Review Article Postpneumonectomy pulmonary edema (original) (raw)
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Post-pneumonectomy pulmonary edema: analysis and risk factors
European Journal of Cardio-Thoracic Surgery, 1996
Objective. To analyze the risk factors for postpneumonectomy pulmonary edema in 146 consecutive patients. Methods. In 1992, 146 consecutive patients, aged 60.5_+9.4 years, underwent pneumonectomy, mostly for cancer (n= 136). Pulmonary edema was defined clinically and radiologically in the absence of left ventricular dysfunction or infection. Several parameters, including preoperative functional respiratory values, pulmonary perfusion scan data and intraoperative data were analyzed. Two groups were determined according to the occurrence of pulmonary edema and differences were compared by univariate and multivariate analyses. Results. Twenty-two patients (15%) developed pulmonary edema within the 1st postoperative week. Most cases were mild or moderate. Severe pulmonary edema occurred in five (3.4%) patients requiring mechanical ventilation; among them, two died. Previous chemotherapy (P<0.01), radiotherapy (P<0.0001), predictive postoperative forced expiratory volume in the 1st second less than 45% (P<0.01), a remaining lung perfusion of 55% or less (P<0,05) and an intraoperative fluid load of 2000 ml fluid or more (P<0.01) were associated with pulmonary edema in the univariate analysis. Multivariate analysis identified prior radiotherapy, perfusion of the remaining lung of 55% or less and high intraoperative fluid load as independent and significant risk factors for pulmonary edema. Conclusions. This study demonstrates that previous treatment with radiotherapy resection of well perfused lung parenchyma and excessive fluid load are high risk factors for the development of non-cardiogenic pulmonary edema and that patients for whom these factors are relevant should be closely monitored in their postoperative course.
Intraoperative factors and the risk of respiratory complications after pneumonectomy
Methods. We conducted a retrospective cohort study; charts of 129 patients who underwent elective pneumonectomy at the University of Virginia were reviewed. Logistic regression was used to estimate the effect of anesthetic factors on the odds of at least one respiratory complication. Linear regression models were fit to assess the impact of these outcomes on length of stay (LOS).
The Annals of Thoracic Surgery, 1986
Patients who have undergone pneumonectomy are reported to be at increased risk of serious pulmonary edema. Monitoring fluid therapy using the Swan-Ganz balloon-tipped catheter is therefore important in the perioperative management of these patients. Pulmonary artery occlusion pressure (PAOP), determined by inflating a balloon to occlude a branch of the pulmonary artery, is routinely used to measure pulmonary wedge pressure (PWP). In turn, PWP reflects left atrial pressure (LAP). We clinically observed postpneumonectomy patients in whom pulmonary edema developed, but whose PAOP was near normal. Our findings led us to suspect that PAOP in such patients may reflect a falsely low PWP value. We hypothesized that after pneumonectomy inflation of the balloon on the Swan-Ganz catheter to obtain PWP can result in considerable occlusion of the remaining cross-sectional area of pulmonary circulation. This occlusion acutely increases the right ventricular afterload, resulting in reduced cardiac output and reduced LAP. Although the PAOP under these circumstances still accurately reflects the LAP, these values have been artificially lowered; hence, they result in falsely low PWP readings. To verify this hypothesis, the following canine experiments were performed. Five dogs were monitored with a Swan-Ganz catheter, a left atrial catheter, and an electromagnetic flow probe applied to a carotid artery. Before pneumonectomy, inflation of the balloon to obtain PAOP caused no statistically significant change in LAP or carotid flow, and PAOP was identical to both LAP and PWP. (PWP was determined by advancing and wedging the pulmonary artery catheter tip into a peripheral branch without inflating the balloon.) After pneumonectomy, however, balloon inflation reduced LAP and carotid flow. The PAOP obtained was significantly lower (p < .05, by paired t test) than the true LAP and PWP. Our findings support our hypothesis that PAOP readings may be falsely low after pneumonectomy. This pitfall should be considered in the fluid management of pneu-From the
Long-term respiratory functional results after pneumonectomy
