Phrenic Nerve Injury
نویسنده
چکیده
1618 Communications to the Editor monectomy. He was discharged home but died on the 85th postoperative day. While the majority of studies examining preoperative risk have acknowledged that hypercarbia represents a relative contraindication to lung resection, a threshold value of 45 mm Hg has not been formally evaluated.3 Most studies have not listed PaCO2 values, although it is likely the majority of patients had a PaCO2 value <45 mm Hg. Smith et al4 included one patient with a PaCO2 of 48 mm Hg who suffered a subendocardial infarction postoperatively but survived. Interestingly, despite a PaCO2 of 48 mm Hg, his maximal oxygen consumption on a preoperative exercise test was 17.0 ml/kg/mmn-a value that suggested he would tolerate surgical resection. We would agree the presence of hypercarbia suggests the patient is at high risk for lung resection. Until we have viable treatment alternatives to surgical resection for bronchogenic cancer, however, it is reasonable to continue attempts to redefine acceptable operable criteria. Exercise testing may identify a subgroup of patients who, despite not meeting gas exchange cmitenia, would tolerate lung resection. Finally, if the PaCO2 is used to deny the patient a potentially curative therapy, the clinician must be sure the hypercarbia reflects a limited ventilatory reserve and not an underlying metabolic alkalosis or respiratory drive problem.
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