Patients experiencing early acute respiratory failure have high postoperative mortality after pneumonectomy

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.…”

Delving into the details of postpneumonectomy prognosis

“…In this issue of The Journal of Thoracic and Cardiovascular Surgery, Blanc and colleagues 6 present an in-depth analysis of risk factors of postpneumonectomy respiratory failure, the complication most strongly associated with in-hospital mortality. They studied a large and detailed institutional cohort, which allowed them to perform a multivariable analysis aimed at specifically identifying preoperative factors that should alter clinical decision making.…”

Sometimes the “right” is wrong

“…Pneumonectomy is one of the oldest thoracic procedures consistently reported in the literature, 1,2 and it is one extremely technically challenging operation that we continue to improve on 3 in terms of outcomes, survival, and quality. In this edition of The Journal of Thoracic and Cardiovascular Surgery, Blanc and colleagues 4 perform an extensive and introspective review of a decade (2005-2015) of experience at their institution and investigate the impact of perioperative pulmonary insufficiency leading to invasive ventilation and the often profound implications for short and long-term survivals.…”

“…In the end, Blanc and colleagues 4 have provided us with a very extensive and detailed analysis of patients who have early acute respiratory failure occur after pneumonectomy. From their analysis, we are able to identify areas for risk stratification preoperatively, intraoperatively, and postoperatively where opportunities for patient selection and surgical acumen may be focused to target improved outcomes.…”