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Zhou C, Song S, Fu J, Zhao X, Liu H, Pei H, Zhang S, Guo H, Cui X. Protecting the non-operative lobe/s of the operative lung can reduce the pneumonia incidence after thoracoscopic lobectomy: a randomised controlled trial. Sci Rep 2024; 14:9442. [PMID: 38658777 PMCID: PMC11043406 DOI: 10.1038/s41598-024-60114-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 04/18/2024] [Indexed: 04/26/2024] Open
Abstract
Lung isolation usually refers to the isolation of the operative from the non-operative lung without isolating the non-operative lobe(s) of the operative lung. We aimed to evaluate whether protecting the non-operative lobe of the operative lung using a double-bronchial blocker (DBB) with continuous positive airway pressure (CPAP) could reduce the incidence of postoperative pneumonia. Eighty patients were randomly divided into two groups (n = 40 each): the DBB with CPAP (Group DBB) and routine bronchial blocker (Group BB) groups. In Group DBB, a 7-Fr BB was placed in the middle bronchus of the right lung for right lung surgery and in the inferior lobar bronchus of the left lung for left lung surgery. Further, a 9-Fr BB was placed in the main bronchus of the operative lung. In Group BB, routine BB placement was performed on the main bronchus on the surgical side. The primary endpoint was the postoperative pneumonia incidence. Compared with Group BB, Group DBB had a significantly lower postoperative pneumonia incidence in the operative (27.5% vs 5%, P = 0.013) and non-operative lung (40% vs 15%) on postoperative day 1. Compared with routine BB use for thoracoscopic lobectomy, using the DBB technique to isolate the operative lobe from the non-operative lobe(s) of the operative lung and providing CPAP to the non-operative lobe(s) through a BB can reduce the incidence of postoperative pneumonia in the operative and non-operative lungs.
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Affiliation(s)
- Chao Zhou
- Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Shan Song
- Department of Respiratory, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jianfeng Fu
- Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
| | - Xuelian Zhao
- Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Huaqin Liu
- Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Huanshuang Pei
- Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Shasha Zhang
- Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Hongbo Guo
- Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xinxin Cui
- Department of Anesthesiology, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, China
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Tseng SC, Gagne S, Hatabu H, Lin G, Sholl L, Nishino M. Lung Cancer in Lung Transplant Recipients: Clinical, Radiologic, and Pathologic Characteristics and Treatment Outcome. J Comput Assist Tomogr 2023; 47:590-597. [PMID: 36944140 PMCID: PMC10363202 DOI: 10.1097/rct.0000000000001466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVE This study aimed to investigate clinical and radiologic characteristics of lung cancer in lung transplant recipients and evaluate the treatment course and prognosis. METHODS The study included 448 patients who underwent lung transplant between 2005 and 2021. All patients had pretransplant chest computed tomography (CT), 429 patients had posttransplant CT, whereas 19 had no posttransplant CT (median number of posttransplant CT, 6; range, 0-24). Medical records of these patients were reviewed to identify patients who developed lung cancer after lung transplant. Computed tomography and positron emission tomography/CT at the time of lung cancer diagnoses were reviewed to obtain imaging features. Demographics, tumor histology, stages, and survival were compared using Fisher exact test and Wilcoxon rank sum test. RESULTS Among 448 lung transplant recipients with a median follow-up of 71.3 months after lung transplant, 15 patients (3.3%) developed posttransplant lung cancer (13 unilateral, 2 bilateral; 10 men, 5 women; median age, 63.1 years; median time from transplantation to cancer diagnosis, 3.1 years). Twelve cancers were in native lung, and 3 were in transplanted lung. The incidence of lung cancer was higher in single lung transplant recipients than in bilateral lung transplant recipients (10.3% vs 0.6%, respectively; P < 0.0001). Imaging manifestations varied according to tumor stages. Among 12 patients treated for lung cancer, 2 patients developed posttreatment acute respiratory distress syndrome. The median survival from cancer diagnosis of cancer was 6.2 months. CONCLUSIONS Posttransplant lung cancer was noted in 3% of lung transplant recipients and was more common in unilateral transplant recipients. The prognosis upon diagnosis was poor with rapid clinical deterioration and serious posttreatment complications.
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Affiliation(s)
- Shu-Chi Tseng
- Department of Imaging, Dana-Farber Cancer Institute 450 Brookline Ave. Boston MA, 02215, USA
- Department of Radiology, Brigham and Women’s Hospital 75 Francis St. Boston MA, 02215, USA
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Staci Gagne
- Department of Imaging, Dana-Farber Cancer Institute 450 Brookline Ave. Boston MA, 02215, USA
- Department of Radiology, Brigham and Women’s Hospital 75 Francis St. Boston MA, 02215, USA
| | - Hiroto Hatabu
- Department of Imaging, Dana-Farber Cancer Institute 450 Brookline Ave. Boston MA, 02215, USA
- Department of Radiology, Brigham and Women’s Hospital 75 Francis St. Boston MA, 02215, USA
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Lynnette Sholl
- Department of Pathology, Brigham and Women’s Hospital 75 Francis St. Boston MA, 02215, USA
| | - Mizuki Nishino
- Department of Imaging, Dana-Farber Cancer Institute 450 Brookline Ave. Boston MA, 02215, USA
- Department of Radiology, Brigham and Women’s Hospital 75 Francis St. Boston MA, 02215, USA
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Shelley B, Marczin N. Do we have the 'power' to 'drive' down the incidence of pulmonary complications after thoracic surgery. Br J Anaesth 2023; 130:e37-e40. [PMID: 36586730 DOI: 10.1016/j.bja.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/18/2022] [Indexed: 01/06/2023] Open
Abstract
The concept, mechanisms, and physical and physiological determinants of ventilator-induced lung injury, as well as the influence of lung-protective ventilation strategies, are novel paradigms of modern intensive care and perioperative medicine. Driving pressure and mechanical power have emerged as meaningful and modifiable targets with specific relevance to thoracic anaesthesia and one-lung ventilation. The relationship between these factors and postoperative pulmonary complications remains complex because of the methodological design and outcome selection. Larger observational studies are required to better understand the characteristics of driving pressure and power in current practice of thoracic anaesthesia in order to design future trials in high-risk thoracic populations at risk of acute lung injury.
