Delayed Pulmonary Arterial Hypertension in Relation to Pulmonary Damage Score after Pneumonectomy under Protective Ventilation: Experimental Study

Berthet, Jean‐Philippe; Attard, Olivier; Solovei, Laurence; Bourdin, Arnaud; Serre, Isabelle; Molinari, Nicolas; Richard, Sylvain; Matecki, Stéfan

doi:10.1159/000357058

Cited by 4 publications

(3 citation statements)

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“…Unilateral pneumonectomy places considerable stress on the animal’s cardiopulmonary system and hemodynamics, especially in the setting of severe blood loss 10,11 . The combination of pneumonectomy and high blood loss can lead to severe right heart failure and rapid decompensation despite aggressive fluid resuscitation.…”

Section: Discussionmentioning

confidence: 99%

Technique and perioperative management of left pneumonectomy in neonatal piglets

Dao

Anez‐Bustillos

O’Loughlin

et al. 2017

Journal of Surgical Research

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Background Although commonly performed in adult swine, unilateral pneumonectomy in piglets requires significant modifications in the surgical approach and peri-operative care due to their smaller size and limited physiologic reserve. Methods Nineteen neonatal piglets underwent a left pneumonectomy. They were allowed 5–7 days of pre-operative acclimation and nutritional optimization. Pre-operative weight gain and laboratory values were obtained before the time of surgery. A “ventro-cranial” approach is adopted where components of the pulmonary hilum were sequentially identified and ligated, starting from the most ventral and cranial structure, the superior pulmonary vein. The principle of gentle ventilation was followed throughout the entire operation. Results The median age of the piglets at the time of surgery was 12 (10–12) days. The median pre-operative weight gain and albumin level were 20 (16–16)% and 2.3 (2.1–2.4) g/dL, respectively. The operation required a median of 59 (50–70) minutes to complete. Five of the first 9 piglets died from complications, two from poor pre-operative nutritional optimization (both with less than 10% weight gain and 2 g/dL for albumin), one from an intubation complication, one from intra-operative bleeding, and one in the post-operative period from a ruptured bulla. No mortality occurred for the next 10 cases. Conclusions Successful outcomes for unilateral pneumonectomy in piglets require special attention to pre-operative nutritional optimization, gentle ventilation, and meticulous surgical dissection. Pre-operative weight gain and albumin levels should be used to identify appropriate surgical candidates. The “ventro-cranial” approach allows for a technically straightforward completion of the procedure.

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Section: Discussionmentioning

confidence: 99%

Technique and perioperative management of left pneumonectomy in neonatal piglets

Dao

Anez‐Bustillos

O’Loughlin

et al. 2017

Journal of Surgical Research

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“…They identified that excessive alveolar distension causes widening of the intercellular interval in capillary endothelium easing fluid and protein leak. Administration of excessive fluids is controversial in PPE; however, they proposed that as there is no third cavity in the chest, fluid limitation is appropriate at present and hyperinflation should be avoided especially in right pneumonectomy to prevent mediastinal shifting [28]. Farkas et al identified that lying position after pneumonectomy was associated with PPE [29].…”

Section: Discussionmentioning

confidence: 99%

The role of fluids in postpneumonectomic pulmonary edema: an experimental study

Akkuş¹,

Kutluk²

2019

Curr Thorac Surg

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Background:The role of fluids in the etiology of postpneumonectomy pulmonary edema (PPE) is controversial. The aim of this experimental study was to assess the effect of crystalloid or colloid fluids and normal or high volume on the etiology of PPE.Materials and Methods: 20 New Zealand rabbits were used and divided into 4 groups. Pneumonectomy had performed firstly in each subject, then for 3 hours, normal and high volume of crystalloid and colloid fluids were administered. The first group were administered 3 ml/kg/h crystalloid (0.9% NaCl), the second group received 10 ml/kg/h of the same crystalloid, the third group were administered 3 ml/ kg/h colloid (6% HES/0.7) and the fourth group received 10 ml/kg/h of the same colloid infusion.Pneumonectomy and remaining lung materials were weighed when wet and dry and pathologic investigation was performed with a light microscopy.Results: There was no significant difference between the preoperative and postoperative wet/dry ratio (W/DR) of pneumonectomy and remaining lung material in all groups administered crystalloid and colloid (1st Group Z = 0.707; p = 0.480, 2nd Group Z = 0.577; p = 0.564, 3rd Group Z = 0.577; p = 0.564, 4th Group Z = 0.677; p = 0.498). There was no significant difference identified between pneumonectomy material W/DR for all crystalloid and colloid groups (x2 = 2.787; p = 0.426) and again between the remaining lung material W/DR (x2 = 2.858; p = 0.414). The histopathologic assessments of all groups were similar. Conclusion:Administration of crystalloid or colloid fluids at normal or high volume was assessed not be responsible alone for the PPE etiology in subjects with normal cardiac function. Histopathologic findings were similar in all groups.

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“…The reduction of half of the respiratory field could be a surrogate of respiratory insufficiency [6] or it can create the condition to evaluate physiological changes after surgery [7,8]. Oncological investigations have been successfully performed for pleuropulmonary disease [9] as well as bronchovascular elements response to surgical stimulation [10,11]. Other potential fields of investigation are the supportive therapy for respiratory distress and perioperative medicine [12,13].…”

Section: Discussionmentioning

confidence: 99%