PII: S0003-4975(99)01209-6

Abstract

The appearance of acute respiratory failure after pulmonary resection has long been recognized. In the past, this phenomenon has been variously termed pneumonia, post-pneumonectomy pulmonary edema, or simply respiratory failure, and has been simplistically ascribed to overzealous fluid resuscitation in patients undergoing pulmonary resection. This paper represents a crucial leap forward by recognizing acute postoperative respiratory failure for what it really is—namely, acute lung injury (ALI)/adult respiratory distress syndrome (ARDS). The advent of definitions for ALI and ARDS has opened the door to a careful analysis of the factors associated with the development of ALI/ARDS after pulmonary resection as demonstrated in this paper. ALI/ARDS is the major cause of mortality following pulmonary resection; in this series, it accounted for 72% of deaths. This is due in part to the reduction of mortality from other causes compared with surgical resections 20 and 30 years ago. It is surprising that this issue has not been studied in greater detail in the past. The next step would be to further investigate the biochemical and hormonal changes associated with the development of ALI/ARDS. The population of patients undergoing a major pulmonary resection may be an ideal group of patients to study because, in contrast to trauma patients, the intervention is planned and more controlled. This paper may mark the beginning of a new understanding of one of the major causes of mortality following pulmonary resection.