Objective: To characterize pulmonary hemodynamic changes in relation to lung injury at 2 time points [48 h (H48) and 168 h (H168)] after pneumonectomy under intraoperative protective ventilation in order to improve postpneumonectomy pulmonary edema (PPE) prevention. Method: Fifteen pigs (25 ± 1.9 kg) were randomly allocated to nonsurgical (control, n = 5) and surgical (H48 and H168) groups. A left pneumonectomy under volume-controlled one-lung ventilation (OLV) (low tidal volume, positive end-expiratory pressure = 4 cm H2O, inspired oxygen fraction = 50%) was performed in surgical animals. Mean pulmonary artery pressure (MPAP) and pulmonary artery occlusion pressure were recorded. Pulmonary vascular resistance (PVR) was calculated. Pulmonary damage score (PDS) and bronchoalveolar albumin level were evaluated. Data were collected after induction (T0), after OLV (T1), after left pneumonectomy (T2), and at H48 or H168 (T3). Results: Pneumonectomy caused precapillary pulmonary arterial hypertension (PAH) measured at T3 H48 (36.2 ± 3.67 mm Hg). PAH was delayed temporarily (both after OLV and after pneumonectomy) (p < 0.001), and linked with PVR (r = 0.93; p < 0.05). PDS and bronchoalveolar albumin level varied with MPAP (r = 0.76; p < 0.001 and r = 0.55; p < 0.05). Conclusion: Given that PAH is delayed and related to PVR increase, indicating secondary pulmonary vascular bed adaptation limits, pharmacological treatment should focus on a delayed failure in pulmonary capacitance in patients at risk of PPE.

Licker M, de Perrot M, Spiliopoulos A, Robert J, Diaper J, Chevalley C, Tschopp JM: Risk factors for acute lung injury after thoracic surgery for lung cancer. Anesth Analg 2003;97:1558-1565.
Tang SS, Redmond K, Griffiths M, Ladas G, Goldstraw P, Dusmet M: The mortality from acute respiratory distress syndrome after pulmonary resection is reduced: a 10 year single lung institutional experience. Eur J Cardiothorac Surg 2008;34:898-902.
Kutlu CA, Williams EA, Evans TW, Pastorino U, Goldstraw P: Acute lung injury and acute respiratory distress syndrome after pulmonary resection. Ann Thorac Surg 2000;69:376-380.
Slinger PD: Perioperative fluid management for thoracic surgery: the puzzle of postpneumonectomy pulmonary edema. J Cardiothorac Vasc Anesth 1995;9:442-451.
Zeldin RA, Normandin D, Landtwing D, Peters RM: Postpneumonectomy pulmonary edema. J Thorac Cardiovasc Surg 1984;87:359-365.
Zairns CK, Rice CL, Peters RM, Virgilio RW: Lymph and pulmonary response to isobaric reduction in plasma oncotic pressure in baboons. Circ Res 1978;43:925-930.
Miserocchi G: Mechanisms controlling the volume of pleural fluid and extravascular lung water. Eur Respir Rev 2009;18:244-252.
Reed CE, Spinale FG, Crawford FA: Effect of pulmonary resection on right ventricular function. Ann Thorac Surg 1992;53:578-582.
West JB, Mathieu-Costello O: Stress failure of pulmonary capillaries, role in lung and heart disease. Lancet 1992;340:762-767.
Turnage WS, Lunn JJ: Postpneumonectomy pulmonary edema. A retrospective analysis of associated variables. Chest 1993;103:1646-1650.
Williams DA: Network assessment of capillary hydraulic conductivity after abrupt changes in fluid shear stress. Microvasc Res 1999;57:107-117.
Li YS, Haga JH, Chien S: Molecular basis of the effects of shear stress on vascular endothelial cells. J Biomech 2005;38:1949-1971.
Maxey TS, Fernandez LG, Reece TB, Keeling WB, Kron IL, Laubach VE: Endothelial nitric oxide synthase is essential for postpneumonectomy compensatory vasodilation. Ann Thorac Surg 2006;81:1234-1238.
Van der Werff YD, van der Houwen HK, Heijmans PJ, Duurkens VA, Leusink HA, van Heesewijk HP, de Boer A: Postpneumonectomy pulmonary edema. A retrospective analysis of incidence and possible risk factors. Chest 1997;111:1278-1284.
de Prost N, Ricard JD, Saumon G, Dreyfuss D: Ventilator-induced lung injury: historical perspectives and clinical implications. Ann Intensive Care 2011;1:28.
Schmitt JM, Vieillard-Baron A, Augarde R, Prin S, Page B, Jardin F: Positive end-expiratory pressure titration in acute respiratory distress syndrome patients: impact on right ventricular outflow impedance evaluated by pulmonary artery Doppler flow velocity measurements. Crit Care Med 2001;29:1154-1158.
Jaber S, Sebbane M, Koechlin C, Hayot M, Capdevila X, Eledjam JJ, Prefaut C, Ramonatxo M, Matecki S: Effects of short vs prolonged mechanical ventilation on antioxidant systems in piglet diaphragm. Intensive Care Med 2005;31:1427-1433.
Quintel M, Heine M, Hirschl RB, Tillmanns R, Wessendorf V: Effects of partial liquid ventilation on lung injury in a model of acute respiratory failure: a histologic and morphometric analysis. Crit Care Med 1998;26:833-843.
Park BJ: Respiratory failure following pulmonary resection. Semin Thorac Cardiovasc Surg 2007;19:374-379.
Bougaci N, Costes F, Bertoletti L: Non-invasive study of pulmonary vascular recruitment during exercise. Rev Pneumol Clin 2010;66:173-178.
Dumas JP, Bardou M, Goirand F, et al: Hypoxic pulmonary vasoconstriction. Gen Pharmacol 1999;33:289-297.
Roch A, Michelet P, D'Journo B, Brousse D, Blayac D, Lambert D, Auffray JP: Accuracy and limits of transpulmonary dilution methods in estimating extravascular lung water after pneumonectomy. Chest 2005;128:927-933.
Filaire M, Fadel E, Decante B, Seccatore F, Mazmanian GM, Hervé P: Inhaled nitric oxide does not prevent postpneumonectomy pulmonary edema in pigs. J Thorac Cardiovasc Surg 2007;133:770-774.
Dantzker DR, Brook CJ, Dehart P, et al: Ventilation-perfusion distributions in the adult respiratory distress syndrome. Am Rev Respir Dis 1979;120:1039-1052.
Ricciardolo FL, Sterk PJ, Gaston B, Folkerts G: Nitric oxide in health and disease of the respiratory system. Physiol Rev 2004;84:731-765.
Fu Z, Costello ML, Tsukimoto K, et al: High lung volume increases stress failure in pulmonary capillaries. J Appl Physiol 1992;73:123-133.
Ward C, Walters EH, Zheng L, Whitford H, Williams TJ, Snell GI: Increased soluble CD14 in bronchoalveolar lavage fluid of stable lung transplant recipients. Eur Respir J 2002;19:472-478.
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