Assessment and perioperative management for unilateral destroyed lung

Abstract

We studied assessment and perioperative management after pneumonectomy or completion pneumonectomy for unilateral destroyed lung due to frequent infection. The infections included Aspergillosis, Pseudomonas aeruginosa and Methicillin resistant staphylococcus aureus. Three had previous lung resection due to pulmonary tuberculosis or mycobacterial infection. The blood gas analysis was normal except one patient with over 50 mmHg of Paco2. The average pre-operative vital capacity and forced expiratory volume were 57.1% and 63.3% of the predicted value, respectively. Pre-operatively, all patients showed scintigram of the unilateral destroyed lung with less than 5% of perfusion and less than 10% of ventilation. The forced vital capacity decreased significantly from 1.84 liters preoperatively to 1.72 liters postoperatively : however Pao₂ was significantly improved from 77.9 to 86.1 mmHg. Two patients needed mini-tracheostomy due to retention of sputum and one had pleuro-cutaneous fistula, however there was no operative or hospital death. We concluded that contralateral lung should show normal function by blood gas analysis, pulmonary spirometry and scintigram and that perioperative management must prevent spread of infection to the contralateral normal lung.