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At least 19 recordsLinked to original sources
PubMed2003

Factors associated with cardiac rhythm disturbances in the early post-pneumonectomy period: a study on 259 pneumonectomies.

OBJECTIVE: To identify predisposing factors associated with cardiac rhythm disturbances during the early post-pneumonectomy period (first 7 postoperative days). MATERIALS AND METHODS: During the study period (1995-1999), 259 pneumonectomies were performed for malignant (244 cases) or benign disease (15 cases). Postoperative monitoring of patients included continuous arterial pressure - rhythm monitoring and pulse oximetry. Cardiac rhythm disturbances during the intensive care unit stay were detected on the monitor screen and recorded with a 12-lead electrocardiogram. Cardiac rhythm disturbances associated with electrolytes or fluid balance abnormality, mediastinal deviation or surgical postoperative complications were excluded from the study. Age of patients, preexisting cardiac disease, side of pneumonectomy, intrapericardial procedures, stage of the malignant disease, expected postoperative FEV(1)<1200 ml, intraoperative transfusions of packed red cells, elevated right heart pressures, low postoperative serum magnesium levels and long operative times were considered as predisposing factors for the development of post-pneumonectomy cardiac rhythm disturbances. Statistical analysis has been made using logistic regression analysis, Student t-test and chi-square test. RESULTS: Cardiac rhythm disturbances were detected in 49 patients (18.91%). Atrial fibrillation/flutter (31 cases), supraventricular tachycardia (14 cases), and premature ventricular contractions (four cases) were the observed rhythm disturbances. Right pneumonectomy versus left pneumonectomy (P<0.0001) and intrapericardial pneumonectomy versus standard pneumonectomy (P<0.0001) were identified as strong predisposing factors for the establishment of post-pneumonectomy cardiac rhythm disturbances. Patients who established post-pneumonectomy cardiac rhythm disturbances had significantly higher (P=0.024) right ventricular systolic pressure (42.50+/-15.50 mmHg) when compared with patients who had postoperative sinus rhythm (29.07+/-7.71 mmHg) and had also longer operative times than patients who did not develop rhythm disturbances (P=0.015). Mortality rate in patients who developed post-pneumonectomy rhythm disturbances was 20.40%. CONCLUSIONS: Cardiac rhythm disturbances observed early after pneumonectomy are mainly of supraventricular origin, complicating right and intrapericardial pneumonectomies, patients with elevated right heart pressures and long operative times, and are associated with high mortality rates.

Age Factors↗
PubMed1999

Indications for pneumonectomy. Pneumonectomy for benign disease.

A wide variety of nonmalignant diseases of the lung require pneumonectomy. Pneumonectomy for inflammatory lung disease is frequently associated with high morbidity rates, and the frequencies of postpneumonectomy space empyema and bronchopleural fistula are high. It is essential to treat underlying infections prior to surgery in an effort to minimize the sputum production, maximize the patient's nutritional status, minimize the chance for intraoperative spillage, and decrease the risk of postoperative bronchopleural fistulas and postpneumonectomy space empyemas. Despite the challenges of performing a pneumonectomy for inflammatory diseases, cure rates for MDR-TB, MOTT infections, and fungal disease, including invasive fungal disease, are excellent. Pneumonectomy for trauma is associated with very high mortality, and efforts should be made to avoid pneumonectomy if possible. Pneumonectomy for other benign conditions is unusual.

Bronchiectasis↗
PubMed1987

Results of surgical treatment of stage III lung carcinoma with carinal proximity. The role of sleeve lobectomy versus pneumonectomy and the role of sleeve pneumonectomy.

Sleeve lobectomy in specific situations can be an alternative to pneumonectomy. Sleeve pneumonectomy is an aggressive resection for carcinoma involving the tracheobronchial angle, carina, or lower trachea and lung. Sleeve lobectomy is questioned because of its technical difficulties and its postoperative complications. Sleeve pneumonectomy is controversial in that its postoperative mortality and long-term survival rates are similar, it is a technically difficult procedure, and its mortality rate is greater than that of standard pneumonectomy. The indications for the procedures and patient selection are discussed.

