Evidence of lung injury during reconstructive surgery for adult spinal deformities with pulmonary artery pressure monitoring

Study Design: Observational analyses of 55 adult patients who underwent ele ctive sequential anterior-posterior thoracolumbosacral surgical corrections for spinal deformities were used to evaluate the efficacy of pulmonary art ery catheter monitoring. Objective: To demonstrate that during complex reconstructive surgery for sp inal deformities, pulmonary artery catheter monitoring identifies a subset of patients with pulmonary injury and is essential in their management. Summary of Background Data: Patients who undergo sequential anterior-poster ior thoracolumbosacral surgical corrections for spinal deformities experien ce significant perioperative morbidity. Although the value of pulmonary art ery catheter monitoring is controversial, its use in these procedures may h elp identify potential physiologic complications and improve surgical outco me. Methods: All patients were monitored with a pulmonary artery catheter durin g surgery until at least postoperative day 1. Outcome measurements included blood loss, vertebral levels fused, operative time, postoperative respirat ory complications, and days in intensive care. Results: Eight (8/55: 14.5%) patients according to pulmonary artery cathete r monitoring demonstrated elevated pulmonary vascular resistance and noncar diac pulmonary edema. These patients had longer operative procedures with g reater blood loss and had more postoperative respiratory complications. The y were treated appropriately in intensive care and discharged without furth er complications. Conclusion: Pulmonary artery catheter monitoring of patients who undergo co mplex spinal fusion facilitates the identification of patients with pulmona ry injury and is essential in the management of these patients in the posto perative period. It may, also, be a marker for embolic injury to the lung.