Noncardiogenic pulmonary edema complicating lung resection

Postresectional pulmonary edema is a rare but potentially fatal complication of thoracic operations. In a retrospective study of 402 lung resections we have identified 11 cases of postresectional, noncardiogenic pulmonary edema. We have analyzed the individual data to test recognized hypotheses regarding this condition. Pulmonary edema occurred in 5.1% of right pneumonectomies, 4.0% of left pneumonectomies, and 1% of all lobectomies. In 2 patients the symptoms occurred immediately after operation; in the other 9 the mean interval to diagnosis was 43.4 hours. All 11 patients were in a positive fluid balance in the first 24 hours after operation (mean, 20.8 +/- 9.1 mL/kg). However, there was no significant difference between this value and the respective values for control groups of 20 patients having pneumonectomies and 20 patients having lobectomies in whom pulmonary edema did not develop. Our findings differ from other reported series in that perioperative fluid overload was not found to be a significant contributory factor in the development of postresectional pulmonary edema. We discuss other possible mechanisms for this phenomenon.