• Kim Blanc, Agnès Dechartres, Rym Zaimi, Aurélie Lefebvre, Aurélie Janet-Vendroux, Ludovic Fournel, Hervé Dermine, Christine Lorut, Xavier Becanne, Emelyne Hamelin-Canny, Antonio Bobbio, Nicolas Roche, Jean-François Regnard, Marco Alifano, and Antoine Rabbat.
• Department of Chest Disease and Respiratory Intensive Care, Cochin Hospital, HUPC, APHP, Paris Descartes University, Paris, France.
• J. Thorac. Cardiovasc. Surg. 2018 Dec 1; 156 (6): 2368-2376.

ObjectivePost-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.MethodsWe 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.ResultsAmong 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).ConclusionsEarly acute respiratory failure requiring reintubation remains a severe complication of pneumonectomy with a poor outcome.Copyright © 2018. Published by Elsevier Inc.

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