title: Intraoperative maintenance of tissue perfusion prevents ARDS. Adult Respiratory Distress Syndrome.
abstract: Patients undergoing prolonged, complex oncological surgery are at increased risk of developing the adult respiratory distress syndrome (ARDS) and other organ failures. Our hypothesis is that maintaining adequate tissue perfusion and oxygenation may prevent tissue hypoxia and acidosis in pulmonary, peripheral, and splanchnic microcirculations. Experimental evidence suggests that the hypoxic, acidotic endothelium stimulates the release of cytokines, kinins, and other mediators. We developed and tested an intraoperative protocol for surgical patients likely to develop ARDS and organ dysfunction; the protocol focuses on the intraoperative period but is not limited to this time. Nitroglycerin and fluids were used to maintain tissue perfusion and prevent tissue hypoxia as reflected by transcutaneous oxygen tension values. In 155 high-risk patients, none developed ARDS. We conclude that maintenance of tissue perfusion and oxygenation in high-risk surgical patients decreases the incidence of ARDS.
authors.affiliation: Department of Anesthesiology, University of Southern California School of Medicine, Los Angeles, USA.
authors.forename: D
authors.initials: D
authors.lastname: Thangathurai
authors.forename: C
authors.initials: C
authors.lastname: Charbonnet
authors.forename: C C
authors.initials: CC
authors.lastname: Wo
authors.forename: W C
authors.initials: WC
authors.lastname: Shoemaker
authors.forename: M S
authors.initials: MS
authors.lastname: Mikhail
authors.forename: P
authors.initials: P
authors.lastname: Roffey
authors.forename: P
authors.initials: P
authors.lastname: Roessler
authors.forename: K
authors.initials: K
authors.lastname: Kuchta
authors.forename: V
authors.initials: V
authors.lastname: Zelman
authors.forename: T R
authors.initials: TR
authors.lastname: DeMeester
authors.forename: R
authors.initials: R
authors.lastname: Katz
mesh_terms: D000328:Adult; D000368:Aged; D005440:Fluid Therapy; D006439:Hemodynamics; D006801:Humans; D007430:Intraoperative Care; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D005996:Nitroglycerin / Q000008:administration & dosage*; D010100:Oxygen / Q000097:blood*; D011183:Postoperative Complications / Q000517:prevention & control*; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000503:physiopathology / Q000517:prevention & control*; D012307:Risk Factors; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin; D010100:Oxygen