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Risk factors for acute lung injury after thoracic surgery for lung cancer

Diaper, John
Published in Anesthesia and analgesia. 2003, vol. 97, no. 6, p. 1558-65
Abstract Acute lung injury (ALI) may complicate thoracic surgery and is a major contributor to postoperative mortality. We analyzed risk factors for ALI in a cohort of 879 consecutive patients who underwent pulmonary resections for non-small cell lung carcinoma. Clinical, anesthetic, surgical, radiological, biochemical, and histopathologic data were prospectively collected. The total incidence of ALI was 4.2% (n = 37). In 10 cases, intercurrent complications (bronchopneumonia, n = 5; bronchopulmonary fistula, n = 2; gastric aspiration, n = 2; thromboembolism, n = 1) triggered the onset of ALI 3 to 12 days after surgery, and this was associated with a 60% mortality rate (secondary ALI). In the remaining 27 patients, no clinical adverse event preceded the development of ALI-0 to 3 days after surgery-that was associated with a 26% mortality rate (primary ALI). Four independent risk factors for primary ALI were identified: high intraoperative ventilatory pressure index (odds ratio, 3.5; 95% confidence interval, 1.7-8.4), excessive fluid infusion (odds ratio, 2.9; 95% confidence interval, 1.9-7.4), pneumonectomy (odds ratio, 2.8; 95% confidence interval, 1.4-6.3), and preoperative alcohol abuse (odds ratio, 1.9; 95% confidence interval, 1.1-4.6). In conclusion, we describe two clinical forms of post-thoracotomy ALI: 1). delayed-onset ALI triggered by intercurrent complications and 2). an early form of ALI amenable to risk-reducing strategies, including preoperative alcohol abstinence, lung-protective ventilatory modes, and limited fluid intake.
Keywords Acute DiseaseAge FactorsAgedAlcoholism/complicationsCarcinoma, Non-Small-Cell Lung/surgeryCohort StudiesDiabetes ComplicationsFemaleHumansLung/surgeryLung InjuryLung Neoplasms/surgeryMaleMiddle AgedPneumonectomyPostoperative Complications/epidemiology/mortalityRespiratory Function TestsRetrospective StudiesRisk FactorsThoracic Surgical Procedures/adverse effects/mortality
PMID: 14633519
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Research group Dysfonctions cardio-pulmonaires et cérébrales (278)
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LICKER, Marc et al. Risk factors for acute lung injury after thoracic surgery for lung cancer. In: Anesthesia and analgesia, 2003, vol. 97, n° 6, p. 1558-65. doi: 10.1213/01.ANE.0000087799.85495.8A https://archive-ouverte.unige.ch/unige:45191

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Deposited on : 2015-01-14

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