Physiologic assessment and management of the preoperative patient with pulmonary emphysema

Over the past two decades there has been an increasing awareness of the high surgical risk in patients with disabling chronic pulmonary disease. The recognition of the factors which augur an increased incidence of postoperative complications as well as intolerance to pulmonary resection is difficult on clinical grounds alone. The factors of greatest import in the assessment of the patient are the degree and reversibility of bronchial obstruction, the presence of hypercapnia, the pulmonary diffusing capacity and the pressure in the pulmonary artery. Fortunately, methods are available to obtain quantitative information about all of these aspects of pulmonary and cardiovascular function. The data so obtained supplement the clinical examination and serve as an objective basis for the management and selection of patients.