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PMID: 14633519 Published · ppublish English Journal Article Research Support, Non-U.S. Gov't

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

Anesthesia and analgesia ·Vol. 97 ·No. 6 ·2003-12-00 ·Pages 1558-1565

Licker M, de Perrot M, Spiliopoulos A, Robert J, Diaper J, Chevalley C, Tschopp JM

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. In an observational study including all patients undergoing lung surgery, we describe two clinical forms of acute lung injury (ALI): a delayed-onset form triggered by intercurrent complications and an early form associated with preoperative alcohol consumption, pneumonectomy, high intraoperative pressure index, and excessive fluid intake over the first 24 h.

MeSH Terms
Acute Disease Age Factors Aged Alcoholism/complications Carcinoma, Non-Small-Cell Lung/surgery Cohort Studies Diabetes Complications Female Humans Lung/surgery Lung Injury Lung Neoplasms/surgery Male Middle Aged Pneumonectomy Postoperative Complications/epidemiology,mortality Respiratory Function Tests Retrospective Studies Risk Factors Thoracic Surgical Procedures/adverse effects,mortality
Authors & Affiliations
7 authors, click to expand affiliations / ORCID
Licker Marc
*Department of Anaesthesiology, Pharmacology and Surgical Intensive Care and the †Unit of Thoracic Surgery, University Hospital of Geneva, Switzerland; and ‡Chest Medical Center, Montana.
de Perrot Marc
Spiliopoulos Anastase
Robert John
Diaper John
Chevalley Catherine
Tschopp Jean-Marie
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49 references, click to expand
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Article Info
Journal
Anesthesia and analgesia
Abbr.
Anesth Analg
ISSN
0003-2999
DOI
10.1213/01.ANE.0000087799.85495.8A
Published
2003-12-00
Pages
1558-1565
Language
English
Region
United States
NLM ID
1310650
Subset
IM
Corrections
CommentIn
PMID: 14633517
External Links
PubMed source DOI: 10.1213/01.ANE.0000087799.85495.8A View journal details
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