Abstract
Background. Postoperative lung injury is a cause of most fatal outcomes after extensive lung resections. Death rates due to postpneumonectomy pulmonary edema have remained unchanged within the past 20 years and are currently tending to 100%. Objective: to make prolonged lung edema monitoring in patients after extensive thoracic interventions. Subjects and methods. The observational study covered 27 patients who had undergone pneumonectomy (PE) (n=16) or lung resection (n=11). Invasive monitoring by the PiCCOplus system was performed to examine the systemic and pulmonary hemodynamics of all the patients during surgery and within 48 postoperative hours. Results. PE rather than lung resection was accompanied by a significant reduction in the extravascular lung water index (EVLWI). Most patients who had undergone PE were found to have a subclinical increase in EVLWI 36-48 hours after termination of the intervention. Conclusion. In this observational clinical study, isolated thermodilution showed an immediate decrease in EVLWI after PE and its increase at 36—48 postoperative hours. Lobar or segmental interventions failed to cause significant changes in EVLWI in the perioperative period. Key words: pneumonectomy, lung resection, lung edema, extravascular lung water, acute lung injury.
Highlights
Postoperative lung injury is a cause of most fatal outcomes after extensive lung resections
PE rather than lung resection was accompanied by a significant reduction in the extravascular lung water index (EVLWI)
Most patients who had undergone PE were found to have a subclinical increase in EVLWI 36 48 hours after termina tion of the intervention
Summary
Послеоперационное повреждение легких является причиной большинства смертельных ис ходов после обширных резекционных легочных вмешательств. Целью данного ис следования было проведение продленного мониторинга отека легких у пациентов после обширных торакальных вмешательств. В обсервационное исследование включено 27 пациентов, которым была вы полнена пневмонэктомия (n=16) или резекция легких (n=11). Пневмонэктомия (ПЭ), но не резекция легких, со провождалась достоверным снижением индекса внесосудистой воды легких (ИВСВЛ). Спустя 36—48 часов по сле окончания вмешательства у большинства пациентов, перенесших ПЭ, было выявлено субклиническое повышение ИВСВЛ. В представленном обсервационном клиническом исследовании изолированная термодилюция показала немедленное уменьшение ИВСВЛ после ПЭ и его повышение к 36 48 часам послеопера ционного периода. Долевые или сегментарные вмешательства не вели к значимым изменениям ИВСВЛ в пери операционном периоде. Ключевые слова: пневмонэктомия, резекция легких, отек легких, внесосудистая вода легких, острое повреждение легких
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