The importance of intraoperative fluid balance for the prevention of postoperative acute exacerbation of idiopathic pulmonary fibrosis after pulmonary resection for primary lung cancer

Eur J Cardiothorac Surg. 2012 Jun;41(6):e161-5. doi: 10.1093/ejcts/ezs147. Epub 2012 Apr 14.


Objectives: Postoperative acute exacerbation (PAE) of idiopathic pulmonary fibrosis (IPF) is a serious complication that is hard to treat. Therefore, it is important to manage IPF patients in such a way as to avoid PAE. Conversely, the relationship between postoperative acute lung injury and perioperative fluid administration has been reported. Herein, we analyse the perioperative risk factors of PAE of IPF, including fluid management.

Methods: Fifty-two patients diagnosed as having clinical IPF who underwent pulmonary resection (segmentectomy, lobectomy or bilobectomy) for primary lung cancer were analysed retrospectively. Preoperative predictive factors and perioperative management items, especially fluid management, were evaluated.

Results: The incidence of PAE of IPF was 13.5% (7 of 52 patients). Six patients (85.7%) died of respiratory failure induced by uncontrollable PAE of IPF. Upon univariate analysis, the amount of the intraoperative fluid infused (ml/kg/h), the intraoperative fluid balance (ml/kg/h) and the preoperative C-reactive protein (CRP) level were found to be significantly higher in IPF patients who developed PAE than in those who did not. A multivariate logistic regression analysis showed that the intraoperative fluid balance and the preoperative CRP were prognostic factors for PAE of IPF [P = 0.026, odds ratio (OR) = 1.312 and P = 0.048, OR = 1.280, respectively].

Conclusions: To prevent PAE of IPF, intraoperative management that minimizes intravenous fluid administration is essential. Moreover, caution is particularly important in patients with preoperative evidence of inflammation.

Publication types

  • Multicenter Study

MeSH terms

  • Acute Disease
  • Aged
  • Biomarkers / blood
  • C-Reactive Protein / metabolism
  • Female
  • Fluid Therapy / adverse effects
  • Fluid Therapy / methods
  • Humans
  • Idiopathic Pulmonary Fibrosis / etiology
  • Idiopathic Pulmonary Fibrosis / prevention & control*
  • Intraoperative Care / adverse effects
  • Intraoperative Care / methods*
  • Lung Neoplasms / surgery*
  • Male
  • Middle Aged
  • Pneumonectomy / adverse effects
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Water-Electrolyte Balance / physiology*


  • Biomarkers
  • C-Reactive Protein