Pulmonary Complications Following Lung Resection

Stéphan, François; Boucheseiche, S; Hollande, J.; Flahault, Antoine; Cheffi, Ali; Bazelly, B; Bonnet, Francis

doi:10.1378/chest.118.5.1263

Cited by 353 publications

(94 citation statements)

References 39 publications

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“…We defined a prolonged air leak as an air leak lasting 5 or more days postoperatively. In previous studies, PAL has been found to occur in up to 26% of patients following lobectomy and lesser pulmonary resections [4] [5] [6] [7] [8] and is associated with increased postoperative morbidity through increased rates of pulmonary and pleural complications such as empyema, pneumonia, and atelectasis [5] [8] [9]. In this study the incidence of prolonged air leak was 11.52% which is similar to the incidence found in previous studies.…”

Section: Discussionsupporting

confidence: 87%

“…The definition of a prolonged air leak (PAL) varies in the literature, but the currently accepted definition is an air leak lasting 5 or more days postoperatively [2] which is the average length of stay (LOS) in hospital following lobectomy [3]. In previous studies, PAL has been found to occur in up to 26% of patients following lobectomy and lesser pulmonary resections [4] [5] [6] [7] [8].…”

Section: Introductionmentioning

confidence: 99%

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Incidence Risk and Independent Predictors of Prolonged Air Leak in 269 Consecutive Pulmonary Resection Patients over Nine Months: A Single-Center Retrospective Cohort Study

Drewbrook¹,

Das²,

Mousadoust³

et al. 2016

OJTS

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Introduction: Prolonged air leak (PAL) is a common complication following pulmonary resection. It is associated with pneumonia, empyema, increased length of hospital stay and health-care costs. Intraoperative techniques have been developed to mitigate the risk of developing a PAL, but for their use to be efficient, identification of patients at risk for PAL is necessary. Aim: To determine the incidence of PAL following lobectomy and lesser pulmonary resections, risk factors for development of PALs, and the impact of PAL on hospital stay and readmission rates. Methods: The following variables were analyzed as PAL risk factors: patient characteristics of age, sex, body mass index (BMI), forced minute expiratory volume and capacity ratio (FEV1 and FEV1/FVC), diffusion capacity (DCLO), and transplant recipient status. Validated scoring systems included the Charlson Comorbidity Index (CCI), Medical Research Council (MRC) dyspnea score, and Eastern Cooperative Oncology Group (EGOC) score. Surgical factors included surgical technique, unplanned conversion from video-assisted thoracoscopic surgery (VATS) to thoracotomy, location and extent of resection, presence of adhesions, completeness of fissures, and method of fissure completion. Length of hospital stay and readmission rates were analyzed. Statistical tests performed on the data include univariate and multivariate logistic regression analyses. Results: Over the 9-month study duration there were 269 lung resections, of which 31 (11.52%) had an air leak lasting longer than 5 days. Mean length of stay in hospital was significantly longer in patients with PAL compared to the control group (13 vs 5 days, P < 0.001). Significant risk factors for PAL from multivariate 34planned conversion from video-assisted thoracoscopic surgery (VATS) to thoracotomy (P = 0.023). Conclusion: The incidence of PAL in our study population is similar to that found in previous studies. PAL prolongs hospital length of stay. Normal BMI, right upper lobectomy, and unplanned conversion from VATS to thoracotomy are risk factors for PAL.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Incidence Risk and Independent Predictors of Prolonged Air Leak in 269 Consecutive Pulmonary Resection Patients over Nine Months: A Single-Center Retrospective Cohort Study

Drewbrook¹,

Das²,

Mousadoust³

et al. 2016

OJTS

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“…In retrospective studies, the predicted pulmonary function is inaccurate due to resection of tumourous or non-efficient lung parenchyma, which limits the interpretation of the results for predicting operative risk [25,35,36]. To exclude this bias we validated the predicted lung function by a ventilation-perfusion scan.…”

Section: Discussionmentioning

confidence: 99%

Non-Invasive Pressure Support Ventilation in Major Lung Resection for High Risk Patients: Does It Matter?

