PMID- 8634840
OWN - NLM
STAT- MEDLINE
DCOM- 19960708
LR  - 20220408
IS  - 0967-2109 (Print)
IS  - 0967-2109 (Linking)
VI  - 4
IP  - 1
DP  - 1996 Feb
TI  - Adult respiratory distress syndrome after cardiac surgery.
PG  - 15-21
AB  - Adult respiratory distress syndrome, characterized by high permeability pulmonary 
      oedema caused by endothelial cell damage, resulting in refractory hypoxemia, has 
      a very high mortality. Cardiopulmonary bypass is said to be responsible for the 
      development of adult respiratory distress syndrome after cardiac surgery. The 
      present study was performed in order to identify predicting and aetiological 
      factors of adult respiratory distress syndrome and multiple organ failure after 
      cardiac surgery. Between January 1984 and December 1993, 3848 patients underwent 
      cardiac surgery with cardiopulmonary bypass in the authors' institution, and were 
      analysed in a retrospective manner. The operations performed were 3444 coronary 
      artery bypass grafts (CABG), 267 valve and 137 combined (CABG + valve) 
      procedures. The incidence of adult respiratory distress syndrome was 1.0% (38 of 
      3848) with an overall mortality rate of 68.4% (26 patients); 24 of these died 
      from multiple organ failure. Multivariate regression analysis identified 
      hypertension, current smoking, emergency surgery, preoperative New York Heart 
      Association (NYHA) class 3 and 4, low postoperative cardiac output and left 
      ventricular ejection fraction < 40% as significant, independent predictors for 
      adult respiratory distress syndrome. Combined cardiac surgery and diffuse 
      coronary disease were also significant predictors; cardiopulmonary bypass time 
      was not. Thirty-six of the 38 patients that later developed adult respiratory 
      distress syndrome had low postoperative cardiac output, 12 requiring intra-aortic 
      balloon pump support. The remaining two had severe hypotension caused by 
      postoperative bleeding. Twenty-six adult respiratory two had severe hypotension 
      caused by postoperative bleeding. Twenty-six adult respiratory distress syndrome 
      patients (68%) had confirmed gastrointestinal complication (e.g. intestinal 
      ischaemia). Adult respiratory distress syndrome is a rare complication after 
      cardiac surgery but is associated with a very high mortality. Preoperative 
      predictors were identified. Cardiopulmonary bypass alone was not found to be an 
      important factor. Postoperative low cardiac output leading to splanchnic 
      hypoperfusion may be the most important single factor in developing adult 
      respiratory distress syndrome after cardiac surgery.
FAU - Christenson, J T
AU  - Christenson JT
AD  - Cardiovascular Surgery Unit, Hopital de la Tour, Meyrin-Geneva, Switzerland.
FAU - Aeberhard, J M
AU  - Aeberhard JM
FAU - Badel, P
AU  - Badel P
FAU - Pepcak, F
AU  - Pepcak F
FAU - Maurice, J
AU  - Maurice J
FAU - Simonet, F
AU  - Simonet F
FAU - Velebit, V
AU  - Velebit V
FAU - Schmuziger, M
AU  - Schmuziger M
LA  - eng
PT  - Journal Article
PL  - England
TA  - Cardiovasc Surg
JT  - Cardiovascular surgery (London, England)
JID - 9308765
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cardiac Output, Low/complications
MH  - Cardiac Surgical Procedures/*adverse effects
MH  - Cardiopulmonary Bypass/adverse effects
MH  - Coronary Artery Bypass/adverse effects
MH  - Coronary Disease/complications
MH  - Female
MH  - Forecasting
MH  - Heart Valve Diseases/surgery
MH  - Humans
MH  - Hypertension/complications
MH  - Hypotension/complications
MH  - Hypoxia/etiology
MH  - Incidence
MH  - Intestines/blood supply
MH  - Intra-Aortic Balloon Pumping
MH  - Ischemia/complications
MH  - Male
MH  - Middle Aged
MH  - Multiple Organ Failure/etiology
MH  - Multivariate Analysis
MH  - Postoperative Hemorrhage/complications
MH  - Pulmonary Edema/etiology
MH  - Regression Analysis
MH  - Respiratory Distress Syndrome/*etiology
MH  - Retrospective Studies
MH  - Smoking/adverse effects
MH  - Stroke Volume
MH  - Survival Rate
MH  - Ventricular Dysfunction, Left/complications
EDAT- 1996/02/01 00:00
MHDA- 1996/02/01 00:01
CRDT- 1996/02/01 00:00
PHST- 1996/02/01 00:00 [pubmed]
PHST- 1996/02/01 00:01 [medline]
PHST- 1996/02/01 00:00 [entrez]
AID - 0967210996837781 [pii]
AID - 10.1016/0967-2109(96)83778-1 [doi]
PST - ppublish
SO  - Cardiovasc Surg. 1996 Feb;4(1):15-21. doi: 10.1016/0967-2109(96)83778-1.