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Prevalence and Mortality of Acute Lung Injury and ARDS After Lung Resection^*

^* From the Critical Care Medicine Service, Department of Anesthesiology and Critical Care Medicine (Drs. Dulu, Pastores, and Halpern), Thoracic Surgical Service, Department of Surgery (Drs. Park and Rusch), and Department of Epidemiology and Biostatistics (Ms. Riedel), Memorial Sloan-Kettering Cancer Center, New York, NY.

Correspondence to: Stephen M. Pastores, MD, Associate Attending, Critical Care Medicine Service, Department of Anesthesiology and Critical Care Medicine. Memorial Sloan-Kettering Cancer Center, 1275 York Ave M-210, New York, NY 10021; e-mail: pastores{at}mskcc.org

Abstract

Study objectives: To describe the frequency and outcome of patients with acute lung injury (ALI) and ARDS who require mechanical ventilation (MV) after lung resection, and to analyze preoperative and perioperative variables associated with mortality.

Methods: We retrospectively reviewed the case records of all patients who underwent lung resection and acquired ALI and/or ARDS and required invasive MV and ICU admission at a tertiary-care cancer center from January 1, 2002, to December 31, 2004. Preoperative and perioperative information including ICU-specific variables and outcome data were analyzed. Data are presented as median (range).

Results: During the study period, 2,039 patients underwent a total of 2,192 lung resections. ALI/ARDS developed in 50 patients (2.45%). The prevalence of ALI/ARDS by procedure was as follows: pneumonectomy, 7.9% (10 cases in 126 procedures); lobectomy/bilobectomy, 2.96% (31 cases in 1,047 procedures); and sublobar resection, 0.88% (9 cases in 1,019 procedures). There were 28 men (56%) and 22 women (44%). Median age was 68.5 years (range, 44 to 88 days). Median time of presentation to the ICU with ALI/ARDS following surgery was 4 days (range, 1 to 22 days). Median ICU length of stay was 10 days (range, 2 to 43 days), and median hospital LOS was 26.5 days (range, 6 to 93 days). During hospitalization, 20 of the 50 patients (40%) died: 16 in the ICU and 4 after ICU discharge. The mortality rate was highest after pneumonectomy (50%), followed by lobectomy (42%) and sublobar resections (22%). Although increased age was associated with a higher ICU mortality, none of the preoperative and perioperative variables were significantly associated with hospital mortality. There was a marginally significant association between mortality and time of presentation to the ICU after surgery (p = 0.06).

Conclusions: Our results confirm that ALI/ARDS after lung resection is associated with a high mortality in patients who require invasive MV and ICU care.

Key Words: acute lung injury • ARDS • ICU • lung resection • mechanical ventilation • mortality • thoracic surgery

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