The complications of lung resection in adults: acute respiratory distress syndrome (ARDS).

Postoperative lung injury is a recognized complication of pulmonary resection. In adults, this is manifest in its most severe form as the acute respiratory distress syndrome (ARDS). ARDS is characterized by high permeability pulmonary oedema resulting in refractory and often terminal hypoxaemia. Few data exist regarding the prevalence of lung injury following lung resection. Most recent series suggest that around 5% of patients develop some degree of lung injury. Those that develop frank ARDS have a poor prognosis compared to those who suffer lesser degrees of damage. The pathogenesis of lung injury in these circumstances remains unknown. Perioperative fluid overload, increased blood flow through the remaining lung postoperatively, reoxygenation injury and activation of inflammatory mediators have been postulated as possible causes. Conventional parameters for preoperative assessment do not predict those patients most likely to develop lung injury in these circumstances. Clinical management strategies for acute respiratory distress syndrome complicating lung resection are discussed.