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


CONCLUSIONS
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.
Licker
Marc
M
*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
M
Spiliopoulos
Anastase
A
Robert
John
J
Diaper
John
J
Chevalley
Catherine
C
Tschopp
Jean-Marie
JM
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000437:Alcoholism / Q000150:complications; D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery*; D015331:Cohort Studies; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D008168:Lung / Q000601:surgery*; D055370:Lung Injury; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012307:Risk Factors; D019616:Thoracic Surgical Procedures / Q000009:adverse effects* / Q000401:mortality