Predicting risk of intensive care unit admission after resection for non-small cell lung cancer: a validation study.

A model for predicting the risk of emergency, unplanned intensive care unit (ICU) admission after lung resection for lung cancer has been reported. However, it has not been validated outside of the derivation cohort, and the aim of our study was to undertake external validation at our institution. We reviewed a series of consecutive patients who underwent major lung resection for non-small cell lung cancer over a 6-year period. Test performance was evaluated by area under the receiver operator characteristic (ROC) curve. Between 2003 and 2008, 425 patients underwent major lung resections for lung cancer. The mean age (SD) was 65 (10) years and 241 (57%) were men. A total of 77 (18%) patients were admitted to ICU, 47 for elective admission and 30 (7%) for treatment of post-procedure complications. Of the 30 patients admitted for complications, the median length of ICU (interquartile range) stay was 3 days (1-15 days). The mortality rate among these patients was 17%. The area under the ROC curve was 0.66 (95% CI 0.53-0.79). The Brunelli scoring system had moderate discriminating ability to predict the risk of ICU admission after lung resection in our institution.

Debridement alone without decortication can achieve lung re-expansion in patients with empyema: an observational study.

Decortication is widely performed for empyema, but the effectiveness in achieving lung re-expansion has never been formally reported. The aim of this study is to quantify the degree of lung re-expansion in comparison to that achieved naturally after debridement alone. A retrospective review of patients who underwent either decortication or debridement for empyema between 2007 and 2009. The change of the cavity size with time were standardized and recorded before, immediately after surgery and on follow-up. Of 25 patients who underwent surgical management of empyema, 16 (64%) underwent debridement alone and nine (36%) underwent decortication. The mean age (standard deviation) was 58 (19) years and 15 (60%) were male. On radiological follow-up at a median [interquartile range (IQR)] of 45 (36-116) days, further reduction of 36% and 34% was achieved leaving 27% and 12% of the original cavity size in the debridement and decortication groups, respectively. Procedure (debridement or decortication) was not associated with any difference to the eventual follow-up cavity size (P = 0.937). Similar follow-up results were achieved by debridement alone without decortication in patients presenting with empyema, despite the presence of an underlying trapped lung.