Adult↗
PubMed1999

[Treatments for post-pneumonectomy pyothorax without broncho-pleural fistula: irrigation of the post-pneumonectomy space].

Between January 1986 and December 1997 pneumonectomy was performed in 58 patients. Of the 58 patients, four had pyothorax without broncho-pleural fistula. Four patients underwent chest tube drainage and irrigation of the post-pneumonectomy space, and one of which died of lung cancer during treatment for pyothorax. Two had no evidence of recurrent infection, and one had a chest wall fistula after about one year and a fistulectomy was performed. These observations suggest that draining and irrigating of the post-pneumonectomy space are effective and non-invasive methods for treating post-pneumonectomy pyothorax without broncho-pleural fistula. However we were not able to investigate specific methods, fluid types, or irrigation time frames.

Empyema, Pleural↗
PubMed1999

Indications for pneumonectomy. Pneumonectomy for malignant disease.

The anatomic extent of a pulmonary malignancy usually dictates the need for pneumonectomy to achieve a complete resection. The requirement for a pneumonectomy can frequently be predicted by accurate clinical staging, but may also be required due to intraoperative findings relating to tumor invasion or nodal spread. Completion pneumonectomy is usually reserved for locally recurrent lung cancer or early to late complications following pulmonary resection. Malignant involvement of the carina frequently requires sleeve pneumonectomy.

Humans↗
PubMed1996

Trauma pneumonectomy revisited: the role of simultaneously stapled pneumonectomy.

OBJECTIVE: The aim of this study was to compare simultaneously stapled pneumonectomy (SSP) with individual ligation (IND) as a method for performing urgent pneumonectomy (Py) for trauma. METHODS: Twelve patients who required Py were reviewed. SSP was performed in nine cases and IND in three cases. The two groups had statistically similar injury severity scores, presenting systolic blood pressures, and Trauma and Injury Severity Score derived probabilities of survival. An animal model of Py was developed, in which seven animals underwent SSP and seven underwent IND methods. Burst pressures of the pulmonary artery and bronchus were calculated after 14 days. RESULTS: There were no differences noted in survival rates between SSP (5 (56%)) and IND (1 (33%)), nor in incidence of bronchopleural fistula. The SSP group had a significantly shorter operative time compared with that of IND (88.9 +/- 14.3 minutes vs 213 +/- 57.8 minutes, respectively, p - 0.01). The animal study revealed no difference in burst pressures of the bronchus (SSP = 662.9 +/- 169.9 mm Hg vs. IND = 591.4 +/- 193.2 mm Hg, p = 0.752) or of the pulmonary artery (SSP = 554.3 +/- 195.1 mm Hg vs. IND = 477.7 +/- 247.5 mm Hg, p = 0.529). CONCLUSION: Survival after pulmonary injuries that require Py depends upon the rapidity of hilar control and of the procedures itself. Simultaneously stapled pneumonectomy is an effective and rapid method of dealing with such rare injuries.

Adult↗
PubMed1999

Techniques of pneumonectomy. Sleeve pneumonectomy.

Sleeve pneumonectomy is a technically demanding procedure, the indications of which include non-small bronchogenic tumors extending to the tracheobronchial bifurcation without diseased mediastinal nodes. Right sleeve pneumonectomies are best approached through an ipsilateral thoracotomy in the fifth (or fourth) intercostal space. Median sternotomy for left sleeve pneumonectomy gives outstanding exposure to the tracheobronchial bifurcation, and less incisional discomfort and ventilatory restriction than an ipsilateral thoracotomy. If a tracheobronchial anastomosis is under tension, excessive tracheobronchial and mediastinal dissection and perioperative fluid overload are avoided, then the most common and often fatal early (noncardiogenic pulmonary edema) and late (anastomotic dehiscence) complications are significantly lowered. If these guidelines are respected, this operation generates 5-year survival rates exceeding 40%.

Humans↗
PubMed1999

Indications for pneumonectomy. Extrapleural pneumonectomy.

Surgical resection is considered a mainstay for the treatment of malignant pleural mesothelioma (MPM), but the indications for extrapleural pneumonectomy in this disease remain controversial. In general terms, an operation contributes to cancer management if it can be performed with low morbidity and mortality and improves local control, overall survival, or quality of life. The potential role of extrapleural pneumonectomy in MPM is best considered in this context.

