title: Effect of the amount of intraoperative fluid administration on postoperative pulmonary complications following anatomic lung resections.
abstract: OBJECTIVE
  Excessive fluid administration during lung resections is a risk for pulmonary injury. We analyzed the effect of intraoperative fluids on postoperative pulmonary complications (PCs).
  
  
  METHODS
  Patients who underwent anatomic pulmonary resections during 2012 to 2013 were included. Age, weight, pulmonary function data, smoking (pack-years), the infusion rate and the total amount of intraoperative fluids (including crystalloid, colloid, and blood products), duration of anesthesia, hospital stay, PCs, and mortality were recorded. PCs were defined as acute respiratory distress syndrome, need for intubation, bronchoscopy, atelectasis, pneumonia, prolonged air leak, and failure to expand. Univariate analyses and multivariate logistic regression were performed. A Lowess curve was drawn for intraoperative fluid threshold.
  
  
  RESULTS
  In 139 patients, types of resections were segmentectomy-lobectomy (n = 69; extended n = 37; video-assisted thoracoscopic surgery n = 19) and pneumonectomy (n = 9; extended n = 5). One hundred sixty-one PCs were observed in 76 patients (acute respiratory distress syndrome [n = 5], need for intubation [n = 9], atelectasis [n = 60], need for bronchoscopy [n = 19], pneumonia [n = 26], prolonged air leak [n = 19], and failure to expand [n = 23]). Overall mortality was 4.3% (6 out of 139 patients). Mean hospital stay was 8.5 ± 4.8 days. Univariate analyses showed that smoking, intraoperative total amount of fluids, crystalloids, blood products, and infusion rate as well as total amount of crystalloids and infusion rate during the postoperative first 48 hours were significant for PCs (P = .033, P < .0001, P = .001, P = .03, P < .0001, P = .002, and P < .0001, respectively). In multivariate logistic regression analysis intraoperative infusion rate (P < .0001) and smoking were significant (P = .023). An infusion rate of 6 mL/kg/h was found to be the threshold.
  
  
  CONCLUSIONS
  The occurrence of postoperative PCs is seen more frequently if the intraoperative infusion rate of fluids exceeds 6 mL/kg/h.
authors.affiliation: Department of Anesthesiology and Reanimation, Marmara University Faculty of Medicine, Istanbul, Turkey.
authors.forename: Mustafa Kemal
authors.initials: MK
authors.lastname: Arslantas
authors.affiliation: Department of Thoracic Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey.
authors.forename: Hasan Volkan
authors.initials: HV
authors.lastname: Kara
authors.affiliation: Department of Anesthesiology and Reanimation, Marmara University Faculty of Medicine, Istanbul, Turkey.
authors.forename: Beliz Bilgili
authors.initials: BB
authors.lastname: Tuncer
authors.affiliation: Department of Thoracic Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey.
authors.forename: Bedrettin
authors.initials: B
authors.lastname: Yildizeli
authors.affiliation: Department of Thoracic Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Yuksel
authors.affiliation: Department of Thoracic Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey.
authors.forename: Korkut
authors.initials: K
authors.lastname: Bostanci
authors.affiliation: Department of Biostatistics, Marmara University Faculty of Medicine, Istanbul, Turkey.
authors.forename: Nural
authors.initials: N
authors.lastname: Bekiroglu
authors.affiliation: Department of Anesthesiology and Reanimation, Marmara University Faculty of Medicine, Istanbul, Turkey.
authors.forename: Alper
authors.initials: A
authors.lastname: Kararmaz
authors.affiliation: Department of Anesthesiology and Reanimation, Marmara University Faculty of Medicine, Istanbul, Turkey.
authors.forename: Ismail
authors.initials: I
authors.lastname: Cinel
authors.affiliation: Department of Thoracic Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey. Electronic address: hbatirel@marmara.edu.tr.
authors.forename: Hasan F
authors.initials: HF
authors.lastname: Batirel
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D007262:Infusions, Intravenous; D007430:Intraoperative Care; D016015:Logistic Models; D008171:Lung Diseases / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011013:Pneumonectomy / Q000009:adverse effects* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome