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SMART 2004 - Milan, May 12-14, 2004
Bigatello L. M. 1, Allain R. 1, Gaissert H. A. 2
1 Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
2 Division of Thoracic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
Primary Acute Lung Injury (ALI) after lung resection (or “post-pneumonectomy pulmonary edema”) is a rare form of acute respiratory failure characterized by dyspnea, hypoxemia, diffuse infiltrates on chest radiogram, and rapid evolution often unresponsive to therapy. ALI occurs almost exclusively following pneumonectomy, within 3 days from surgery and without a preceding cause. Factors implicated in its pathogenesis may include excessive fluid administration, alveolar injury during one-lung ventilation, pulmonary hypertension, and impaired lymph drainage. There is no specific therapy. Suggested measures in the perioperative care include the meticulous maintenance of physiological stability, judicious fluid restriction, and the limitation of ventilatory volumes and pressures.