LUNG INJURY IN PATIENTS FOLLOWING THORACOTOMY

Background - Postoperative lung injury is a recognised complication of thoracotomy for which there are few data regarding incidence and outc ome. Methods - In a case controlled study the notes of all adult patie nts who developed acute lung injury (ALI) or acute respiratory distres s syndrome (ARDS) following thoracotomy between 1991 and 1994 were exa mined and classified according to the guidelines of the American Thora cic Society/European Respiratory Society for ALI/ARDS. The predictive value of a routine preoperative assessment and duration of anaesthesia in determining those patients most likely to develop ALI/ARDS was ass essed. Results - Between 1991 and 1994 231 lobectomies, 103 pneumonect omies, and 135 wedge resections and segmentectomies were performed. Th e overall incidence of lung injury was 5 . 1%; 17 patients developed A RDS (two survived) and seven developed ALI (five survived). There was no significant difference compared with case matched controls in preop erative spirometric values, arterial oxygen tension (PaO2), or duratio n of anaesthesia. None of these parameters was useful in predicting th ose patients most likely to develop lung injury. Conclusion - Lung inj ury after thoracotomy is associated with a high mortality. Conventiona l parameters for preoperative assessment do not predict those patients most likely to develop ALI/ARDS in these circumstances.