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. 2016 Oct;8(10):2862-2871.
doi: 10.21037/jtd.2016.10.10.

Analysis of risk factors for and the prognosis of postoperative acute respiratory distress syndrome in patients with Stanford type A aortic dissection

Mei-Fang Chen  1 , Liang-Wan Chen  1 , Hua Cao  1 , Yong Lin  1
Affiliations

Analysis of risk factors for and the prognosis of postoperative acute respiratory distress syndrome in patients with Stanford type A aortic dissection

Mei-Fang Chen et al. J Thorac Dis. 2016 Oct.

Abstract

Background: To explore the risk factors for and the prognosis of postoperative acute respiratory distress syndrome (ARDS) in patients with Stanford type A aortic dissection (AD).

Methods: This retrospective nested case-control study included 527 Stanford type A AD patients who were divided into ARDS groups and non-ARDS groups. The clinical features of the groups were examined.

Results: The fifty-nine patients in the ARDS group exhibited extended durations of cardiopulmonary bypass (CPB) (P=0.004), deep hypothermic circulatory arrest (DHCA) (P=0.000), ventilator support (P=0.013) and intensive care unit (ICU) stay (P=0.045), higher hospital costs (P=0.000), larger perioperative transfusions volumes [red blood cells (RBC): P=0.002, platelets (PLT): P=0.040, fresh frozen plasma (FFP): P=0.001], more frequent pulmonary infection (P=0.018) and multiple organ dysfunction syndrome (MODS) (P=0.040) and a higher rate of in-hospital mortality (P=0.020). The ARDS group exhibited worse statuses in terms of oxygenation index (OI) values (P=0.000) and Apache II scores (P=0.000). DHCA [P=0.000, odds ratio (OR) =2.589] and perioperative transfusion (RBC: P=0.000, OR =2.573; PLT: P=0.027, OR =1.571; FFP: P=0.002, OR =1.929) were independent risk factors for postoperative ARDS. The survival rates and median survival times after discharge were similar between the two groups (P=0.843).

Conclusions: DHCA duration and perioperative transfusion volume were independent risk factors for postoperative ARDS which warrants greater attention by the cardiac surgeons.

Keywords: Respiratory distress syndrome; adult; aortic aneurysm; cardiopulmonary bypass; circulatory arrest; deep hypothermia induced.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
The patients were divided into two groups: a non-ARDS group (n=405) and an ARDS group (n=59). Fifty-nine patients from the non-ARDS group were randomly selected as matched cases. Sixty–three cases were excluded from this study according to exclusion criteria described in detail below. ARDS, acute respiratory distress syndrome.
Figure 2
Figure 2
Repeated measures analysis revealed that the postoperative oxygenation index (OI) values was lower in the patients in the ARDS group than in the patients in the non-ARDS group (F=21.280, P=0.000). ARDS, acute respiratory distress syndrome.
Figure 3
Figure 3
Repeated measures analysis revealed that the postoperative Apache II scores of the patients in the ARDS group were higher than those of the patients in the non-ARDS group (F=25.918, P=0.000). ARDS, acute respiratory distress syndrome.
Figure 4
Figure 4
Kaplan-Meier plots revealing that no significant difference in the survival rate or the median survival time between the patients in the ARDS group and the patients in the non-ARDS group (log-rank result: χ2=0.039, P=0.843), (36 vs. 36 months). ARDS, acute respiratory distress syndrome.
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