullaectomy

  • The giant bullae (1-4 cm, giant bullae may occupy 1/3rd of lung tissue) seen in patients of emphysema can compress the surrounding lung tissues and cause compromised ventilation and blood flow to unaffected lung.
  • Bullectomy is the process of removing these bullae and can help these patients as it causes expansion of the compressed lung
  • Patients who are symptomatic and have an FEV1 of less than 50% of the predicted value have a better outcome after bullectomy.
  • Postoperative bronchopleural air leak is the major complication.

Resectional Surgery

  • The ICSI 2011 COPD guidelines state that lung reduction surgery may be an option for patients with severe symptoms that are not responding to maximal medical therapy.
  • Surgeons generally resect 20-30% of each lung from the upper zones.
  • The surgery can be considered in heterogeneous (upper lobe) disease, low exercise capacity despite optimal medical therapy and cardiopulmonary rehabilitation. It should be avoided in (high risk group). Patients with an FEV1 of less than 20% of predicted and either homogenous disease or DLCO (diffusing capacity of lung for carbon monoxide) of less than 20% of predicted)
  • Several studies have demonstrated significant benefit in spirometry, exercise tolerance, dyspnea, health-related quality of life, and mortality in selected group of patients.
  • Complications
    • Mortality ranges somewhere between 0-18%
    • Pneumonia
    • Prolonged air leaks

Lung Transplantation

  • Lung transplantation is still not very popular around the world. It is undertaken mostly at tertiary centers.
  • It is primarily done for improvement of symptoms and quality of life. Large scale trials are still needed to show its effect on survival.
  • COPD patients are the largest single category of patients who undergo lung transplantation.
  • Mean survival after lung transplantation is 5 years.
  • The survival at 1 year is 80-90%.
  • Criteria to consider in patient selection-
    • Symptoms
    • Co-morbid conditions
    • BODE index >5, projected survival without transplantation
    • Most centers have an age limit of 65 years.

References


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