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To the Editor: The Clinical Crossroads article by Dr Smetana¹ discussed a patient with severe symptomatic chronic obstructive pulmonary disease (COPD) associated with a past history of cardiopathy who was contemplating surgery for colon cancer. The patient was a long-term smoker with compromised pulmonary function and increased risk of PPCs.

For this patient, an accurate preoperative pulmonary evaluation is needed. History and physical examination together with spirometry, chest radiography, and venous blood testing are usually considered appropriate preoperative examinations for predicting risk of PPCs. While this may be true for routine preoperative screening² even for patients with moderate COPD, for patients with severe and symptomatic COPD, arterial blood gas testing is also needed.³ Arterial blood gas measurement is recommended to rule out initial hypoxemia or hypercapnia.

The Clinical Crossroads article stated that the patient's oxygen saturation was 96%. However, this value may overestimate the real oxyhemoglobin value for 2 reasons. . . . [Full Text of this Article]

Domenico Galetta, MD
mimgaletta@yahoo.com
Division of Thoracic Surgery
European Institute of Oncology
Milan, Italy

Maria Serra, MD; Lucia Occhionero, MD
SOC Pneumologia
Ospedale Cardinal Massaia
Asti, Italy