Intraoperative oxygen challenge for toleration of single lung ventilation in a patient with severe obstructive airway disease: A case report. (January 2020)

• Record Type: Journal Article
• Authors: Weinberg, Laurence; Cosic, Luka; Louis, Maleck; Garry, Tom; Lloyd-Donald, Patryck; Barnett, Stephen; Miles, Lachlan F.
• Is Part Of: Annals of medicine and surgery. Volume 49(2020)
• Page Start: 28
• Page End: 32
• Publication Date: 2020-01
• Subjects: Case report -- Risk stratification -- Anaesthesia -- Thoracic surgery -- Bronchial blocker; COPD chronic obstructive pulmonary disease -- CPET cardiopulmonary exercise testing -- CT computed tomography -- FEV1 forced expiratory volume in 1 second -- FVC forced vital capacity -- TLCO carbon monoxide transfer factor -- SABR stereotactic ablative radiotherapy -- SPECT single photon emission computed tomography -- VE/VCO2 minute ventilation/carbon dioxide -- VO2 maximum oxygen consumption; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2019.10.032
• Languages: English
• ISSNs: 2049-0801

Abstract

Abstract: Perioperative risk assessment is complex in patients with chronic obstructive pulmonary disease who have undergone previous lung resection surgery. A 70-year-old female with severe chronic obstructive pulmonary disease and previous right middle and lower lobectomy, presented for left lower lobe superior segmentectomy. Respiratory function tests revealed a forced expiratory volume in 1 second of 0.72L, a forced vital capacity of 1.93L, and a carbon monoxide transfer factor of 10.0 ml/min/mmHg. A cardiopulmonary exercise test demonstrated little ventilatory reserve with profound arterial desaturation on peak exercise, however, a normal peak oxygen consumption (16.7 ml/min/kg) and a nadir minute ventilation/carbon dioxide slope of 24 implied a limited risk of perioperative cardiovascular morbidity. Given these conflicting results we performed an intraoperative oxygen challenge test under general anaesthesia with sequential ventilation of different lobes of the lung. We demonstrate the use of the oxygen challenge test as an effective intervention to further assess safety and tolerance of anaesthesia of patients with limited respiratory reserve being assessed for further complex redo lung resection surgery. Further, this test was a risk stratification tool that allowed informed decisions to be made by the patient about therapeutic options for treating their lung cancer. The prognostic value of traditional physiological parameters in patients with chronic obstructive pulmonary disease who have undergone previous lung resection surgery is uncertain. The intraoperative oxygen challenge test is another risk stratification tool to assist clinicians in assessment of safety and tolerance of anaesthesia for patients being considered for lung resection. Highlights: Perioperative risk assessment is complex in patients with COPD and previous lung resection. Cardiopulmonary exercise testing and pulmonary function tests can be inconclusive for perioperative risk stratification. Elective oxygen challenge test is an additional effective risk stratification tool. Oxygen challenge test can guide optimum device choice for lung separation. Joint shared decision-making processes are predicated upon effective communication of perioperative risk.