Postoperative Remote Lung Injury and Its Impact on Surgical Outcome

Lin Chen; Hailin Zhao; Azeem Alam; Emma Mi; Shiori Eguchi; Shanglong Yao; Daqing Ma

BMC Anesthesiol. 2019;19(30)

Conclusion

Postoperative remote lung injury is not an uncommon condition clinically, and it is associated with adverse effects on overall patient survival. The pathological mechanisms are complex, involving cytokines and DAMPs released by injured organs or surgical sites. As a result, the normal function of the respiratory system is compromised, contributing to the development of lung injury. Due to the poor outcome associated with postoperative remote lung injury, predicting the population at risk is critical in order to facilitate lung injury prevention at the incipient stage. Approaches to ameliorate the pathological effects of postoperative remote lung injury are still required and necessitate further investigation, particularly utilizing well-powered, randomized controlled trials.

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Abbreviations
ALI: Acute lung injury; ARDS: Acute respiratory distress syndrome; BALF: Bronchoalveolar lavage fluid; CPB: Cardiopulmonary bypass; DAMPs: Damage-associated molecular patterns; HMGB1: High-mobility group box-1; HSP: Heat shock protein; I/R: Ischaemia/reperfusion; IL: Interleukin; NLRP3: NOD-like receptor protein 3; PEEP: Positive end expiratory pressure; PPC: Postoperative pulmonary complication; ROS: Reactive oxygen species; SLIP: Surgical lung injury prediction; SPR: Stress protein response; TLR4: Tolllike receptor 4; TNF-α: Tumor necrosis factor-α; TRALI: Transfusion related acute lung injury; VT: Tidal volume

Acknowledgements
Not applicable.

Funding
The work was supported by the Medical Research Council, The Developmental Pathway Funding Scheme program (project grant G802392), BJA/RCoA Research Fellowship grant, London, UK and the Basic and Frontier Research Fund (DM) and National Natural Science Foundation of China (No. 81671890) (SLY). The funders have no role in regarding study design, data collection, analysis and manuscript preparation.

Availability of data and materials
All data generated or analysed during this study are included in this published article.

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Table 1. The modifiable and non-modifiable factors in prediction of postoperative remote lung injury
	Modifiable factors	Non-modifiable factors
Preoperative variables	Anaemia FIO₂ greater than 35% Impaired cognitive function Increased respiratory rate Low arterial oxygen saturation SpO₂ less than 95% Sputum production	Acute respiratory infection in the last month Advanced age Admission locations other than home BMI over 27 Cirrhosis History of cancer Sepsis Smoking history within the past 8 weeks
Intraoperative varibles	Anaesthesia duration Blood loss Colloid administration Operation period Tidal volume	Emergency surgery High-risk aortic vascular surgery High-risk cardiac surgery Proximal tumor location Surgical site Upper abdominal or intrathoracic surgery
Postoperative variables	Nasogastric intubation

BMI body mass index, FIO₂ fraction of inspiration O₂, SpO₂ peripheral capillary oxygen saturation

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Postoperative Remote Lung Injury and Its Impact on Surgical Outcome

Conclusion

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