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Post-Pneumonectomy Complications

Post-Pneumonectomy Complications. - A few short notes – Alan D L Sihoe. Complications. Remember: General complications Vs Operation-specific complications Also: Early vs Late complications. Post-pneumonectomy complications. 30-day post-op mortality 6-8% (Right > Left)

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Post-Pneumonectomy Complications

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  1. Post-Pneumonectomy Complications - A few short notes – Alan D L Sihoe

  2. Complications • Remember: General complications Vs Operation-specific complications • Also: Early vs Late complications

  3. Post-pneumonectomy complications • 30-day post-op mortality 6-8% (Right > Left) • Risk factors for mortality: Advanced age* Bronchopleural fistula* Cardiovascular disease+ Hematologic disease+ Right pneumonectomy+ Extended resection+ Pre-op adjuvant therapy+ Respiratory failure$ Sepsis$ Male sex$ * Eur J Cardiothorac Surg 2001; 20: 476-80 +J Thorac Cardiovasc Surg 2001; 121: 1076-82 $ Am Surg 2001; 67: 318-21

  4. 1. Respiratory complications • Respiratory failure: 50-100% mortality • Prevention most important • e.g. pre-op chest physio, optimise COAD Mx etc. • Smoking (Ann Thorac Surg 2001; 72: 1662-7) • Only factor associated with Major Pulmonary Event • With MPE: mortality rate increased almost 20x

  5. 1. Respiratory complications • Remember: only one functional lung left i pulmonary reserve to cope with infection etc. • Post-op care: • Aggressive chest physio • Early mobilisation • Adequate analgesia • Bronchial toileting if necessary • Consider mini-tracheostomy

  6. 2. Cardiac complications • Cardiac dysrhythmias: ~ 40% • Esp. Atrial fibrillation • Can you think why ? • Myocardial infarction • often similar risk factors (e.g. age, smoking)

  7. 3. Bronchopleural fistula • 3-6% of lung resections • Esp. post-pneumonectomy >> lobectomy • Factors: Ann Thorac Surg 2001; 72: 1662-7 • Technique (long stump) • Medical co-morbidities (COAD & poor FEV1, DM) • Adjuvant therapies (steroid) • Ventilation/BiPAP • [also: Infection, Tumour]

  8. 3. Bronchopleural fistula • Presentation: • SOB • Cough • fluid from post-pneumonectomy space • Bubbling from chest drain (if one present) • Decreased fluid level on CXR • Confirm diagnosis by bronchoscopy

  9. 3. Bronchopleural fistula • Management: • Resuscitation & oxygen • Lie with pneumonectomy side DOWN • Insert chest drain (if one not in situ already) • Broad-spectrum antibiotic cover • Consider double-lumen tube Consider why we do each of these ! • Low threshold for Surgical Repair

  10. 4. Post-pneumonectomy syndrome • Herniation of heart, mediastinal contents towards pneumonectomy space • kinking/distortion of vascular structures • cardiovascular collapse • May require surgical correction • ?fixing during initial op if problem anticipated • Note: hence controversy over whether to leave chest drain in situ after pneumonectomy

  11. 5. Post-pneumonectomy infection • High mortality • ?also develop other complications during prolonged treatment (e.g. infection) • Difficult to eradicate • warm, moist space • antibiotics cannot reach • Meticulous aseptic technique required during surgery • Consider antibiotic lavage

  12. 5. Post-pneumonectomy infection • Management options: • Drainage & antibiotics • Lavage via chest drain • Surgical drainage & decortication • Open drainage / thoracostomy • Thoracoplasty

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