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Anesth Analg 2003;97:1558-1565
© 2003 International Anesthesia Research Society

CARDIOVASCULAR ANESTHESIA

Risk Factors for Acute Lung Injury After Thoracic Surgery for Lung Cancer

Marc Licker, MD*, Marc de Perrot, MD{dagger}, Anastase Spiliopoulos, MD{dagger}, John Robert, MD{dagger}, John Diaper, RN*, Catherine Chevalley, MD*, and Jean-Marie Tschopp, MD{ddagger}

*Department of Anaesthesiology, Pharmacology and Surgical Intensive Care and the {dagger}Unit of Thoracic Surgery, University Hospital of Geneva, Switzerland; and {ddagger}Chest Medical Center, Montana

Address correspondence and reprint requests to Marc Licker, MD, Division d’Anesthésiologie, Hopital Universitaire, rue Micheli-Ducrest, CH-1211 Genève 14, Switzerland. Address e-mail to marc-joseph.licker{at}hcuge.ch

Acute lung injury (ALI) may complicate thoracic surgery and is a major contributor to postoperative mortality. We analyzed risk factors for ALI in a cohort of 879 consecutive patients who underwent pulmonary resections for non-small cell lung carcinoma. Clinical, anesthetic, surgical, radiological, biochemical, and histopathologic data were prospectively collected. The total incidence of ALI was 4.2% (n = 37). In 10 cases, intercurrent complications (bronchopneumonia, n = 5; bronchopulmonary fistula, n = 2; gastric aspiration, n = 2; thromboembolism, n = 1) triggered the onset of ALI 3 to 12 days after surgery, and this was associated with a 60% mortality rate (secondary ALI). In the remaining 27 patients, no clinical adverse event preceded the development of ALI—0 to 3 days after surgery—that was associated with a 26% mortality rate (primary ALI). Four independent risk factors for primary ALI were identified: high intraoperative ventilatory pressure index (odds ratio, 3.5; 95% confidence interval, 1.7–8.4), excessive fluid infusion (odds ratio, 2.9; 95% confidence interval, 1.9–7.4), pneumonectomy (odds ratio, 2.8; 95% confidence interval, 1.4–6.3), and preoperative alcohol abuse (odds ratio, 1.9; 95% confidence interval, 1.1–4.6). In conclusion, we describe two clinical forms of postthoracotomy ALI: 1) delayed-onset ALI triggered by intercurrent complications and 2) an early form of ALI amenable to risk-reducing strategies, including preoperative alcohol abstinence, lung-protective ventilatory modes, and limited fluid intake.

IMPLICATIONS: In an observational study including all patients undergoing lung surgery, we describe two clinical forms of acute lung injury (ALI): a delayed-onset form triggered by intercurrent complications and an early form associated with preoperative alcohol consumption, pneumonectomy, high intraoperative pressure index, and excessive fluid intake over the first 24 h.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2003 by the International Anesthesia Research Society.