This is the first of a two part series of episodes on the management of patients with respiratory disease. In this, part 1, I cover the preoperative evaluation, history and physical exam, and the preoperative planning and optimization of the patient. This includes the key board topics of smoking cessation and cardiac risk assessment.
Here are the slides that go along with this episode: Management of Respiratory Diseases slides part 1
4 thoughts on “Episode 7: Management of the patient with respiratory disease part 1”
What’s your thought on routine preop stress test for AV fistula creation in patients with multiple risk factors for CAD and unknown functional status or METS<4? Some people argue that it’s a lower risk vascular surgical procedure. I believe the risk of MACE after AVF surgery in a study is about 2%, not high risk but not low either (low risk is <1%). Another argument for not cancelling this surgery is it’s not an elective procedure, but not emergent either. I agree delaying does have its own risks. Thanks.
Great question, to which I do not have a definitive answer. Things that may factor in include anesthetic technique (purely regional vs GA) and other comorbidities. Of course the risk tolerance of the clinician always plays a role as well whether it should or not. I’m certainly curious to hear if others have thoughts.
The severity of AECOPD without respiratory failure can be classified according to several staging systems. The traditional system uses the Winnipeg criteria, which were derived from a double-blind, placebo-controlled trial that evaluated the role of antibiotics in patients with COPD with acute exacerbations ( 42 ). The three-stage system is based on three principal symptoms: increase in sputum volume, increase in sputum purulence, and increase in shortness of breath (
Thanks for sharing that!