Studies on the Effects of Various Types of Collapse Therapy and Pulmonary Resection upon Cardiopulmonary Function in Patients with Pulmonary Tuberculosis (1) : Pneumothorax and its Intrapleural Complications.

Abstract

The effects of pneumothorax upon pulmonary function have been studied since long time ago, and many authors have reported their observations with spirometry and blood gas analysis. Some data have been reported upon the effects of pneumothorax on pulmonary circulation by the simple indirect methods; since venous catheterization was introduced in this field, a few authors have reported their studies using this method. But the author can not find a report in which the effects of pneumothorax upon cardiopulmonary function have been generally studied, nor studies on the pulmonary circulation in patients with intrapleural complications caused by pneumothorax. So this paper reports the present author's results upon these points.Methods : The venous catheterization was performed according a modified method of Cournand and Ranges. Pressures were recorded by means of Hamilton's optical manometer or Sanborn strain gauge electromanometer, and the arbitrary zeropoint of all pressures was the midpoint between the second cost-sternal angle and the corresponding point of back. Cardiac output was determined by the direct Fick principle. Alveolar O2 tension and arterial O2 and CO2 tension were determined by O2-CO2 Diagram reported by Rahn & Fenn. Alveolar ventilation was calculated by the following formula, provided that arterial CO2 tension was equal to alveolar CO2 tension. VA=VCO2/FAO2 and the work of right ventricle against pressure was calculated both by Riley's formula and by the present author's following formula.WR (Watanabe)=(mPAP-dRVP)×CO×0.1332 (joules/min) where mPAP=mean pulmonary arterial pressure (mmHg), dRVP=right ventricular enddiastolic pressure (mmHg), CO=cardiac output (1/min). Measurement of lung volume was carried out by means of Gebauer's spirometer, predicted vital capacity was calaulated by the Ebina's vital capacity index. Predicited maximum breathing capacity was calculated by multiplying predicted vital capacity by vital capacity-maximum breathing capacity ratio (VC/MBC) obtained by the present author's measurement of those who are free from cardiopulmonary diseases. The degree of lung collapse caused by pneumothorax was estimated by the dorso-ventral X ray film. When the collapsed area remained within one third of one lung, it was classified as slight ; when it was from one-third to two-thirds of one lung, moderate, and when it became over two-thirds of one lung, high. Patients were classified according to N T A criteria. Muscular exercise was performed with bicycle ergometer.The subjects were 18 patients under pneumothorax (group I) and 5 patients with its intrapleural complications (group II). And group 1 was divided into two groups, the one (group a) consisting of 11 patients under unilateral pneumothorax, and the other (group b) of 7 patients under bilateral pneumothorax (Table II).Results : 1. Group 1 : The decrease in vital capacity was relatively slight, alveolar ventilation ratio (VA/VE), diminished, and the latter decreased remarkably in group b (Table III). Arterial O2 tension showed negative correlation with A-a O2 tension gradient (Fig 1). Cardiac index was increased in most cases in group a, showing only slight decrease after air refill, while in group b it was decreased in many cases and decreased markedly again after air refill (Table V). The intrathoracic pressure during cardiac catheterization was almost similar to that during the first pneumothorax in 5 cases whereinformation was available on the first pneumothorax (Table VII).Right auricular pressure was normal in general, and in a few patients it even dropped clearly, while on the other hand it was elevated slightly after the air refill. [the rest omitted]