- 2-7 days before surgery;
- w/ spirometry, measure the response with bronchodilators;
- w/ thoracic surgery: FEV1 < 50% = high risk
- w/ peripheral surgery FEV1 < 30% = high risk
- FEV1/FVC ratio of less than 0.5 - pCO2 > 45 (and patient is not receiving meds that decrease ventilation abdominal or thoracic operations) carry life threatening risk of pulmonary complications;
- Perioperative Prophylactic Pulmonary Maneuvers:
- stop smoking, administer ATB for purulent sputum, bronchodilators, PT
- bronchodilators
- chest PT and postural drainage
- education & post op use of INS & deep breathing exercises;
- perioperative antibiotics if sputum is purulent
- early post op ambulation