Postoperative acute respiratory distress syndrome in patients with previous exposure to bleomycin.
OBJECTIVE
To determine the incidence and risk factors for postoperative acute respiratory distress syndrome (ARDS) in a large cohort of bleomycin-exposed patients undergoing surgery with general endotracheal anesthesia.


METHODS
From a Mayo Clinic cancer registry, we identified patients who had received systemic bleomycin and then underwent a major surgical procedure that required more than 1 hour of general anesthesia from January 1, 2000, through August 30, 2012. Heart, lung, and liver transplantations were excluded. Postoperative ARDS (within 7 days after surgery) was defined according to the Berlin criteria.


RESULTS
We identified 316 patients who underwent 541 major surgical procedures. Only 7 patients met the criteria for postoperative ARDS; all were white men, and 6 were current or former smokers. On univariate analysis, we observed an increased risk of postoperative ARDS in patients who were current or former smokers. Furthermore, significantly greater crystalloid and colloid administration was found in patients with postoperative ARDS. We also observed a trend toward longer surgical duration and red blood cell transfusion in patients with postoperative ARDS, although this finding was not significant. Intraoperative fraction of inspired oxygen was not associated with postoperative ARDS. In bleomycin-exposed patients, the incidence of postoperative ARDS after major surgery with general anesthesia is approximately 1.3% (95% CI, 0.6%-2.6%). For first major procedures after bleomycin therapy, the incidence is 1.9% (95% CI, 0.9%-4.1%).


CONCLUSIONS
The risk of postoperative ARDS in patients exposed to systemic bleomycin appears to be lower than expected. Smoking status may be an important factor that modifies the risk of postoperative ARDS in these patients.
Department of Anesthesiology, Mayo Clinic, Rochester, MN.
Benjamin M
BM
Aakre
Stony Brook University School of Medicine, Stony Brook, NY.
Richard I
RI
Efem
Department of Respiratory Care, Mayo Clinic, Rochester, MN.
Gregory A
GA
Wilson
Department of Anesthesiology, Mayo Clinic, Rochester, MN.
Daryl J
DJ
Kor
Department of Anesthesiology, Mayo Clinic, Rochester, MN. Electronic address: eisenach.john@mayo.edu.
John H
JH
Eisenach
D000328:Adult; D000768:Anesthesia, General / Q000706:statistics & numerical data; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D001761:Bleomycin / Q000009:adverse effects*; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000139:chemically induced*; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000139:chemically induced*; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects
D000903:Antibiotics, Antineoplastic; D001761:Bleomycin
ARDS; Fio(2); ICU; MCLSS/DDQB; Mayo Clinic Life Sciences Services/Data Discovery Query Builder; PEEP; acute respiratory distress syndrome; fraction of inspired oxygen; intensive care unit; positive end expiratory pressure