Lung volume reduction surgery is performed on patients with severe bullous emphysema who experience incapacitating dyspnea despite maximal medical therapy and is often performed as a “bridge” to lung transplantation. The goal is to relieve thoracic distention and improve the mechanics of ventilation. Patients are selected under strict criteria and undergo a period of cardiopulmonary conditioning before surgery. Patients have extremely limited respiratory reserve, complicating induction and extubation.