Post-pneumonectomy pulmonary edema: analysis and risk factors

To analyze the risk factors for postpneumonectomy pulmonary edema in 146 consecutive patients.

In 1992, 146 consecutive patients, aged 60.5 +/- 9.4 years, underwent pneumonectomy, mostly for cancer (n = 136). Pulmonary edema was defined clinically and radiologically in the absence of left ventricular dysfunction or infection. Several parameters, including preoperative functional respiratory values, pulmonary perfusion scan data and intraoperative data were analyzed. Two groups were determined according to the occurrence of pulmonary edema and differences were compared by univariate and multivariate analyses.

Twenty-two patients (15%) developed pulmonary edema within the 1st postoperative week. Most cases were mild or moderate. Severe pulmonary edema occurred in five (3.4%) patients requiring mechanical ventilation; among them, two died. Previous chemotherapy (P < 0.01), radiotherapy (P < 0.0001), predictive postoperative forced expiratory volume in the 1st second less than 45% (P < 0.01), a remaining lung perfusion of 55% or less (P < 0,05) and an intraoperative fluid load of 2000 ml fluid or more (P < 0.01) were associated with pulmonary edema in the univariate analysis. Multivariate analysis identified prior radiotherapy, perfusion of the remaining lung of 55% or less and high intraoperative fluid load as independent and significant risk factors for pulmonary edema.

This study demonstrates that previous treatment with radiotherapy resection of well perfused lung parenchyma and excessive fluid load are high risk factors for the development of non-cardiogenic pulmonary edema and that patients for whom these factors are relevant should be closely monitored in their postoperative course.