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Ann Thorac Surg 1999;67:1460-1465
© 1999 The Society of Thoracic Surgeons
a Departments of Thoracic Surgery, Gabriel Montpied Hospital, Clermond-Ferrand, France
b Respiratory Physiology, Gabriel Montpied Hospital, Clermond-Ferrand, France
c Biostatistics, Gabriel Montpied Hospital, Clermond-Ferrand, France
Accepted for publication November 30, 1998.
Address reprint requests to Dr Filaire, Service de Chirurgie Thoracique, Hôpital Gabriel Montpied, 30 Place Henri Dunant, 63003 Clermont-Ferrand, France
e-mail: mfilaire{at}chu-clermontferrand.fr
Background. Hypoxemia usually occurs after thoracotomy, and respiratory failure represents a major complication.
Methods. To define predictive factors of postoperative hypoxemia and mechanical ventilation (MV), we prospectively studied 48 patients who had undergone lung resection. Preoperative data included, age, lung volume, force expiratory volume in one second (FEV1), predictive postoperative FEV1 (FEV1ppo), blood gases, diffusing capacity, and number of resected subsegments.
Results. On postoperative day 1 or 2, hypoxemia was assessed by measurement of PaO2 and alveolar-arterial oxygen tension difference (A-aDO2) in 35 nonventilated patients breathing room air. The other patients (5 lobectomies, 9 pneumonectomies) required MV for pulmonary or nonpulmonary complications. Using simple and multiple regression analysis, the best predictors of postoperative hypoxemia were FEV1ppo (r = 0.74, p < 0.001) in lobectomy and tidal volume (r = 0.67, p < 0.01) in pneumonectomy. Using discriminant analysis, FEV1ppo in lobectomy and tidal volume in pneumonectomy were also considered as the best predictive factors of MV for pulmonary complications.
Conclusions. These results suggest that the degree of chronic obstructive pulmonary disease in lobectomy and impairment of preoperative breathing pattern in pneumonectomy are the main factors of respiratory failure after lung resection.
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