scholarly journals A Nomogram to Predict Acute Respiratory Distress Syndrome After Cardiac Surgery

2021 ◽  
Vol 24 (3) ◽  
pp. E445-E450
Author(s):  
Yan Liu ◽  
Man Song ◽  
Lixue Huang ◽  
Guangfa Zhu
Keyword(s):  
Cardiac Surgery ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Odds Ratio ◽  
Distress Syndrome ◽  
Artery Bypass ◽  
Albumin Level ◽  
Internal Validation ◽  
History Of

Purpose: To establish a model to predict the risk of acute respiratory distress syndrome (ARDS) after cardiac surgery. Methods: Data were collected on 132 ARDS patients, who received valvular or coronary artery bypass grafting surgery from January 2009 to December 2019. We developed the prediction model by multivariable logistic regression. Then, we used the coefficients for developing a nomogram that predicts ARDS occurrence. Internal validation was performed using resampling techniques to evaluate and optimize the model. Results: All variables fit into the model, including albumin level before surgery (odds ratio [OR]: 0.96; 95% confidence interval [CI]: 0.92, 0.99; P = .01), cardiopulmonary bypass time (OR: 1.01; 95% CI: 1.00, 1.02; P = .02), APACHE II after surgery (OR: 1.21; 95% CI: 1.13, 1.29; P < .001), and history of diabetes (OR: 2.31; 95% CI: 1.88, 3.87; P < .001); these were considered to build the nomogram. The score distinguished ARDS patients from non-ARDS patients with an AUC of 0.785 (95% CI: 0.740, 0.830) and was well calibrated (Hosmer–Lemeshow P = .53). Conclusions: Our developed model predicted ARDS in patients undergoing cardiac surgery and may serve as a tool for identifying patients at high risk for ARDS after cardiac surgery.

scholarly journals Early Packed Red Blood Cell Transfusion and Acute Respiratory Distress Syndrome after Trauma

2009 ◽  
Vol 110 (2) ◽  
pp. 351-360 ◽  
Author(s):  
Onuma Chaiwat ◽  
John D. Lang ◽  
Monica S. Vavilala ◽  
Jin Wang ◽  
Ellen J. MacKenzie ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Distress Syndrome ◽  
Red Blood Cell Transfusion ◽  
Thoracic Injury ◽  
National Study ◽  
Trauma Patients

Background Transfusion of packed red blood cells (PRBCs) is a risk factor for acute respiratory distress syndrome (ARDS) in trauma patients. Yet, there is a paucity of information regarding the risk of ARDS with incremental PRBCs exposure. Methods For this retrospective analysis, eligible patients from National Study on Costs and Outcomes of Trauma were included. Our main exposure was defined as units of PRBCs transfused during the first 24 h after admission. The main outcome was ARDS. Results A total of 521 (4.6%) of 14070 patients developed ARDS, and 331 patients (63.5%) who developed ARDS received PRBCs transfusion. Injury severity, thoracic injury, polytrauma, and pneumonia receiving more than 5 units of fresh frozen plasma and 6-10 units of PRBCs were independent predictors of ARDS. Patients receiving more than 5 units of PRBCs had higher risk of developing ARDS (patients who received 6-10 units: adjusted odds ratio 2.5, 95% CI 1.12-5.3; patients who received more than 10 units: odds ratio 2.6, 95% CI 1.1-6.4). Each additional unit of PRBCs transfused conferred a 6% higher risk of ARDS (adjusted odds ratio 1.06; 95% CI 1.03-1.10). Conclusions Early transfusion of PRBCs is an independent predictor of ARDS in adult trauma patients. Conservative transfusion strategies that decrease PRBC exposure by even 1 unit may be warranted to reduce the risk of ARDS in injured patients.

scholarly journals Effect of low-dose exogenous surfactant on infants with acute respiratory distress syndrome after cardiac surgery: A retrospective analysis

2020 ◽  
Author(s):  
Rongyuan Zhang ◽  
Xu Wang ◽  
Shoujun Li ◽  
Jun Yan
Keyword(s):  
Cardiac Surgery ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Standard Therapy ◽  
Low Dose ◽  
Distress Syndrome ◽  
Exogenous Surfactant ◽  
Control Group ◽  
Surfactant Treatment

Abstract Background: To evaluate the effect of low-dose exogenous surfactant therapy on infants suffering acute respiratory distress syndrome (ARDS) after cardiac surgery. Methods: We conducted a retrospective case-control study of infants diagnosed with moderate-severe ARDS after cardiac surgery. A case was defined as a patient that received surfactant and standard therapy, while a control was defined as a patient that underwent standard therapy. The primary endpoint was the improvement in oxygenation index (OI) after 24-hour of surfactant treatment; and secondary endpoints were the ventilator time and PICU time. Results: 22 infants treated with surfactant were matched with 22 controls. Early low-dose (20mg/kg) surfactant treatment was associated with improved outcomes. After surfactant administration for 24-hour, the surfactant group was much better compared with the control group at the 24-hour in OI (difference in average change from baseline, -6.7 [95% CI, -9.3 to -4.1]) (P < 0.01) and VI (mean difference, -11.9 [95% CI, -18.1 to -5.7]) (P < 0.01). Ventilation time and PICU time were significantly shorter in the surfactant group compared with the control group (133.6h±27.2 vs 218.4h±28.7, P < 0.01 ; 10.7d±5.1 vs 17.5d±6.8, P < 0.01). Infants in the surfactant group under 3 months benefit more from OI and VI than the infants over 3 months in a preliminary exploratory analysis.Conclusions: In infants with moderate-severe ARDS after cardiac surgery, early low-dose exogenous surfactant treatment could prominently improve oxygenation and reduce mechanical ventilation time and PICU time. Infants younger than 3 months may get more benefit of oxygenation than the older ones.

Gas Exchange of prone positioning in influenza pneumonia-related acute respiratory distress syndrome: A multicenter retrospective cohort study in Taiwan

2019 ◽  
Author(s):  
Ko-Wei Chang ◽  
Shih-Wei Lin ◽  
Li-Pang Chuang ◽  
Shinn-Jye Liang ◽  
Kuang-Yao Yang ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Distress Syndrome ◽  
Prone Positioning ◽  
Younger Age ◽  
Influenza Pneumonia ◽  
Paco2 Level

Abstract Background: Prone positioning has demonstrated decreased mortality in severe acute respiratory distress syndrome (ARDS) patients. The aim of this study was to investigate the effect of prone positioning in patients with influenza pneumonia-related severe ARDS. Methods: This retrospective study includes eight tertiary referral centers. All the patients with influenza pneumonia induced severe ARDS and receiving prone positioning were enrolled. Demographic data, laboratory data, treatment record, ventilator setting data and outcomes were collected. PaO2 responders were defined as the PaO2/FiO2 ratio increasing by ≥20% or ≥20 mm Hg, while PaCO2 responders were defined as PaCO2 decreasing by ≥1 mm Hg after prone positioning for one day. Results: Sixty-five patients receiving prone positioning were enrolled, with 37 (57%) were PaO2 responders and 33 (51%) were PaCO2 responders. Mortality rates were not significantly different between responders and non-responders. PaCO2 responder survivors had significantly shortened length of stay at the ICU (21.0 ± 13.5 vs. 31.7 ± 18.5 days, P = 0.038) and hospital (30.2 ± 16.6 vs. 43.0 ± 16.3 days, P = 0.013) than did non-responders. Multivariate analysis revealed younger age (odds ratio 0.903, 95% confidence interval 0.824-0.989; P = 0.028) and higher PaCO2 level before prone positioning (odds ratio 1.121 confidence interval 1.020-1.231; P = 0.017) were the predictors of PaCO2 responders. Conclusions: In this multicenter retrospective cohort study of influenza pneumonia patients with severe ARDS receiving prone positioning, PaCO2 responders had modestly better clinical outcomes. Younger age and higher PaCO2 level before prone positioning were the predictors of PaCO2 responders. Keywords: Prone positioning, Acute Respiratory Distress Syndrome, Influenza, Gas exchange, Outcome

