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Perioperative mortality and morbidity of pleuropneumonectomy for malignant mesothelioma is extremely high and it's postoperative management is by no means easy. We report the postoperative management of 6 patients with malignant mesothelioma listed in the table 1. Although there were no perioperative death, serious postoperative complications occurred in two cases. In Case 1, complications were serious heart failure and respiratory failure during the 3rd to 5th postoperative day. In Case 4, complications were heart failure, respiratory failure, and disruption of the bronchial stump which required reoperation. The patient developed heart failure associated with ventricular tachycardia, atrial flutter and atrial fibrillation after the second surgery. He also developed empyema with MRSA and needed prolonged mechanical ventilation. Extended surgical resection to parietal pleura, diaphragm and pericardium causes postoperative bleeding and exudates excessive. A lot of fluid and blood have to be infused to stabilize hemodynamics, while pulmonary vascular beds are reduced. This is the reason why the patients easily develop heart failure during the refilling phase. We think that an appropriate volume loading to keep optimal preload is most important to avoid postoperative heart failure in patients with malignant mesothelioma.
一般社団法人日本集中治療医学会の論文