Acute lung injury and outcomes after thoracic surgery.
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.
Licker
Marc
M
Department of Anaesthesiology, Pharmacology and Intensive Care, rue Micheli-du-Crest, University Hospital of Geneva, Geneva, Switzerland.
Fauconnet
Pascal
P
Villiger
Yann
Y
Tschopp
Jean-Marie
JM
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