Acute respiratory distress syndrome is a serious complication of microwave coagulation therapy for liver tumors.
BACKGROUND
Acute respiratory distress syndrome (ARDS), also known as noncardiogenic pulmonary edema, is a severe complication in cirrhotic patients undergoing microwave coagulation therapy (MCT) for liver tumor. In this study, cirrhotic patients with ARDS after MCT were compared with others without ARDS.


METHODS
Four patients with ARDS after open MCT and 17 other patients without ARDS were compared in terms of preoperative status, intraoperative findings, and postoperative management.


RESULTS
The preoperative Child-Pugh score and intraoperative amount of irradiation showed no significant differences were observed. The postoperative cumulative water balance until the third day was 1,692 +/- 1,315 mL for the ARDS group and 165 +/- 1,524 mL for the non-ARDS group (P = .079), and by the fourth day the respective values were 1,992 +/- 1,585 mL and 66 +/- 1,685 mL, showing a significant difference (P = .049). The postoperative cumulative sodium administration until the third day was 510 +/- 132 mEq for the ARDS group and 362 +/- 122 mEq for the non-ARDS group with a significant difference (P = .044), and by the fourth day the respective values were 642 +/- 141 mEq and 477 +/- 160 mEq (P = .073). Of the 17 patients in the non-ARDS group, 6 were given aldosterone antagonist until the fourth postoperative day, but it was not administered to any of the patients in the ARDS group.


CONCLUSIONS
The water balance and sodium administration have to be closely monitored to prevent cirrhotic patients undergoing MCT from developing ARDS. Aldosterone antagonist appears to be useful for the prevention of ARDS.
Ajisaka
Hideyuki
H
Department of Emergency and Critical Care Medicine, Graduate School of Medical Science, Kanazawa University, Takara-machi 13-1, Kanazawa, Japan. ajihide@yahoo.co.jp
Miwa
Koichi
K
D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D004564:Electrocoagulation / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008872:Microwaves / Q000009:adverse effects*; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D011182:Postoperative Care; D011184:Postoperative Period; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000517:prevention & control; D012964:Sodium / Q000008:administration & dosage; D014882:Water-Electrolyte Balance
D000451:Mineralocorticoid Receptor Antagonists; D012964:Sodium