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Risk factors for post-pneumonectomy acute lung injury/acute respiratory distress syndrome in primary lung cancer patients - 10/2/2009

Anaesth Intensive Care 2009; 37: 14-9


These authors investigated the incidence and outcome of patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS) who required mechanical ventilation within one week of undergoing pneumonectomy for primary lung cancer, and analysed the risk factors.


The authors retrospectively reviewed the medical records of 146 patients who underwent pneumonectomy for primary lung cancer between May 2001 and April 2006.


Preoperative, perioperative and postoperative clinical data were analysed. Post-pneumonectomy ALI/ARDS was found to develop within the first postoperative week in 18 (12%) patients. Patients who developed ALI/ARDS had a longer duration of in-hospital stay (median [interquartile range], 26 [18 to 75] versus 8 [7 to 11] days; p<0.001) and higher in-hospital mortality (12 [67%] versus 0 [0%]; p<0.001). A univariate analysis showed that post-pneumonectomy ALI/ARDS was associated with larger tidal volume (VT) and higher airway pressure (Paw) during one-lung ventilation (VT 8.2 [7.5 to 9.0] versus 7.7 [6.9 to 8.2] ml/kg predicted body weight, p=0.016; Paw, 28.9 [27.6 to 30.0] versus 27.2 [25.6 to 28.5] cmH2O, p=0.001). VT during two-lung ventilation was also greater in patients who developed ALI/ARDS (p=0.014) than in those who did not, but Paw during two-lung ventilation did not differ. In a multiple logistic regression analysis, post-pneumonectomy ALI/ARDS was independently associated with a larger VT (OR 3.37 per 1 ml/kg predicted body weight increase; 95% confidence interval [CI] 1.65 to 6.86) and higher Paw (OR 2.32 per 1 cmH2O increase; 95% CI 1.46 to 3.67) during the period of one-lung ventilation.


The authors conclude that a large VT and high Paw during one-lung ventilation were associated with an increased risk of post-pneumonectomy ALI/ARDS in primary lung cancer patients.

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