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Presented by Leslie Wattkis

Gas Exchange and Pulmonary Hemodynamics During Lung Resection in Patients at Increased Risk: Relationship With Preoperative Exercise Testing. Presented by Leslie Wattkis

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Presented by Leslie Wattkis

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  1. Gas Exchange and Pulmonary Hemodynamics During Lung Resection in Patients at Increased Risk: Relationship With Preoperative Exercise Testing Presented by Leslie Wattkis Gas Exchange and Pulmonary Hemodynamics During Lung Resection in Patients at Increased Risk: Relationship With Preoperative Exercise Testing Ribas J, M Jiménez, J Barberà,J Roca, C Gomar, E Canalís, R Rodriguez and Robert 120(3) 2001 852-859

  2. Background • Chronic obstructive pulmonary Disease (COPD) • Cardiac out (Qt) • Venous partial oxygen (Vpo2) • Arterial partial oxygen (Pao2) • Partial arterial carbon dioxide (Paco2) • Arterial blood Gas (ABG)

  3. Continue • Two Lung ventilation (TLV) • One-lung ventilation (OLV) • Fraction of inspired oxygen (FIO2) • Swan Ganz catheter • Pulmonary artery clamping

  4. Pulmonary function

  5. Concept behind Thoracomy and Hemodynamics

  6. Note: Alveolar & capillary is the same in each

  7. Pressure comparison • Pulmonary artery pressure (PAP) • Pulmonary capillary wedge pressure (PCWP) • Plateau airway pressure (Pplat) • Predicted postpneumonectomy (PPN) • Mixed venous PO2 • Pulmonary vascular resistance (PVR)

  8. Thoracotomy • 1. Closed chest, supine position, and two-lung ventilation (TLV) (baseline [BSL]) • 2. Closed chest, lateral decubitus position, and TLV (LD) • 3. Open chest, lateral decubitus position. OLV, before pulmonary resection, without clamping pulmonary vessels (OLV-BR) • 4. Open chest, lateral decubitus position. OLV, postpulmonary resection (OLV-PR) • 5. Closed chest, supine position, and TLV (OLV of the remaining lung in the 16 patients who required pneumonectomy) BSL-P

  9. Intraoperative measurement

  10. Hypoxemia • Hypoxemia, or reduced oxygen in the blood, can be caused by: • 1. Low partial pressure of atmospheric oxygen (e.g., high altitudes) • 2. Inadequate pulmonary ventilation (e.g., chronic obstructive pulmonary disease) • 3. Carbon monoxide poisoning • 4. Reduced hemoglobin content in erythrocytes

  11. Mechanical ventilation • Intubation • Tidal Volume (VT) • Respiratory Rate (RT) • Inspiratory Expiratory ratio (IE Ratio) • Positive end expiratory Pressure (PEEP) • Fractional inspiratory of oxygen (Fio2) • Plateau pressure • Flow rate

  12. Conclusion • Patients that received right thoracotomy tend to have significant difference during surgery. • Preoperative testing does show patients that are most at risk for lung resection. • patients that have lung resection are more likely to improve standard of living

  13. Any Questions ????

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