Evidence of lung injury during reconstructive surgery for adult spinal deformities with pulmonary artery pressure monitoring.
METHODS
Observational analyses of 55 adult patients who underwent elective sequential anterior-posterior thoracolumbosacral surgical corrections for spinal deformities were used to evaluate the efficacy of pulmonary artery catheter monitoring.


OBJECTIVE
To demonstrate that during complex reconstructive surgery for spinal deformities, pulmonary artery catheter monitoring identifies a subset of patients with pulmonary injury and is essential in their management.


BACKGROUND
Patients who undergo sequential anterior-posterior thoracolumbosacral surgical corrections for spinal deformities experience significant perioperative morbidity. Although the value of pulmonary artery catheter monitoring is controversial, its use in these procedures may help identify potential physiologic complications and improve surgical outcome.


METHODS
All patients were monitored with a pulmonary artery catheter during surgery until at least postoperative day 1. Outcome measurements included blood loss, vertebral levels fused, operative time, postoperative respiratory complications, and days in intensive care.


RESULTS
Eight (8/55; 14.5%) patients according to pulmonary artery catheter monitoring demonstrated elevated pulmonary vascular resistance and noncardiac pulmonary edema. These patients had longer operative procedures with greater blood loss and had more postoperative respiratory complications. They were treated appropriately in intensive care and discharged without further complications.


CONCLUSIONS
Pulmonary artery catheter monitoring of patients who undergo complex spinal fusion facilitates the identification of patients with pulmonary injury and is essential in the management of these patients in the postoperative period. It may, also, be a marker for embolic injury to the lung.
Department of Anesthesiology, The Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York, USA. MKPU@aol.com
M K
MK
Urban
B
B
Urquhart
O
O
Boachie-Adjei
D000328:Adult; D002407:Catheterization, Swan-Ganz / Q000379:methods / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D011651:Pulmonary Artery / Q000502:physiology; D011654:Pulmonary Edema / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D012044:Regression Analysis; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D013121:Spinal Curvatures / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome