Skip to main content
SpringerLink
Log in

Perioperative Lung Injury

  • Chapter
  • First Online:
Principles and Practice of Anesthesia for Thoracic Surgery

Abstract

Traditional patterns of mechanical ventilation with large (e.g., 10–12 mL/kg) tidal volumes and without PEEP cause a subclinical injury in healthy lungs in proportion to the duration of ventilation. Perioperative acute lung injury becomes clinically important when injurious ventilation patterns are used in patients who have other concomitant lung injuries such as large pulmonary resection, cardiopulmonary bypass, or transfusion-related lung injury. Lung-protective patterns of mechanical ventilation, using more physiologic tidal volumes and appropriate PEEP, reduce the severity of this lung injury. A recent decrease in the incidence of lung injury after pulmonary resection is primarily due to a decrease in the frequency of pneumonectomies.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bernard GR, Artigas A, Brigham KL, et al. The American-European Consensus Conference on ARDS. Am J Respir Crit Care Med. 1994;149:818–24.

    PubMed  CAS  Google Scholar 

  2. Licker M, Widikker I, Robert J, et al. Operative mortality and respiratory complications after lung resection for cancer: impact of chronic obstructive pulmonary disease and time trends. Ann Thorac Surg. 2006;81:1830–8.

    Article  PubMed  Google Scholar 

  3. Alam N, Park BM, Wilton A, et al. Incidence and risk factors for lung injury after lung cancer resection. Ann Thorac Surg. 2007;84:1085–91.

    Article  PubMed  Google Scholar 

  4. Bendixen HH, Hedley-White J, Laver MB. Impaired oxygenation in surgical patients during general anesthesia with controlled ventilation: a concept of atelectasis. N Engl J Med. 1963;96:156–66.

    Google Scholar 

  5. Tenny SM, Remmers JE. Comparative quantitative morphology of the mammalian lung: diffusing area. Nature. 1963;197:54–6.

    Article  Google Scholar 

  6. Gajic O, Dara SI, Mendez JL, et al. Ventilator associated lung injury in patients without acute lung injury at the onset of mechanical ventilation. Crit Care Med. 2004;32:1817–24.

    Article  PubMed  Google Scholar 

  7. Gajic O, Frutos-Vivar F, Esteban A, et al. Ventilator settings as a risk factor for acute respiratory distress syndrome in mechanically ventilated patients. Intens Care Med. 2005;31:922–6.

    Article  Google Scholar 

  8. Michelet P, D’Journo X-B, Roch A, et al. Protective ventilation influences systemic inflammation after esophagectomy. Anesthesiology. 2006;105:911–9.

    Article  PubMed  Google Scholar 

  9. Choi G, Wolthuis EK, Bresser P, et al. Mechanical ventilation with lower tidal volumes and positive end-expiratory pressure prevents alveolar coagulation in patients without lung injury. Anesthesiology. 2006;105:689–95.

    Article  PubMed  Google Scholar 

  10. Lindberg P, Gunnarsson L, Tokics L, et al. Atelectasis and lung function in the postoperative period. Acta Anaesthesiol Scand. 1992;36:546–53.

    Article  PubMed  CAS  Google Scholar 

  11. Tusman G, Bohm SH, Suarez-Sipmann F. Alveolar recruitment improves ventilatory efficiency of the lungs during anesthesia. Can J Anesth. 2004;51:723–7.

    Article  PubMed  Google Scholar 

  12. Duggan M, Kavanagh B. Pulmonary Atelectasis a pathological perioperative entity. Anesthesiology. 2005;102:838–54.

    Article  PubMed  Google Scholar 

  13. Tsuchida S, Engelberts D, Peltekova V, et al. Atelectasis causes alveolar injury in nonatelectatic lung regions. Am J Resp Crit Care Med. 2006;174:279–89.

    Article  PubMed  Google Scholar 

  14. Ballantyne JC, Carr DB, deFerranti S. The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analysis of randomized, controlled trials. Anesth Analg. 1998;86:598–612.

