Post-pneumonectomy pulmonary edema: analysis and risk factors

Abstract

OBJECTIVE: To analyze the risk factors for postpneumonectomy pulmonaryedema in 146 consecutive patients. METHODS: In 1992, 146 consecutivepatients, aged 60.5 +/- 9.4 years, underwent pneumonectomy, mostly forcancer (n = 136). Pulmonary edema was defined clinically and radiologicallyin the absence of left ventricular dysfunction or infection. Severalparameters, including preoperative functional respiratory values, pulmonaryperfusion scan data and intraoperative data were analyzed. Two groups weredetermined according to the occurrence of pulmonary edema and differenceswere compared by univariate and multivariate analyses. RESULTS: Twenty-twopatients (15%) developed pulmonary edema within the 1st postoperative week.Most cases were mild or moderate. Severe pulmonary edema occurred in five(3.4%) patients requiring mechanical ventilation; among them, two died.Previous chemotherapy (P < 0.01), radiotherapy (P < 0.0001),predictive postoperative forced expiratory volume in the 1st second lessthan 45% (P < 0.01), a remaining lung perfusion of 55% or less (P <0,05) and an intraoperative fluid load of 2000 ml fluid or more (P <0.01) were associated with pulmonary edema in the univariate analysis.Multivariate analysis identified prior radiotherapy, perfusion of theremaining lung of 55% or less and high intraoperative fluid load asindependent and significant risk factors for pulmonary edema. CONCLUSIONS:This study demonstrates that previous treatment with radiotherapy resectionof well perfused lung parenchyma and excessive fluid load are high riskfactors for the development of non-cardiogenic pulmonary edema and thatpatients for whom these factors are relevant should be closely monitored intheir postoperative course.