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The Journal of Cardiovascular Surgery 1998 December;39(6):777-81

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

Adult respiratory distress syndrome following cardiopulmonary bypass: incidence, prophylaxis and management

Kaul T. K., Fields B. L., Riggins L. S., Wyatt D. A., Jones Ch. R., Nagle D.

From the Department of Cardiac Surgery, Baptist Medical Center, Birmingham, Alabama, USA


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Background. In ­this ret­ro­spec­tive ­study, we ­have exam­ined the inci­dence and the pre­dic­tors of ­ARDS (­adult res­pir­a­to­ry dis­tress syn­drome), in ­patients under­go­ing cor­o­nary ­artery ­bypass (­CABG) sur­gery on car­di­o­pul­mo­nary ­bypass (CPB). The pro­phy­lac­tic and ther­a­peu­tic meas­ures ­that ­were ­used in ­this ­series ­were ­also eval­u­at­ed.
Methods. Between January 1988 and January 1995, 4318 con­sec­u­tive ­patients under­go­ing an iso­lat­ed and a pri­mary ­CABG pro­ce­dure ­were includ­ed. Patients ­with ­poor ­left ven­tric­u­lar func­tion, con­ges­tive ­heart fail­ure (CHF), ­renal fail­ure and ­with an abnor­mal ­chest radio­gram ­were ­exclud­ed.
Results. The inde­pen­dent pre­dic­tors of ­ARDS ­were: ­recent cig­ar­ette smok­ing, ­advanced ­COPD (chron­ic obstruc­tive pul­mo­nary dis­ease) and emer­gen­cy sur­gery. The over­all inci­dence of ­ARDS was 2.5% and hos­pi­tal mor­tal­ity in ­patients ­with an estab­lished ­ARDS was 27.7% (30/108). The pro­phy­lac­tic and the ther­a­peu­tic meas­ures ­which ­have ­been ­used in ­this ­series had no sig­nif­i­cant ­impact on the inci­dence and hos­pi­tal mor­tal­ity.
Conclusions. In ­view of a ­high per­i­op­er­a­tive mor­tal­ity in ­patients ­with estab­lished ­ARDS, a man­date for a reg­u­lar use of pro­phy­lac­tic and ther­a­peu­tic meas­ures ­that are ­based on its pathoph­y­sio­lo­gy, clear­ly ­exists.

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