Postoperative acute respiratory distress syndrome in patients with previous exposure to bleomycin

Abstract

Objective: To determine the incidence and risk factors for postoperative acute respiratory distress syndrome (ARDS) in a large cohort of bleomycin-exposed patients undergoing surgery with general endotracheal anesthesia.

Patients and methods: From a Mayo Clinic cancer registry, we identified patients who had received systemic bleomycin and then underwent a major surgical procedure that required more than 1 hour of general anesthesia from January 1, 2000, through August 30, 2012. Heart, lung, and liver transplantations were excluded. Postoperative ARDS (within 7 days after surgery) was defined according to the Berlin criteria.

Results: We identified 316 patients who underwent 541 major surgical procedures. Only 7 patients met the criteria for postoperative ARDS; all were white men, and 6 were current or former smokers. On univariate analysis, we observed an increased risk of postoperative ARDS in patients who were current or former smokers. Furthermore, significantly greater crystalloid and colloid administration was found in patients with postoperative ARDS. We also observed a trend toward longer surgical duration and red blood cell transfusion in patients with postoperative ARDS, although this finding was not significant. Intraoperative fraction of inspired oxygen was not associated with postoperative ARDS. In bleomycin-exposed patients, the incidence of postoperative ARDS after major surgery with general anesthesia is approximately 1.3% (95% CI, 0.6%-2.6%). For first major procedures after bleomycin therapy, the incidence is 1.9% (95% CI, 0.9%-4.1%).

Conclusion: The risk of postoperative ARDS in patients exposed to systemic bleomycin appears to be lower than expected. Smoking status may be an important factor that modifies the risk of postoperative ARDS in these patients.

Keywords: ARDS; Fio(2); ICU; MCLSS/DDQB; Mayo Clinic Life Sciences Services/Data Discovery Query Builder; PEEP; acute respiratory distress syndrome; fraction of inspired oxygen; intensive care unit; positive end expiratory pressure.

Figure 1

Methods flow diagram. PO-ARDS was determined in 7 out of 541 procedures 1.3% (C.I. 0.6–2.6). Because 1 of the 7 patients developed PO-ARDS after the sixth surgery following bleomycin therapy, the incidence of PO-ARDS associated with the first major procedure after last exposure to bleomycin was 6 out of 315 patients 1.9% (C.I. 0.9–4.1). See text for further explanation. Unless otherwise indicated, n=number of procedures and number of patients. MCLSS: Mayo Clinic Life Science Services and the Data Discovery Query Builder.