Assessment and management of patients with pulmonary disease.
OBJECTIVE
Often, the critically ill are not optimized in terms of their chronic diseases and are with little physiologic reserves.


METHODS
This article contains a review of the pathophysiology of the major preexisting and chronic pulmonary disease encountered in the critically ill, such as asthma, emphysematous disease, and chronic bronchitis. It also includes a summary of other significant disease processes such as acute respiratory disease syndrome, cigarette smoking, and pulmonary alveolar proteinosis and the implications of obesity and obstructive sleep apnea. When confronted with critical illness, the morbidity is magnified. Close observation of patients for evidence that the underlying disease may complicate their pulmonary status, and vice versa, creates an environment where the whole patient can heal and recover from illness.


CONCLUSIONS
The aim of the intensive care unit team should be recognition of the patient at risk, use of necessary therapies (i.e., bronchodilators) as early as feasible, and treatment titrated to realistic endpoints as the acute illness progresses and subsequently resolves.
Tamul
Paul C
PC
Section of Critical Care Medicine, Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Peruzzi
William T
WT
D001993:Bronchodilator Agents / Q000627:therapeutic use; D002908:Chronic Disease; D006801:Humans; D008171:Lung Diseases / Q000517:prevention & control* / Q000601:surgery* / Q000628:therapy; D008173:Lung Diseases, Obstructive / Q000601:surgery / Q000628:therapy; D010347:Patient Care Planning; D019990:Perioperative Care; D011183:Postoperative Complications / Q000517:prevention & control* / Q000628:therapy; D012138:Respiratory Therapy / Q000379:methods
D001993:Bronchodilator Agents