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Affiliation(s)
- Ben Shelley
- Department of Cardiothoracic Anaesthesia and Intensive Care, Golden Jubilee National Hospital, Glasgow, UK; Anaesthesia, Perioperative Medicine and Critical Care Research Group, University of Glasgow, Glasgow, UK.
| | - Nandor Marczin
- Division of Anaesthesia Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK; Department of Anaesthesia and Critical Care, Harefield Hospital, Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK; Department of Anaesthesia and Intensive Care, Semmelweis University, Budapest, Hungary
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Mammana M, Sella N, Giraudo C, Verzeletti V, Carere A, Bonis A, Silvestrin S, Pacchiarini G, Pettenuzzo T, Monaco E, Lorenzoni G, Navalesi P, Rea F. Postoperative hypoxaemic acute respiratory failure after neoadjuvant treatment for lung cancer: radiologic findings and risk factors. Eur J Cardiothorac Surg 2022; 63:6935786. [PMID: 36534820 DOI: 10.1093/ejcts/ezac569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/15/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To investigate the rate of hypoxaemic acute respiratory failure (hARF) on patients undergoing surgery for non-small-cell lung cancer (NSCLC) after neoadjuvant chemotherapy, to describe clinical and radiological findings and to explore potential risk factors for this complication. METHODS Retrospective review of medical records of all patients who underwent surgery for NSCLC after neoadjuvant chemotherapy at a single centre between 2014 and 2021. Computed tomography scans of patients who developed hARF were reviewed by an experienced radiologist to provide a quantitative assessment of radiologic alterations. RESULTS The final cohort consisted of 211 patients. Major morbidity was 13.3% (28/211) and hARF was the most common major complication (n = 11, 5.2%). Postoperative mortality was 1.9% (4/211) and occurred only in patients who experienced hARF. Most patients who experienced hARF underwent major procedures, including pneumonectomy (n = 3), lobectomy with chest wall resection (n = 3), bronchial or vascular reconstructions (n = 3) and extended or bilateral resections (n = 2). Analysis of computed tomography findings revealed that crazy paving and ground glass were the most common alterations and were more represented in the non-operated lung. Male gender, current smoking status, pathologic stage III-IV and operative time resulted significant risk factors for hARF at univariable analysis (P < 0.05). CONCLUSIONS hARF is the main cause of major morbidity and mortality after neoadjuvant therapy and surgery for NSCLC and occurs more frequently after complex and lengthier surgical procedures. Overall, our findings suggest that operative time may represent the most important risk factor for hARF.
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Affiliation(s)
- Marco Mammana
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, Padua, Italy
| | - Nicolò Sella
- Institute of Anesthesia and Intensive Care, Padua University Hospital, Padua, Italy
| | - Chiara Giraudo
- Department of Medicine-DIMED, Padua University Hospital, Padua, Italy
| | - Vincenzo Verzeletti
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, Padua, Italy
| | - Anna Carere
- Institute of Anesthesia and Intensive Care, Padua University Hospital, Padua, Italy.,Department of Medicine-DIMED, Padua University Hospital, Padua, Italy
| | - Alessandro Bonis
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, Padua, Italy
| | - Stefano Silvestrin
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, Padua, Italy
| | - Giorgia Pacchiarini
- Institute of Anesthesia and Intensive Care, Padua University Hospital, Padua, Italy.,Department of Medicine-DIMED, Padua University Hospital, Padua, Italy
| | - Tommaso Pettenuzzo
- Institute of Anesthesia and Intensive Care, Padua University Hospital, Padua, Italy
| | - Eleonora Monaco
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, Padua, Italy
| | - Giulia Lorenzoni
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, Padua, Italy
| | - Paolo Navalesi
- Institute of Anesthesia and Intensive Care, Padua University Hospital, Padua, Italy.,Department of Medicine-DIMED, Padua University Hospital, Padua, Italy
| | - Federico Rea
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, Padua, Italy
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Defosse JM, Wappler F, Schieren M. [Anaesthetic Management of Non-intubated Video-assisted Thoracic Surgery]. Anasthesiol Intensivmed Notfallmed Schmerzther 2022; 57:405-416. [PMID: 35728591 DOI: 10.1055/a-1497-9883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Non-intubated thoracic surgery is currently gaining popularity. In select patients and in experienced centres, non-intubated approaches may enable patients to safely undergo thoracic surgical procedures, who would otherwise be considered at high risk from general anaesthesia. While non-intubated techniques have been widely adopted for minor surgical procedures, its role in major thoracic surgery is a topic of controversial debate.This article discusses disadvantages of intubated anaesthetic approaches and advantages of non-intubated thoracic surgery as well as the anaesthetic management. This includes surgical and anaesthetic criteria for patient selection, suitable regional anaesthetic techniques, concepts for sedation and maintenance of airway patency as well as the management of perioperative complications.Non-intubated thoracic surgery has the potential to reduce postoperative morbidity and hospital length of stay. Successful non-intubated management depends on a standardised and well-trained interdisciplinary approach, especially regarding patient selection and perioperative complications.
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Bergmann A, Schilling T. [Intraoperative Ventilation Approaches to One-lung Ventilation]. Anasthesiol Intensivmed Notfallmed Schmerzther 2021; 56:329-341. [PMID: 34038972 DOI: 10.1055/a-1189-8031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The management of thoracic surgery patients is challenging to the anesthetist, since one-lung ventilation (OLV) includes at least two major conditions: sufficient oxygenation and lung protection. The first is mainly because the ventilation of one lung is stopped while perfusion to that lung continues; the latter is related to the fact that the whole ventilation is applied to only a single lung. Recommendations for maintaining the oxygenation and methods of lung protection may contradict each other (e. g. high vs. low inspiratory oxygen fraction (FiO2), high vs. low tidal volume, etc.). Therefore, a high degree of pathophysiological understanding and manual skills are required in the management of these patients.In light of recent clinical studies, this review focuses on a current protective strategy for OLV, which includes a possible decrease in FiO2, lowered VT, the application of positive end-expiratory pressure (PEEP) to the dependent and continuous positive airway pressure (CPAP) to the non-dependent lung and alveolar recruitment manoeuvres as well. Other approaches such as the choice of anaesthetics, remote ischemic preconditioning, fluid management and pain therapy can support the success of ventilatory strategy. The present work describes new developments that may change the classical approach in this respect.