Acute Respiratory Distress Syndrome Prediction Score: Derivation and Validation

2021 ◽  
Vol 30 (1) ◽  
pp. 64-71
Author(s):  
Lixue Huang ◽  
Man Song ◽  
Yan Liu ◽  
Wenmei Zhang ◽  
Zhenye Pei ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Acute Respiratory Distress Syndrome ◽  
High Risk ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Aortic Surgery ◽  
Area Under The Curve ◽  
Prediction Score ◽  
Derivation Cohort

Background Despite advances in treatment strategies, acute respiratory distress syndrome (ARDS) after cardiac surgery remains associated with high morbidity and mortality. A method of screening patients for risk of ARDS after cardiac surgery is needed. Objectives To develop and validate an ARDS prediction score designed to identify patients at high risk of ARDS after cardiac or aortic surgery. Methods An ARDS prediction score was derived from a retrospective derivation cohort and validated in a prospective cohort. Discrimination and calibration of the score were assessed with area under the receiver operating characteristic curve and the Hosmer-Lemeshow goodness-of-fit test, respectively. A sensitivity analysis was conducted to assess model performance at different cutoff points. Results The retrospective derivation cohort consisted of 201 patients with and 602 patients without ARDS who had undergone cardiac or aortic surgery. Nine routinely available clinical variables were included in the ARDS prediction score. In the derivation cohort, the score distinguished patients with versus without ARDS with area under the curve of 0.84 (95% CI, 0.81-0.88; Hosmer-Lemeshow P = .55). In the validation cohort, 46 of 1834 patients (2.5%) had ARDS develop within 7 days after cardiac or aortic surgery. Area under the curve was 0.78 (95% CI, 0.71-0.85), and the score was well calibrated (Hosmer-Lemeshow P = .53). Conclusions The ARDS prediction score can be used to identify high-risk patients from the first day after cardiac or aortic surgery. Patients with a score of 3 or greater should be closely monitored. The score requires external validation before clinical use.

Perioperative proADM-change is associated with the development of acute respiratory distress syndrome in critically ill cardiac surgery patients: a prospective cohort study

2019 ◽  
Vol 13 (13) ◽  
pp. 1081-1091
Author(s):  
Judith van Paassen ◽  
Jaap T van Dissel ◽  
Pieter S Hiemstra ◽  
Jaap Jan Zwaginga ◽  
Christa M Cobbaert ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Mixed Models ◽  
Distress Syndrome ◽  
Predictive Capacity ◽  
Post Surgery ◽  
Definition Of ◽  
The Impact

Aim: Biomarkers of acute respiratory distress syndrome (ARDS) after cardiac-surgery may help risk-stratification and management. Preoperative single-value proADM increases predictive capacity of scoring-system EuroSCORE. To include the impact of surgery, we aim to assess the predictive value of the perioperative proADM-change on development of ARDS in 40 cardiac-surgery patients. Materials & methods: ProADM was measured in nine sequential blood samples. The Berlin definition of ARDS was used. For data-analyses, a multivariate model of EuroSCORE and perioperative proADM-change, linear mixed models and logistic regression were used. Results: Perioperative proADM-change was associated with ARDS after cardiac-surgery, and it was superior to EuroSCORE. A perioperative proADM-change >1.5 nmol/l could predict ARDS. Conclusion: Predicting post-surgery ARDS with perioperative proADM-change enables clinicians to intensify lung-protective interventions and individualized fluid therapy to minimize secondary injury.

What is Acute Respiratory Distress Syndrome?

1998 ◽  
Vol 13 (2) ◽  
pp. 59-67 ◽  
Author(s):  
Marc Moss ◽  
Polly E. Parsons
Keyword(s):  
Clinical Trials ◽  
Acute Respiratory Distress Syndrome ◽  
Acute Lung Injury ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Clear Definition ◽  
History Of ◽  
Definition Of ◽  
Major Illness

Acute respiratory distress syndrome (ARDS) is a form of acute lung injury which usually occurs within 24 hours of a major illness or injury. Unfortunately a clear definition of ARDS does not presently exist, and the variability in the diagnostic criteria may impact on the results of clinical trials for ARDS and our understanding of the epidemiology and pathogenesis of this syndrome. In this article the history of ARDS is reviewed and a few of the definitions that have evolved over wtime are explored in depth. In addition, several controversies with these existing defiitions are discussed.

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