Monday, August 5, 2013

Spiro

You see three patients in thoracic surgery pre-operative clinic, all with a 100 pack-year smoking history, COPD, and lung cancer.

Patient 1 has an FEV1 of 1.4L and will undergo a lobectomy. Based on a CT scan, you predict his postoperative FEV1 to be 900mL.

Patient 2 has an FEV1 of 1.9L and will undergo a lobectomy. He also has interstitial lung disease and his DLCO is 55%.

Patient 3 has an FEV1 of 2.2L and will undergo a pneumonectomy. He does not have any further studies.

Challenge: All three patients are scheduled for surgery tomorrow. Do you need to cancel or delay any surgeries for further studies?

Image shown under GNU Free Documentation License, from Wikipedia.

1 comment:

Craig Chen said...

Spiro

Given the high prevalence of COPD among patients with lung cancer, it is important to obtain spirometry prior to lung resection. An FEV1 > 2L (or >80% predicted) suggests a patient should tolerate pneumonectomy. An FEV1 > 1.5L suggests a patient should tolerate lobectomy. If the patient’s values are lower, then a predicted postoperative FEV1 should be calculated based on the preoperative value and fractional functional contribution of the lung to be resected (estimated with quantitative perfusion, ventilation, or CT scanning). A predicted postoperative FEV1 > 800mL suggests a patient can undergo resection. A DLCO < 40% suggests a high postoperative risk. Here, all three patients are appropriate to proceed to surgery.

Source: UpToDate.