    PubMed  CAS  Google Scholar 

  15. Rigg J, Jamrozik K, Myles P, et al. Epidural anaesthesia and analgesia and outcome of major surgery: a randomized trial. Lancet. 2002;359:1276–82.

    Article  PubMed  Google Scholar 

  16. Squadrone V, Coha M, Cerutti E, et al. Continuous positive airway pressure for treatment of postoperative hypoxemia. JAMA. 2005;293:589–95.

    Article  PubMed  CAS  Google Scholar 

  17. Grichnik KP, D’Amico TA. Acute lung injury and acute respiratory distress syndrome after pulmonary resection. Sem Cardiothorac Vasc Anesth. 2004;8:317–34.

    Article  Google Scholar 

  18. Zeldin RA, Normadin D, Landtwing BS, Peters RM. Postpneumonectomy pulmonary edema. J Thorac Cardiovasc Surg. 1984;87:359–65.

    PubMed  CAS  Google Scholar 

  19. Slinger P. Post-pneumonectomy pulmonary edema: is anesthesia to blame? Curr Opin Anesthesiol. 1999;12:49–54.

    Article  CAS  Google Scholar 

  20. Turnage WS, Lunn JL. Postpneumonectomy pulmonary edema. A retrospective analysis of associated variables. Chest. 1993;103:1646–50.

    Article  PubMed  CAS  Google Scholar 

  21. Waller DA, Gebitekin C, Saundres NR, Walker DR. Noncardiogenic pulmonary edema complicating lung resection. Ann Thorac Surg. 1993;55:140–3.

    Article  PubMed  CAS  Google Scholar 

  22. Keegan MT, Harrison BA, De Ruyter ML, Deschamps C. Post-pneumonectony pulmonary edema are we making progress? Anesthesiology. 2004;101:A431.

    Google Scholar 

  23. Licker M, De Perrot M, Spiliopoulos A, et al. Risk factors for acute lung injury after thoracic surgery for lung cancer. Anesth Analg. 2003;97:1558–65.

    Article  PubMed  Google Scholar 

  24. Padley SPG, Jordan SJ, Goldstraw P, et al. Asymmetric ARDS following pulmonary resection. Radiology. 2002;223:468–73.

    Article  PubMed  Google Scholar 

  25. Waller DA, Keavey P, Woodfine L, Dark JH. Pulmonary endothelial permeability changes after major resection. Ann Thorac Surg. 1996;61:1435–40.

    Article  PubMed  CAS  Google Scholar 

  26. Williams EA, Quinlan GJ, Goldstraw P, et al. Postoperative lung injury and oxidative damage in patients undergoing pulmonary resection. Eur Respir J. 1998;11:1028–34.

    Article  PubMed  CAS  Google Scholar 

  27. Tayama K, Takamori S, Mitsuoka M, et al. Natriuretic peptides after pulmonary resection. Ann Thorac Surg. 2002;73:1582–6.

    Article  PubMed  Google Scholar 

  28. Misthos P, Katsaragikis A, Milingos N, et al. Postresectional pulmonary oxidative stress in lung cancer patients. The role of one-lung ventilation. Eur J Cardiothorac Surg. 2005;27:379–83.

    Article  PubMed  CAS  Google Scholar 

  29. Licker M, Fauconnet P, Villiger Y, et al. Acute lung injury and outcomes after thoracic surgery. Curr Opin Anaesthesiol. 2009;22:61–7.

    Article  PubMed  Google Scholar 

  30. Stewart DJ, Martin-Uncar AE, Edwards JG, et al. Extra-pleural pneumonectomy for malignant mesothelioma: the risks of induction chemotherapy, right-sided procedures and prolonged operations. Eur J Cardiothorac Surg. 2005;27:373–8.

    Article  PubMed  Google Scholar 

  31. Marzec JM, Christie JD, Reddy SR, et al. Functional polymorphisms in the transcription factor NRF2 in humans increase the risk of acute lung injury. FASEB J. 2007;21:2237–46.