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Abstract
The intraoperative anesthetic management for thoracic surgery can impact a patient's postoperative course, especially in patients with significant lung disease. One-lung ventilation poses an inherent risk to patients, including hypoxemia, acute lung injury, and right ventricular dysfunction. Patient-specific ventilator management strategies during one-lung ventilation can reduce postoperative morbidity.
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Postoperative complications of pulmonary resection. Clin Radiol 2020; 75:876.e1-876.e15. [PMID: 32600652 DOI: 10.1016/j.crad.2020.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 05/06/2020] [Indexed: 12/25/2022]
Abstract
Thoracic surgery has seen a resurgence in recent years with increasing numbers of cases taken on since the mid-2000s. There has been a paradigm shift in how we manage lung cancer with more emphasis on surgical resection, and this has been aided by minimally invasive video-assisted thoracic surgery (VATS) techniques. As a result, the prevalence of postoperative findings and complications is also increasing, and it is increasingly important for the general radiologist to recognise and diagnose these conditions as thoracic surgical patients may present acutely to non-thoracic surgical institutions. This review will cover both the early and late complications following a variety of lung resection surgeries.
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Hayashi K, Nakashima K, Noma S, Aoshima M, Kusanagi H. Laparoscopic surgery in patients with interstitial lung disease: A single-center retrospective observational cohort study. Asian J Endosc Surg 2020; 13:279-286. [PMID: 31691544 DOI: 10.1111/ases.12762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 08/11/2019] [Accepted: 10/06/2019] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Laparoscopic surgery requiring longer operative times and artificial pneumoperitoneum may affect pulmonary function; its feasibility in patients with interstitial lung disease remains unknown. Therefore, we examined the feasibility of laparoscopic surgery in patients with interstitial lung disease. METHODS We conducted a retrospective observational cohort study and examined the clinical data of patients with interstitial lung disease who had undergone abdominal surgery under general anesthesia. The primary end-point was the incidence of pulmonary complications. The secondary end-points were non-pulmonary complications and in-hospital mortality. RESULTS Twenty-nine patients who had undergone abdominal surgery were diagnosed with interstitial lung disease after a review of their clinical and imaging records. Laparoscopic surgery and open surgery were performed in 11 and 18 patients, respectively. Acute exacerbation occurred in one (9%) patient in the laparoscopic group and three patients (17%) in the open group; all had undergone emergency surgery. Postoperative pneumonia did not occur in any patients. Non-pulmonary complications occurred in one patient (9%) in the laparoscopic group and two patients (11%) in the open group. One patient in each group died of acute exacerbation during hospitalization. CONCLUSION Neither acute exacerbation nor pulmonary complications occurred after elective laparoscopic or open surgery in patients with interstitial lung disease. The risk of acute exacerbation after elective laparoscopic surgery may not be as high as that after elective thoracic surgery.
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Affiliation(s)
- Kentaro Hayashi
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Japan
| | - Kei Nakashima
- Department of Pulmonology, Kameda Medical Center, Kamogawa, Japan
| | - Satoshi Noma
- Department of Pulmonology, Kameda Medical Center, Kamogawa, Japan
| | - Masahiro Aoshima
- Department of Pulmonology, Kameda Medical Center, Kamogawa, Japan
| | - Hiroshi Kusanagi
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Japan
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Abdullah T, Şentürk M. Positive End-Expiratory Pressure (PEEP), Tidal Volume, or
Alveolar Recruitment: Which One Does Matter in One-Lung Ventilation? CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00350-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bignami E, Saglietti F, Di Lullo A. Mechanical ventilation management during cardiothoracic surgery: an open challenge. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:380. [PMID: 30460254 DOI: 10.21037/atm.2018.06.08] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Mechanical ventilation during surgery is a highly complex procedure, particularly in cardiothoracic surgery, where patients need to undergo substantial hemodynamic management, involving large fluid exchanges and pharmacological manipulation of vascular resistance, as well as direct manipulation of the lungs themselves. Cardiothoracic surgery is burdened by a high rate of postoperative pulmonary complication (PPC), comorbidity, and mortality. Recent trials have examined various techniques to preserve lung function, although consensus on best practice has yet to be reached. This might be due to the close relationship between the circulatory and pulmonary systems. The use of a technique designed to prevent pulmonary complication might negatively impact the hemodynamics of an already critical patient. Stress-induced lung injury can occur during surgery for various reasons, some of which have yet to be fully investigated. In cardiac surgery, this damage is mainly ascribed to two events: cardiopulmonary bypass (CPB) and sternotomy. In thoracic surgery, on the other hand, overdistention and permissive hyperoxia, both routinely used on one lung to compensate for the collapse of the other, are generally to blame for lung injury. In recent years "protective" ventilation strategies have been proposed to spare lung parenchyma from stress-induced damage. Despite the growing interest in protective ventilation techniques, there are still no clear international guidelines for mechanical ventilation in cardiothoracic surgery. However, some recent progress has been made, with positive clinical outcomes.
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Affiliation(s)
- Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesco Saglietti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Di Lullo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Cardinale L, Priola AM, Priola SM, Boccuzzi F, Dervishi N, Lisi E, Veltri A, Ardissone F. Radiological contribution to the diagnosis of early postoperative complications after lung resection for primary tumor: a revisional study. J Thorac Dis 2016; 8:E643-52. [PMID: 27621893 DOI: 10.21037/jtd.2016.07.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In the post-operative course of the interventions of lung resection for primary tumor, complications of different nature and severity can arise, recognizing different pathogenetic mechanisms and differing according to the type of resection performed and to the time elapsed after surgery. The low diagnostic accuracy of chest radiography requires a thorough knowledge of the radiologist about all radiographic findings, both normal and pathological, which can be found in the immediate post-operative period (within 30 days after surgery). This article aims to describe the incidence, the clinical features and the radiological aspects of immediate complications following pulmonary resections, with specific reference to those in which the diagnostic imaging provides a fundamental contribution.
