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Mazzella A, Mohamed S, Maisonneuve P, Borri A, Casiraghi M, Bertolaccini L, Petrella F, Lo Iacono G, Spaggiari L. ARDS after Pneumonectomy: How to Prevent It? Development of a Nomogram to Predict the Risk of ARDS after Pneumonectomy for Lung Cancer. Cancers (Basel) 2022; 14:cancers14246048. [PMID: 36551534 PMCID: PMC9775532 DOI: 10.3390/cancers14246048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/25/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
(1) Background: The cause of ARDS after pneumonectomy is still unclear, and the study of risk factors is a subject of debate. (2) Methods: We reviewed a large panel of pre-, peri- and postoperative data of 211 patients who underwent pneumonectomy during the period 2014−2021. Univariable and multivariable logistic regression was used to quantify the association between preoperative parameters and the risk of developing ARDS, in addition to odds ratios and their respective 95% confidence intervals. A backward stepwise selection approach was used to limit the number of variables in the final multivariable model to significant independent predictors of ARDS. A nomogram was constructed based on the results of the final multivariable model, making it possible to estimate the probability of developing ARDS. Statistical significance was defined by a two-tailed p-value < 0.05. (3) Results: Out of 211 patients (13.3%), 28 developed ARDS. In the univariate analysis, increasing age, Charlson Comorbidity Index and ASA scores, DLCO < 75% predicted, preoperative C-reactive protein (CRP), lung perfusion and duration of surgery were associated with ARDS; a significant increase in ARDS was also observed with decreasing VO2max level. Multivariable analysis confirmed the role of ASA score, DLCO < 75% predicted, preoperative C-reactive protein and lung perfusion. Using the nomogram, we classified patients into four classes with rates of ARDS ranking from 2.0% to 34.0%. (4) Conclusions: Classification in four classes of growing risk allows a correct preoperative stratification of these patients in order to quantify the postoperative risk of ARDS and facilitate their global management.
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Affiliation(s)
- Antonio Mazzella
- Division of Thoracic Surgery, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy
- Correspondence: ; Tel.: +39-02-57489665; Fax: +39-02-94379218
| | - Shehab Mohamed
- Division of Thoracic Surgery, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy
| | - Alessandro Borri
- Division of Thoracic Surgery, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy
| | - Monica Casiraghi
- Division of Thoracic Surgery, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy
| | - Luca Bertolaccini
- Division of Thoracic Surgery, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy
| | - Francesco Petrella
- Division of Thoracic Surgery, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy
| | - Giorgio Lo Iacono
- Division of Thoracic Surgery, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy
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Blanc K, Dechartres A, Zaimi R, Lefebvre A, Janet-Vendroux A, Fournel L, Dermine H, Lorut C, Becanne X, Hamelin-Canny E, Bobbio A, Roche N, Regnard JF, Alifano M, Rabbat A. Patients experiencing early acute respiratory failure have high postoperative mortality after pneumonectomy. J Thorac Cardiovasc Surg 2018; 156:2368-2376. [PMID: 30449587 DOI: 10.1016/j.jtcvs.2018.08.113] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/05/2018] [Accepted: 08/17/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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). CONCLUSIONS Early acute respiratory failure requiring reintubation remains a severe complication of pneumonectomy with a poor outcome.
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Affiliation(s)
- Kim Blanc
- Department of Chest Disease and Respiratory Intensive Care, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Agnès Dechartres
- Department of Clinic Epidemiology Center, Hôtel Dieu, HUPC, APHP, Paris Descartes University, Paris, France
| | - Rym Zaimi
- Department of Thoracic Surgery, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Aurélie Lefebvre
- Department of Chest Disease and Respiratory Intensive Care, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Aurélie Janet-Vendroux
- Department of Thoracic Surgery, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Ludovic Fournel
- Department of Thoracic Surgery, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Hervé Dermine
- Department of Anesthesia and Surgical Intensive Care, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Christine Lorut
- Department of Chest Disease and Respiratory Intensive Care, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Xavier Becanne
- Department of Anesthesia and Surgical Intensive Care, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Emelyne Hamelin-Canny
- Department of Thoracic Surgery, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Antonio Bobbio
- Department of Thoracic Surgery, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Nicolas Roche
- Department of Chest Disease and Respiratory Intensive Care, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Jean-François Regnard
- Department of Thoracic Surgery, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
| | - Marco Alifano
- Department of Thoracic Surgery, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France.
| | - Antoine Rabbat
- Department of Chest Disease and Respiratory Intensive Care, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France
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