One lung ventilation allows for the sequential exclusion of the two lungs and the intraoperative identification of the most diseased areas of the lung, which remain hyperinflated. These target areas are resected with staplers reinforced by bovine pericardial or PTFE strips in order to seal the bites produced by of the staples on the diseased parenchyma. The potential for postoperative morbidity with prolonged hospitalization from persistent air leaks is substantial and will be discussed later. Centrolobular emphysema, commonly found in COPD patients, affects predominantly the upper lobes. Other pulmonary lobes, such as the middle and the lower lobes, may be involved by emphysematous changes as in panacinar emphysema, which is commonly found in patients with alfa1-antitrypsin deficiency.
Postoperative care is focused on early extubation, chest tube removal, and, patient's mobilization.
The latter is aimed at achieving muscle reconditioning which, in turn, may improve exercise tolerance. Additional goals are weaning from oxygen therapy and reduction of steroid dependency, both to be obtained over a longer period of time. This improvement is more remarkable if one considers only the first 12 months after LVRS, to slowly decline in time to the aforementioned rates. Likewise, exercise tolerance impro ves possibly because of the restora tion of the diaphragmatic geometric configuration and function. Accordingly, the thoraco-abdominal pressure gradient goes back to normal, thus augmenting the venous return to the right heart.