Book contents
- Frontmatter
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- SECTION 1 Admission to Critical Care
- SECTION 2 General Considerations in Cardiothoracic Critical Care
- SECTION 3 System Management in Cardiothoracic Critical Care
- SECTION 4 Procedure-Specific Care in Cardiothoracic Critical Care
- 47 Routine management after cardiac surgery
- 48 Management after coronary artery bypass grafting surgery
- 49 Management after valve surgery
- 50 Management after aortic surgery
- 51 Management after thoracic surgery
- 52 Lung volume reduction surgery
- 53 Chronic thromboembolic pulmonary hypertension and pulmonary endarterectomy
- 54 Oesophagectomy
- 55 Management after heart transplant
- 56 Management after lung transplant
- 57 Prolonged critical care stay after cardiac surgery
- 58 Palliative care
- SECTION 5 Discharge and Follow-up From Cardiothoracic Critical Care
- SECTION 6 Structure and Organisation in Cardiothoracic Critical Care
- SECTION 7 Ethics, Legal Issues and Research in Cardiothoracic Critical Care
- Appendix Works Cited
- Index
52 - Lung volume reduction surgery
from SECTION 4 - Procedure-Specific Care in Cardiothoracic Critical Care
Published online by Cambridge University Press: 05 July 2014
- Frontmatter
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- SECTION 1 Admission to Critical Care
- SECTION 2 General Considerations in Cardiothoracic Critical Care
- SECTION 3 System Management in Cardiothoracic Critical Care
- SECTION 4 Procedure-Specific Care in Cardiothoracic Critical Care
- 47 Routine management after cardiac surgery
- 48 Management after coronary artery bypass grafting surgery
- 49 Management after valve surgery
- 50 Management after aortic surgery
- 51 Management after thoracic surgery
- 52 Lung volume reduction surgery
- 53 Chronic thromboembolic pulmonary hypertension and pulmonary endarterectomy
- 54 Oesophagectomy
- 55 Management after heart transplant
- 56 Management after lung transplant
- 57 Prolonged critical care stay after cardiac surgery
- 58 Palliative care
- SECTION 5 Discharge and Follow-up From Cardiothoracic Critical Care
- SECTION 6 Structure and Organisation in Cardiothoracic Critical Care
- SECTION 7 Ethics, Legal Issues and Research in Cardiothoracic Critical Care
- Appendix Works Cited
- Index
Summary
Pathophysiology of emphysema
Emphysema is characterized by the loss of lung parenchyma elasticity and alveolar wall destruction with dilatation of the lung unit distal to the terminal bronchiole. In severe emphysema, symptoms of breathlessness and exercise limitation result from the combined effects of several factors that reduce the efficiency of breathing. Loss of elastic recoil of the lung and progressive destruction of normal lung parenchyma lead to dynamic small airways collapse, increased airways resistance, and reduced expiratory driving force. The resulting reduction in expiratory flow produces hyperinflation and gas trapping. Chest wall and diaphragmatic contraction become less efficient owing to suboptimal chest wall mechanics, and the increased work of breathing and hyperinflation produce the sensation of breathlessness.
In addition to these mechanical factors, the reduction in the available alveolar capillary surface area impairs gas exchange and may affect pulmonary haemodynamics. Emphysema may coexist with poor nutritional status, general deconditioning and other comorbidities, particularly related to smoking, that also contribute to poor exercise tolerance.
Lung volume reduction surgery
The rationale for lung volume reduction surgery (LVRS) is to improve the mismatch between the size of the lungs and the thoracic cavity by removing space-occupying, hyperinflated, emphysematous areas of lung that contribute little to gas exchange; LVRS relieves hyperinflation, improves elastic recoil and decreases small airways resistance, leading to improved chest wall and diaphragmatic mechanics and reduced work of breathing.
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- Chapter
- Information
- Core Topics in Cardiothoracic Critical Care , pp. 390 - 394Publisher: Cambridge University PressPrint publication year: 2008