Pre-procedural NPO Requirements

Posted on by Avi Cohen
Ingested MaterialMinimum Fasting Period
Clear Liquids12 hours
Breast Milk4 hours
Infant Formula6 hours
Non-human milk26 hours
Light meal36 hours
Fried/fatty foods or meat8 hours or more

Fasting periods apply to all age groups.

1 Examples of clear liquids include water, fruit juice without pulp, carbonated beverages, clear tea and black coffee.

2 Since non-human milk is similar to solids in gastric emptying, the amount ingested must be considered when determining an appropriate fasting time.

3 A light meal typically consists of toast and clear liquids. Meals that include fried or fatty foods or meat may prolong gastric emptying time. Both the amount and type of foods ingested must be considered when determining an appropriate fasting period.

EPIC Procedure Order Set

Posted on by Avi Cohen
  1. On the top toolbar, click Customization Tools
  2. Select Preference List Compose
  1. Make sure Show inpatient preference lists is checked
  2. Select PROCEDURES PREFERENCE LIST IP
  3. Click Copy User
  1. Change From User to COHEN, AVI
  2. Change To User to YOUR NAME
  3. Select Replace
  4. Select Procedures (Inpatient)
  5. Click Copy

Bronchoscopic Lung Volume Reduction – Inclusion / Exclusion Criteria

Posted on by Avi Cohen

These are only general guidelines and every patient will be evaluated on an individual basis.

Inclusion:

  • Ex-smokers (≥4 months)
  • PFT:
    • Post BD FEV1 15 – 45%
    • TLC ≥100%
    • RV ≥150%
  • 6MWD
    • ≥ 100 – <500 meters after pulmonary rehabilitation program
  • BMI <35 Kg/m2
  • Completed pulmonary rehabilitation program (or is enrolled and completed 6-8 sessions)
  • ABG: PaCO2 <60 on room air, PaO2 >45 on room air
  • Stable on prednisone <20mg/day

Exclusion:

  • Any contraindication to bronchoscopy and/or general anesthesia
  • Lung findings:
    • Pulmonary nodule requiring work up
    • Giant bullae (>1/3 hemithorax). May be referred for bullectomy
  • Comorbidities:
    • Recent CV event (6 months)
    • Recent CVA (3 months)
    • Known uncontrolled PAH sPAP >60
  • Prior lobectomy, LVRS, lung transplant, median sternotomy
  • Careful consideration in:
    • CHF w/EF <45%
    • FEV 1 < 15%
    • DLCO <20%
    • Baseline 6MWD <100m
    • Lack of access to medical care

Tests required within 1 year:

  • Chest CT:
    • Chest CT with SD (super dimension protocol done at HFHS)
    • We can rule in with outside CT (minimum requirement HRCT inspiration only <1.5mm cuts, contrasted images are not analyzable) if done within 1 year. However, we do not rule out based upon outside images
  • Complete PFT
  • ABG
  • 6MWT
  • TTE
  • Perfusion scan ordered on an individual basis. To be determined after IP clinic visit and complete evaluation

Lobe selection process

  1. Little to No Collateral Ventilation
    • Fissure completeness ≥80% preoperatively (StratX). Fissure <80% rules out
    • Intraoperative confirmation with balloon (Chartis) that lobe is CV-
  2. Higher Destruction
    • Emphysema score ≥45% on QCT (Stratx)
    • Prefer lobe with greatest destruction
  3. Larger Lobe Volume
  4. Less Perfusion
    • Perfusion scan may be used when multiple valid target lobes are available
    • Consider if ipsilateral heterogeneity score is low
  5. Greater Heterogeneity
    • Heterogeneity score ≥10% (difference in emphysema score between the target and ipsilateral lobe)