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1 From the Department of Diagnostic Radiology, St. Antonius Hospital, Nieuwegein (Utrecht), the Netherlands
2 From the Department of Pharmacoepidemiology and Pharmacotherapy, Institute of Pharmaceutical Sciences, Utrecht, the Netherlands
3 From the Department of Anesthesiology, St. Antonius Hospital, Nieuwegein (Utrecht), the Netherlands
4 From the Department of Pulmonary Diseases, St. Antonius Hospital, Nieuwegein (Utrecht), the Netherlands
Objective: To analyze the incidence of postpneumonectomy pulmonary edema (PPE) and to determine potential risk factors for PPE.
Material and methods: A group of 197 patients was studied retrospectively, and the incidence of PPE was recorded over a 5-year period. Preoperative, perioperative, and postoperative clinical data were collected, and preoperative and postoperative chest radiographs were reviewed. A scoring system was used to distinguish between premanifest and manifest PPE. Postpneumonectomy patients with pulmonary edema, with no clinically evident cause, were considered to have PPE.
Results: The incidence of premanifest PPE was 12.2% (n=24), and that of manifest PPE was 2.5% (n=5). Mortality in the group of patients who developed manifest PPE was 100%. Two significant perioperative associations were found in the PPE group. One was the administration of fresh frozen plasma (FFP) transfusions (relative risk, 4.3; 95% confidence interval, 1.3 to 14.4 corrected for age and sex), while the other was higher mechanical ventilation pressures during surgery (relative risk, 3.0; 95% confidence interval, 1.2 to 7.3).
Conclusion: Our data suggest that FFP transfusions form an important risk factor for PPE. The mechanism may be an increased permeability of the pulmonary vessels due to an immunologic reaction after multiple FFP transfusions. The significantly higher mechanical ventilation pressures we found in the PPE group may be explained as an early sign of the development of PPE.
Key Words: capillary permeability • cytokines • extravascular lung water • mechanical ventilation • pneumonectomy • pulmonary edema • transfusion
Submitted on February 9, 1996
Accepted on November 1, 2007
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