Review Article Postpneumonectomy pulmonary edema (original) (raw)
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.
Intraoperative Tidal Volume as a Risk Factor for Respiratory Failure after Pneumonectomy
Anesthesiology, 2006
PURPOSE: Alveolar epithelium is exposed to high CO2 tensions (hypercapnia) in patients with COPD and during permissive hypercapnia in mechanically ventilated subjects. Recently, some reports propose that hypercapnia could be beneficial in the treatment of ALI/ARDS. However, more recently new data has been presented suggesting that hypercapnia may have deleterious effects on the pulmonary epithelium. The objective of our investigation was to determine the effects of hypercapnia on alveolar epithelial function.
European Journal of Cardio-Thoracic Surgery, 2008
Objective: Pulmonary resections after pneumonectomy due to metastases or metachronous non-small cell lung cancer (NSCLC) are rare because of the high potential risk of the second procedure and uncertain long-term results. On the basis of our series (largest in Europe) we tried to assess the long-term survival of patients treated in stage IV NSCLC. Methods: Retrospective analysis was carried out on 18 patients treated at our department by pneumonectomy followed by additional resection in the years 1981-2002 (15 males and 3 females, 44-69 years, mean 57). Eleven pneumonectomies were performed on the right side and seven on the left. Twelve squamous cell carcinomas and six adenocarcinomas were diagnosed. All patients were staged postoperatively as IIB-IIIA (four were N2). Their WHO status ranged between 0 and 1. The second surgical procedure (16 wedge resections, 2 chest wall resections) was performed 4-106 months later (mean 26). The patients staged N2 were radiated postoperatively. Results: There were no early postoperative deaths. The morbidity rate after second surgery was comparable to that observed after ordinary wedge resection. Histology of the lesions removed during the second operation was the same as after pneumonectomy in all patients. The pulmonary function tests (PFT) results worsened significantly but still reached 56-63% of the predicted values. Sixteen resected tumors of the remaining lung were staged T1 (<3 cm), 2 -T3 (<3 cm but infiltration of the parietal pleura on an area of 2-4 cm 2 ). Three patients revealed N2 disease (they were all N0 after pneumonectomy). All patients were considered M1 after second surgery. WHO status after the second procedure remained the same in 8 patients (44%) and worsened in 10 patients (56%). The survival rates were as follows: 11 patients survived 2 years (61%) while 8 patients survived 5 years (44%). The majority of patients died due to lung cancer (70%) but all the rest (30%) due to circulatory or respiratory insufficiency. There was a significant difference ( p < 0.05) in 5-year survival for N0-N1 vs N2 status (63% vs 14% -1 patient) and also regarding the time interval between surgeries: less than 12 months vs more than 12 months (0% vs 63%). Conclusions: Pulmonary resections performed after pneumonectomy due to NSCLC are rare procedures but with an acceptable perioperative risk. The second procedure should be limited to wedge resection. The prognosis is poor for patients with N2 status and for those treated by second surgery earlier than 12 months after the first procedure. #
Post-lung resection pulmonary edema: A case for aggressive management
Journal of Cardiothoracic and Vascular Anesthesia, 1998
OST-LUNG RESECTION pulmonary edema is a complication associated with a high mortality. Although recognized today as a distinct clinical syndrome, it remains a difficult diagnosis to establish because it remains a diagnosis by exclusion. Furthermore, the underlying pathophysiology is unclear. Despite conventional methods of medical management, including O2 therapy, intravenous (IV) fluid restriction, IV diuretics, renal-dose IV dopamine, and antibiotics, the prognosis is poor. The clinical course is one of progressive respiratory embarrassment requiring endotracheal intubation and ventilatory support. The authors' experience and knowledge of this condition concur with this poor response to traditional management, which delays intubation in patients post-lung resection. The authors, therefore, propose an aggressive management protocol, based on a high index of suspicion, using early high-dose corticosteroids and elective intubation with invasive hemodynamic monitoring. CASE REPORTS This is a prospective report of five cases of post-lung resection pulmonary edema. From January 1, 1993, to June 30, 1996, 180 lung resections were performed: 28 pneumonectomies (right, 11; left, 17) and 152 lobectomies (three lingulectomies, 10 bilobeetomies, 139 lobectomies). Patient characteristics, tumor staging and pathology, surgical details, anesthetic details, perioperative IV fluid volume load, patient weight changes, intercostal drainage losses, postsurgical clinical events, and hemodynamic data are meticulously detailed in Tables 1 through 3. Synopses of the individual cases are detailed below. In all cases, the surgery was uneventful and mediastinal dissection was not performed in any case. With case 4, the dissection was protracted because of dense pleura/ symphyses. The anesthetic management included induction with IV thiopental (Pentothal; Abbott) and vecuronium (Norcuron; Organon-Teknika) and maintenance with enflurane (Ethrane; Abbott) and a mixture of nitrous oxide and oxygen (O2) in a ratio of 1:2. A left-sided double-lumen tube was used in all cases, delivering inspired O2 concentrations (F~O2) of 66%. Cephamandole (Mandol; Lily), 2 g IV, was administered to all cases immediately after anesthetic induction. With cases 2, 3, and 5, a central venous catheter was inserted at the time of anesthetic induction and dopamine (David Bull Ltd, Australia), 3 lag/kg/min IV, was started. All patients had indwelling urethral catheters inserted. The postoperative chest tube management for pneumonectomy patients included an underwater seal with no suction. The tube was removed on day 1. Serial chest x-rays (CXR) revealed no evidence of overdistention of the contralateral lung. For the lobectomy patient, two chest tubes were placed on underwater seal with continuous suction of 10 cm H20.
