A 76-year-old female who is a former smoker with a 30 pack-year history is admitted to the ICU with new productive cough, fevers, dyspnea, and hypoxia. She is started on high flow nasal cannula, steroids, and antibiotics with workup initiated for COPD exacerbation versus pneumonia. Her admission chest X-ray reveals a new focal lesion in the left upper lobe (LUL); follow-up CT shows a solitary tumor involving a portion of the LUL with PET scan finding no evidence of metastases. The patient’s recent pulmonary function testing demonstrates a forced expiratory volume in one second (FEV1) and diffusion capacity (DLCO) of 100%. She is being evaluated by your thoracic surgery team for possible left upper lobectomy. Using the lung segment model, what is her predicted postoperative (PPO) FEV1 and DLCO and what additional testing is necessary to further stratify her operative risk?
A. Her predicted postoperative (ppo)-FEV1 and ppo-DLCO are approximately 75%; no further testing is necessary as she is considered low risk for anatomic lung resection Correct Choice
B. Her ppo-FEV1 and ppo-DLCO are approximately 50%; no further testing is necessary as she is considered low risk for anatomic lung resection Wrong Choice!
C. Her ppo-FEV1 and ppo-DLCO are approximately 75%; low technology exercise testing is necessary (either stair climb or shuttle walk) Wrong Choice!
D. Her ppo-FEV1 and ppo-DLCO are approximately 50%; low technology exercise testing is necessary (either stair climb or shuttle walk) Wrong Choice!
Answer:A
A 76-year-old female who is a former smoker with a 30 pack-year history is admitted to the ICU with new productive cough, fevers, dyspnea, and hypoxia. She is started on high flow nasal cannula, steroids, and antibiotics with workup initiated for COPD exacerbation versus pneumonia. Her admission chest X-ray reveals a new focal lesion in the left upper lobe (LUL); follow-up CT shows a solitary tumor involving a portion of the LUL with PET scan finding no evidence of metastases. The patient’s recent pulmonary function testing demonstrates a forced expiratory volume in one second (FEV1) and diffusion capacity (DLCO) of 100%. She is being evaluated by your thoracic surgery team for possible left upper lobectomy. Using the lung segment model, what is her predicted postoperative (PPO) FEV1 and DLCO and what additional testing is necessary to further stratify her operative risk?
A. Her predicted postoperative (ppo)-FEV1 and ppo-DLCO are approximately 75%; no further testing is necessary as she is considered low risk for anatomic lung resection Correct Choice B. Her ppo-FEV1 and ppo-DLCO are approximately 50%; no further testing is necessary as she is considered low risk for anatomic lung resection Wrong Choice! C. Her ppo-FEV1 and ppo-DLCO are approximately 75%; low technology exercise testing is necessary (either stair climb or shuttle walk) Wrong Choice! D. Her ppo-FEV1 and ppo-DLCO are approximately 50%; low technology exercise testing is necessary (either stair climb or shuttle walk) Wrong Choice!