Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Mar;10(3):1628-1634.
doi: 10.21037/jtd.2018.03.48.

Inflammation is related to preoperative hypoxemia in patients with acute Stanford type A aortic dissection

Xu-Zhou Duan  1 , Zhi-Yun Xu  1 , Fang-Lin Lu  1 , Lin Han  1 , Yang-Feng Tang  1 , Hao Tang  1 , Yang Liu  1
Affiliations

Inflammation is related to preoperative hypoxemia in patients with acute Stanford type A aortic dissection

Xu-Zhou Duan et al. J Thorac Dis. 2018 Mar.

Abstract

Background: Preoperative hypoxemia is a frequent complication of acute Stanford type A aortic dissection (ATAAD). The aim of the present study was to determine which factors were associated with hypoxemia.

Methods: A series of data were collected in a statistical analysis to evaluate preoperative hypoxemia in patients with ATAAD. After retrospectively analyzing data for 172 patients, we identified the risk factors for preoperative hypoxemia. Hypoxemia was defined by an arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) ratio of 200 or lower. Subsequent to identifying the patient population, a prospective study was conducted using ulinastatin as a preoperative intervention. The ulinastatin group received ulinastatin at a total dose of 300,000 units prior to surgery. All the pertinent factors were investigated through univariate and multiple logistic regression analysis.

Results: The factors associated with preoperative hypoxemia in ATAAD comprised the following: body mass index (BMI) ≥25; white blood cell count (WBC) and neutrophil counts; levels of C-reactive protein (CRP), D-dimer, and interleukin-6 (IL-6); ATAAD involving the celiac trunk, renal artery, or mesenteric artery. Logistic regression analysis showed that CRP and IL-6 levels were independent predictive factors. We found that ulinastatin effectively could improve oxygenation, since compared to the control group the oxygenation in the ulinastatin group was significantly improved.

Conclusions: Systemic inflammatory reactions played a vital role in preoperative hypoxemia after the onset of ATAAD. The oxygenation of the patient could be improved significantly by inhibiting the inflammatory response prior to surgery.

Keywords: Acute Stanford type A aortic dissection (ATAAD); hypoxemia; preoperative risk factors.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

References

    1. De León Ayala IA, Chen YF. Acute aortic dissection: an update. Kaohsiung J Med Sci 2012;28:299-305. 10.1016/j.kjms.2011.11.010 - DOI - PMC - PubMed
    1. Algarni KD, Yanagawa B, Rao V, et al. Profound hypothermia compared with moderate hypothermia in repair of acute type A aortic dissection. J Thorac Cardiovasc Surg 2014;148:2888-94. 10.1016/j.jtcvs.2014.01.020 - DOI - PubMed
    1. Wang W, Duan W, Xue Y, et al. Clinical features of acute aortic dissection from the Registry of Aortic Dissection in China. J Thorac Cardiovasc Surg 2014;148:2995-3000. 10.1016/j.jtcvs.2014.07.068 - DOI - PubMed
    1. Hughes GC, Ganapathi AM, Keenan JE, et al. Thoracic endovascular aortic repair for chronic DeBakey IIIb aortic dissection. Ann Thorac Surg 2014;98:2092-7; discussion 2098. 10.1016/j.athoracsur.2014.06.066 - DOI - PMC - PubMed
    1. Wilbring M, Ghazy T, Matschke K, et al. Complete endovascular treatment of acute proximal ascending aortic dissection and combined aortic valve pathology. J Thorac Cardiovasc Surg 2015;149:e59-60. 10.1016/j.jtcvs.2015.01.002 - DOI - PubMed