Acute lung injury after pulmonary resection

Acute lung injury (ALI) after lung resection is a rare form of acute respiratory failure characterized by dyspnoea, hypoxaemia, diffuse infiltrates on chest radiogram, and rapid evolution often unresponsive to conventional therapy. ALI occurs almost exclusively following pneumonectomy without a preceding cause. Factors implicated in its pathogenesis include excessive fluid administration, lung injury during one-lung ventilation due to alveolar hyperinflation and toxic action of oxygen, right pneumonectomy and impaired lymph drainage. Mortality is high. There is no specific therapy. Suggested management of patients during thoracic surgery and perioperatively includes judicious fluid restriction, lung-protective ventilation by the limitation of ventilatory volumes and pressures and alternative techniques of ventilation such as high-frequency jet ventilation.