Patient selection: thoracic surgery for lung cancer
Types of acute lung injury:
(1) primary, which usually is early onset (0 to 3 days after surgery)
(2) secondary to a complication, which usually has a delayed onset (3 to 12 days after surgery)
Mortality rate:
(1) primary: 26%
(2) secondary: 60%
Risk factors for primary ALI:
(1) high intraoperative ventilatory pressure index (odds ratio 3.5, described as the product of inspiratory plateau pressure > 10 cm H2) and duration of one lung ventilation)
(2) excessive intravenous fluid administration (odds ratio 2.9)
(3) pneumonectomy (odds ratio 2.8)
(4) preoperative alcohol abuse (odds ratio 1.9)
Risk factors for secondary ALI:
(1) gastric aspiration
(2) pulmonary embolism
(3) bronchopneumonia
(4) bronchopulmonary fistula
(5) major atelectasis