Humans↗
PubMed1999

Techniques of pneumonectomy. Pneumonectomy through an empyema.

The practical management of the patient with a destroyed lung in association with a preexisting empyema, based on considerable experiences, is discussed. Control of infection before proceeding with pneumonectomy by adequate drainage of the empyema and control of tuberculosis and pneumonia, particularly on the opposite side, is stressed. Pneumonectomy is undertaken through the empyema and usually in the intrapleural plane.

Drainage↗
PubMed1999

Techniques of pneumonectomy. Completion pneumonectomy.

Completion pneumonectomy refers to an operation intended to remove what is left of a lung partially resected during previous surgery. Completion pneumonectomy is a technically demanding procedure, which carries an increased operative mortality and morbidity. If the planning and the surgical technique are done meticulously, the good prospect for long-term survival justifies the higher risk.

Adolescent↗
PubMed1999

Techniques of pneumonectomy. Video-assisted thoracic surgery pneumonectomy.

Thoracoscopic major pulmonary resections such as lobectomies or pneumonectomies are the most difficult operations that can be attempted thoracoscopically, and still have limited routine application in thoracic surgical practice. The precise indications for thoracoscopic pneumonectomy are very rare and have not yet been defined precisely; we limited the procedure only to double tumors, small tumors infiltrating the fissure, and small tumors at the secondary carina not amenable to a bronchoplasty procedure. Although the technique still has very limited applications, the advantages include reduced surgical trauma and consequent minimal postoperative pain, a shortened hospital stay, and a rapid resumption of normal activities which ultimately reduces costs. Wider acceptance, larger series, and a more extensive follow-up will assess the role of thoracoscopic anatomical lung resection in modern thoracic surgical practice.

Humans↗
PubMed1999

Techniques of pneumonectomy. Standard pneumonectomy.

An understanding of the anatomical, three-dimensional organization of the pulmonary hilum is the foundation necessary for pneumonectomy. The incision type and sequence of control of hilar structure are determined by anatomic position, extent of tumor, and patient safety factors.

Humans↗
PubMed1999

Techniques of pneumonectomy. Pleural pneumonectomy.

This article reviews the preoperative assessment and selection of patients for extrapleural pneumonectomy, the surgical technique, and recent data outlining our experience with multimodality therapy for MPM.

Humans↗
PubMed1999

Techniques of pneumonectomy. Drainage after pneumonectomy.

After most pneumonectomies, the pleural space can be safely closed without drainage. If a chest tube must be used, a balanced drainage system is recommended. This article specifically addresses some of the controversial issues in the early management of the postpneumonectomy space. It also describes the indications, advantages, and disadvantages of drainage and the methods commonly used for this purpose.

Chest Tubes↗
PubMed1999

Physiologic consequences of pneumonectomy. Long-term consequences of pneumonectomy done in children.

Lung resections in children are performed for a variety of reasons including congenital malformations, infections, bronchiectasis, and tumors. There are no long-term reports on pneumonectomy alone in children, but those on lung resection as a group state that children tolerate these operations well, with mild sequelae if any, and that the majority of them in adulthood can perform non-physically demanding jobs adequately. The authors' findings concur with the reports that younger patients can endure pulmonary resections with minimal functional limitations.

Adolescent↗
PubMed1996

[Right-to-left interatrial shunt with normal pulmonary pressures after pneumonectomy. Apropos of a case with severe cyanosis following left pneumonectomy].

Atrial septal defects usually give rise to left-to right in the absence of obstruction of the pulmonary outflow tract or pulmonary hypertension. The authors report a case of atrial septal defect with a right-to-left shunt despite normal pulmonary pressures at catheterisation in a 56 year-old-man who had undergone left pneumonectomy 6 months previously. The shunt was responsible for major arterial desaturation aggravated by the left lateral or dorsal decubitus position. Surgical closure of the defect resulted in cure with disappearance of cyanosis and normalisation of blood gases. The physiopathological mechanisms of these right-to-left shunts with normal pulmonary pressures are discussed with reference to previously reported cases in the literature.

Blood Gas Analysis↗