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Infant thoracic surgery: procedure-dependent pulmonary response
J S Greenspan1, D A Davis, P Russo
1Department of Pediatrics, Thomas Jefferson Medical College, Philadelphia, PA, USA.
Insights
Infants undergoing thoracic surgery experience airway issues. Pulmonary function, specifically airway resistance, takes longer to recover after shunting procedures compared to aortic coarctation repair.
Area of Science:
- Pediatric Surgery
- Pulmonary Medicine
- Critical Care
Background:
- Respiratory insufficiency is a frequent complication following infant thoracic surgery.
- Pulmonary compliance (CL) and resistance (R) are key indicators of respiratory function.
Purpose of the Study:
- To define respiratory dysfunction after thoracic procedures in infants.
- To compare pulmonary mechanics following Blalock-Taussing shunting and aortic coarctation repair.
Main Methods:
- Measured pulmonary compliance (CL) and resistance (R) in 17 infants.
- Data collected preoperatively and at 0, 1, and 3 days postoperatively.
- Compared outcomes between Blalock-Taussing shunting (n=7) and aortic coarctation repair (n=10).
Main Results:
- Both groups showed decreased CL and increased R on postoperative day 0.
- Infants with coarctation repair recovered CL by day 1 and R by day 3.
- Infants with shunting procedures did not recover CL or R to preoperative values by day 3.
- Postoperative changes in R were more pronounced than CL changes.
Conclusions:
- Thoracic procedures in infants cause airway-predominant pulmonary morbidity.
- Recovery time and severity of pulmonary compromise are procedure-specific.
- Shunting procedures are associated with longer-lasting pulmonary dysfunction compared to aortic coarctation repair.
Abstract:
Respiratory insufficiency is a common complication of thoracic surgery in infants. To better define this dysfunction, pulmonary compliance (CL) and resistance (R) were measured for 17 infants who underwent common thoracic procedures: Blalock-Taussing shunting (n = 7) repair of congenital coarctation of the aorta (n = 10). Measurements were obtained preoperatively and 0, 1, and 3 days postoperatively. Preoperatively, CL was lower and R was similar for the two groups. Both groups had decreased CL and increased R on postoperative day 0; infants with coarctation had recovery to preoperative values by postoperative day 1 for CL, and day 3 for R. CL and R did not return to the preoperative values by postoperative day 3 in infants with a shunt procedure. The changes in R were greater than those in CL for both groups in the postoperative period. These data indicate that such thoracic procedures are associated with pulmonary morbidity that is airway-predominant, and that the degree of compromise and the time until recovery are, in part, procedure-specific.