The aim of this study is to evaluate the long-term respiratory outcome of patients who underwent pneumonectomy for non-small cell lung cancer (NSCLC), analysing functional tests. Materials and methods: Twenty-seven consecutive patients who were candidates for pneumonectomy performed spirometry before and at least 24 months after surgery in the same laboratory. Diffusion of carbon monoxide and the most common dynamic and static lung volumes were evaluated in percentage of predicted and compared. Results: A significant inverse correlation was observed between the preoperative FEV1 (%) and FVC (%) and their postoperative loss, respectively r = À641 ( p < 0.0001) and r = À789 ( p < 0.0001). Also the correlation between the RV/TLC ratio and the FEV1 loss confirmed a better postoperative outcome in patients with major airway obstruction ( p = 0.02). To investigate these data, the series were divided into two groups: group A included BPCO patients with a FEV1 lower than 80%, the others were considered group B. Group B showed a significant major postoperative FEV1 (%) and FVC (%) impairment, 31% versus 12%, p = 0.005, and FVC (%) loss, 37% versus 16% ( p = 0.02), meanwhile group A showed a significant major postoperative RV (%) reduction, 43% versus 17%, p = 0.03. Despite being significantly higher preoperatively in BPCO patients, the RV% becomes similar between the two groups in the postoperative. Conclusions: In our experience patients with major preoperative airway obstruction who underwent pneumonectomy had lower impairment in FEV1% at almost one year after surgery than those with normal respiratory function. The resection of a certain amount of non-functional parenchyma associated with the mediastinal shift, with an improvement of the chest cavity for the remaining lung, could give a reduction volume effect in BPCO/emphysematous patients. #
Early complications after pneumonectomy: retrospective study of 168 patients
Interactive CardioVascular and Thoracic Surgery, 2010
The purpose of this study was to assess the mortality and risk factors of complications after pneumonectomy for lung cancer. Between 1996 and 2001, we reviewed and analysed the demographic, clinical, functional, and surgical variables of 168 patients to identify risk factors of postoperative complications by univariate and multivariate analyses with Medlog software system. The mean age was 60"10 years, overall mortality and morbidity rates were 4.17% and 41.6%, respectively. All frequencies of respiratory complications were 1.2% for acute respiratory failure, 10.1% for pneumonia, 2.4% for acute pulmonary oedema, 4.17% for bronchopleural fistula, 2.4% for thoracic empyema and 18.5% for left recurrent nerve injuries. Postoperative arrhythmias developed in 46% of our patients. The risk factors for cardiopulmonary morbidity and mortality with univariate analysis were advanced age (P-0.01), preoperative poor performance status (P-0.015), and chronic artery disease (P-0.008). Factors adversely affecting morbidity with multivariate analysis included age (Ps0.0001), associated cardiovascular disease (Ps0.001), and altered forced expiratory volume in 1 s (Ps0.0005). Complications after pneumonectomy are associated with high mortality. Careful attention must be paid to patients with advanced age and heart disease. Chest physiotherapy is paramount to have uneventful outcomes.
Anatomical changes after pneumonectomy
Annals of Anatomy - Anatomischer Anzeiger, 2011
Pneumonectomy is associated with many diverse post-operative conditions, e.g. hydropneumothorax, diaphragm elevation, progressive mediastinal displacement, thorax wall deformation, and hydrothorax. By means of imaging procedures, such pneumonectomy-related anatomical changes can easily be determined; here we summarize some of the common diagnostic findings and in addition report the case of a 100-year-old woman, who underwent left pneumonectomy at the age of 47, survived for another 53 years with only one lung and then became body donor to our department. Investigation of the cadaver revealed that, compared to similar-aged individuals still having both lungs, mediastinal structures had been displaced to the side of the missing lung. In addition, the remaining lung had herniated across the midline to a position anterior to the heart. Histological examination of the remaining lung tissue revealed changes comparable to those generally expected in lungs of individuals of the same age-group; tissue changes directly associated with pneumonectomy could not be observed. The findings document anatomical alterations that arise physiologically due to pneumectomy if no pathological complications occur.