Perioperative Hemodynamic Changes During Video-Assisted Thoracoscopic Decortication for empyema

Fang-Ting Chen1, *, An-Hsun Chou1, 2, *, Chun-Yu Chen1, 2, Pei-Chi Ting1, Ming-Wen Yang1, Chun-Hui Lee1, Yun-Hui Teng1
1 Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
2 College of Medicine, Chang Gung University, Taoyuan, Taiwan

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© 2017 Chen et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* These authors contributed equally to this work* Address correspondence to this author at the Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center No. 5, Fusing St, Guishan District, Taoyuan City 33305, Taiwan; Tel: 886-3-328 1200 ext 3624; Fax: 886-3-3281200 ext 2787; E-mail :


Background and Objective:

Hemodynamic consequences during video-assisted thoracoscopic surgery (VATS) with decortication during empyema drainage are unclear. The aim of the study was to assess the perioperative hemodynamic changes decortication during empyema drainage.


A prospective study enrolled 23 patients with empyema who underwent decortication. Hemodynamic parameters were continuously obtained at 15 time points: supine two lung ventilation after induction, lateral decubitus position and two lung ventilation, lateral decubitus position and one-lung ventilation, every 5 min after decortication upto 60 minutes and at the end of surgery. We divided patients into three groups according to microorganisms, group 1: patients with no growth of organism; group 2: patients with staphylococcus aureus and pseudomonas; group 3: patients with streptococcus, yeast and fungus, gram-positive bacilli, and mycobacterium tuberculosis. The hemodynamic variables were recorded by the third-generation Vigileo/FloTracTM system and variables for each time interval were compared with the baseline by Wilcoxon Signed Ranks Test.


In group 1, hemodynamic parameters showed no significant changes over time. However, in group 2 and 3, both CO and CI increased 10 to 15 minutes after decortication and remained elevated during the remainder of surgery. However, SVR and SVRI decreased 10 to 15 minutes after decortication in both groups, especially, with a more significant decrease noted in group 2 than group 3.


Close perioperative hemodynamic monitoring during decortication in empyema patients is required because of potential hemodynamic disturbances especially patients with toxic microorganisms.

Keywords: Empyema, Decortication, Video-assisted thoracoscopic surgery (VATS), FloTrac/VigileoTM, One lung ventilation, Hemodynamic changes and anesthesia.