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Affiliation(s)
- Luciano Cardinale
- Department of Radiology, AOU San Luigi Gonzaga University Hospital, Orbassano (Torino), Italy
| | | | - Sandro Massimo Priola
- Department of Radiology, AOU San Luigi Gonzaga University Hospital, Orbassano (Torino), Italy
| | - Francesco Boccuzzi
- Department of Radiology, AOU San Luigi Gonzaga University Hospital, Orbassano (Torino), Italy
| | - Najada Dervishi
- Department of Radiology, AOU San Luigi Gonzaga University Hospital, Orbassano (Torino), Italy
| | - Elena Lisi
- Department of Thoracic Surgery, AOU San Luigi Gonzaga University Hospital, Orbassano (Torino), Italy
| | - Andrea Veltri
- Department of Radiology, AOU San Luigi Gonzaga University Hospital, Orbassano (Torino), Italy
| | - Francesco Ardissone
- Department of Thoracic Surgery, AOU San Luigi Gonzaga University Hospital, Orbassano (Torino), Italy
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Sugino K, Nakamura Y, Muramatsu Y, Hata Y, Shibuya K, Homma S. Analysis of blood neutrophil elastase, glutathione levels and pathological findings in postoperative acute exacerbation of idiopathic pulmonary fibrosis associated with lung cancer: Two case reports. Mol Clin Oncol 2016; 5:402-406. [PMID: 27699034 DOI: 10.3892/mco.2016.993] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/25/2016] [Indexed: 01/27/2023] Open
Abstract
Acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF) is characterized by severe worsening dyspnea and high mortality. It has been proven that the serum neutrophil elastase (NE) level, in addition to the serum Krebs von den Lungen-6 (KL-6) and surfactant protein-D (SP-D) levels, was elevated in patients with IPF-AE. Glutathione (GSH) is the major antioxidant involved in cell metabolism and survival. It is also known that IPF is characterized by reduced GSH levels in bronchoalveolar lavage fluid and blood. Case 1 was a 67-year-old man who was referred to our hospital complaining of a 2-year history of progressive dyspnea on exertion (DOE). The patient was initially diagnosed with IPF, followed by inhaled N-acetylcysteine monotherapy. Two years later, left upper lobectomy with lymph node dissection was performed due to primary lung cancer, which was large-cell neuroendocrine carcinoma (pT2aN2M0, stage IIIA). Five days after lung surgery, the patient developed AE. Case 2 was a 67-year-old man who was referred to our hospital with suspected lung cancer, complaining of dry cough and DOE. The patient underwent left upper lobectomy with lymph node dissection for primary lung cancer, which was diagnosed as well-differentiated adenocarcinoma (pT2aN2M0, stage IIIA). Ten days after lung surgery, the patient developed AE. The levels of biomarkers, such as serum NE, redox balance [reduced GSH (rGSH)/oxidized GSH (GSSG)] in the blood, as well as the correlation between serial changes of these biomarkers and prognosis, were analyzed in 2 patients with postoperative IPF-AE associated with lung cancer. Interestingly, the serial changes of the serum rGSH/GSSG ratio may suggest the possibility of predicting the onset of postoperative AE and/or survival, along with serum NE levels.
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Affiliation(s)
- Keishi Sugino
- Department of Respiratory Medicine, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan
| | - Yasuhiko Nakamura
- Department of Respiratory Medicine, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan
| | - Yoko Muramatsu
- Department of Respiratory Medicine, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan
| | - Yoshinobu Hata
- Department of Chest Surgery, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan
| | - Kazutoshi Shibuya
- Department of Surgical Pathology, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan
| | - Sakae Homma
- Department of Respiratory Medicine, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan
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16
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Intraoperative mechanical ventilation strategies for one-lung ventilation. Best Pract Res Clin Anaesthesiol 2015; 29:357-69. [DOI: 10.1016/j.bpa.2015.08.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 08/04/2015] [Accepted: 08/12/2015] [Indexed: 02/05/2023]
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Rotman JA, Plodkowski AJ, Hayes SA, de Groot PM, Shepard JAO, Munden RF, Ginsberg MS. Postoperative complications after thoracic surgery for lung cancer. Clin Imaging 2015; 39:735-49. [PMID: 26117564 DOI: 10.1016/j.clinimag.2015.05.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/18/2015] [Accepted: 05/21/2015] [Indexed: 11/17/2022]
Abstract
UNLABELLED Lung cancer is the leading cause of cancer-related deaths in the United States. Several surgical techniques are currently used as part of the standard of care for early-stage lung cancer. Differentiating normal postoperative changes from complications is essential in the management of these patients. This article will review the various surgical approaches used, ranging from wedge resection to pneumonectomy, and will outline their expected postsurgical changes. Early and late postsurgical complications will be described, some of which are unique to the type of surgery performed. In addition, local tumor recurrence is a form of postoperative complication and must be distinguished from typical postoperative or postradiation change. Knowledge of both common and uncommon postoperative complications is crucial in the follow-up of lung cancer patients. SUMMARY STATEMENT Familiarity with the appearance of postoperative complications in lung cancer patients is vital to distinguish it from the normal postoperative or postradiation appearance in follow-up imaging.
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Affiliation(s)
- Jessica A Rotman
- Department of Radiology, NY Presbyterian/Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065.
| | - Andrew J Plodkowski
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065.
| | - Sara A Hayes
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065.
| | - Patricia M de Groot
- Department of Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030.
| | - Jo-Anne O Shepard
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114.
| | - Reginald F Munden
- Department of Radiology, Houston Methodist Hospital, 6550 Fannin Street, Houston, TX, 77030.
| | - Michelle S Ginsberg
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065.
