Adult respiratory distress syndrome following cardiopulmonary bypass: incidence, prophylaxis and management.
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.
Kaul
T K
TK
Department of Cardiac Surgery, Baptist Medical Center, Birmingham, Alabama 35211, USA.
Fields
B L
BL
Riggins
L S
LS
Wyatt
D A
DA
Jones
C R
CR
Nagle
D
D
D000368:Aged; D000975:Antioxidants / Q000627:therapeutic use; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D003169:Complement Inactivator Proteins / Q000627:therapeutic use; D001026:Coronary Artery Bypass / Q000009:adverse effects; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D016896:Treatment Outcome; D014462:Ultrafiltration