Early acute respiratory distress syndrome after pneumonectomy: Presentation, management, and short- and long-term outcomes

Abstract

Objective: Postpneumonectomy acute respiratory failure leading to invasive mechanical ventilation carries a severe prognosis, especially when acute respiratory distress syndrome develops. The aim of this study was to describe the risk factors, management, and outcome of postpneumonectomy acute respiratory distress syndrome.

Methods: We retrospectively reviewed the clinical files of patients undergoing pneumonectomy in a single center between 2005 and 2015. Risk factors for acute respiratory distress syndrome, management characteristics, and short- and long-term outcomes were assessed.

Results: Among the 543 patients undergoing pneumonectomy, 89 (16.4%) needed reintubation within the 30th postoperative day, including 60 (11%) who developed acute respiratory distress syndrome. At multivariate analysis, right-side pneumonectomy (odds ratio [OR], 2.75; 95% confidence interval [CI], 1.51-5.02; P = .0009) and higher Charlson Comorbidity Index (OR, 1.26; 95% CI, 1.07-1.49; P = .007) were identified as independent risk factors for acute respiratory distress syndrome. Operative mortality was 8.1% for all pneumonectomies, 43.8% (n = 39/89) in intubated patients, and 56.7% (34/60) in patients with acute respiratory distress syndrome. Mortality was higher in severe (25/36, 69.4%) than in mild or moderate acute respiratory distress syndrome (9/24, 37.5%, P = .014). Logistic regression identified 3 independent predictors of operative mortality in patients with acute respiratory distress syndrome: age (OR, 1.08; 95% CI, 1.01-1.15; P = .02), right pneumonectomy (OR, 5.97; 95% CI, 1.33-26.71; P = .02), and severe acute respiratory distress syndrome (OR, 7.19; 95% CI, 1.74-29.73; P = .006). Five-year survival was 17.6% for patients with acute respiratory distress syndrome.

Conclusions: Acute respiratory distress syndrome is a severe early complication of pneumonectomy with a poor outcome. The low survival underlines the need for novel management strategies.

Keywords: acute respiratory distress syndrome; acute respiratory failure; lung cancer; outcome; pneumonectomy; protective ventilation.