Abstract
Acute respiratory distress syndrome (ARDS) and acute lung injury (ALI) developing after a pulmonary resection have a mortality rate >50%. Present-day treatment for ARDS/ALI is supportive care. We reviewed our results over a 10-year period in 12 patients who were prospectively treated with low-dose steroids (hydrocortisone 100 mg every 8 h) within 48 hours of developing ARDS/ALI after a lobectomy (n=12). The clinical presentation, radiologic findings, and response to steroid therapy were reviewed. A total of 625 lobectomies were performed between August 1999 and January 2010. Eleven patients developed ARDS and 2 developed ALI. Symptoms developed an average of 3.2 days (1 to 5 d) after surgery. Early chest x-ray findings showed only nonspecific infiltrative process that started in the lung contralateral to the side of resection. Computed tomography (CT) scans demonstrated diffuse ground-glass opacities that were not recognized by chest x-rays. The response to this steroid regimen was rapid with a significant improvement occurring in the PaO2/FiO2 ratio within 24 hours. There were no mortalities. The average time on a ventilator was 1.5 days and the average hospital length of stay was 11 days. A CT scan and a high degree of clinical awareness are essential in making an early diagnosis of ARDS/ALI after a lobectomy. Nonseptic patients with ARDS/ALI identified by CT scan and given steroids early in the course of ARDS after surgery demonstrated a rapid recovery, which is considerably better than historical data.