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Protective Ventilatory Approaches to One-Lung Ventilation: More than Reduction of Tidal Volume. CURRENT ANESTHESIOLOGY REPORTS 2014. [DOI: 10.1007/s40140-014-0057-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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19
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Leite CF, Marangoni FA, Camargo EA, Braga ADFDA, Toro IFC, Antunes E, Landucci ECT, Mussi RK. Simvastatin attenuates neutrophil recruitment in one-lung ventilation model in rats. Acta Cir Bras 2013; 28:245-50. [PMID: 23568231 DOI: 10.1590/s0102-86502013000400003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 03/19/2013] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To investigate the anti-inflammatory effects of simvastatin in rats undergoing one-lung ventilation (OLV) followed by lung re-expansion. METHODS Male Wistar rats (n=30) were submitted to 1-h OLV followed by 1-h lung re-expansion. Treated group received simvastatin (40 mg/kg for 21 days) previous to OLV protocol. Control group received no treatment or surgical/ventilation interventions. Measurements of pulmonary myeloperoxidase (MPO) activity, pulmonary protein extravasation, and serum levels of cytokines and C-reactive protein (CRP) were performed. RESULTS OLV significantly increased the MPO activity in the collapsed and continuously ventilated lungs (31% and 52% increase, respectively) compared with control (p<0.05). Treatment with simvastatin significantly reduced the MPO activity in the continuously ventilated lung but had no effect on lung edema after OLV. The serum IL-6 and CRP levels were markedly higher in OLV group, but simvastatin treatment failed to affect the production of these inflammatory markers. Serum levels of IL-1β, TNF-α and IL-10 remained below the detection limit in all groups. CONCLUSIONS In an experimental one-lung ventilation model pre-operative treatment with simvastatin reduces remote neutrophil infiltration in the continuously ventilated lung. Our findings suggest that simvastatin may be of therapeutic value in OLV-induced pulmonary inflammation deserving clinical investigations.
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Affiliation(s)
- Camila Ferreira Leite
- Postgraduate Program in Sciences of Surgery, Department of Surgery, Faculty of Medical Sciences, UNICAMP, Campinas, SP, Brazil
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Slinger P. Are lung-protective ventilation strategies worth the effort? SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2013. [DOI: 10.1080/22201173.2013.10872890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Better understanding of the pathophysiology of acute lung injury (ALI) and the hazards inherent to extremes in volume status has led efforts toward goal-directed, individualized therapies designed to achieve optimal hemodynamic status. The role for colloids both as a volume expander and potential protective agent against ALI is receiving revived interest. The evidence for the impact of fluid therapy is encouraging and supports the undertaking of properly designed perioperative fluid trials in thoracic surgeries. Such work offers hope that optimal fluid strategies can be defined and reduce the adverse events that have affected patients having lung resection.
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Affiliation(s)
- Cait P Searl
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK.
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Slinger P, Kilpatrick B. Perioperative lung protection strategies in cardiothoracic anesthesia: are they useful? Anesthesiol Clin 2012; 30:607-28. [PMID: 23089498 DOI: 10.1016/j.anclin.2012.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Patients are at risk for several types of lung injury in the perioperative period. These injuries include atelectasis, pneumonia, pneumothorax, bronchopleural fistula, acute lung injury, and acute respiratory distress syndrome. Anesthetic management can cause, exacerbate, or ameliorate most of these injuries. Lung-protective ventilation strategies using more physiologic tidal volumes and appropriate levels of positive end-expiratory pressure can decrease the extent of this injury. This review discusses the effects of mechanical ventilation and its role in ventilator-induced lung injury with specific reference to cardiothoracic anesthesia.
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Affiliation(s)
- Peter Slinger
- Department of Anesthesia, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
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Pool K, Munden R, Vaporciyan A, O'Sullivan P. Radiographic imaging features of thoracic complications after pneumonectomy in oncologic patients. Eur J Radiol 2012; 81:165-72. [DOI: 10.1016/j.ejrad.2010.08.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 08/26/2010] [Accepted: 08/27/2010] [Indexed: 10/19/2022]
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Bhatia R, Shaffer TH, Hossain J, Fisher AO, Horner LM, Rodriguez ME, Penfil S, Theroux MC. Surfactant administration prior to one lung ventilation: physiological and inflammatory correlates in a piglet model. Pediatr Pulmonol 2011; 46:1069-78. [PMID: 21618717 PMCID: PMC3320852 DOI: 10.1002/ppul.21485] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 03/22/2011] [Accepted: 03/26/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To test the hypothesis that surfactant, when given prophylactically during one lung ventilation (OLV), improves physiological stability and reduces inflammation. METHODS Prospective controlled animal study. After 30 min of mechanical ventilation, surfactant was administered to the left lung of the treatment group. Right lung mechanical ventilation continued for 3 hr, after which the left lung was unblocked. Bilateral mechanical ventilation was continued for 30 min thereafter. Physiological parameters and biomarkers of inflammation in plasma, lung tissue homogenates, and bronchoalveolar lavage (BAL) were measured. MEASUREMENTS AND MAIN RESULTS Oxygenation improved in the surfactant group, reaching statistical significance at 3 hr of OLV and again after 30 min of bilateral mechanical ventilation following the OLV. Plasma levels of interleukin (IL)-1 β, IL-6, and tumor necrosis factor (TNF)-α showed a trend for reduction. The lung homogenates from the ventilated lungs had significantly lower levels of IL-1 β (P < 0.01) and IL-6 (P < 0.01). The BAL specimen showed an overall reduction in the cytokine levels; IL-1 β was significantly lower in the ventilated lungs (P < 0.01). CONCLUSIONS Surfactant administration improves oxygenation and decreases inflammation, as evidenced by a decrease in several inflammatory cytokines both in the plasma and lungs of a piglet model of OLV.
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The effect of one-lung ventilation upon pulmonary inflammatory responses during lung resection. J Anesth 2011; 25:170-7. [DOI: 10.1007/s00540-011-1100-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 01/18/2011] [Indexed: 10/18/2022]
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Abstract
Patients are at risk for several types of lung injury in the perioperative period including atelectasis, pneumonia, pneumothorax, acute lung injury, and acute respiratory distress syndrome. Anaesthetic management can cause, exacerbate, or ameliorate these injuries. This review examines the effects of perioperative mechanical ventilation and its role in ventilator-induced lung injury. Lung protective ventilatory strategies to specific clinical situations such as cardiopulmonary bypass and one-lung ventilation along with newer novel lung protective strategies are discussed.
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Affiliation(s)
- B Kilpatrick
- Department of Anaesthesia, 3 EN, The Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4.
