Peri-operative risk factors for acute lung injury after elective oesophagectomy

Acute lung injury after oesophagectomy is well recognized butthe risk factors associated with its development are poorlydefined. We analysed retrospectively the effect of a numberof pre-, peri- and post-operative risk factors on the developmentof lung injury in 168 patients after elective oesophagectomyperformed at a single centre. The acute respiratory distresssyndrome (ARDS) developed in 14.5% of patients and acute lunginjury in 23.8%. Mortality in patients developing ARDS was 50%compared with 3.5% in the remainder. Features associated withthe development of ARDS included a low pre-operative body massindex, a history of cigarette smoking, the experience of thesurgeon, the duration of both the operation and of one-lungventilation, and the occurrence of a post-operative anastomoticleak. Peri-operative cardiorespiratory instability (measuredby peri-operative hypoxaemia, hypotension, fluid and blood requirementsand the need for inotropic support) was also associated withARDS. Acute lung injury after elective oesophagectomy is associatedwith intraoperative cardiorespiratory instability. Br J Anaesth 2001; 86: 633–8