    Article  PubMed  CAS  Google Scholar 

  32. Boker A, Haberman C, Girling L, et al. Variable ventilation improves perioperative lung function in patients undergoing abdominal aortic aneurysmectomy. Anesthesiology. 2004;100: 608–16.

    Article  PubMed  Google Scholar 

  33. Mols G, Priebe H-J, Guttmann J. Alveolar recruitment in acute lung injury. Br J Anaesth. 2006;96:156–66.

    Article  PubMed  CAS  Google Scholar 

  34. Dreyfuss D, Soler P, Basset G, et al. High Inflation pressure pulmonary edema. Am Rev Resp Dis. 1988;137:1159–64.

    PubMed  CAS  Google Scholar 

  35. Slinger P, Hickey DR. The interaction between applied PEEP and auto-PEEP during one-lung ventilation. J Thorac Cardiovasc Anesth. 1998;12:133–6.

    CAS  Google Scholar 

  36. Capan LM, Turndorf H, Patel C, et al. Optimization of arterial oxygenation during one-lung anesthesia. Anesth Analg. 1980;59:847–51.

    PubMed  CAS  Google Scholar 

  37. Slinger P, Kruger M, McRae K, Winton T. Relation of the static compliance curve and positive end-expiratory pressure to oxygenation during one-lung. Anesthesiology. 2001;95:1096–102.

    Article  PubMed  CAS  Google Scholar 

  38. Fujiwara M, Abe K, Mashimo T. The effect of positive end-expiratory pressure and continuous positive airway pressure on the oxygenation and shunt fraction during one-lung ventilation with propofol anesthesia. J Clin Anesthesia. 2001;13:473–7.

    Article  CAS  Google Scholar 

  39. Tsuchida S, Engleberts D, Peltekova V, et al. Atelectais causes alveolar injury in nonatelectatic lung regions. AJRCCM. 2006;174:279–89.

    Google Scholar 

  40. Leo F, Solli P, Spaggiari L, et al. Respiratory function changes after chemotherapy: an additional risk for post-operative respiratory complications? Ann Thorac Surg. 2004;77:260–5.

    Article  PubMed  Google Scholar 

  41. Van der Werff YD, van der Houwen HK, Heilmans PJM, et al. Postpneumonectomy pulmonary edema. A retrospective analysis of incidence and possible risk factors. Chest. 1997;111:1278–84.

    Article  PubMed  Google Scholar 

  42. Fernandez-Perez E, Keegan M, Brown DR. Intraoperative tidal volume as a risk factor for respiratory failure after pneumonectomy. Anesthesiology. 2006;105:14–8.

    Article  PubMed  Google Scholar 

  43. Kuzkov V, Subarov E, Kirov M. Extravascular lung water after pneumonectomy and one-lung ventilation in sheep. Crit Care Med. 2007;35:1550–9.

    Article  PubMed  Google Scholar 

  44. Alvarez JM, Panda RK, Newman MAJ, et al. Postpneumonectomy pulmonary edema. J Cardiothorac Vasc Anesth. 2003;17: 388–95.

    Article  PubMed  Google Scholar 

  45. Tang SSK, Redmond K, Griffiths M, et al. The mortality from acute respiratory distress syndrome after pulmonary resection is reducing. Eur J Cardiothorac Surg. 2008;34:898–902.

    Article  PubMed  Google Scholar 

  46. Zupancich E. Mechanical ventilation affects inflammatory mediators in patients undergoing cardiopulmonary bypass for cardiac surgery: a randomized controlled trial. J Thorac Cardiovasc Surg. 2005;130:378–83.

    Article  PubMed  Google Scholar 

  47. Bux J, Sachs UJH. The pathogenesis of transfusion related lung injury (TRALI). Br J Haematol. 2007;136:788–99.

    Article  PubMed  CAS  Google Scholar 

  48. Popovsky MA, Moore SB. Diagnostic and pathogenic considerations in transfusion-realted acute lung injury. Transfusion. 1985;25:573–7.

