Effect of lung resection on pleuro-pulmonary mechanics and fluid balance
Introduction
A recent study (Miserocchi et al., 2010) described a model of perturbation of lung–chest wall mechanical coupling following lung resection based on the amount of resected mass as well as the preoperative lung mechanical properties. The study proposed to measure lung compliance in order to estimate the degree of lung hyperinflation when attempting to fit the resected lung to the chest. The hypothesis was put forward that hyperinflation of the resected lung might be a causative factor of postoperative pulmonary complications that include hydrothorax, lung edema and air leak. Following this line, an experimental animal model was developed to evaluate the decrease in lung compliance after lung resection aiming to relate it to the amount of resected mass as well as to an experimental hydrothorax of various entity (Salito et al., 2014a). Data from this study confirmed that comparing post-operative to the pre-operative lung compliance values provides a useful indication of the potential degree of hyperinflation following lung re-expansion in the chest. In fact, on occasion, the decrease in lung compliance following lung resection exceeded that expected based on resected mass, suggesting some perturbance affecting either the number of alveolar units available for lung ventilation and/or the elastic properties of the operated lung. The aim of the present study was to evaluate in human patients the effect of lung resection on pleuro-pulmonary mechanics and pleural fluid balance.
Section snippets
Methods
Data were gathered from 11 patients undergoing lung resection by minimally invasive video-assisted thoracoscopic surgery (VATS). This study was conducted in accordance with the amended Declaration of Helsinki. Patients were anesthetized and ventilated through a double-lumen bronchial intubation with pressure controlled. Conventional ventilator settings with both lungs consisted of a tidal volume (Vt) of 7–8 ml/kg, a respiratory rate required to maintain end-tidal exhaled carbon dioxide tension
Results
Table 1 reports the anthropometric and spirometric data of the patients, the side and the lobe to be operated, the amount of resected mass, the amount of the total pleural fluid drained and time of drainage removal. On the average FEV1/FVC was only mildly reduced relative to the control value of 0.78 as derived from Salito et al. (2014b) and RV/TLC was moderately increased relative to control value of 0.34 (Salito et al., 2014b). Patients had no history of renal/heart failure, nor of systemic
Discussion
This is the first study presenting data concerning the effect of lung resection on respiratory mechanics and on pleural effusion in a group of patients undergoing lung resection for lung cancer.
Acknowledgement
The study was in part supported by Medela AG, Medical Technology.
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