Postoperative Lung Function In Patients Research Articles

Pulmonary Function Following Completion of Minimally Invasive Repair for Pectus Excavatum (MIRPE)

Pulmonary function testing remains part of the routine preoperative investigations in patients with pectus excavatum, although there is evidence that reduced exercise capacity is predominantly due to impaired cardiovascular performance rather than ventilatory limitation. To evaluate the change of pulmonary function in patients after completion (metal bar removal) of minimally invasive repair for pectus excavatum compared to the preoperative functional results. All patients who underwent minimally invasive repair for pectus excavatum (MIRPE) between February 2000 and June 2006 and subsequently had their metal bars removed were examined. Pulmonary function tests were performed as part of the routine pre- and postoperative protocol. Vital capacity (VC), forced expiratory volume in one second (FEV1), total lung capacity (TLC), residual volume (RV) and maximal expiratory flow rate at 25 % (MEF25) were evaluated. In addition, comparisons were made between patients with a low (<or= 6) and those with a high (> 6) pectus severity index (PSI) to establish the relative pre- to postoperative change of the above-mentioned lung function parameters. Fifteen patients were included in the study (14 males, 1 female). The median age at surgery was 15.9 years. The metal bar(s) were removed after a median of 37 months following the initial operation. Lung function tests were performed at a median of 32 days preoperatively and 129 days after completion of the procedure. Preoperative lung function values lay below population averages. The majority of patients had either a restrictive, obstructive or combined pulmonary disorder. Improvement was observed in all lung function parameters after metal bar removal compared to preoperative values and was significant for VC, FEV1 and the RV/TLC ratios. With regard to the severity of the deformity, although not statistically significant, patients with a higher PSI (> 6) appeared to benefit particularly from the operation. Our findings indicate that pulmonary function improves in patients after completion of minimally invasive repair of pectus excavatum. However, a review of the literature suggests that, in all probability, following surgery, patients benefit more with regard to enhanced cardiovascular performance than from improved pulmonary limitations. The value of routine testing of pre- and postoperative lung function in patients with pectus excavatum is questionable.

The effects of various leukocyte filtration strategies in cardiac surgery

It is known that cardiopulmonary bypass causes an inflammatory reaction with an associated morbidity and mortality. Several anti-inflammatory strategies have been implemented to reduce this response, including leukocyte removal from the circulation using specialised filters. The aim of this study is to systematically review the available evidence on leukocyte filtration in cardiac surgery, focusing on its effect on systemic inflammation and whether this has influenced clinical outcomes. Five electronic databases were systematically searched for studies reporting the effect of leukocyte filtration at any point within the cardiopulmonary bypass circuit in humans. Reference lists of all identified studies were checked for any missing publications. Two authors independently extracted the data from the included studies. Whilst systemic leukodepleting filters do not appear to consistently lower leukocyte counts, they may preferentially remove activated leukocytes. Small improvements in early post-operative lung function in patients receiving systemic leukodepletion have been reported, but this does not lead to reduced hospital stay or decreased mortality. There is substantial evidence that cardioplegic leukocyte filtration attenuates the reperfusion injury at a cellular level, but this has not been translated into clinical improvements. Finally, whilst various strategies involving multiple leukocyte filters, or the incorporation of pharmacological agents into leukocyte-depleting protocols have been evaluated, the current available results are not conclusive. Our study suggests that there is not enough high quality or consistent evidence to draw guidelines regarding the use of leukocyte-depleting filters within routine cardiac surgical practice.

Reliability of Quantitative Computed Tomography to Predict Postoperative Lung Function in Patients With Chronic Obstructive Pulmonary Disease Having a Lobectomy

To verify the reliability of quantitative computed tomography (CT) to estimate the postoperative lung function in patients with mild to severe chronic obstructive pulmonary disease (COPD) who underwent a lobectomy. Nine COPD patients with lung cancer having a lung lobectomy with preoperative CT were enrolled. By applying a density mask technique and a specific equation, predicted postoperative forced expiratory volume in 1 second (FEV1) and vital capacity (VC) were calculated. Predicted values were correlated with postoperative measured values. Estimated FEV1 and VC were always significantly lower than the corresponding postoperative values; however, CT-estimated postresection FEV1 values were better than the postresection VC values (biases between estimated and measured values were -0.14 and -0.536 L, respectively, according to the Bland-Altman method). Quantitative CT predicted postoperative FEV1 (r = 0.97, P < 0.001) and VC (r = 0.93, P < 0.001) well in all patients, however. Quantitative CT may be an alternative tool to perfusion scan to predict postresection lung function, even in patients with borderline pulmonary function undergoing a lobectomy.

Positive end-expiratory pressure to the dependent lung during one-lung ventilation improves postoperative lung function in patients with high FEV1

Positive end-expiratory pressure to the dependent lung during one-lung ventilation improves postoperative lung function in patients with high FEV1

Quantitative Spiral CT: Clinical Usefulness in Prediction of Postoperative Lung Function in Patients with Pulmonary Resection

Quantitative Spiral CT: Clinical Usefulness in Prediction of Postoperative Lung Function in Patients with Pulmonary Resection

Use of quantitative CT to predict postoperative lung function in patients with lung cancer.

To evaluate the effectiveness of quantitative computed tomography (CT) for predicting postoperative lung function in patients with lung cancer. Preoperative spirometry and conventional CT of the chest were performed in 38 patients. A postprocessing CT program was applied to quantitate the volume of whole-lung parenchyma with attenuations of -500 to -910 HU; this was defined as total functional lung volume (TFLV). The regional functional lung volume (RFLV) of the lobes or lung to be resected was quantitated separately. CT-predicted postoperative forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were derived by multiplying the preoperative spirometry values by (1 - RFLV/TFLV). CT-predicted values correlated well with postoperatively measured results (FEV1: r = .93, P < .001; FVC: r = .86, P < .001) in patients who underwent pneumonectomy or lobectomy, regardless of the patient's preoperative ventilation status. This method is effective in the prediction of postoperative FEV1 and FVC in patients undergoing pulmonary resection.