Chest
Volume 62, Issue 6, December 1972, Pages 694-698
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Prediction of Pulmonary Function Loss Due to Pneumonectomy Using 133Xe-Radiospirometry

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MATERIAL

The material consisted of 19 patients, aged 44 to 73, on whom pneumonectomy was performed for treatment of bronchial cancer during the years 1967 to 1970 at the Clinic of Thoracic Surgery, Malmö General Hospital, Malmö, Sweden. The patients are identified by the letters A through T (Table 1). One patient, E, had been treated for bilateral pulmonary tuberculosis when the cancer was discovered. Two patients, I and L, had sarcoidosis in addition to cancer. Twelve of the patients had left-sided

METHODS

Spirometry was performed preoperatively with the use of the modified Bernstein spirometer described by Berglund and co-workers.12 The predicted normal values were obtained from Berglund and associates12 and Birath and colleagues.13 Functional residual capacity was measured by wash-out of nitrogen during oxygen breathing, which also permitted an estimation of the efficiency of the alveolar ventilation14, 15, 16, 17 (normal values from unpublished data in this laboratory). Arterial oxygen and

CALCULATIONS

The postoperative value for vital capacity was predicted from the preoperative vital capacity measured with conventional spirometry, multiplied by the percentage of vital capacity on the nonoperated side determined from the preoperative 133Xe-radiospirometry. The postoperative ventilatory capacity (FEV1.0) was predicted in the same way but with the use of the percentage of ventilation in the nonoperated lung.

RESULTS

The results of the preoperative investigations are given in Table 1 which also includes survival times after surgery. There was no operative mortality. Of the 11 patients (A-L) who died, one died of pneumonia five months after surgery and the other ten from their cancer. There was little difference between those who have survived and those who are dead in regard to preoperative lung function.

In Figures 2 and 3, the predicted values for vital capacity and FEV1.0 are given on the X-axis and the

DISCUSSION

The present group of patients, subjected to pneumonectomy because of lung cancer, is small and select. It should be noted, however, that the preoperative lung function was quite poor in some cases, eg subject N had an FEV1.0 of 1.4 liter. The postoperative FEV1.0 was between 1.2 and 1.4 in four subjects. Thus, several subjects had a ventilatory capacity quite close to what we consider the lower limit of operability, ie a predicted postoperative value of FEV1.0 less than 1.0 liter. The present

ACKNOWLEDGMENT

This study was supported by a grant from The Swedish Association against Heart and Lung Diseases.

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