Specific Considerations with Pulmonary Disease - Identification of the Patient at Risk
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- Patient-related information to be obtained, per meta-analysis, includes advanced age (>60), preexisting lung disease (e.g., COPD), and nonpulmonary information related to overall physical fitness and conditions (ASA-PS 2 or greater, poor functional status, malnutrition, and CHF). Other risk factors may include hypoxemia, anemia, obstructive sleep apnea (OSA), recent respiratory infection, and current sepsis. Among laboratory predictors, good evidence exists only for low serum albumin levels (<30 g/L) in predicting POPCs.
- Symptoms of respiratory disease such as cough, expectoration, hemoptysis, wheezing, dyspnea, and chest pain should be elicited. Occupational exposures, medications, recent changes in clinical status as well as symptoms of OSA should be defined.
- Chronic cough may suggest bronchitis or asthma. If cough is productive, sputum should be examined for evidence of infection and, if appropriate, sent for Gram stain, culture, or cytology.
- Smoking history should be quantified in pack years (number of packs smoked per day multiplied by the number of years smoked). The risks of malignancy, COPD, and POPCs are directly proportional to the smoking history.
- Dyspnea is an uncomfortable sensation of breathing. The activity level should be defined; severe dyspnea (occurring at minimal activity or at rest) may be a predictor of both poor ventilatory reserve and the need for postoperative ventilatory support.