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Sakamoto S, Homma S, Mun M, Fujii T, Kurosaki A, Yoshimura K. Acute exacerbation of idiopathic interstitial pneumonia following lung surgery in 3 of 68 consecutive patients: a retrospective study. Intern Med 2011; 50:77-85. [PMID: 21245629 DOI: 10.2169/internalmedicine.50.3390] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Acute exacerbation (AE) of idiopathic interstitial pneumonia (IIP) is occasionally observed after lung surgery. However, the risk of lung surgery in patients with IIPs is not yet clearly known. SUBJECTS AND METHODS We conducted a retrospective study of consecutive patients who underwent lung surgery for cancer or for the diagnosis of interstitial pneumonia (IP) between 2000 and 2006. Patients who developed AE following the lung operation were assessed. RESULTS The data of 68 consecutive patients (males: 56, females: 12) with IP who underwent lung surgery were analyzed. The lung surgery included lobectomy for lung cancer in 48 patients [idiopathic pulmonary fibrosis (IPF) 31, non-IPF 17], and lung biopsy in 20 patients [IPF 8, non-specific interstitial pneumonia (NSIP) 8, unclassified 4]. Three patients with IPF (4.4% in total) developed AE after the operation (2 lobectomy, 1 biopsy). The triggers of AE were considered to be prolonged ventilation at a large tidal volume with oxygen supplementation at a high concentration. At the time of the AE, the extent of parenchymal involvement on the HRCT images was greater on the non-operated side. All three patients died of respiratory failure 12 to 82 days after the onset of AE despite corticosteroid therapy. CONCLUSION It is essential to be aware of the risk of AE of IPF following lung operation. Intraoperative respiratory management, such as oxygen supplementation at a high concentration and/or prolonged mechanical ventilation are likely possible etiologic factors.
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Affiliation(s)
- Susumu Sakamoto
- Department of Respiratory Medicine, Toho University School of Medicine, Toho, Japan.
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Hasegawa M, Sakai F. 1. Approach to Diagnosis, 2) Radiological Findings of ALI/ARDS. ACTA ACUST UNITED AC 2011; 100:1545-51. [DOI: 10.2169/naika.100.1545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Mizue Hasegawa
- Department of Diagnostic Radiology, Saitama International Medical Center, Saitama Medical University
| | - Fumikazu Sakai
- Department of Diagnostic Radiology, Saitama International Medical Center, Saitama Medical University
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CT predictors of mortality in pathology confirmed ARDS. Eur Radiol 2010; 21:730-7. [DOI: 10.1007/s00330-010-1979-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2010] [Revised: 08/11/2010] [Accepted: 09/07/2010] [Indexed: 01/28/2023]
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Theroux MC, Fisher AO, Horner LM, Rodriguez ME, Costarino AT, Miller TL, Shaffer TH. Protective ventilation to reduce inflammatory injury from one lung ventilation in a piglet model. Paediatr Anaesth 2010; 20:356-64. [PMID: 19919624 DOI: 10.1111/j.1460-9592.2009.03195.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To test the hypothesis that protective ventilation strategy (PVS) as defined by the use of low stretch ventilation (tidal volume of 5 ml x kg(-1) and employing 5 cm of positive end expiratory pressure (PEEP) during one lung ventilation (OLV) in piglets would result in reduced injury compared to a control group of piglets who received the conventional ventilation (tidal volume of 10 ml x kg(-1) and no PEEP). BACKGROUND PVS has been found to be beneficial in adults to minimize injury from OLV. We designed the current study to test the beneficial effects of PVS in a piglet model of OLV. METHODS Ten piglets each were assigned to either 'Control' group (tidal volume of 10 ml x kg(-1) and no PEEP) or 'PVS' group (tidal volume of 5 ml x kg(-1) during the OLV phase and PEEP of 5 cm of H2O throughout the study). Experiment consisted of 30 min of baseline ventilation, 3 h of OLV, and again 30 min of bilateral ventilation. Respiratory parameters and proinflammatory markers were measured as outcome. RESULTS There was no difference in PaO2 between groups. PaCO2 (P < 0.01) and ventilatory rate (P < 0.01) were higher at 1.5 h OLV and at the end point in the PVS group. Peak inflating pressure (PIP) and pulmonary resistance were higher (P < 0.05) in the control group at 1.5 h OLV. tumor necrosis factor-alpha (P < 0.04) and IL-8 were less (P < 0.001) in the plasma from the PVS group, while IL-6 and IL-8 were less (P < 0.04) in the lung tissue from ventilated lungs in the PVS group. CONCLUSIONS Based on this model, PVS decreases inflammatory injury both systemically and in the lung tissue with no adverse effect on oxygenation, ventilation, or lung function.
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Affiliation(s)
- Mary C Theroux
- Department of Anesthesiology and Critical Care Medicine, Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA.
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Shires AL, Green TM, Owen HL, Hansen TN, Iqbal Z, Markan S, Lilly RE, Pagel PS, Slinger PD, DeRose JJ. CASE 4—2009 Severe Reexpansion Pulmonary Edema After Minimally Invasive Aortic Valve Replacement: Management Using Extracorporeal Membrane Oxygenation. J Cardiothorac Vasc Anesth 2009; 23:549-54. [DOI: 10.1053/j.jvca.2009.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Indexed: 11/11/2022]
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Kozian A, Schilling T, Schütze H, Heres F, Hachenberg T, Hedenstierna G. Lung computed tomography density distribution in a porcine model of one-lung ventilation. Br J Anaesth 2009; 102:551-60. [DOI: 10.1093/bja/aep006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Park BJ. Respiratory failure following pulmonary resection. Semin Thorac Cardiovasc Surg 2008; 19:374-9. [PMID: 18395641 DOI: 10.1053/j.semtcvs.2007.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2007] [Indexed: 11/11/2022]
Abstract
Improvements in the perioperative management of the patient undergoing pulmonary resections have reduced postoperative complication rates steadily in the last several decades. However, postresection respiratory failure, particularly lung injury with no discernible cause, remains a major cause of morbidity and mortality. Because the incidence of this entity is relatively low, the terminology, pathogenesis, and optimal management are poorly delineated in the literature. The purpose of this review is to describe the criteria used to define postresection lung injury, discuss the possible etiologic factors, and outline currently available treatment strategies.
