Case Reports Chemotherapy-Induced Late Acute Respiratory Distress Syndrome Following Right Pneumonectomy for Bronchogenic Carcinoma

We report 2 patients who suffered late postoperative acute respiratory distress syndrome (ARDS) that was probably chemotherapy-induced. Both patients underwent neoadjuvant combination che-motherapy prior to right pneumonectomy for primary bronchogenic carcinoma, and then suffered ARDS in the remaining lung a few weeks after surgery. No evidence of infection or other specific ARDS etiologies could be found, whereas the bronchoalveolar lavage fluid cell differentiation and protein content suggested the permeability form of lung edema. Both patients had rapid clinical, functional, and radiologic improvement with high-dose corticosteroids. In the first patient the course was complicated by the development of a critical illness polyneuropathy with complete tetraplegia, but the patient recovered. The second patient died from septic shock 4 weeks after starting mechanical ventilation. The incidence of a chemotherapy-related ARDS in the remaining lung, occurring more than 4 weeks after extensive operations or after a pneumonectomy, is un-known. This kind of acute lung injury calls for particularly delicate treatments, the most potentially life-threatening complications being mainly associated with difficulties in ventilatory support and the high doses of corticosteroids required to rescue the remaining lung. Key words: neoadjuvant, chemotherapy, pneumonectomy, acute respiratory distress syndrome, ARDS, mechanical ventilation, corticosteroids. [Respir Care 2003;48(6):606–610. © 2003 Daedalus Enterprises