I．心臓血管領域：4．低肺機能合併例の手術適応と周術期管理

Pulmonary dysfunction is one of the major factors for postoperative pulmonary complication. Preoperative pulmonary function test reveals possible operative risk. Particularly, in the patient with stage Ⅲ and Ⅳ chronic obstructive pulmonary disease （COPD）, open heart surgery with cardiopulmonary bypass is at higher risk of complication. In these patients, safe and reliable surgical procedures are required. Preoperatively, quitting smoking and incentive spirometry can reduce the risk of pulmonary complications. Furthermore, noninvasive positive pressure ventilation （NPPV） on the appropriate indication can help to improve the outcome in the patients with pulmonary dysfunction.