Chest
Volume 111, Issue 5, May 1997, Pages 1278-1284
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Clinical Investigations: Surgery
Postpneumonectomy Pulmonary Edema: A Retrospective Analysis of Incidence and Possible Risk Factors

https://doi.org/10.1378/chest.111.5.1278Get rights and content

Objective

To analyze the incidence of postpneumonectomy pulmonary edema (PPE) and to determine potential risk factors for PPE.

Material and methods

A group of 197 patients was studied retrospectively, and the incidence of PPE was recorded over a 5-year period. Preoperative, perioperative, and postoperative clinical data were collected, and preoperative and postoperative chest radiographs were reviewed. A scoring system was used to distinguish between premanifest and manifest PPE. Postpneumonectomy patients with pulmonary edema, with no clinically evident cause, were considered to have PPE.

Results

The incidence of premanifest PPE was 12.2% (n=24), and that of manifest PPE was 2.5% (n=5). Mortality in the group of patients who developed manifest PPE was 100%. Two significant perioperative associations were found in the PPE group. One was the administration of fresh frozen plasma (FFP) transfusions (relative risk, 4.3; 95% confidence interval, 1.3 to 14.4 corrected for age and sex), while the other was higher mechanical ventilation pressures during surgery (relative risk, 3.0; 95% confidence interval, 1.2 to 7.3).

Conclusion

Our data suggest that FFP transfusions form an important risk factor for PPE. The mechanism may be an increased permeability of the pulmonary vessels due to an immunologic reaction after multiple FFP transfusions. The significantly higher mechanical ventilation pressures we found in the PPE group may be explained as an early sign of the development of PPE.

Section snippets

MATERIALS AND METHODS

Clinical data of 197 consecutive patients who underwent a pneumonectomy during the period from January 1989 through January 1995 were collected retrospectively. The aim was to determine the incidence and mortality of PPE, as well as to assess the potential preoperative, perioperative, and postoperative risk factors for the occurrence of PPE. Preoperative, perioperative, and postoperative clinical data were retrieved from medical records and evaluated. A list of the analyzed parameters is shown

RESULTS

Pulmonary edema was found in 54 of the 197 patients in the postoperative phase. Of these, 25 had pulmonary edema due to causes other than PPE. The pulmonary edema in 14 patients was due to heart failure. Five patients had manifestations of severe atelectasis. In four patients, the visible abnormalities were due to infectious lung disease. In one patient, the ARDS was due to pancreatitis, which complicated the postoperative recovery. In another patient, the edema and consolidation were due to

DISCUSSION

PPE is a serious complication. Characteristically, a pneumonectomy patient suffering from PPE complains of severe dyspnea in the first 3 postoperative days. The dyspnea is not relieved by supplemental oxygen. Chest radiography will usually show signs of pulmonary edema following the onset of symptoms. In the manifest form, the pulmonary congestion starts to consolidate despite reintubation, mechanical ventilation, and forced diuresis.

The vast majority die as a result of multiple organ failure.2

ACKNOWLEDGMENTS

We thank Linda C. Meiners and Margaret Bush Estabrook for valuable help.

REFERENCES (20)

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