Postpneumonectomy Pulmonary Edema

Turnage, W. Sherman; Lunn, Jeffrey J.

doi:10.1378/chest.103.6.1646

Cited by 146 publications

(12 citation statements)

References 8 publications

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“…The resulting mechanical stress on the capillaries, increased permeability of the alveolocapillary membrane, high intraoperative ventilation pressures, transfusions of fresh frozen plasma and abnormal pre-operative lung function can lead to this condition. [ 33 34 ]…”

Section: Post-lung Resection Pulmonary Oedemamentioning

confidence: 99%

Post-operative pulmonary complications after thoracotomy

Sengupta

2015

Indian J Anaesth

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Pulmonary complications are a major cause of morbidity and mortality in the post-operative period after thoracotomy. The type of complications and the severity of complications depend on the type of thoracic surgery that has been performed as well as on the patient's pre-operative medical status. Risk stratification can help in predicting the possibility of the post-operative complications. Certain airway complications are more prone to develop with thoracic surgery. Vocal cord injuries, bronchopleural fistulae, pulmonary emboli and post-thoracic surgery non-cardiogenic pulmonary oedema are some of the unique complications that occur in this subset of patients. The major pulmonary complications such as atelectasis, bronchospasm and pneumonia can lead to respiratory failure. This review was compiled after a search for search terms within ‘post-operative pulmonary complications after thoracic surgery and thoracotomy’ on search engines including PubMed and standard text references on the subject from 2000 to 2015.

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Section: Post-lung Resection Pulmonary Oedemamentioning

confidence: 99%

Post-operative pulmonary complications after thoracotomy

Sengupta

2015

Indian J Anaesth

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“…66 Postmortem studies in patients with PPE have demonstrated the classical features of ARDS seen from other causes. 67 In addition, ARDS in its initial phase has the same histologic features as seen after lung resection. 68 It is possible that damage or degradation of glycocalyx integrity by ischemia and inflammatory responses is a major mediator for edema formation in these settings.…”

Section: The Glycocalyx and Lung Injury – A New Paradigmmentioning

confidence: 96%

“…68 It is possible that damage or degradation of glycocalyx integrity by ischemia and inflammatory responses is a major mediator for edema formation in these settings. Though the pathogenesis of pulmonary edema and specific etiologies of lung injury after pulmonary resection are not well understood, 69 ongoing investigations are improving our understanding of the complex factors involved in the pathophysiology of postlung resection lung injury and ARDS. Several studies have focused on the contribution of patient and surgical factors as well as anesthetic variables including one-lung ventilation, 70,71,72 protective ventilation strategies, 73,74 fluid management, 75,76 and the role of putative protective pharmacologic agents.…”

Section: The Glycocalyx and Lung Injury – A New Paradigmmentioning

confidence: 99%

“…76,82,83 Fundamental to our understanding of postlung resection lung injury is the development of a low-pressure, high-protein-content pulmonary edema, an indication of injury to the endothelium. 69,84 Pulmonary endothelial cells are exposed to shear stress and higher transvascular pressures after pneumonectomy; these changes may induce alterations in cellular signaling pathways including the production of reactive oxygen species (ROS) and NO. 58 Of significance, plasma markers of oxidative damage and lung injury in patients undergoing routine thoracic surgery were found to be largest in patients undergoing pneumonectomy, modest in lobectomy, and not significant in lesser (wedge, segment) resections.…”

Section: Lung Injury Pulmonary Resection and Pulmonary Edemamentioning

confidence: 99%

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The Endothelial Glycocalyx

Collins

Blank

Deatherage

et al. 2013

Anesthesia &Amp; Analgesia

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The endothelial glycocalyx is a dynamic layer of macromolecules at the luminal surface of vascular endothelium that is involved in fluid homeostasis and regulation. Its role in vascular permeability and edema formation is emerging but is still not well understood. In this special article, we highlight key concepts of endothelial dysfunction with regards to the glycocalyx and provide new insights into the glycocalyx as a mediator of processes central to the development of pulmonary edema and lung injury.

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“…Hemodynamic disorders have a central role: perioperative fluid overload, increased pulmonary capillary pressure [5], lung lymphatics interruption [4,5,6,7], right ventricular dysfunction [8], and pulmonary endothelial damage [9] have been implicated. It has been suggested that after cross-clamping the arterial supply of the lung to be resected, increased blood flow in the remaining lung may induce an immediate rise in pulmonary capillary pressures and immediate plasma translocation to interstitial space [4,10]. …”

Section: Introductionmentioning

confidence: 99%

Delayed Pulmonary Arterial Hypertension in Relation to Pulmonary Damage Score after Pneumonectomy under Protective Ventilation: Experimental Study

et al. 2013

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Objective: To characterize pulmonary hemodynamic changes in relation to lung injury at 2 time points [48 h (H48) and 168 h (H168)] after pneumonectomy under intraoperative protective ventilation in order to improve postpneumonectomy pulmonary edema (PPE) prevention. Method: Fifteen pigs (25 ± 1.9 kg) were randomly allocated to nonsurgical (control, n = 5) and surgical (H48 and H168) groups. A left pneumonectomy under volume-controlled one-lung ventilation (OLV) (low tidal volume, positive end-expiratory pressure = 4 cm H₂O, inspired oxygen fraction = 50%) was performed in surgical animals. Mean pulmonary artery pressure (MPAP) and pulmonary artery occlusion pressure were recorded. Pulmonary vascular resistance (PVR) was calculated. Pulmonary damage score (PDS) and bronchoalveolar albumin level were evaluated. Data were collected after induction (T0), after OLV (T1), after left pneumonectomy (T2), and at H48 or H168 (T3). Results: Pneumonectomy caused precapillary pulmonary arterial hypertension (PAH) measured at T3 H48 (36.2 ± 3.67 mm Hg). PAH was delayed temporarily (both after OLV and after pneumonectomy) (p < 0.001), and linked with PVR (r = 0.93; p < 0.05). PDS and bronchoalveolar albumin level varied with MPAP (r = 0.76; p < 0.001 and r = 0.55; p < 0.05). Conclusion: Given that PAH is delayed and related to PVR increase, indicating secondary pulmonary vascular bed adaptation limits, pharmacological treatment should focus on a delayed failure in pulmonary capacitance in patients at risk of PPE.

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Postpneumonectomy Pulmonary Edema

Cited by 146 publications

References 8 publications

Post-operative pulmonary complications after thoracotomy

Post-operative pulmonary complications after thoracotomy

The Endothelial Glycocalyx

Delayed Pulmonary Arterial Hypertension in Relation to Pulmonary Damage Score after Pneumonectomy under Protective Ventilation: Experimental Study

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