Case report: Causes of acute respiratory distress syndrome complications after lung resection

Postoperative acute respiratory distress syndrome (ARDS), characterized by bilateral infiltrates and severe hypoxemia, is a critical complication following thoracic surgery, particularly lung resection. Perioperative transfusions and mechanical ventilation strategies are potential contributors to ARDS development, yet the exact mechanisms driving this association remain incompletely understood. Despite advancements in surgical and perioperative care, ARDS remains a severe complication with a high mortality rate. This study explores the occurrence of ARDS in two patients with nonsmall-cell lung cancer postlung resection, focusing on the association of intraoperative blood transfusion and mechanical ventilation parameters. Both patients received intraoperative blood transfusions (>2 U red blood cells) and exhibited elevated peak plateau pressure (30-31 cmH₂O) with tidal volumes of 6 to 8 mL/kg. Postoperatively, both patients developed acute pulmonary edema and hypoxemia, requiring intensive care management, including mechanical ventilation, lung-protective ventilation strategies, restrictive fluid management, and pharmacological therapy. One patient recovered and was discharged, whereas the other died. ARDS after lung resection arises from synergistic insults, including transfusion-induced inflammation, mechanical ventilation stressors, and reduced pulmonary reserve. Strict adherence to lung-protective ventilation, restrictive transfusion volumes, and multidisciplinary perioperative care are essential to improve outcomes. Future research should prioritize multicenter studies to validate causal mechanisms and refine evidence-based protocols, addressing the urgent need for targeted therapies to reduce ARDS-related mortality.