Lung injury in patients following thoracotomy.

Hayes, James; Williams, Elizabeth A.; Goldstraw, Peter; Evans, Timothy W.

doi:10.1136/thx.50.9.990

Cited by 63 publications

(43 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This in itself is a recognized precipitating factor for ARDS. Age and preoperative lung function do not appear to correlate with the development of PPO [11]. Aspiration of gastric contents in the post operative period and early-onset postoperative infection may mimic PPO, but are not in themselves risk factors.…”

Section: Other Factorsmentioning

confidence: 89%

“…A study using the Consensus Committee Guidelines for ALI/ARDS found an overall incidence of lung injury of 7%. PPO severe enough to constitute ARDS was recorded in 5.2% of lobectomies and 4.9% of pneumonectomies, and ALI in 2.2% of lobectomies and 1.9% of pneumonectomies, with no cases of either following segmentectomy, wedge resection or open lung biopsy [11]. This was a retrospective investigation and may therefore have underestimated the number of patients who developed ALI postoperatively.…”

Section: Incidence Of Postpneumonectomy Pulmonary Oedemamentioning

confidence: 98%

“…Most authors report figures in the range 50±100% [3,6,8,10,11]. There are no specific data concerning morbidity in survivors after PPO, although the high mortality rates imply that permanently impaired lung function may ensue, especially given the perioperative loss of lung parenchyma and the strong possibility of pre-existing chronic underlying lung disease.…”

Section: Outcome Of Postpneumonectomy Pulmonary Oedemamentioning

confidence: 99%

“…Contralateral lymph vessels therefore play an important role in draining intrathoracic fluid, especially in the case of the left lung. However, although some reports have detected a higher incidence of PPO following right, compared to left, pneumonectomy [3,19], others have not [6,9,11]. It is probably reasonable to assume that lymphatic disruption may play some role in the clinical manifestation or severity of PPO, although unlikely that this alone would be sufficient to induce its onset.…”

Section: Impaired Lymphatic Drainagementioning

confidence: 99%

“…Given the delicate structure of the lung, it is possible that some degree of parenchymal injury, similar in nature to contusion, occurs, following which an inflammatory reaction develops, although duration of surgery does not appear to be implicated [11].…”

Section: Surgical Techniquementioning

confidence: 99%

See 4 more Smart Citations

The pathogenesis of lung injury following pulmonary resection

Jordan¹,

Mitchell²,

Quinlan³

et al. 2000

Eur Respir J

233

115

View full text Add to dashboard Cite

Postpneumonectomy pulmonary oedema (PPO) develops in~5% of patients undergoing pneumonectomy or lobectomy, and has a high associated mortality (>50%). In its extreme form, PPO follows a clinical and histopathological course indistinguishable from acute respiratory distress syndrome.Perioperative fluid overload, impaired lymphatic drainage following node dissection and trauma caused by surgical manipulation have been implicated in the pathogenesis of PPO. However, PPO more probably represents the pulmonary manifestation of a panendothelial injury consequent upon inflammatory processes induced by the surgical procedure, which involves collapse and re-expansion of the operative lung to permit hilar dissection and pulmonary resection.High inspired oxygen concentrations are required to overcome the effects of shunt. Animal studies have shown that pulmonary ischaemia/reperfusion can result in oedema formation, possibly due to the generation of pro-oxidant forces. Moreover, plasma taken from patients undergoing lobectomy or pneumonectomy (but not lesser resections) shows evidence of oxidative damage.Such evidence suggests either that the high inspired oxygen concentrations associated with one-lung ventilation, or ischaemia/reperfusion injury, may modulate postpneumonectomy pulmonary oedema. Mechanisms by which redox imbalance may result in tissue damage and postpneumonectomy pulmonary oedema are discussed. Eur Respir J 2000; 15: 790±799.

show abstract

Section: Other Factorsmentioning

confidence: 89%

Section: Incidence Of Postpneumonectomy Pulmonary Oedemamentioning

confidence: 98%