To describe the frequency, predictors of mortality and outcome of acute lung injury (ALI) and/or acute respiratory distress syndrome (ARDS) after lung resection.
We retrospectively reviewed the case records of all patients who underwent lung resection and developed ALI/ARDS requiring mechanical ventilation and admission to the Intensive Care Unit (ICU) between January 1, 2002 to December 31, 2004. ALI/ARDS were defined according to the American-European Consensus Conference. Perioperative and in-hospital information including ICU-specific data were collected. All patients received supportive treatment for ALI/ARDS including low tidal volume ventilation. Data are presented as mean +/- SD, absolute numbers or percentages. Statistical analyses used were Student’s t-test and chi-square tests. P-values < 0.05 were considered significant.
During the study period, 1801 patients underwent lung resection (Table 1). Of these, 50 (2.8%) developed ALI and/or ARDS. The majority of patients (92%) underwent resection for cancer. There were 28 men (56%) and 22 women (44%) with a mean age of 69±10 years. Eight (16%) received neoadjuvant chemotherapy and 5 (10%) had radiotherapy. The mean postoperative day (POD) to ICU admission was 5±4 days. The mean ICU LOS was 14.4±10.6 days and mean hospital LOS was 30.5±20.2 days. 20 patients (40%) died, 16 in the ICU and 4 after ICU discharge. The mortality rate was highest after pneumonectomy followed by lobectomy and sublobar resections. Older age was associated with higher mortality but not gender, preoperative lung function, use of neoadjuvant therapy, mean POD to ICU admission, glucose and lactate level on ICU admission and paO2/FiO2 ratio (Table 2).
The prevalence rate of ALI/ARDS after lung resection requiring MV and ICU admission was 2.8% with an overall mortality rate of 40%. Mortality was highest after pneumonectomy. Older age correlated with poor outcome.
Implementation of risk-reduction strategies and advances in ICU support are necessary to reduce the mortality rate associated with ALI/ARDS after lung resection.
ALI/ARDSALI/ARDS MortalityTotal lung resectionsN=1801N=50 (2.8%)N=20 (40%)Pneumonectomy118105Lobectomy/Bilobectomy10913113Sublobar resections59292VariableALIVE (N=34)DEAD (N=16)p ValueMean± SDMean± SDAge67 ± 1073 ± 90.035*POD to ICU admission4 ± 36 ± 50.1 (NS)ICU LOS13 ± 1018 ± 110.97 (NS)Hospital LOS32 ± 2128 ± 190.534 (NS)Glucose151.24 ± 42.59 133 ± 26.830.13 (NS)Lactate1.72 ± 1.141.66 ± 0.970.861 (NS)pO2/FiO2154 ± 63.65141 ± 60.760.5 (NS)FEV1 %78.65 ± 21.9187.69 ± 15.450.145 (NS)DLCO %68.55 ± 19.9270.73 ± 14.820.711 (NS)
Alina Dulu, None.