Postpneumonectomy pulmonary edema. A retrospective analysis of associated variables.

STUDY OBJECTIVE

Evaluate the correlation between intravenous fluid administration and postpneumonectomy pulmonary edema.

DESIGN

Retrospective chart review.

SETTING

Large multispecialty group practice hospital.

PATIENTS

Adults who had a pneumonectomy performed between 1977 and 1988.

MEASUREMENTS AND RESULTS

Patients were identified who had postpneumonectomy pulmonary edema (PPE). Fluid administration and fluid balance information was found in records and compared with age- and sex-matched control patients who did not develop PPE. The side of pneumonectomy was noted for patients in each group. Autopsy findings were recorded for patients who died. Twenty-one patients met PPE criteria. No significant difference was found between groups for fluid administration or fluid balance. Patients who had right pneumonectomy had a significantly higher incidence of PPE. Patients with PPE had a 100 percent mortality rate and histologic evidence of the adult respiratory distress syndrome (ARDS) at autopsy.

CONCLUSIONS

PPE is caused by noncardiogenic pulmonary edema rather than excess intravenous fluid administration. There is a greater incidence of the syndrome with right pneumonectomy for unknown reasons. The mortality rate is high despite interventions for ARDS.