Postpneumonectomy pulmonary edema. A retrospective analysis of associated variables.

Abstract

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.