title: Risk factors for acute lung injury after thoracic surgery for lung cancer.
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.
  
  
  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.
authors: *Department of Anaesthesiology, Pharmacology and Surgical Intensive Care and the †Unit of Thoracic Surgery, University Hospital of Geneva, Switzerland; and ‡Chest Medical Center, Montana.
authors: Marc
authors: M
authors: Licker
authors: Marc
authors: M
authors: de Perrot
authors: Anastase
authors: A
authors: Spiliopoulos
authors: John
authors: J
authors: Robert
authors: John
authors: J
authors: Diaper
authors: Catherine
authors: C
authors: Chevalley
authors: Jean-Marie
authors: JM
authors: Tschopp
mesh_terms: 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