title: Intraoperative risk factors for acute respiratory distress syndrome in critically ill patients.
abstract: BACKGROUND
  Risk factors for the development of acute respiratory distress syndrome (ARDS) in the intensive care unit (ICU) include positive fluid balance, high tidal volumes (TVs), high airway pressures, and transfusion of blood products. However, research examining intraoperative factors such as fluid resuscitation, mechanical ventilation strategies, and blood administration on the postoperative development of ARDS is lacking.
  
  
  METHODS
  We assessed patients admitted to the ICU with postoperative hypoxemic respiratory failure requiring mechanical ventilation for the development of ARDS in the first 7 postoperative days using established clinical and radiological criteria. Data on risk factors for ARDS were obtained from the electronic anesthetic and medical records. Logistic regression was used to examine the independent association between fluid resuscitation, TV per ideal body weight, and number of blood products transfused during surgery and the postoperative development of ARDS, adjusting for important clinical covariates.
  
  
  RESULTS
  Of the 89 patients with postoperative respiratory failure, 25 developed ARDS. Compared with those who received <10 mL/kg/h fluid resuscitation in the operating room, patients receiving >20 mL/kg/h fluid resuscitation had a 3.8 times higher adjusted odds of developing ARDS (P = 0.04), and those receiving 10 to 20 mL/kg/h had a 2.4 times higher adjusted odds of developing ARDS (P = 0.14). TV per ideal body weight and the number of blood units transfused were not associated with ARDS development in this study.
  
  
  CONCLUSIONS
  This cohort study provides evidence to suggest a relationship between intraoperative fluid resuscitation and the development of ARDS. Larger prospective trials are required to confirm these findings.
authors.affiliation: Department of Anesthesiology, Division of Critical Care, Vanderbilt University Medical Center, 526 MAB, 1211 21st Ave. South, Nashville, TN 37212, USA. christopher.hughes@vanderbilt.ed
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Hughes
authors.forename: Lisa
authors.initials: L
authors.lastname: Weavind
authors.forename: Arna
authors.initials: A
authors.lastname: Banerjee
authors.forename: Nathaniel D
authors.initials: ND
authors.lastname: Mercaldo
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Schildcrout
authors.forename: Pratik P
authors.initials: PP
authors.lastname: Pandharipande
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D016638:Critical Illness; D019992:Databases as Topic; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects; D006801:Humans; D007430:Intraoperative Care; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology*; D012121:Respiration, Artificial / Q000009:adverse effects; D012128:Respiratory Distress Syndrome / Q000209:etiology*; D012151:Resuscitation / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D065227:Transfusion Reaction