Normalized Pulmonary Artery Diameter Predicts Occurrence of Postpneumonectomy Respiratory Failure, ARDS, and Mortality

Abstract

Hypothesizing that pulmonary artery diameter is a marker of subclinical pulmonary hypertension, we assessed its impact on postoperative outcome in patients requiring pneumonectomy. Morphometric, clinical, and laboratory data were retrospectively retrieved from files of 294 consecutive patients treated by pneumonectomy for malignancy (289 NSCLC). Pulmonary artery was measured at bifurcation level on CT scan and normalized by body surface area. Median normalized pulmonary artery diameter (cut-off for analyses) was 14 mm/m2. Postoperatively, 46 patients required re-do intubation and 30 had acute respiratory distress syndrome (ARDS). Multivariate analysis showed that Charlson Comorbidity Index >5 (p = 0.0009, OR 3.8 [1.76–8.22]), right side of pneumonectomy (p = 0.013, OR 2.37 [1.20–4.71]), and higher normalized pulmonary artery diameter (p = 0.029, OR 2.16 [1.08–4.33]) were independent predictors of re-do intubation, while Charlson Comorbidity Index >5 (p = 0.018, OR 2.55 [1.17–5.59]) and higher normalized pulmonary artery diameter (p = 0.028, OR = 2.52 [1.10–5.77]) were independently associated with occurrence of ARDS. Post-operative mortality was 8.5%. Higher normalized pulmonary artery diameter, (p = 0.026, OR 3.39 [1.15–9.95]), right side of pneumonectomy (p = 0.0074, OR 4.11 [1.46–11.56]), and Charlson Comorbidity Index >5 (p = 0.0011, OR 5.56 [1.99–15.54]) were independent predictors of postoperative death. We conclude that pre-operative normalized pulmonary artery diameter predicts the risk of re-do intubation, ARDS and mortality in patients undergoing pneumonectomy for cancer.

Total Psoas Area and Total Muscular Parietal Area Affect Long-Term Survival of Patients Undergoing Pneumonectomy for Non-Small Cell Lung Cancer

“…A standardized case report form was employed to collected patient characteristics, treatment procedures, and short-term outcomes, as previously described [ 6 , 7 , 8 , 9 ]. In particular, we collected: age, sex, weight, height, Body Mass Index (BMI), smoking habits, side of tumor, comorbid illness, Charlson Comorbidity Index (CCI), American Society of Anesthesiologists score (ASA score), respiratory function parameters (forced expiratory volume (FEV1), FEV1/forced vital capacity (FVC) ratio, carbon monoxide transfer coefficient (KCO), predicted postoperative FEV1, modified Borg dyspnea scale).…”

“…Surgical techniques have been refined in the past decades to allow parenchymal-sparing procedures, including bronchial and bronchovascular sleeve resections [ 2 ], but pneumonectomy continues to be the sole possible surgical procedure in a subset of lung cancer patients with centrally located lesions [ 3 ]. Pneumonectomy continue to be associated with significant postoperative mortality [ 4 , 5 , 6 ], with figures around 10 percent; thus, identifying patients at high postoperative risk is of paramount importance to select surgical candidates [ 4 , 5 , 6 ], but identifying patients more likely to achieve definitive cure after surgery is at least as important [ 3 ]. As a general rule in lung cancer, pathologic stage is generally considered as the most powerful determinant of long-term survival [ 7 ].…”

“…As a general rule in lung cancer, pathologic stage is generally considered as the most powerful determinant of long-term survival [ 7 ]. However, patients undergoing pneumonectomy have often locally advanced disease, reducing the interest of tumor stage as the dominant outcome determinant [ 3 , 4 , 5 , 6 , 7 , 8 ]. In the era of patient-directed thinking, rather than cancer-directed thinking, assessing host parameters seems particularly promising [ 9 ].…”

ARDS after Pneumonectomy: How to Prevent It? Development of a Nomogram to Predict the Risk of ARDS after Pneumonectomy for Lung Cancer

“…Pulmonary artery diameters were considered as crude (PAD) and normalized (nPAD) for body surface area. Some authors demonstrated that higher PAD-nPAD is an important independent predictor of postoperative respiratory failure, ARDS and mortality in patients undergoing pneumonectomy for lung cancer [ 24 , 25 ].…”

New Therapeutic Strategies for Lung Cancer

“…Hypothesizing that pulmonary artery diameter was a marker of subclinical pulmonary hypertension, this parameter was recorded at the bifurcation level on CT scan and normalized by body surface area. Its impact on postoperative mortality was assessed in 294 consecutive patients (289 NSCLC) in the study of Daffré et al [ 4 ]. Post-operative mortality was 8.5%.…”