Various physiological changes occur as a result of the pregnant state, affecting patients with pre-existing lung disease and affecting the assessment and management of the patient with respiratory failure. Asthma, pulmonary infections, tuberculosis are some of the conditions not specific to pregnancy. Acute severe asthma in pregnancy may be treated as in the non-pregnant patient with intravenous beta- 2-adrenergic agonists, intravenous theophylline, intravenous magnesium sulfate and steroids. Standard drug therapy, namely with isoniazid, rifampin, and ethambutol has an acceptable safety profile in pregnancy and is recommended for pregnant women by the US Centers for Disease Control and Prevention and the American Thoracic Society. Acute respiratory distress syndrome (ARDS) occurs fairly frequently in pregnancy and is a leading cause of maternal death. Several approaches to respiratory support, including conventional mechanical ventilation, airway pressure release ventilation, high-frequency oscillation, and extracorporeal membrane oxygenation, have been used successfully in pregnancy.

This chapter focuses on how to select patients who will gain maximum benefit from lung transplantation (LT). It outlines the general considerations and exclusions pertaining to all potential recipients and focuses on disease specific guidance for the major recipient groups: chronic obstructive pulmonary disease (COPD), cystic fibrosis (CF), idiopathic pulmonary fibrosis (IPF), and idiopathic pulmonary arterial hypertension (IPAH). Pulmonary infections with highly resistant bacteria have been shown to have poorer outcomes in comparison with non-infected patients. The presence of fungus in the native lungs can cause problems after LT and needs careful assessment in each individual. The presence of comorbidities outside of the failing respiratory system is important considerations that can impact patient outcomes. COPD accounts for approximately 40% of LTs performed, with CF and IPF accounting for 20% each. In the current era there remains a critical shortage of donor organs, and thus unfortunately, recipient selection remains extremely important.

Chest computed tomography (CT) is extremely useful in the assessment of injuries to the aorta, chest wall, lung parenchyma, airway, pleura, and diaphragm. It is very useful in estimating the extent of contusion, which is important in predicting the degree of posttraumatic respiratory insufficiency. The sensitivity of CT in detecting pulmonary contusions is very high. Pneumothorax succeeds rib fractures as the second most common injury seen in chest trauma. CT is able to detect pneumothoraces missed by initial chest radiograph in 5% to 15% of trauma patients. Empyemas are exudates associated with pulmonary infections. On CT, they usually have a regularly shaped lumen and a smooth inner surface. Traumatic rupture of the aorta (TRA) is rarely visualized on CT because patients expire from exsanguination before reaching medical facilities. Posterior dislocations are more easily diagnosed on CT. Scapular fractures are frequently overlooked on the interpretation of chest radiographs.