Use of Sulfur Hexafluoride, SF₆, in the Management of the Postpneumonectomy Pleural Space

Abstract

After a pneumonectomy in patients of advanced age with lung cancer, over-inflation of the contralateral lung causes a further emphysematous change. This aggravation of emphysematous disturbances occasionally leads to serious cardiopulmonary dysfunctions. Therefore, we have devised a new therapeutic method which consists in injecting sulfur hexafluoride, SF₆, an inert gas, into the postpneumonectomy pleural space so as to maintain the chest cavity. As SFó gas is slowly absorbed through the pleura, gas injection at intervals of 6 months can maintain a clear pleural space with neither retention of pleural effusion nor deformity of the thorax. As a result, in 23 patients who were treated by this method, overinflation of the contralateral lung after unilateral pneumonectomy could be prevented, and respiratory functions could be improved, i.e., the vital capacity increased about 20% and the residual volume decreased over 20% after SF₆ gas injection. All patients have been in good condition of their performance status, and it was not disadvantageous to continue the SF₆ gas injection for a long term such as several years

Exacerbation of Bleomycin-Induced Injury and Fibrosis by Pneumonectomy in the Residual Lung of Mice

“…In our model, although we reduced the tidal volume after PNX, we observed prominent inflation of the right lung, protrusion of the diaphragmatic lobe into the left pleural cavity, and a left-shift of the mediastinum in the PNX group at the time of sacrifice, similar to that observed clinically in residual lungs after PNX [43]. Overinflation of the residual lung after PNX may cause lung tissue injury with release of HMGB1 into the alveolar space [41].…”

SF6 is a useful expander for post-pneumonectomy syndrome in the long-term course: a case report

“…In this case, we employed SF 6 gas, which is a readily available and straightforward procedure. SF 6 exhibits twofold expansion within 72–92 h post-injection, subsequently returning to the injected volume within a week [ 10 ]. Kimura reported that this patient complained of chest discomfort 3 days after the injection [ 11 ].…”

Laparoscopic toupet fundoplication for gastroesophageal reflux disease due to postpneumonectomy syndrome

“…We have no way of prediction for this syndrome and attempts of preventing this natural space obliteration process have largely been abandoned [4]. We do know that together with displacement of mediastinal structures, hyperinflation of the contralateral lung becomes possible and is beneficial in terms of pulmonary function tests and quality of life in long term follow up of pneumonectomy patients [5].…”