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British Journal of Anaesthesia, 2003, Vol. 91, No. 1 132-142
© 2003 The Board of Management and Trustees of the British Journal of Anaesthesia

Review Article

Lung injury after thoracotomy

S. V. Baudouin

Department of Anaesthesia, Leazes Wing, Royal Victoria Infirmary, Newcastle upon Tyne, UKE-mail: S.V.Baudouin@ncl.ac.uk

Keywords: complications, acute respiratory distress syndrome; lung, damage; surgery, gastrointestinal; surgery, thoracic; ventilation, one-lung

The first 150 words of the full text of this article appear below.

Postoperative respiratory complications are the commonest problem after all types of thoracic surgery. The exact incidence depends on the type of surgery and the preoperative health and lung function of the patient, but rates of up to 50% are often quoted.1 2 Most of these complications are diagnosed as either ‘pneumonia’ or ‘postoperative atelectasis’. However, the role of microbiological pathogens is often uncertain and the diagnosis of atelectasis usually rests on the presence of shadowing on the postoperative chest x-ray.

This article will discuss a specific type of severe respiratory problem that occurs after thoracotomy, namely the syndrome of acute lung injury (ALI). The features of lung injury after thoracotomy for oesophageal and lung resection surgery will be discussed in detail. The review will draw on the extensive experimental and clinical literature on the pathogenesis of the acute respiratory distress syndrome (ARDS) and ALI to suggest possible mechanisms of perioperative lung . . . [Full Text of this Article]

Acute lung injury

The pathology of ALI
The physiology of ALI
The cellular and molecular biology of acute lung injury
Cytokines
Cellular mediators
Other mediators
Surfactant
Lung injury after elective oesophagectomy

The incidence of lung injury after oesophagectomy
Pulmonary permeability changes
Plasma cytokine and inflammatory mediators
Pulmonary cytokine and inflammatory mediators
Cellular changes
Prediction of lung injury after oesophagectomy
Lung injury after pulmonary resection

Mechanisms of lung injury after thoracotomy

Ischaemia–reperfusion injury in the lung
Oxidative stress injury to the lung
Ventilator-induced lung injury
Pulmonary capillary stress failure
Conclusions


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