2001 Volume 15 Issue 5 Pages 561-570
Background: Mean pulmonary artery pressure (mPAP) is one of the important indicators for predicting the tolerance of a patient for a lung resection. Unilateral pulmonary artery occlusion test (UPAO) is widely used for the evaluation of mPAP and other indicators, but it is time consuming and expensive, and a more simple and reliable method is required.
Patients studied: Fifty-seven consecutive patients regarded as candidates for a lobectomy or pneumonectomy on basis of spirometric tests and blood bas analysis were studied.
Method: A Swan-Ganz-catheter (SGC) was inserted in the right pulmonary artery in each patient in OR shortly after the induction of anesthesia. Cardiac output and mPAP were measured perioperatively at the following points: post-intubation in the supine position, prethoracotomy in the lateral position, post-thoracotomy before lung resection, one lung ventila tion, pre-extubation, and postop.rday #1. Differences of mPAP were analyzed in relation to thoracotomy and/or the patient's position.
Result: In the lateral position and during thoracotomy, mPAP increased by 2.2±4.7 mmHg in cases of right thoracotomy, and 3.4±4.0 mmHg in left thoracotomies. No patients were excluded as candidates for resection due to pulmonary hypertension. These findings were similar to our earlier findings, in which only two patients were excluded from 550 patients undergoing lobectomy or pneumonectomy.
Discussion: The influence of thoracotomy on the mPAP was not as marked as expected. Using a SGC in the right pulmonary artery, mPAP measured following thoracotomy may be useful as the last minutes indicator for lung resection, using mPAP of 33 mmHg after occlusion of the main PA as the limit for right pneumonectomy, and 35 mmHg for left. These data could be applied to the lobectomies without PA occlusion.
Conclusion: Perioperative monitoring of mPAP with SGC may be an alternative practical method of evaluating pulmonary circulation during lung resection.
