Acute Exacerbation of Idiopathic Interstitial Pneumonia Following Lung Surgery in 3 of 68 Consecutive Patients: A Retrospective Study

Abstract

Background Acute exacerbation (AE) of idiopathic interstitial pneumonia (IIP) is occasionally observed after lung surgery. However, the risk of lung surgery in patients with IIPs is not yet clearly known. Subjects and MethodsWe conducted a retrospective study of consecutive patients who underwent lung surgery for cancer or for the diagnosis of interstitial pneumonia (IP) between 2000 and 2006. Patients who developed AE following the lung operation were assessed. Results The data of 68 consecutive patients (males: 56, females: 12) with IP who underwent lung surgery were analyzed. The lung surgery included lobectomy for lung cancer in 48 patients [idiopathic pulmonary fibrosis (IPF) 31, non-IPF 17], and lung biopsy in 20 patients [IPF 8, non-specific interstitial pneumonia (NSIP) 8, unclassified 4]. Three patients with IPF (4.4% in total) developed AE after the operation (2 lobectomy, 1 biopsy). The triggers of AE were considered to be prolonged ventilation at a large tidal volume with oxygen supplementation at a high concentration. At the time of the AE, the extent of parenchymal involvement on the HRCT images was greater on the non-operated side. All three patients died of respiratory failure 12 to 82 days after the onset of AE despite corticosteroid therapy. Conclusion It is essential to be aware of the risk of AE of IPF following lung operation. Intraoperative respiratory management, such as oxygen supplementation at a high concentration and/or prolonged mechanical ventilation are likely possible etiologic factors.

The Preoperative Composite Physiologic Index May Predict Mortality in Lung Cancer Patients with Combined Pulmonary Fibrosis and Emphysema

“…We assume that one reason for the difference between these results may be the presence or absence of triggers of an acute exacerbation following lung surgery regardless of the serum KL-6 level. One of the triggers of acute exacerbation following lung surgery is considered to be prolonged ventilation at a large tidal volume with oxygen supplementation at a high concentration [42]. …”

Acute exacerbation of idiopathic pulmonary fibrosis: shifting the paradigm

“…For example, idiopathic AE-IPF is more common in the winter months [24,30], and in patients that are immunosuppressed [9], indicating that some cases of idiopathic AE-IPF may be triggered by a preceding infection [40][41][42]. Additional potential triggers that can lead to a similar presentation in patients with IPF include aspiration [43,44], pollution [45], thoracic surgical procedures [20,25,26,37,[46][47][48][49][50], cryobiopsy [51] and, possibly, bronchoalveolar lavage [20,52]. AE-IPF has also been reported following non-pulmonary surgery [47], potentially related to mechanical trauma secondary to mechanical ventilation.…”

Acute exacerbation of idiopathic pulmonary fibrosis: a proposal

“…A large cohort of AE-IPF patients included 15 that occurred post-operatively (8 lung biopsies, 3 lung resections and 3 non-respiratory surgeries) [3]. Prolonged mechanical ventilation, high tidal volume and high concentration of supplemental oxygen during surgery have been proposed as potential causes [32, 33]. Other contributors to increased risk of AE-IPF after surgery may be the presence of typical histologic honeycombing [34], increased extent of radiographic fibrosis [35], elevated serum Krebs von den Lungen-6 (KL-6), greater extent of surgical resection (lobe vs. wedge resection) [36], high intra-operative fluid balance, and pre-operative elevations in C-reactive protein (CRP) [37].…”