How do I prepare for an upcoming surgery post- ARDS?



ARDS is an acute, severe injury to most or all of both lungs. An ARDS survivor when faced with the possibility of surgery is faced with a very fearful situation. This natural fear is compounded if the survivor developed ARDS following a previous surgery. The ARDS Support Center receives inquiries from survivors who are faced with this very serious situation. The following information has been gleaned from the experiences of ARDS survivors who have already faced this situation or who have secured guidance and advice from their physicians, surgeons or anesthesiologists.

First, it is important to know that even though in some cases ARDS developed following a previous surgery that does not mean that it will necessarily happen again. All ARDS survivors who face surgery should do as much research and ask as many questions of the health professionals as possible. The more understanding that is gained the more it will be possible to develop a good level of confidence in yourself and confidence in those who will be caring for you.

Prior to surgery the services of an Ear, Nose and Throat (ENT) specialist may help determine if there are any abnormalities or if there are any atypical conditions in the respiratory system that may make a difference in the work of the anesthesiologist. The anesthesiologist should be made fully aware of the specialists' findings. If the ARDS resulted from lung aspiration make sure the aspiration was not the result of any abnormality in the swallowing mechanism.

Another preparatory step would be to consult with a pulmonary physician to have a pulmonary function test performed in order to determine if there is any diminished lung capacity.  Musicians playing wind instruments and vocalists learn breathing techniques that maximize utilization of lung capacity.  The physician may be able to provide advice about how some of these techniques could be used to improve lung function.

Another consideration is to determine if the procedure is one that can be performed with a regional or local anesthetic. If so, a general anesthesia may not be required. The current trend is to perform many procedures on an outpatient basis because the 23-hour period permits an overnight stay. Make sure the health professionals are aware of the ARDS medical history. Even though the procedure is one normally done on an outpatient basis be sure that the ARDS history is recognized in order that the surgery not necessarily be considered as an out patient procedure.

If the surgical procedure requires the services of an anesthesiologist the role of that person may be as vital as is the role of the surgeon.  In advance of the day the surgery is scheduled make every effort to meet with the anesthesiologist who will be assisting the physician at the time of the surgery.  If that is not possible be sure to speak with one on the staff who will be able to relay the information you provide to the anesthesiologist who will be on duty.  In the discussion with the anesthesiologist be sure to give all the information you have about the previous experience with ARDS, the treatment received and about any abnormalities or information of atypical situations of which you are aware.  Provide the anesthesiologist with the results of the pulmonary function test.  As a last resort, if you have not been able to meet with an anesthesiologist prior to the date of the surgery ask the admitting nurse for the name of your anesthesiologist and indicate that it is imperative that you speak with that person.  Be sure that this is done before any pre-operative sedation is administered.  It is necessary to have a clear mind during the discussion with the anesthesiologist.  Ask the scheduled anesthesiologist if he has been made aware of the previous encounter with ARDS.  Every effort should be made to assure that the health professionals are aware of your previous experience with ARDS and of any other factors that may be involved.  

Determine the level of familiarity the surgeon and anesthesiologist have with ARDS. If a general anesthesia is required the surgery should only be done in a major facility that has ventilators and ICU backup.

Not only is it important to make every effort to assure that the medical professionals are aware of as many aspects of your previous ARDS experience as possible but it is also wise to share this information with family and loved ones. This will be of help to them in providing much needed support and understanding before, during and after the surgery. It will bolster your level of confidence to know that others share in what you have learned and what you have done to assure that the surgery will be successful in every respect. Doing so may lessen the sometimes inevitable questions like…"if we had only known" or "why didn't we think of that".

As mentioned above, do as much research and ask as many questions as possible. Being sure that the medical professionals are aware of all known factors will help in arriving at a good level of comfort and confidence. Develop and maintain a positive attitude, something that is of great importance at all times whether before or after the surgery is performed. One medical professional follows the practice of telling the patient that if they go to sleep with a smile on their face they will wake up with a smile.