What are the pulmonary risk assessments?

From the Guidelines

Pulmonary risk assessments should include a dedicated score to evaluate the risk of postoperative pulmonary complications, considering factors such as age, BMI, ASA status, and preoperative conditions like obstructive sleep apnea and anaemia, as recommended by a 2019 consensus statement 1. When evaluating pulmonary risk, it is essential to consider the patient's medical history, including respiratory symptoms, smoking history, and previous pulmonary conditions like COPD or asthma.

• A thorough physical examination should be performed to identify abnormal breath sounds, respiratory rate, and oxygen saturation.
• Pulmonary function tests, such as spirometry, may be ordered to quantify lung function, especially in patients with significant respiratory disease.
• Chest imaging, like X-rays or CT scans, can help identify structural abnormalities or active infections. According to the American College of Physicians, patients undergoing prolonged surgery, abdominal surgery, thoracic surgery, or emergency surgery are at higher risk for postoperative pulmonary complications and should receive pre- and postoperative interventions to reduce pulmonary complications 1. A low-tidal-volume protective-ventilation strategy (6-8 ml/kg predicted body weight) should be used, and positive end-expiratory pressure (PEEP) should be individualized to the patient to avoid increases in driving pressure while maintaining a low tidal volume, as recommended by the 2019 consensus statement 1. Preoperative interventions, such as smoking cessation, optimization of bronchodilator therapy, and treatment of respiratory infections, can help reduce postoperative pulmonary complications in high-risk patients.
• The use of non-invasive positive-pressure ventilation (NIPPV) or continuous positive airway pressure (CPAP) before induction of anesthesia can help attenuate anesthesia-induced respiratory changes.
• During induction, monitoring for obstructive breathing patterns and using appropriate techniques, such as positioning or placement of a nasopharyngeal airway, can help avoid upper airway obstruction. By prioritizing these assessments and interventions, healthcare providers can help reduce the risk of postoperative pulmonary complications and improve patient outcomes.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Pulmonary Risk Assessments

• Pulmonary assessment is a crucial step in identifying patient problems and selecting appropriate goals and interventions for patients with pulmonary diseases 2.
• A thorough assessment of the pulmonary system includes a step-by-step evaluation of the patient's history, physical examination, and potential causes of symptoms 2.
• In patients with chronic obstructive pulmonary disease (COPD), pulmonary risk assessments may involve evaluating the effectiveness of combination bronchodilator and inhaled corticosteroid therapy 3.
• Dual bronchodilation with a long-acting β2-agonist and long-acting muscarinic antagonist may be indicated in patients with COPD who have insufficient symptomatic response, frequent exacerbations, or deteriorating symptoms 4.

Preoperative Pulmonary Evaluation

• Preoperative pulmonary evaluation is an essential component of the preanesthesia evaluation, aiming to optimize patients with underlying medical diseases and identify potential risks for perioperative complications 5.
• The evaluation should include a thorough assessment of patients' medical history, physical examination, and laboratory tests to determine their overall risk for perioperative complications 5.
• Patients with pulmonary diseases require special considerations during preoperative evaluation, including assessment of their lung function, symptoms, and potential risks for complications 5.

COPD Management

• COPD management involves a multifaceted approach, including pharmacological and non-pharmacological therapies, with a focus on optimizing bronchodilator therapy 3, 6.
• The choice of inhaler device and proper inhaler technique are crucial in ensuring the effectiveness of inhaled therapies in patients with COPD 6.
• Dual bronchodilation may be a more effective treatment option for patients with significant symptoms, frequent exacerbations, or deteriorating lung function 4.