The superiority of exercise testing over spirometry in the evaluation of postoperative lung function for patients with pulmonary disease

Ultrasonography and Lung Mechanics Can Diagnose Diaphragmatic Paralysis Quickly

Diaphragmatic paralysis after cardiovascular surgery requires early diagnosis prior to extubation. The effectiveness of ultrasonography and a lung mechanics assessment was evaluated. Paralysis of the diaphragm was diagnosed when the diaphragm failed to move or moved in a cephalad direction during inspiration. It was diagnosed in 3 of 40 patients (7.5%) who underwent cardiovascular surgery from 1998 to 1999. Patients were extubated when all parameters met the extubation criteria, irrespective of the presence or absence of diaphragmatic paralysis. One patient required prolonged assisted ventilation and died from mediastinitis on the 35th postoperative day. The other 2 patients required assisted ventilation for an additional 1–3 days. Ultrasonography and a lung mechanics assessment are effective tools for the early diagnosis of diaphragmatic paralysis and assessment of respiratory function after cardiovascular surgery.

Long-term recovery after parapneumonic empyema in children

BACKGROUND

The incidence of parapneumonic empyema in children has increased worldwide, but the long-term anatomical and functional consequences in the lungs after empyema are not known.

METHODS

We investigated the long-term outcome of childhood empyema in 26 patients by physical examination, chest radiograph and magnetic resonance image (MRI) of the lungs, and pulmonary function tests.

RESULTS

At follow-up 3-19 years (mean 8 years) after empyema, all patients had normal findings in the physical examination. Spirometry was normal in 80% of patients, and evidence of obstructive airway disease was detected in 16%. Thirty-six percent of patients had abnormal findings in the chest radiograph and 92% in the MRI of the lungs. In six patients, the MRI revealed significant pleural scarring (extension longer than 1 cm). Thirteen patients (50%) reported persistent respiratory symptoms, such as impaired tolerance of physical activity or prolonged cough after a common cold. During the follow-up four patients suffered a second pneumonia.

CONCLUSIONS

The long-term recovery of children with parapneumonic empyema is good, since most patients subsequently have normal lung function, chest radiograph, and clinical recovery. Half of the patients reported subjective respiratory symptoms and most patients had minor lung abnormalities, mostly pleural scars, detected in the MRI many years after empyema. However, as long-term impairment of lung function was rarely found, the clinical significance of the anatomical residues seen in the lung MRI seems to be minor.

Surgical treatment for chronic pleural empyema

Various surgical procedures have been developed in an attempt to alleviate the significant problems caused by chronic pleural empyema. The present study evaluates our 11-year experience of employing a number of therapeutic approaches for chronic empyema. Between 1987 and 1997, 45 consecutive patients underwent treatment for chronic empyema at our hospitals. They comprised 21 patients (47%) presenting with post-tuberculosis, 11 (24%) receiving cancer therapy including pulmonary resection, and 13 (29%) with postpneumonic empyema. Omentopexy, lung resection, and thoracoscopic surgery were performed in 10 (22%), 5 (11%), and 4 (9%) patients, respectively. Poor results of treatment were observed in two of the patients with post-tuberculous empyema, and three of the patients treated for cancer died of recurrence. The other 40 patients remain symptom-free. An improvement in quality of postoperative life was revealed by the exercise test rather than by static spirometry. Optimal therapy for chronic empyema requires selection of the most appropriate first and staged procedures for each patient. Moreover, lung resection should be minimal. In a critical state, open thoracostomy must be performed as the first procedure, while omentopexy or thoracoplasty should be restricted to selected cases. Dead space and minor air leakage may safely be left behind. A video-assisted procedure can be selected for postpneumonia empyema.