title: Acute lung injury and outcomes after thoracic surgery.
abstract: OBJECTIVE
  The present review evaluates the evidence available in the literature tracking perioperative mortality and morbidity as well as the pathogenesis and management of acute lung injury (ALI) in patients undergoing thoracotomy.
  
  
  RESULTS
  Over the last decade, despite increasing age and comorbid conditions, the operative mortality has remained unchanged for patients undergoing lung resection, whereas procedure-related complications have declined. Better clinical outcomes are achieved in high-volume hospitals and when procedures are performed by a thoracic surgeon. Postthoracotomy ALI has become the leading cause of operative death, its incidence has remained stable (2-5%) and earlier diagnosis can be made by assessing the extravascular lung water volume with the single-indicator dilution technique. The pathogenesis of ALI implicates a multiple-hit sequence of various triggering factors (e.g. oxidative stress and surgical-induced inflammation) in addition to injurious ventilatory settings and genetic predisposition.
  
  
  CONCLUSIONS
  Knowledge of the perioperative risk factors of major complications and understanding of the mechanisms of postthoracotomy ALI enable anesthesiologists to implement 'protective' lung strategies including the use of low tidal volume (VT) with recruitment maneuvers, a goal-directed fluid approach and prophylactic treatment with inhaled beta2-adrenergic agonists.
authors.affiliation: Department of Anaesthesiology, Pharmacology and Intensive Care, rue Micheli-du-Crest, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Licker
authors.forename: Pascal
authors.initials: P
authors.lastname: Fauconnet
authors.forename: Yann
authors.initials: Y
authors.lastname: Villiger
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Tschopp
mesh_terms: D055371:Acute Lung Injury / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D006801:Humans; D011652:Pulmonary Circulation / Q000502:physiology; D012121:Respiration, Artificial; D012307:Risk Factors; D019616:Thoracic Surgical Procedures / Q000401:mortality; D016896:Treatment Outcome