Critical care of the lung volume reduction surgery patient

Lung volume reduction surgery (LVRS) offers the potential to improve lung f unction, exercise tolerance, and quality of life for patients with advanced emphysema. At present, the specific role of this procedure in the treatmen t of advanced emphysema is a subject of ongoing investigation. LVRS is most commonly performed bilaterally via either median sternotomy or video thora coscopic approach with resection of the most severely affected lung tissue to reduce the overall lung volume by 20-30%. This results in improvements i n lung elastic recoil, airway conductance, chest wall, and diaphragmatic fu nction leading to greater inspiratory and expiratory airflow decreased hype rinflation, and improved exercise tolerance. The greatest improvement after LVRS occurs within 3-6 months after surgery In the perioperative period, h owever lung function may be compromised by surgical incisions, pain, chest tubes, retained secretions, pneumonia, and parenchymal injury associated wi th resection. The risks of LVRS are not insignificant, with reported mortal ity prior to hospital discharge ranging from 2.5 to 14%. Pulmonary complica tions may include respiratory failure, persistent air leaks, pneumonia, tra cheobronchitis, retained secretions, atelectasis, pneumothorax, bleeding, a nd sternal wound infections or dehiscence. Cardiac and gastrointestinal com plications are the most common extrathoracic causes of perioperative morbid ity after LVRS. Although many patients have an uneventful postoperative cou rse, patients who experience complications frequently require prolonged mec hanical ventilation and intensive care. Critical care practitioners must th erefore be familiar with LVRS, its potential complications, and the ICU man agement of LVRS patients.