    Article  PubMed  CAS  Google Scholar 

  49. Chaiwat O, Lang JD, Vavilala MS, et al. Early packed red blood cell transfusion and acute respiratory distress syndrome after trauma. Anesthesiology. 2009;110:351–60.

    Article  PubMed  Google Scholar 

  50. Lytle FT, Brown DR. Appropriate ventilator settings for thoracic surgery: intraoperative and postoperative. Sem Cardiothorac Vasc Anesth. 2008;12:97–108.

    Article  Google Scholar 

  51. Yilmaz M, Gajic O. Optimal ventilator settings in acute lung injury and acute respiratory distress syndrome. Eur J Anaesthesiol. 2008;25:89–96.

    Article  PubMed  CAS  Google Scholar 

  52. Unzueta MC, Casas JI, Moral MV. Pressure-controlled versus volume-controlled ventilation during one-lung ventilation for thoracic surgery. Anesth Analg. 2007;104:1029–33.

    Article  PubMed  Google Scholar 

  53. De Hert S, ten Broecke PW, Mertens E, et al. Sevoflurane but not propofol preserves myocardial function in coronary surgery patients. Anesthesiology. 2002;97:42–9.

    Article  PubMed  Google Scholar 

  54. Schilling T, Kozian A, Kretzschmar M, et al. Effects of desflurane or propofol on pulmonary and systemic immune response s to one-lung ventilation. Br J Anaesth. 2007;99:368–75.

    Article  PubMed  CAS  Google Scholar 

  55. De Conno E, Steurer M, Wittlinger M, et al. Anesthetic-induced improvement of the inflammatory response to one-lung ventilation. Anesthesiology. 2009;110:1316–26.

    Article  PubMed  Google Scholar 

  56. Jefferson RF, Leon Y, Moallem S, et al. Immobility, hypoxemia and pulmonary arteriovenous shunting. Arch Surg. 1974;109:537–41.

    Article  Google Scholar 

  57. Bernard GR. Acute respiratory distress syndrome. Am J Resp Crit Care Med. 2005;171:1125–8.

    Article  Google Scholar 

  58. Matthay M. ß-adrenergic agonist therapy as apotential treatment for acute lung injury. Am J Resp Crit care Med. 2006;173:254–5.

    Article  PubMed  Google Scholar 

  59. Perkins GD, McAuley DF, Thickett DR, et al. The ß-agonist lung injury trial. Am J Resp Crit Care Med. 2006;173:281–7.

    Article  PubMed  CAS  Google Scholar 

  60. Sartori C, Allemann Y, Duplain H, et al. Salmeterol for the prevention of high altitude pulmonary edema. N Eng J Med. 2002;346:1631–6.

    Article  CAS  Google Scholar 

  61. Iglesias M, Martinez E, Badia JR, et al. Extrapulmonary ventilation for unresponsive severe acute respiratory distress syndrome after pulmonary resection. Ann Thorac Surg. 2008;85:237–44.

    Article  PubMed  Google Scholar 

  62. Fu Z et al. High lung volume increases stress failure in pulmonary capillaries. J Appl Physiol. 1992;73:123–33.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesia, Toronto General Hospital, Toronto, ON, Canada

    Peter Slinger MD, FRCPC

Authors
  1. Peter Slinger MD, FRCPC
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. University of Toronto, Staff Anesthesiologist, Professor of Anesthesia, Toronto, M5G 2C4, Ontario, Canada

    Peter Slinger, MD, FRCPC

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Slinger, P. (2011). Perioperative Lung Injury. In: Slinger, MD, FRCPC, P. (eds) Principles and Practice of Anesthesia for Thoracic Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0184-2_10

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-0184-2_10

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-0183-5

  • Online ISBN: 978-1-4419-0184-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation