From 1978 to 1982 365 patients were treated surgically for bronchial carcinoma. Lobectomy was performed in 250 and pneumonectomy in 115. Sixteen (4.4%) needed mechanical ventilation for acute respiratory failure. Six out of eight with a lobectomy, but only two out of eight with a pneumonectomy, survived initially. Of these eight survivors, five died from recurrent malignancy within a year but three were alive and well at two years. The complications leading to acute respiratory failure were unpredictable in most patients. Improving techniques of mechanical ventilation and intensive care may lead to better results in the future.Previously published work contains many data on the.early and late results of surgery for bronchial carcinoma, but most studies have been concerned with operative morbidity and mortality, subsequent lung function,'-" and long term survival."'4'' Data on postoperative acute respiratory failure necessitating mechanical ventilation are scarce and lack detail." We are not aware of any study that describes in detail the causes, course, and outcome of this uncommon but menacing complication. We therefore studied retrospectively, all patients who underwent mechanical ventilation for acute respiratory failure within 30 days after undergoing lobectomy or pneumonectomy for bronchial carcinoma. All other patients undergoing thoracotomy were excluded. In particular, we tried to answer the following questions: (1) which factors caused acute respiratory failure and are these factors predictable and preventable? (2) should patients with acute respiratory failure after lobectomy or pneumonectomy be accepted for mechanical ventilation? (3)
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