Journal article
Preoperative and Intraoperative Predictors of Postoperative Acute Respiratory Distress Syndrome in a General Surgical Population
Anesthesiology (Philadelphia), Vol.118(1), pp.19-29
2013
DOI: 10.1097/ALN.0b013e3182794975
PMCID: PMC3813014
PMID: 23221870
Abstract
Background: Acute respiratory distress syndrome (ARDS) is a devastating condition with an estimated mortality exceeding 30%. There are data suggesting risk factors for ARDS development in high-risk populations, but few data are available in lower incidence populations. Using risk-matched analysis and a combination of clinical and research data sets, we determined the incidence and risk factors for the development of ARDS in this general surgical population.
Methods: We conducted a review of common adult surgical procedures completed between June 1, 2004 and May 31, 2009 using an anesthesia information system. This data set was merged with an ARDS registry and an institutional death registry. Preoperative variables were subjected to multivariate analysis. Matching and multivariate regression was used to determine intraoperative factors associated with ARDS development.
Results: In total, 50,367 separate patient admissions were identified, and 93 (0.2%) of these patients developed ARDS. Preoperative risk factors for ARDS development included American Society of Anesthesiologist status 3-5 (odds ratio [OR] 18.96), emergent surgery (OR 9.34), renal failure (OR 2.19), chronic obstructive pulmonary disease (OR 2.16), number of anesthetics during the admission (OR 1.37), and male sex (OR 1.65). After matching, intraoperative risk factors included drive pressure (OR 1.17), fraction inspired oxygen (OR 1.02), crystalloid administration in liters (1.43), and erythrocyte transfusion (OR 5.36).
Conclusions: ARDS is a rare condition postoperatively in the general surgical population and is exceptionally uncommon in low American Society of Anesthesiologists status patients undergoing scheduled surgery. Analysis after matching suggests that ARDS development is associated with median drive pressure, fraction inspired oxygen, crystalloid volume, and transfusion.
Details
- Title: Subtitle
- Preoperative and Intraoperative Predictors of Postoperative Acute Respiratory Distress Syndrome in a General Surgical Population
- Creators
- James M BLUM - Received from the Departments of Anesthesiology, Respiratory Therapy, and Surgery, University of Michigan Health System, Ann Arbor, Michigan, United StatesMichael J STENTZ - Received from the Departments of Anesthesiology, Respiratory Therapy, and Surgery, University of Michigan Health System, Ann Arbor, Michigan, United StatesRonald DECHERT - Received from the Departments of Anesthesiology, Respiratory Therapy, and Surgery, University of Michigan Health System, Ann Arbor, Michigan, United StatesElizabeth JEWELL - Received from the Departments of Anesthesiology, Respiratory Therapy, and Surgery, University of Michigan Health System, Ann Arbor, Michigan, United StatesMilo ENGOREN - Received from the Departments of Anesthesiology, Respiratory Therapy, and Surgery, University of Michigan Health System, Ann Arbor, Michigan, United StatesAndrew L ROSENBERG - Received from the Departments of Anesthesiology, Respiratory Therapy, and Surgery, University of Michigan Health System, Ann Arbor, Michigan, United StatesPauline K PARK - Received from the Departments of Anesthesiology, Respiratory Therapy, and Surgery, University of Michigan Health System, Ann Arbor, Michigan, United States
- Resource Type
- Journal article
- Publication Details
- Anesthesiology (Philadelphia), Vol.118(1), pp.19-29
- Publisher
- Lippincott Williams & Wilkins; Hagerstown, MD
- DOI
- 10.1097/ALN.0b013e3182794975
- PMID
- 23221870
- PMCID
- PMC3813014
- ISSN
- 0003-3022
- eISSN
- 1528-1175
- Language
- English
- Date published
- 2013
- Academic Unit
- Anesthesia
- Record Identifier
- 9984013276802771
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