Lung injury after thoracic surgery and one-lung ventilation.
OBJECTIVE
An update is provided for anaesthetists, on recent work investigating the incidence and cause of lung injury following thoracic surgery. Pulmonary damage is also discussed in relation to the management of one-lung ventilation.


RESULTS
The extent of recent original literature on lung injury, following thoracic surgery, is limited for the review period (2004-2005). Increasing evidence that pulmonary oxidative stress and an increase in proinflammatory cytokines are significant contributors to lung injury following thoracic surgery, however, exists. This is particularly the case in patients with lung or oesophageal carcinoma. Animal experiments confirm the above and also indicate that anaesthetic agents may offer some protection against the ischaemia-reperfusion injury sustained as a result of one-lung ventilation.


CONCLUSIONS
Pulmonary damage in the form of acute lung injury and adult respiratory distress syndrome is a major cause of morbidity and mortality after thoracic surgery. An understanding of the pathogenesis of lung damage, following thoracic surgery, may enable anaesthetists to modify this process and decrease the incidence and severity of the problem.
Gothard
John
J
Royal Brompton Hospital, Sydney St, London, UK. j.gothard@rbh.nthames.nhs.uk
D000777:Anesthetics / Q000627:therapeutic use; D004322:Drainage; D006801:Humans; D007249:Inflammation / Q000473:pathology; D008168:Lung / Q000473:pathology; D008171:Lung Diseases / Q000517:prevention & control; D055370:Lung Injury; D018384:Oxidative Stress / Q000502:physiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D012121:Respiration, Artificial / Q000009:adverse effects*; D009626:Terminology as Topic; D019616:Thoracic Surgical Procedures; D014882:Water-Electrolyte Balance / Q000502:physiology
D000777:Anesthetics