title: Early respiratory acidosis is a new risk factor for pneumonia after lung resection.
abstract: Postoperative pneumonia (POP) is a life-threatening complication of lung resection (LR). Its risk factors, bacteriological profile and outcome are not well known. The aims of this study were to describe the outcome and causal bacteria and to identify risk factors for POP. We reviewed all cases admitted to intensive care after LR. Clinical parameters, operative and postoperative data were recorded. POP was suspected on the basis of fever, radiographic infiltrate, and either leucocytosis or purulent sputum. The diagnosis was confirmed by culture of a respiratory sample. Risk factors for POP were identified by univariate and multivariate analysis. We included 159 patients in this study. POP was diagnosed in 23 patients (14.4%) and was associated with a higher hospital mortality rate (30% versus 5%, P = 0.0007) and a longer hospital stay. Members of the Enterobacteriaceae and Pseudomonas species were the most frequently identified pathogens. Early respiratory acidosis (ERA; OR, 2.94; 95% CI, 1.1-8.1), blood transfusion (OR, 3.8; 95% CI, 1.1-13.1), bilobectomy (OR, 7.26; 95% CI, 1.2-43.1) and smoking history (OR, 1.84; 95% CI, 1.1-3) were identified as independent risk factors. ERA may be a risk factor for POP and could serve as a target for therapeutic interventions.
authors.affiliation: Department of Respiratory and Intensive Care, Université Paris Descartes, AP-HP, Paris, France. benjamin.planquette@egp.aphp.fr
authors.forename: Benjamin
authors.initials: B
authors.lastname: Planquette
authors.forename: Françoise
authors.initials: F
authors.lastname: Le Pimpec-Barthes
authors.forename: Ludovic
authors.initials: L
authors.lastname: Trinquart
authors.forename: Guy
authors.initials: G
authors.lastname: Meyer
authors.forename: Marc
authors.initials: M
authors.lastname: Riquet
authors.forename: Olivier
authors.initials: O
authors.lastname: Sanchez
mesh_terms: D000142:Acidosis, Respiratory / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D001999:Bronchoscopy; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects*; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D011183:Postoperative Complications; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors