Abstract
Perioperative acute lung injury (ALI) is a syndrome characterised by hypoxia and chest radiograph changes. It is a serious post-operative complication, associated with considerable mortality and morbidity. In addition to mechanical ventilation, remote organ insult could also trigger systemic responses which induce ALI. Currently, there are limited treatment options available beyond conservative respiratory support. However, increasing understanding of the pathophysiology of ALI and the biochemical pathways involved will aid the development of novel treatments and help to improve patient outcome as well as to reduce cost to the health service. In this review we will discuss the epidemiology of peri-operative ALI; the cellular and molecular mechanisms involved on the pathological process; the clinical considerations in preventing and managing perioperative ALI and the potential future treatment options.
Highlights
The term acute lung injury (ALI) was first introduced in 1994 by the American–European Consensus Conference Committee[1]
In a study based on American health care expenditure in 2013, it has been estimated that initial hospital management of ALI costs approximately $100,000, with another $35,000 spent on two years of follow up treatment[21]
It is widely accepted that protective ventilation, a combination of low tidal volume, use of PEEP and recruitment manoeuvre is significantly associated with incidence of perioperative ALI
Summary
The term acute lung injury (ALI) was first introduced in 1994 by the American–European Consensus Conference Committee[1]. In patients without significant risk factors, the average ALI incidence in thoracic and abdominal surgery is 1.3-. Two cohort studies involving a total of 7,126 patients with pre-operative risk factors for developing ALI reported an incidence of 6.8%-7.5%[11,15]. Emergency surgery is the most consistently reported predictor of ALI; other frequently reported predictors of ALI include age, pre-operative renal failure, chronic obstructive pulmonary disease (COPD) and pneumonia, hypoalbuminaemia and alcohol consumption These four models employed different markers of respiratory distress (desaturation, tachyapnoea, dysapnoea and oxygen requirement), all of which are statistically significant predictors from the literature that are listed in Table 1[3,11,15,16,17,18]. In a study based on American health care expenditure in 2013, it has been estimated that initial hospital management of ALI costs approximately $100,000, with another $35,000 spent on two years of follow up treatment[21]
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