Chest
Volume 66, Issue 1, July 1974, Pages 13-16
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Clinical Investigations
Prediction of Postpneumonectomy Pulmonary Function Using Quantitative Macroaggregate Lung Scanning

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A simple, practical method is described for estimating unilateral lung function. Overall lung function is multiplied by right-left fractional perfusion estimated from a quantitative technetium ferric hydroxide macroaggregate lung scan. The calculated function attributed to the lung to be resected is then subtracted from the overall pulmonary function. The data from 13 patients indicate that the following postpneumonectomy functions can be predicted: forced vital capacity, forced expiratory one second volume, maximum voluntary ventilation, functional residual capacity, total lung capacity and diffusing capacity. The precedures described are available in most hospitals and represent a practical alternative to classic bronchospirometry, xenon radiospirometry and unilateral pulmonary artery balloon occlusion in the estimation of split lung function.

Section snippets

Materials and Methods

Thirteen patients presenting with bronchogenic carcinoma complicated by signs and symptoms of chronic obstructive airway disease were studied with routine pulmonary function studies. Spirometry before and after administration of isoproterenol was performed and yielded a forced vital capacity (FVC), forced expiratory volume in one second (FEV1.0), and maximum voluntary ventilation (MVV). Open-circuit nitrogen washout was performed to determine the functional residual capacity (FRC). With the

Results

The prepneumonectomy, predicted postpneumonectomy and observed postpneumonectomy pulmonary function findings are listed in Table 1. The majority of these patients demonstrate moderate to severe chronic obstructive airway disease. The correlation coefficients between the predicted and observed postoperative pulmonary function values are graphically represented in Figure 1, Figure 2, Figure 3, Figure 4, Figure 5. The correlations are seen to be uniformly positive (r = .617 to .747) and

Discussion

Screening pulmonary functions can indicate those patients at increased risk of postoperative cardiorespiratory insufficiency. The tests have been used by many to exclude those patients with poor function from surgery. If the lung to be removed is contributing little to overall cardiopulmonary function the risks of surgery are less. Considering the overall prognosis of carcinoma of the lung untreated,10 an attempt to offer surgery to more patients seems warranted. The techniques available to

ACKNOWLEDGMENTS

The authors wish to acknowledge the indispensible technical assistance of Ms. Joyce Fencl, Mr. Fred Carey and Mr. Ode E. Cox as well as the secretarial skills of Mrs. Shawn Tomlinson and Mrs. Mary Ann Cobb. We are also extremely grateful to the Department of Radiology, University of Florida, for the use of the radiologic equipment necessary to perform this study.

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Manuscript received December 5; revision accepted February 18.

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