Outcomes in patients requiring mechanical ventilation following pneumonectomy

The aim of this study was to clarify the outcomes of patients who require post-pneumonectomy mechanical ventilation (PPMV).

The medical records of all 548 patients who underwent pneumonectomy between January 1994 and December 2009 were reviewed. PPMV was defined as mechanical ventilation via an endotracheal tube following thoracotomy (continued PPMV) or reintubated and started within 30 days of the pneumonectomy (reintubated PPMV) and continued for longer than 24 h. Perioperative characteristics, indications, management, complications and outcomes [weaning at hospital dismissal and overall survival (OS)] were compared between the two groups using the χ(2) test, Mann-Whitney U-test or Kaplan-Meier and log-rank methods. Potential prognostic factors were analysed with the Cox proportional hazard model.

Twenty-two (4.0%) patients required continued PPMV and 69 (12.6%) required reintubated PPMV. Although significant differences were noted in perioperative characteristics, indications and management, the rate of complication of PPMV (P = 0.46), the rate of weaning at hospital dismissal (P = 0.98) and OS (P = 0.12) were not significantly different between the two groups. In reintubated PPMV patients, in univariate analysis, a lower fraction of inhaled oxygen was a significant factor of improved OS (P = 0.032) and weaning (P = 0.005), and a less positive fluid balance was a significant factor of weaning (P = 0.007) and showed a tendency for improved OS (P = 0.053).

Our findings suggest that continued PPMV patients may have a rate of weaning at hospital dismissal and OS comparable to reintubated PPMV patients. A lower fraction of inhaled oxygen and less positive fluid balance may be favoured managements in reintubated PPMV patients.