Gm. Barnas et al., ACUTE EFFECTS OF BILATERAL LUNG-VOLUME REDUCTION SURGERY ON LUNG AND CHEST-WALL MECHANICAL-PROPERTIES, Chest, 114(1), 1998, pp. 61-68
Citations number
25
Categorie Soggetti
Respiratory System","Cardiac & Cardiovascular System
Study objectives: To characterize acute changes in the dynamic, passiv
e mechanical propel-ties of the lungs and chest wall, elastance (E) an
d resistance (R), caused by lung volume reduction surgery (LVRS). Desi
gn: Prospective data collection. Patients: Nine anesthetized/paralyzed
patients with severe emphysema, Interventions: Bilateral LVRS. Measur
ements and results: From measurements of airway and esophageal. pressu
res and flow during mechanical ventilation throughout the physiologic
range of breathing frequency (f) and tidal volume (VT), E and R of the
total respiratory system (Ers and Rrs), lungs (EL and RL), and chest
wall (Ecw and Rcw) immediately before and after LVRS were calculated.
After surgery, Ers, EL, Rrs, and RL were all greatly increased at each
combination off and VT (p<0.05). Ecw and Rcw showed no consistent cha
nges (p>0.05),The increases in EL were greatest in those patients with
the lowest residual volumes, highest FEV, values, and highest maximum
voluntary ventilations measured 3 months preoperatively (p<0,05); the
increases in RL were greatest in those patients with the lowest preop
erative residual volumes (p<0,05). The largest increases in RL mere in
those patients with the largest decreases in residual volume and tota
l lung capacity, measured 3 months postoperatively, caused by LVRS (p<
0.05). Conclusion: Acute effects of LVRS are large increases in lung e
lastic tension and resistance; these increases need to be considered i
n immediate postoperative care, and can be predicted roughly from resu
lts of preoperative pulmonary function tests.