Acute Lung Injury After Thoracic Surgery

Eichenbaum, Kenneth D.; Neustein, Steven M.

doi:10.1053/j.jvca.2009.10.032

Cited by 36 publications

(24 citation statements)

References 139 publications

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“…Subsequently, this complication has also been found after less invasive pulmonary resection surgery, such as lobectomy, segmentectomy, and esophagectomy. [4][5][6] It shares the same histological features with acute respiratory distress syndrome (ARDS) 7 and is not associated with cardiogenic pulmonary edema. The majority of recent reports define this complication as acute lung injury (ALI) using the American-European Consensus on ARDS (Table 1), 8 with ARDS representing the most severe form.…”

Section: Incidence and Risk Factors Of Lung Injury After Pulmonary Rementioning

confidence: 99%

Perioperative Fluid Management for Pulmonary Resection Surgery and Esophagectomy

Chau

Slinger

2013

Semin Cardiothorac Vasc Anesth

105

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Perioperative fluid management is of significant importance during pulmonary resection surgery and esophagectomy. Excessive fluid administration has been consistently shown as a risk factor for lung injury after thoracic procedures. Probable causes of this serious complication include fluid overload, lung lymphatics and pulmonary endothelial damage. Along with new insights regarding the Starling equation and the absence of a third space, current evidence supports a restrictive fluid regimen for patients undergoing pulmonary resection surgery and esophagectomy. Multiple minimally invasive hemodyamic monitoring devices, including pulse pressure/stroke volume variation, esophageal Doppler, and extravascular lung water measurement, were evaluated for optimizing perioperative fluid therapy. Further research regarding the prevention, diagnosis, and treatment of acute lung injury after pulmonary resection and esophagectomy is required.

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Section: Incidence and Risk Factors Of Lung Injury After Pulmonary Rementioning

confidence: 99%

Perioperative Fluid Management for Pulmonary Resection Surgery and Esophagectomy

Chau

Slinger

2013

Semin Cardiothorac Vasc Anesth

105

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“…It hast to be kept in mind that pulmonary fluid overload has been identified as an independent risk factor for the development of perioperative acute lung injury after lung surgery [6]. Therefore, a volume restrictive regime is usually recommended for lung surgery [6–9]. …”

Section: Introductionmentioning

confidence: 99%

Goal-Directed Fluid Therapy Using Stroke Volume Variation Does Not Result in Pulmonary Fluid Overload in Thoracic Surgery Requiring One-Lung Ventilation

Haas

Eichhorn²,

Hasbach

et al. 2012

Critical Care Research and Practice

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Background. Goal-directed fluid therapy (GDT) guided by functional parameters of preload, such as stroke volume variation (SVV), seems to optimize hemodynamics and possibly improves clinical outcome. However, this strategy is believed to be rather fluid aggressive, and, furthermore, during surgery requiring thoracotomy, the ability of SVV to predict volume responsiveness has raised some controversy. So far it is not known whether GDT is associated with pulmonary fluid overload and a deleterious reduction in pulmonary function in thoracic surgery requiring one-lung-ventilation (OLV). Therefore, we assessed the perioperative course of extravascular lung water index (EVLWI) and -ratio during and after thoracic surgery requiring lateral thoracotomy and OLV to evaluate the hypothesis that fluid therapy guided by SVV results in pulmonary fluid overload.Methods. A total of 27 patients (group T) were enrolled in this prospective study with 11 patients undergoing lung surgery (group L) and 16 patients undergoing esophagectomy (group E). Goal-directed fluid management was guided by SVV (SVV < 10%). Measurements were performed directly after induction of anesthesia (baseline—BL), 15 minutes after implementation OLV (OLVimpl15), and 15 minutes after termination of OLV (OLVterm15). In addition, postoperative measurements were performed at 6 (6postop), 12 (12postop), and 24 (24postop) hours after surgery. EVLWI was measured at all predefined steps. The -ratio was determined at each point during mechanical ventilation (group L: BL-OLVterm15; group E: BL-24postop).Results. In all patients (group T), there was no significant change in EVLWI during the observation period (BL: 7.8 ± 2.5, 24postop: 8.1 ± 2.4 mL/kg). A subgroup analysis for group L and group E also did not reveal significant changes of EVLWI. The -ratio decreased significantly during the observation period (group L: BL: 462 ± 140, OLVterm15: 338 ± 112 mmHg; group E: BL: 389 ± 101, 24postop: 303 ± 74 mmHg) but remained >300 mmHg except during OLV.Conclusions. SVV-guided fluid management in thoracic surgery requiring lateral thoracotomy and one-lung ventilation does not result in pulmonary fluid overload. Although oxygenation was reduced, pulmonary function remained within a clinically acceptable range.

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“…volume replacement, pneumonectomy, and preoperative alcohol abuse. Surgical trauma, lymphatic disruption, hyperinflation, capillary endothelial injury, and increased permeability can all contribute to the developing of post-pneumonectomy lung injury [77]. Although there is an association between postoperative ALI and fluid overload, the noncardiogenic nature of the pulmonary oedema and the protein-rich oedema fluid is more consistent with an ARDS-type mechanism, with endothelial damage playing a key role.…”

Section: Post-resectional Ali/ards and Ventilatory Managementmentioning

confidence: 99%

“…Preventive strategies to reduce the risk of post-resectional ALI or ARDS mainly include the avoidance of intraoperative overhydration and lung hyperinflation during onelung ventilation. In two retrospective observational studies a large Vt and an elevated inspiratory pressure during one lung ventilation have been identified as strong predictors of ALI [77,78]. Both non-invasive and invasive ventilatory strategies have been adopted to support the patients with post-resectional lung injury.…”

Section: Post-resectional Ali/ards and Ventilatory Managementmentioning

confidence: 99%