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Affiliation(s)
- Bernard J Park
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Lagan AL, Quinlan GJ, Mumby S, Melley DD, Goldstraw P, Bellingan GJ, Hill MR, Briggs D, Pantelidis P, du Bois RM, Welsh KI, Evans TW. Variation in Iron Homeostasis Genes Between Patients With ARDS and Healthy Control Subjects. Chest 2008; 133:1302-1311. [DOI: 10.1378/chest.07-1117] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Jackson TA, Mehran RJ, Thakar D, Riedel B, Nunnally ME, Slinger P. Case 5-2007 postoperative complications after pneumonectomy: clinical conference. J Cardiothorac Vasc Anesth 2007; 21:743-51. [PMID: 17905288 DOI: 10.1053/j.jvca.2007.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Timothy A Jackson
- Department of Anesthesiology and Pain Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030-4009, USA.
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Alam N, Park BJ, Wilton A, Seshan VE, Bains MS, Downey RJ, Flores RM, Rizk N, Rusch VW, Amar D. Incidence and Risk Factors for Lung Injury After Lung Cancer Resection. Ann Thorac Surg 2007; 84:1085-91; discussion 1091. [PMID: 17888952 DOI: 10.1016/j.athoracsur.2007.05.053] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Revised: 05/18/2007] [Accepted: 05/21/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND Lung injury, defined as acute hypoxemia accompanied by radiographic pulmonary infiltrates without a clearly identifiable cause, is a major cause of morbidity and mortality after major anatomic pulmonary resection. Our objective was to identify the incidence and risk factors for the development of postoperative lung injury. METHODS A retrospective case-control study of consecutive patients undergoing resection for lung cancer at a single institution was performed. The severity of lung injury was defined using the American European Consensus Conference on ARDS (acute respiratory distress syndrome) criteria and the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0 (http://ctep.cancer.gov/reporting/ctc.html). Patients with lung injury were compared with matched control patients, based on age, sex, and extent of resection, for examination of a priori defined risk factors. RESULTS From January 2001 to June 2004, 1,428 patients underwent attempted curative lung cancer resection. Postoperative lung injury occurred in 76 (5.3%) cases, 44 (3.1%) of which met criteria for acute lung injury or acute respiratory distress syndrome. After matching, there were no differences between cases and control patients with respect to use of induction therapy, perioperative transfusions, or tumor laterality. After univariate and multivariate analysis, increasing perioperative fluid administration and decreasing postoperative predicted lung function were significant risk factors for the development of lung injury. The overall mortality for patients with lung injury was 25%, compared with 2.6% for the control group. CONCLUSIONS Lung injury after lung resection has a high mortality. Lower predicted postoperative lung function, especially diffusion capacity, in combination with greater perioperative fluid administration were significant predictors of postoperative lung injury.
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Affiliation(s)
- Naveed Alam
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Schilling T, Kozian A, Kretzschmar M, Huth C, Welte T, Bühling F, Hedenstierna G, Hachenberg T. Effects of propofol and desflurane anaesthesia on the alveolar inflammatory response to one-lung ventilation. Br J Anaesth 2007; 99:368-75. [PMID: 17621602 DOI: 10.1093/bja/aem184] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND One-lung ventilation (OLV) induces a pro-inflammatory response including cytokine release and leucocyte recruitment in the ventilated lung. Whether volatile or i.v. anaesthetics differentially modulate the alveolar inflammatory response to OLV is unclear. METHODS Thirty patients, ASA II or III, undergoing open thoracic surgery were randomized to receive either propofol 4 mg kg(-1) h(-1) (n = 15) or 1 MAC desflurane in air (n = 15) during thoracic surgery. Analgesia was provided by i.v. infusion of remifentanil (0.25 microg kg(-1) min(-1)) in both groups. The patients were mechanically ventilated according to a standard protocol during two-lung ventilation and OLV. Fibre optic bronchoalveolar lavage (BAL) of the ventilated lung was performed before and after OLV and 2 h postoperatively. Alveolar cells, protein, tumour necrosis factor alpha (TNFalpha), interleukin (IL)-8, soluble intercellular adhesion molecule-1 (sICAM), IL10, and polymorphonuclear (PMN) elastase were determined in the BAL fluid. Data were analysed by parametric or non-parametric tests, as indicated. RESULTS In both groups, an increase in pro-inflammatory markers was found after OLV and 2 h postoperatively; however, the fraction of alveolar granulocytes (median 63.7 vs 31.1%, P < 0.05) was significantly higher in the propofol group compared with the desflurane group. The time courses of alveolar elastase, IL-8, and IL-10 differed between groups, and alveolar TNFalpha (7.4 vs 3.1 pg ml(-1), P < 0.05) and sICAM-1 (52.3 vs 26.3 ng ml(-1), P < 0.05) were significantly higher in the propofol group. CONCLUSIONS These data indicate that pro-inflammatory reactions during OLV were influenced by the type of general anaesthesia. Different patterns of alveolar cytokines may be a result of increased granulocyte recruitment during propofol anaesthesia.
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Affiliation(s)
- T Schilling
- Department of Anaesthesiology and Intensive Care Medicine, Otto-von-Guericke-University Magdeburg, Germany.
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Chae EJ, Seo JB, Kim SY, Do KH, Heo JN, Lee JS, Song KS, Song JW, Lim TH. Radiographic and CT Findings of Thoracic Complications after Pneumonectomy. Radiographics 2006; 26:1449-68. [PMID: 16973775 DOI: 10.1148/rg.265055156] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pneumonectomy is the treatment of choice for bronchogenic carcinoma and intractable end-stage lung diseases such as tuberculosis and bronchiectasis, but it is often followed by postoperative complications, which account for significant morbidity and mortality. Knowledge of the radiologic features of such complications is of critical importance for their early detection and prompt management. Complications of pneumonectomy are classified as early or late, depending on when they occur in relation to the hospitalization period. Early complications of pneumonectomy include pulmonary edema, bronchopleural fistula, pneumonia of the contralateral lung, empyema, and adult respiratory distress syndrome, which may occur separately or in combination. Late postpneumonectomy complications include recurrent disease, infection, effects of radiation therapy or chemotherapy, and surgical complications such as late-onset bronchopleural fistula, postpneumonectomy syndrome, and esophagopleural fistula. Sequential examinations with chest radiography after pneumonectomy are an invaluable method of screening for these complications, especially in the early postoperative period. When the radiographic findings are inconclusive, computed tomography is helpful for establishing a diagnosis and obtaining detailed information about the disease process.
