Studies on increased sputum after bronchoplastic surgery for lung cancer in correlation with hemodynamics and extravascular lung water
Koizumi, K.; Tanaka, S.; Fujisaki, T.; Shioda, M.; Haraguchi, S.; Masaki, Y.; Morota, T.; Shoji, T.; Kawamoto, M.
Nihon Kyobu Geka Gakkai 39(4): 381-387
1991
ISSN/ISBN: 0369-4739 PMID: 2051099 Document Number: 372270
In surgical treatment for lung cancer, large amount of intrabronchial sputum and secretion was occasionally encountered in patients, especially underwent bronchoplastic surgery. It has been discussed as causes which was affected from transection of pulmonary branchies of vagal nerve and bronchial arteries. So we have measured pre- and postoperative hemodynamics and extravascular lung water (EVLW) at the bedside, as to investigate the correlation with foamy sputum and increase of right ventricular afterload which was presumed by lung resection and bronchoplasty. Respiratory complication was classified by the incidence of forced bronchial toilet in acute phase. Seven patients were investigated. Three of seven showed white foamy sputum which was difficult to excrete. EVLW was 9.91 .+-. 2.12 ml/kg in average before operation and then showed a tendency to increase within 102 .+-. 29% of percent exchange (.DELTA.%) between pre- and postoperation. As to comparison of .DELTA.% of EVLW in acute period, the patients underwent bronchoplastic surgery showed a tendency to increase rather than the patients underwent usual lobectomy. According to former studies, we found the uniform correlation R = 0.7075 between observed EVLW and predicted postoperative EVLW estimated by predicted of residual functioning lung volume before operation. And also, the patients showing postoperative EVLW more than predicted EVLW before operation had a tendency to increase amount of sputum. Furthermore, concerning hemodynamic changes, pulmonary arteries resistance index (PARI) elevated to 196 .+-. 165% (83.apprx.515%) in average associated with increased right ventricular stroke work index (RVSWI) as a result of compensatory changes for increased right cardiac afterload. Above all, we concluded that in the patients underwent bronchiplastic surgery for lung cancer, we have to care more intensively as to increase of right ventricular afterload of EVLW caused to increase of fomy sputum.