title: Acute respiratory distress syndrome after gastrointestinal surgery.
abstract: OBJECTIVE
  Acute respiratory distress syndrome (ARDS) occasionally occurs after gastrointestinal surgery involving severe inflammation such as diffuse peritonitis. Management of this condition has been difficult and effective therapies have not yet been established. In the present study the management for ARDS after gastrointestinal surgery was evaluated.
  
  
  METHODS
  A total of 15 patients developed ARDS after gastrointestinal operations performed in our institution. The mean patient age was 75.4±11.1 years. Onset of ARDS occurred ≤24 hours postoperatively in 12 patients and 3- 11 days postoperatively in 3 patients. Treatment for ARDS comprised continuous hemodiafiltration (CHDF), high-dose glucocorticoid therapy or administration of a neutrophil elastase inhibitor (sivelestat).
  
  
  RESULTS
  Four patients died 3-45 days after onset of ARDS (mortality rate, 26.6%). CHDF was performed in 12 patients, 8 patients received highdose glucocorticoid therapy and 11 patients received sivelestat. No differences in severity scores and clinical data were noted between survivors and non-survivors. PaO2/FiO2 ratio was significantly lower in non-survivors than in survivors from 5 days after starting treatment, whereas no difference was apparent at the onset of ARDS.
  
  
  CONCLUSIONS
  Multimodal therapies for ARDS were effective. Longitudinal fluctuation in PaO2/ FiO2 ratio after starting treatment appears to offer a prognostic factor for ARDS.
authors.affiliation: Department of Surgery, Ehime University School of Medicine, Ehime, Japan. atsushi@m.ehime-u.ac.jp
authors.forename: Atsushi
authors.initials: A
authors.lastname: Horiuchi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Kouichi
authors.initials: K
authors.lastname: Sato
authors.forename: Yuji
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sugishita
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kikuchi
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Matsuno
authors.forename: Jun
authors.initials: J
authors.lastname: Kuwabara
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kameoka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D013505:Digestive System Surgical Procedures; D005260:Female; D005767:Gastrointestinal Diseases / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D012307:Risk Factors