Adult bronchiolitis surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

Lung transplant is not the first-line treatment option for patients with adult bronchiolitis. Surgery is usually reserved for patients with untreatable and advanced stage lung disease.

Indications

• Lung transplant is not the first-line treatment option for patients with adult bronchiolitis. Surgery is usually reserved for patients with either:
  • Clinically severe disease where medical therapy is ineffective The risk of death from lung disease without transplantation is >50 percent within two years
  • The likelihood of surviving at least 90 days after lung transplantation is more than 80%
  • Absence of a non-respiratory comorbidity that would limit life expectancy in the first 5 years after transplant●
  • Acceptable social profile and support system

Contraindications

• Absolute contraindications include the following:
  • Uncontrolled or untreatable pulmonary or extrapulmonary infection
  • Active TB infection
  • Malignancy within previous 2 years
  • Significant comorbidity of other vital organs
  • Significant coronary heart disease not treated by revascularization
  • Untreatable bleeding diathesis
  • Significant chest wall or spinal deformity expected to cause severe restriction after transplantation
  • Grade II or III obesity with body mass index (BMI) ≥35 kg/m2
  • Smoker
  • Drug or alcohol dependency
  • Unresolved psychosocial problems or noncompliance with medications
• Relative contraindications include the following:
  • Age >65 years in association with low physiologic reserve or other relative contraindications
  • Grade I obesity with body mass index (BMI )30 to 34.9 kg/m2
  • Severe or progressive malnutrition
  • Severe with clinical manifestations of osteoporosis
  • Previous cardiothoracic surgery
  • Colonization or infection with highly resistant or highly virulent agents
  • HIV positive patient
  • Active hepatitis B or C infection
  • Absence of a consistent social support system