Antonio A. Garzon

Operative Treatment of Massive Hemoptysis

Abstract Fifty-five pulmonary resections have been performed at our institution for hemoptysis of 600 ml. or more in 24 hours. The overall mortality was 18% as compared with more than 75% in patients who bled 600 ml. or more in 16 hours and 54% in patients who bled 600 ml. or more in 48 hours, all of whom were managed conservatively. Mortality correlated with the rate of bleeding irrespective of the extent of resection. Nineteen patients were bleeding massively at the time of pulmonary resection and required single lung ventilation; of these, 7 (37%) died. Of the 36 patients in whom active bleeding had ceased at the time of pulmonary resection, 3 (8%) died. In 2 patients with extensive bilateral disease, cavernostomy and packing of bleeding cavities was employed. The most common cause of death was respiratory insufficiency. Our experience indicates that operative treatment of massive hemoptysis offers a reduced mortality as compared with conservative management.

Surgical management of massive hemoptysis. A ten-year experience.

Pulmonary bleeding was defined as massive when the collected blood was 600 ml or more in 24 hours. Hemoptysis of this magnitude carries more than 50% mortality when managed without surgical intervention. For this reason all patients admitted, bleeding massively, in the past ten years were considered candidates for surgical therapy. Localization of the bleeding was done by bronchoscopy. Pulmonary reserve was evaluated by clinical and radiological observation and, when feasible, by spirometry. Of the 75 patients seen with massive hemoptysis, 68 were operated. Seven patients were excluded for various reasons. Five of these patients died during the acute bleeding episode. Sixty-five resections were performed with 11 deaths (17%) and three cavernostomies with one death. Of 51 lobectomies, seven expired (14%). One segmentectomy survived. Other than the magnitude of the surgical resection, the mortality was related to the amount of bleeding in the 24 hours preceding the surgical procedure. Severe bleeding at the time of resection requiring one-lung ventilation also significantly influenced the mortality (33% against 7%). This experience shows that pulmonary resection is the treatment of choice in patients with massive hemoptysis.

Respiratory Mechanics Following Open-Heart Surgery for Acquired Valvular Disease

1. Pulmonary mechanics were determined preoperatively and postoperatively in 20 patients following open-heart surgery for acquired valvular disease.2. The surviving patients had minimal increase of the work of breathing, associated with an increase in nonelastic resistance during the early postoperative period. These changes in pulmonary mechanics are insufficient to explain the respiratory difficulties experienced by these patients.3. In the fatal cases compliance decreased to half the preoperative level, and respiratory work increased to five times the preoperative value. In these individuals excessive work of breathing produces a significant demand on physiological resources, and controlled mechanical ventilation is indicated.

Severe blunt chest trauma. Studies of pulmonary mechanics and blood gases.

here has been considerable interest in the past few years in the clinical management of severe closed thoracic trauma, comT monly called crushed chest. This interest is justified by the increasing number of automobile accidents, bringing more of these patients to the hospitals, and by the high mortality and morbidity associated with these injuries. Emphasis has been placed on the extent of the bony injury, paradoxical respiration of the flail chest, and control of the deleterious effects of paradoxical respiration by traction, internal fixation, tracheostomy, and positive pressure ventilation [l, 2, 6, 10-121. The prognosis after blunt trauma to the chest has been greatly improved with this type of management. However, little attention had been paid to the traumatized lungs and the effect of lung injury upon the respiratory

Hypothermic lung preservation functions, six or more years later.

The functions of each lung were measured 41 and 79 months following hypothermic twenty-four four lung preservation and autotransplantation in six and four dogs respectively. Functional results were compared with long-term autotransplanted canine lungs. Compliance, total lung capacity, functional reserve capacity and ventilation of preserved lungs were similar to autotransplanted lungs, and only slightly decreased as compared with normal animals. There was no statistically significant difference between the pulmonary diffusion capacity and oxygen uptake of the preserved and autotransplanted lungs group and autotransplants alone. However, in both groups, diffusion capacity and oxygen uptake were decreased as compared with intact animals. Pulmonary hypertension was found on occlusion of the contralateral lungs artery: it was due to increased pulmonary vascular resistance. No gross narrowing of the pulmonary artery or venous anastomosis was found that could explain the increased resistance. Diffuse emphysema of various degrees was observed in all animals. This study seems to indicate that hypothermic preservation of the lung docs not affect significantly the long-term functional ability of the organ, and probably will have practical value in future clinical lung transplantation.