Role of preoperative estimation of unilateral extravascular lung water volume and measurements of those following pneumonectomy in patients with bronchogenic carcinoma
Sakuma, T.; Isogami, K.; Saito, H.; Ono, S.; Sagara, Y.; Ohnuki, T.; Koike, K.; Ohkuda, K.; Nitta, S.; Nakada, T.
Nihon Kyobu Geka Gakkai 36(4): 441-447
1988
ISSN/ISBN: 0369-4739 PMID: 3418173 Document Number: 323178
In seven patients with bronchogenic carcinoma, undergoing pneumonectomy, we studied the changes of extravascular lung water volume (EVLW) by the thermal-dye dilution technique before and during unilateral pulmonary artery occlusion (UPAO) and following surgery. We also measured pulmonary hemodynamics, colloid osmotic pressures, arterial and mixed venous blood gases before and after surgery. The follwoing results were obtained: 1) Values of EVLW were 6.0 .+-. 1.2 (Mean .+-. S.D.) ml/kg, 4.2 .+-. 0.91 ml/kg, 5.2 .+-. 2.9 ml/kg, 6.9 .+-. 3.4 ml/kg, 6.2 .+-. 3.5 ml/kg and 4.3 .+-. 0.9 ml/kg beofre UPAO, during UPAO, at 6th, 24th, 48th postoperative hour and after 21th day, respectively. 2) Although three patterns of changes in EVLW after pneumonectomy were founded within 38 hours, EVLW after 21th day showed the close values to those during UPAO. 3) WVLW during UPAO correlated well not only with the product of EVLW before UPAO and the fraction of contralateral perfusion using quantitative lung scanning with 99m Tc-MAA but also with EVLW after the 21th day. 3) Poor relationships of EVLW to pulmonary hemodynamics, blood oxygen and carbon dioxide tensions and colloid osmotic pressures were revealed in our studies. We concluded that ELVW during UPAO and/or the product of EVLW during UPAO and/or the product of EVLW before UPAO and perfusion ratio are available control values in the measurements of postoperative EVLW in patients undergoing pneumonectomy. We must pay attention to the changes of EVLW following pneumonectomy within 48 hours after surgery to prevent the pulmonary edema as ARDS.