Department of Chest Disease and Respiratory Intensive Care, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France.
Department of Clinic Epidemiology Center, Hôtel Dieu, HUPC, APHP, Paris Descartes University, Paris, France.
J Thorac Cardiovasc Surg. 2018 Dec;156(6):2368-2376. doi: 10.1016/j.jtcvs.2018.08.113. Epub 2018 Sep 27.
Post-pneumonectomy acute respiratory failure leading to invasive mechanical ventilation carries a severe prognosis especially when acute respiratory distress syndrome occurs. The aim of this study was to describe risk factors and outcome of acute respiratory failure.
We retrospectively reviewed clinical files of all patients who underwent pneumonectomy in a single center between 2005 and 2015. Risk factors and outcome of acute respiratory failure were assessed in univariate and multivariate analysis.
Among the 543 patients who underwent pneumonectomy in the period of study, 89 (16.4%) needed reintubation within the 30th postoperative day and 60 of these (11% of all pneumonectomies) developed acute respiratory distress syndrome. In multivariate analysis, right-side of pneumonectomy (odds ratio [OR], 2.29; 95% confidence interval [CI], 1.24-4.22), chronic cardiac disease (OR, 2.15; 95% CI, 1.08-4.25), Charlson Comorbidity Index (OR, 1.35; 95% CI, 1.14-1.61), carinal resection (OR, 3.23; 95% CI, 1.26-8.29), and extrapleural pneumonectomy (OR, 8.36; 95% CI, 3.31-21.11) were identified as independent risk factors of reintubation. Thirty-day mortality was 7.7% for all pneumonectomies, 41.6% (37/89) in the invasive ventilation group, and 53.3% (32/60) in patients with acute respiratory distress syndrome. In non-reintubated patients, 30-day mortality was 1.1% (5/454). In reintubated patients, 5-year survival was 27.1% (95% CI, 17.8-41.4).
Early acute respiratory failure requiring reintubation remains a severe complication of pneumonectomy with a poor outcome.
肺切除术后急性呼吸衰竭导致有创机械通气具有严重的预后，尤其是发生急性呼吸窘迫综合征时。本研究旨在描述急性呼吸衰竭的危险因素和结局。
我们回顾性分析了 2005 年至 2015 年期间在单一中心接受肺切除术的所有患者的临床病历。在单变量和多变量分析中评估了急性呼吸衰竭的危险因素和结局。
在研究期间接受肺切除术的 543 例患者中，有 89 例（16.4%）在术后 30 天内需要重新插管，其中 60 例（所有肺切除术的 11%）发生急性呼吸窘迫综合征。多变量分析显示，右侧肺切除术（比值比 [OR]，2.29；95%置信区间 [CI]，1.24-4.22）、慢性心脏疾病（OR，2.15；95%CI，1.08-4.25）、Charlson 合并症指数（OR，1.35；95%CI，1.14-1.61）、隆嵴切除术（OR，3.23；95%CI，1.26-8.29）和胸膜外肺切除术（OR，8.36；95%CI，3.31-21.11）是重新插管的独立危险因素。所有肺切除术的 30 天死亡率为 7.7%，有创通气组为 41.6%（37/89），急性呼吸窘迫综合征组为 53.3%（32/60）。在未重新插管的患者中，30 天死亡率为 1.1%（5/454）。在重新插管的患者中，5 年生存率为 27.1%（95%CI，17.8-41.4）。
早期需要重新插管的急性呼吸衰竭仍然是肺切除术的严重并发症，预后不良。
