Risk Factors of Acute Lung Injury in Cancer Patients after Operations Accompanied by Excessive Blood Loss

Abstract

Objective: to evaluate the clinical significance of risk factors of acute lung injury (ALI) in cancer patients who have experienced acute excessive intraoperative blood loss (AEIBL), hemorrhagic shock (HS), and acute disseminated intravascular coagulation (DIC), and massive infusion-transfusion therapy. Subjects and methods. Operative days were analyzed in patients from three groups who had sustained AEIBL of 100 to 550% of the circulating blood volume. Group 1 consisted of 14 patients who had experienced HS or HS + acute DIC after extensive intraperitoneal surgical interventions. Group 2 comprised 16 patients who had undergone extensive surgical interventions involving extended thoracic lymph dissection. Group 3 included 15 patients after extensive intraperitoneal surgical interventions. Patients with evolved ALI were identified in each group. In all the patients, an excess (balance) of fluid and oncotic pressure were detected at the end of operative days. Results. There were 4 patients (2 with ALI and 2 with acute respiratory distress syndrome (ARDS)) in Group 1 and 11 patients (2 with ALI and 9 with ARDS) in Group 2. Patients with ALI were not identified in Group 3. At the end of operative days, the excess of fluid turned out to double in patients with evolved ALI/ARDS than in those without signs of respiratory failure. Conclusion. Of the greatest significance in the natural history of ALI in this cohort of patients are the following risk factors: surgical injury and extended thoracic lymph dissection; HS, with cardiovasotonics being used for more than 8 hours; excess fluid accumulation by the end of operative days. The safe excess fluid volume was determined, which was not greater than 50 ml/kg in the patients who had undergone peritoneal surgery and even experienced HS, but with cardiovasotonics being administered for not more than 4 hours. That was 20 ml/kg in those who had sustained excessive surgical injury + thoracic lymph dissection. Key words: acute lung injury, risk factors, infusion therapy, plasma oncotic pressure, fluid balance.