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Acute lung injury and outcomes after thoracic surgery

Licker, Marca; Fauconnet, Pascala; Villiger, Yanna; Tschopp, Jean-Marieb

Current Opinion in Anaesthesiology: February 2009 - Volume 22 - Issue 1 - p 61–67
doi: 10.1097/ACO.0b013e32831b466c
Thoracic anesthesia: Edited By Javier Campos

Purpose of review The present review evaluates the evidence available in the literature tracking perioperative mortality and morbidity as well as the pathogenesis and management of acute lung injury (ALI) in patients undergoing thoracotomy.

Recent findings Over the last decade, despite increasing age and comorbid conditions, the operative mortality has remained unchanged for patients undergoing lung resection, whereas procedure-related complications have declined. Better clinical outcomes are achieved in high-volume hospitals and when procedures are performed by a thoracic surgeon. Postthoracotomy ALI has become the leading cause of operative death, its incidence has remained stable (2–5%) and earlier diagnosis can be made by assessing the extravascular lung water volume with the single-indicator dilution technique. The pathogenesis of ALI implicates a multiple-hit sequence of various triggering factors (e.g. oxidative stress and surgical-induced inflammation) in addition to injurious ventilatory settings and genetic predisposition.

Summary Knowledge of the perioperative risk factors of major complications and understanding of the mechanisms of postthoracotomy ALI enable anesthesiologists to implement ‘protective’ lung strategies including the use of low tidal volume (V T) with recruitment maneuvers, a goal-directed fluid approach and prophylactic treatment with inhaled β2-adrenergic agonists.

aDepartment of Anaesthesiology, Pharmacology and Intensive Care, rue Micheli-du-Crest, University Hospital of Geneva, Geneva, Switzerland

bDepartment of Internal Medicine, Chest Medical Centre, Montana, Switzerland

Correspondence to Marc Licker, MD, Service d'Anesthésiologie, Hôpitaux Universitaires de Genève, Rue Micheli-du-Crest, CH-1211 Geneva, Switzerland Tel: +41 22 3827439; fax: +41 22 3827403; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.