Risk factor analysis for postoperative acute respiratory distress syndrome and early mortality after pneumonectomy: The predictive value of preoperative lung perfusion distribution

Kim, Joon Bum; Lee, Sei Won; Park, Seung-Il; Kim, Yong Hee; Kim, Dong Kwan

doi:10.1016/j.jtcvs.2009.11.021

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 140, Issue 1 , Pages 26-31, July 2010

Risk factor analysis for postoperative acute respiratory distress syndrome and early mortality after pneumonectomy: The predictive value of preoperative lung perfusion distribution

Joon Bum Kim, MD
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Sei Won Lee, MD
- Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea
Seung-Il Park, MD
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Address for reprints: Seung-Il Park, MD, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap 2-dong Songpa-gu, Seoul 138-736, Korea.
Yong Hee Kim, MD
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Dong Kwan Kim, MD
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Received 14 May 2009; received in revised form 27 September 2009; accepted 8 November 2009. published online 04 February 2010.

Objectives

This study aims to establish the preoperative risk factors in the development of acute respiratory distress syndrome (ARDS) and early mortality after pneumonectomy for lung cancer and to examine the influence of reduced pulmonary perfusion on outcomes.

Methods

Between 1994 and 2009, of 425 patients who underwent simple pneumonectomy for primary lung cancer, 164 who were preoperatively evaluated with lung perfusion scanning formed the population of this study.

Results

Of 30 (18.3%) patients who had major pulmonary complications, 17 (10.4%) progressed to ARDS, 15 of whom subsequently died. On multivariable logistic regression analyses, lower predicted postoperative forced expiratory volume in 1 second (ppo-FEV₁; relative risk of 0.93 [P = .020] for ARDS and 0.94 [P = .027] for mortality) and greater perfusion fraction of resected lung (relative risk of 1.10 [P = .003] for ARDS and 1.09 [P = .002] for mortality) were found to be independent factors associated with ARDS and early mortality. With a cut-off value of 35% for perfusion fraction of resected lung, patients with a perfusion fraction of greater than 35% had a greater incidence of ARDS (17.3% vs 3.3%, P = .005) and early mortality (19.8% vs 6.0%, P = .010) than those with a perfusion fraction of 35% or less.

Conclusions

Patients with a low ppo-FEV₁, a high perfusion fraction of resected lung, or both had a higher incidence of ARDS and early mortality after pneumonectomy. Therefore, although the ppo-FEV₁ appears to be within an acceptable limit for pneumonectomy, much attention should be given to patients with a high perfusion fraction of resected lung.

CTSNet classification: 10.4, 11.4

Abbreviations and Acronyms: ARDS, acute respiratory distress syndrome, BPF, bronchopleural fistula, CI, confidence interval, FEV₁, forced expiratory volume in 1 second, ICU, intensive care unit, ppo-FEV₁, predicted postoperative forced expiratory volume in 1 second, RR, relative risk