Early acute respiratory distress syndrome after pneumonectomy: Presentation, management, and short- and long-term outcomes

Abstract

Acute respiratory distress syndrome is a severe early complication of pneumonectomy with a poor outcome. The low survival underlines the need for novel management strategies.

Normalized Pulmonary Artery Diameter Predicts Occurrence of Postpneumonectomy Respiratory Failure, ARDS, and Mortality

“…For ARDS, significance at univariate analysis was lost at multivariate analysis. Several studies, including ours in a larger dataset, reported a higher postoperative rate of respiratory failure and ARDS after right-side pneumonectomy [2,9,15,25]. We underlined that this could relate to multiple factors, including the more frequent predominance of the right lung in terms of perfusion and the higher postoperative PAP after right than left pneumonectomy [26].…”

“…Comorbidities are known to be associated with a higher risk of postoperative respiratory complications [9]. Postoperative pneumonia is the most frequent complication leading to respiratory failure; of note the occurrence of postpneumonectomy pneumonia is associated with comorbidities, suggesting that comorbidities may predispose to pneumonia, which in turn may evolve toward respiratory failure, ARDS, and death [15][16][17][18][19][20][21][22][23][24][25]. Of note, comorbidities are also associated with a higher risk of postoperative bleeding and need for transfusion, which are well-known risk factors for ARDS.…”

“…Results of morphometric measurements are reported in Table 1. Median normalized diameter was 14 mm/m 2 [13][14][15][16]. Thus, 14 mm/m 2 was used as cut-off to differentiate the subgroup of patients with increased NPAD.…”

“…In our recent monocentric study on 543 consecutive patients undergoing pneumonectomy for different indications, mainlyNSCLC, we reported that respiratory failure requiring invasive mechanical ventilation (IMV) and ARDS occurred in 16% and 11% of cases, respectively. At multivariate analysis, only right-side pneumonectomy and higher Charlson Comorbidity Index (CCI) were identified as independent risk factors for acute respiratory distress syndrome, whereas respiratory function parameters did not [15].…”

Can we make pneumonectomy great again?

“…Bland and coworkers 7 have retrospectively reviewed a remarkable 543 patients undergoing pneumonectomy at their institution over a 10-year interval with a specific focus on patients who developed postoperative ARDS. Their finding of 60 patients (11%) in this series developing postoperative ARDS, which was associated with an overall 56.7% risk of death, is sobering.…”