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J Thorac Cardiovasc Surg 2007;133:1446-1447
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

Discussion

Dr Mark K. Ferguson (Chicago, Ill). Alvarez and coauthors are to be congratulated on a unique study that I think was carefully conducted on an important clinical problem. This complication doesn’t happen commonly, but it is quite lethal when it does occur. As far as I can tell, this is the first experimental study to attempt to assess the role of pleural space drainage techniques in the etiology of this disorder. The results provide interesting, albeit preliminary, insights into the potential pathophysiology of this problem.

Dr Alvarez, in your initial experiment in which all animals underwent pleural drainage at 5 kPa pressure, there was a 60% rate of clinical respiratory distress. I understand that you think that this model is a somewhat typical clinical situation, but the extreme mediastinal deviation that you describe is not typical of the clinical situation, and by my calculation the 5 kPa is equivalent to more than –50 cm H₂O suction. Now, could that amount of shift cause a substantial decrease in venous return, elevated venous pressure, and decreased lymphatic drainage from the lung? If so, this problem may be unrelated to hyperexpansion and so-called volotrauma.

In the second experiment, in which you used several different drainage techniques, there were several shortcomings that you yourself mentioned. It isn’t intuitively obvious to me why lack of drainage leads to lung overexpansion. So I wonder whether there were . . . [Full Text of this Article]

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Idiopathic postpneumonectomy pulmonary edema: Hyperinflation of the remaining lung is a potential etiologic factor, but the condition can be averted by balanced pleural drainage

John M. Alvarez, Jeremy Tan, Nand Kejriwal, Karim Ghanim, Mark A.J. Newman, Amanda Segal, Greg Sterret, and Max K. Bulsara
J. Thorac. Cardiovasc. Surg. 2007 133: 1439-1447. [Abstract] [Full Text] [PDF]