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Affiliation(s)
- Eun Jin Chae
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poong-nap-dong, Songpa-ku, Seoul 138-36, Korea
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Kondoh Y, Taniguchi H, Kitaichi M, Yokoi T, Johkoh T, Oishi T, Kimura T, Nishiyama O, Kato K, du Bois RM. Acute exacerbation of interstitial pneumonia following surgical lung biopsy. Respir Med 2006; 100:1753-9. [PMID: 16584880 DOI: 10.1016/j.rmed.2006.02.002] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2005] [Revised: 01/08/2006] [Accepted: 02/05/2006] [Indexed: 01/08/2023]
Abstract
STUDY OBJECTIVES Surgical lung biopsy (SLB) plays an important role in the diagnosis of interstitial pneumonia, however, the occurrence of acute respiratory failure following SLB remains largely unreported. We evaluated the incidence, clinical features, therapy and prognosis of acute exacerbation of interstitial pneumonia following SLB. DESIGN Retrospective study of consecutive patients who underwent SLB to establish a diagnosis of diffuse lung disease between May 1989 and April 2000. Patients with an acute exacerbation following lung biopsy were studied, and the HRCT images of the chest before and after surgery were reviewed. MEASUREMENTS AND RESULTS Among the 236 consecutive patients with interstitial pneumonia who underwent a surgical lung biopsy, five (2.1%) (IPF, 3; NSIP, 1; COP, 1) developed acute exacerbation of the diffuse lung disease in the course of 1-18 days after SLB. The extent of parenchymal involvement on HRCT before surgery was not significantly different between operated and contralateral nonoperated lung. Significantly increased regions of parenchymal involvement on HRCT were seen postoperatively compared with the preoperative CT in both the operated (20.7+/-12.5% versus 38.2+/-10.8%, P = 0.0431) and nonoperated lung (22.7+/-13.8% versus 70.5+/-24.4%, P = 0.0431), but the extent of the parenchymal involvement was significantly greater on the nonoperated side (P = 0.0251). Two of the 3 IPF patients died from the acute exacerbation. CONCLUSIONS It is important to be aware of the possibility of acute exacerbation of interstitial pneumonia following SLB even after an apparently uneventful immediate postoperative course. The asymmetric image findings suggest that intraoperative respiratory management is a possible etiologic factor.
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Affiliation(s)
- Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi 489-8642, Japan.
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Abstract
PURPOSE OF REVIEW An update is provided for anaesthetists, on recent work investigating the incidence and cause of lung injury following thoracic surgery. Pulmonary damage is also discussed in relation to the management of one-lung ventilation. RECENT FINDINGS The extent of recent original literature on lung injury, following thoracic surgery, is limited for the review period (2004-2005). Increasing evidence that pulmonary oxidative stress and an increase in proinflammatory cytokines are significant contributors to lung injury following thoracic surgery, however, exists. This is particularly the case in patients with lung or oesophageal carcinoma. Animal experiments confirm the above and also indicate that anaesthetic agents may offer some protection against the ischaemia-reperfusion injury sustained as a result of one-lung ventilation. SUMMARY Pulmonary damage in the form of acute lung injury and adult respiratory distress syndrome is a major cause of morbidity and mortality after thoracic surgery. An understanding of the pathogenesis of lung damage, following thoracic surgery, may enable anaesthetists to modify this process and decrease the incidence and severity of the problem.
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Ichikado K, Suga M, Muranaka H, Gushima Y, Miyakawa H, Tsubamoto M, Johkoh T, Hirata N, Yoshinaga T, Kinoshita Y, Yamashita Y, Sasaki Y. Prediction of Prognosis for Acute Respiratory Distress Syndrome with Thin-Section CT: Validation in 44 Cases. Radiology 2006; 238:321-9. [PMID: 16293804 DOI: 10.1148/radiol.2373041515] [Citation(s) in RCA: 142] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively evaluate whether the thin-section computed tomographic (CT) appearance has prognostic value for prediction of mortality, number of ventilator-free days (ie, days without mechanical ventilation), and 28-day risk of barotrauma in patients with a clinically early stage of acute respiratory distress syndrome (ARDS) from diverse causes. MATERIALS AND METHODS Institutional review board approval and informed consent were obtained. Two independent observers who were blinded to patient outcomes retrospectively evaluated the thin-section CT scans obtained within 7 days after clinical ARDS onset in 26 survivors and 18 nonsurvivors. Of 44 patients, there were 37 men and seven women (mean age +/- standard deviation, 61.8 years +/- 15.6). CT findings were graded on a scale of 1-6 that corresponded with consecutive pathologic phases: score of 1, normal attenuation; score of 2, ground-glass attenuation; score of 3, consolidation; score of 4, ground-glass attenuation associated with traction bronchiolectasis or bronchiectasis; score of 5, consolidation associated with traction bronchiolectasis or bronchiectasis; and score of 6, honeycombing. An overall CT score was obtained by adding the six averaged scores (three zones in each lung). Multivariate regression analysis was used to assess the independent predictive value of the CT score. RESULTS The area of increased attenuation associated with traction bronchiolectasis or bronchiectasis (P = .002), as well as the overall CT score (P = .002), was smaller in survivors than in nonsurvivors. Results of multivariate regression analysis revealed that CT score was independently associated with mortality (P = .006). A CT score of less than 230 enabled prediction of survival with 73% sensitivity and 75% specificity and was associated with both a greater number of ventilator-free days (P = .018) and a lower incidence of barotrauma (P = .013) within 28 days after ARDS onset. CONCLUSION Extensive thin-section CT abnormalities indicative of fibroproliferative changes were independently predictive of poor prognosis in patients with a clinically early stage of ARDS.
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Affiliation(s)
- Kazuya Ichikado
- Dept of Respiratory Medicine, Graduate School of Medical Sciences, Kumamoto Univ, Kumamoto, Japan.
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