Danner

Koerber²,

Emmert³

et al. 2012

OJTS

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Background and purpose: Patients with severely impaired pulmonary function have an increased operative risk for major lung resection. The clinical benefits of pre-and perioperative, non-invasive pressure support ventilation (NIPSV) have up to now not been extensively evaluated. Patients with severely reduced pulmonary function were investigated in this prospective and randomised single centre clinical trial. Methods: Standard pulmonary evaluation was performed in all patients before major lung resection. To predict postoperative pulmonary function, a lung perfusion-ventilation scan was carried out. All patients enrolled in the study were instructed preoperatively on how to use a NIPSV respirator. After lung resection patients were randomised either for continuation of NIPSV or for standard treatment. Results: Of the 52 patients assessed, 21 patients met the inclusion criteria for the study protocol. Predicted mean postoperative FEV 1 was 1.10 L (range 0.92 -1.27 L). Lobectomy was performed in 14 patients, pneumonectomy in 6 patients and a segmentectomy in 1 patient. No inhospital deaths occurred. Pulmonary complications (reintubation, pneumonia) were more frequent in the NIPSV group than in the control group (3 patients versus 1 patient), without statistical significance (p = 0.31). Conclusions: We observed no mortality and a low morbidity in this high risk group. Postoperative continuation of NIPSV had no beneficial effect on the clinical outcome. Preoperative conditioning with NIPSV, however, seems to be a suitable tool for patients with severely impaired pulmonary function. This study may serve therefore as basis for further investigations for the potential clinical benefits of prophylactic NIPSV in major lung surgery.

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“…Kardiyak komplikasyon olarak da atrial fibrilasyon ve pulmoner emboli görülmektedir (8,15). Bu komplikasyonlar sıklıkla ilk haftada olmaktadır (8).…”

Section: Introductionunclassified

“…Göğüs cerrahisi ile ilgili yayınlanan kılavuzlarda riski yüksek hastalarda da cerrahiye izin verilmesi bu hastalarda fizyoterapi ve rehabilitasyon yaklaşımlarının rolü ve önemini daha da artırmıştır (55,56). Solunum fizyoterapisi ve solunum rehabilitasyonu ile pulmoner morbidite ve göğüs cerrahisi maliyetlerinde azalma olduğunu çalışmalar göstermiştir (42,57,58). Lobektomi sonrasında pulmoner atelektaziyi önlemede göğüs fizyoterapisi insentif spirometre kullanımından daha iyi bulunmuştur (58).…”

Section: Introductionunclassified

Pulmonary Rehabilitation in Patients with Lung Cancer

Gürses¹

2015

Toraks Cer Bult

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In this paper, we will first discuss the incidence of lung cancer in Turkey and the world, along with the incidence of comorbidities and postoperative complications. Further, we will describe the preventive role of physical therapy in operated patients, its role in postoperative complications, its effect in early mobilization, and its effect on early-stage postoperative complications. Finally, we will discuss the benefits of exercise training, in hospital physical therapy approaches for patients with advanced lung cancer, the effects of exercise training, and the difficulties in the implementation of these measures.

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Pulmonary Complications Following Lung Resection

Cited by 353 publications

References 39 publications

Incidence Risk and Independent Predictors of Prolonged Air Leak in 269 Consecutive Pulmonary Resection Patients over Nine Months: A Single-Center Retrospective Cohort Study

Incidence Risk and Independent Predictors of Prolonged Air Leak in 269 Consecutive Pulmonary Resection Patients over Nine Months: A Single-Center Retrospective Cohort Study

Non-Invasive Pressure Support Ventilation in Major Lung Resection for High Risk Patients: Does It Matter?

Pulmonary Rehabilitation in Patients with Lung Cancer

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