Predicting pulmonary complications after pneumonectomy for lung cancer
European Journal of Cardio-Thoracic Surgery, 2003
Objectives: Patients undergoing pneumonectomy for lung cancer are thought to be at high risk for the development of postoperative pulmonary complications (PC) and these complications are associated with high mortality rates. The purpose of this study was to identify independent factors associated with increased risk for the development of postoperative PC after pneumonectomy for lung cancer, and to assess the usefulness of predicted pulmonary function to identify high risk patients and other adverse outcomes. Patients and methods: We reviewed retrospectively 242 patients undergoing pneumonectomy for lung cancer during a 12-year period. Perioperative data (clinical, pulmonary function test, and surgical) were recorded to identify risk factors of PC by univariate and multivariate analyses. Results: Overall mortality and morbidity rates were 5.4 and 59%, respectively. Thirty-four patients (14%) developed PC (acute respiratory failure, ARF ¼ 8:7%, reintubation ¼ 5.4%, pneumonia ¼ 3.3%, atelectasis ¼ 2.9%, postpneumonectomy pulmonary edema ¼ 2.5%, mechanical ventilation more than 24 h ¼ 1.2%, pneumothorax ¼ 0.8%). Patients with surgical (P , 0:001), cardiac (P , 0:001) and other complications (P , 0:01) had higher incidence of PC than those without postoperative complications. Intensive care unit stay (53^39 h vs. 35^19 h; P , 0:001) and hospital stay (18^11 days vs. 12^7 days; P , 0:001) was significantly longer in patients with PC. The mortality rate associated with PC was 35.5% (P , 0:001). By univariate analysis, it was found that older patients (P ¼ 0:007), chronic obstructive pulmonary disease (COPD) (P ¼ 0:023), heart disease (P ¼ 0:019), no previous record of chest physiotherapy (P ¼ 0:008), poor predicted postoperative forced expiratory volume in 1 s (ppo-FEV1) (P ¼ 0:001), and prolonged anesthetic time (P , 0:001) were related with higher risk of PC. In the multiple logistic regression model, the anesthetic time (minutes; odds ratio, OR ¼ 1:012), ppo-FEV1 (ml/s; OR ¼ 0:998), heart disease (OR ¼ 2:703), no previous record of previous chest physiotherapy (OR ¼ 2:639), and COPD (OR ¼ 2:277) were independent risk factors of PC. Conclusions: PC after pneumonectomy are associated with high mortality rates. Careful attention must be paid to patients with COPD and heart disease. Our results confirm the relevance of previous chest physiotherapy and the importance of the length of the surgical procedure to minimize the incidence of PC. The predicted pulmonary function (ppo-FEV1) may be useful to identify high risk patients for PC development and adverse outcomes.
The Journal of Thoracic and Cardiovascular Surgery, 2018
Objective: Post-pneumonectomy acute respiratory failure leading to invasive mechanical ventilation carries a severe prognosis especially when acute respiratory distress syndrome occurs. The aim of this study was to describe risk factors and outcome of acute respiratory failure. Methods: We retrospectively reviewed clinical files of all patients who underwent pneumonectomy in a single center between 2005 and 2015. Risk factors and outcome of acute respiratory failure were assessed in univariate and multivariate analysis. Results: Among the 543 patients who underwent pneumonectomy in the period of study, 89 (16.4%) needed reintubation within the 30th postoperative day and 60 of these (11% of all pneumonectomies) developed acute respiratory distress syndrome. In multivariate analysis, right-side of pneumonectomy (odds ratio [OR], 2.29; 95% confidence interval [