Patients experiencing early acute respiratory failure have high postoperative mortality after pneumonectomy

J Thorac Cardiovasc Surg. 2018 Dec;156(6):2368-2376. doi: 10.1016/j.jtcvs.2018.08.113. Epub 2018 Sep 27.


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.

Keywords: acute respiratory failure; lung cancer; outcome; pneumonectomy.

Publication types

  • Video-Audio Media

MeSH terms

  • Acute Disease
  • Aged
  • Female
  • Humans
  • Intubation, Intratracheal / mortality
  • Male
  • Middle Aged
  • Pneumonectomy / adverse effects
  • Pneumonectomy / mortality*
  • Respiration, Artificial / mortality
  • Respiratory Insufficiency / diagnosis
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / mortality*
  • Respiratory Insufficiency / therapy
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome