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Risk Factors of Tandon et al for Acute Lung Injury Following Elective Esophagectomy

Description

Tandon et al identified risk factors for acute lung injury (ALI) and the adult respiratory distress syndrome (ARDS) after elective esophagectomy for cancer. Development of ARDS is associated with increased mortality. The authors are from Newcastle upon Tyne NHS Trust and the University of Newcastle.


Surgery: 2 stage open procedure with laparotomy followed by right-sided thoracotomy

 

Criteria for ALI: PaO2 to FIO2 < 40 kPa (301 mm Hg)

Criteria for ARDS: PaO2 to FIO2 < 27 kPa (203 mm Hg)

 

ALI occurred in 24% and ARDS in 15%.

 

Risk factors for ARDS:

(1) low preoperative body mass index (BMI; use < 24 kg per sq m in implementation)

(2) current or ex-smoker

(3) experience of the surgeon

(4) prolonged operation

(5) prolonged one lung ventilation

(6) post-operative anastomotic leak

(7) peri-operative cardiorespiratory instability

 

Findings in peri-operative cardiorespiratory instability:

(1) hypoxemia

(2) hypotension requiring inotropic support

(3) fluid and blood product resuscitation


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