title: The impact of the acute respiratory distress syndrome on outcome after oesophagectomy.
abstract: BACKGROUND
  The Acute Respiratory Distress Syndrome (ARDS) is a serious complication of major surgery and consumes substantial healthcare resources. Oesophagectomy is associated with high rates of ARDS. The aim of this study was to characterize patients and identify risk factors for developing ARDS after oesophagectomy.
  
  
  METHODS
  A secondary analysis of data from 331 patients gathered during the Beta Agonists Lung Injury Prevention Trial was undertaken. Characteristics and outcomes of patients with early (first 72 h postoperatively) and late (after 72 h) ARDS were determined. Linear and multivariate regression analysis was used to study the differences between early and late ARDS and identify risk factors.
  
  
  RESULTS
  ARDS was associated with more non-respiratory organ failure (early 44.1%, late 75.0%, no ARDS 27.6% P<0.001), longer ICU stay (mean early 12.1, late 20.2, no ARDS 7.3 days P<0.001) and longer hospital stay (mean early 18.1, late 24.5, no ARDS 14.2 days P<0.001) but no difference in mortality or quality of life. Older patients (OR 1.06 (1.00 to 1.13), P=0.045) and those with mid-oesophageal tumours (OR 7.48 (1.62-34.5), P=0.010) had a higher risk for ARDS.
  
  
  CONCLUSIONS
  Early and late ARDS after oesophagectomy increases intensive care and hospital length of stay. Given the high incidence of ARDS, cohorts of patients undergoing oesophagectomy may be useful as models for studies investigating ARDS prevention and treatment. Further investigations aimed at reducing perioperative ARDS are warranted.
authors.affiliation: Institute for Inflammation and Ageing, University of Birmingham, Queen Elizabeth Hospital Birmingham, B15 2TT, UK.
authors.forename: P
authors.initials: P
authors.lastname: Howells
authors.affiliation: Institute for Inflammation and Ageing, University of Birmingham, Queen Elizabeth Hospital Birmingham, B15 2TT, UK.
authors.forename: D
authors.initials: D
authors.lastname: Thickett
authors.affiliation: Mathematics and Statistics Help Centre, University of Sheffield, Sheffield S10 2HL, UK.
authors.forename: C
authors.initials: C
authors.lastname: Knox
authors.affiliation: Department of Intensive Care Medicine, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK.
authors.forename: D
authors.initials: D
authors.lastname: Park
authors.affiliation: Institute for Inflammation and Ageing, University of Birmingham, Queen Elizabeth Hospital Birmingham, B15 2TT, UK Department of Intensive Care Medicine, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK.
authors.forename: F
authors.initials: F
authors.lastname: Gao
authors.affiliation: Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham B15 2TT, UK.
authors.forename: O
authors.initials: O
authors.lastname: Tucker
authors.affiliation: Department of Anaesthesia and Critical Care Medicine, University Hospitals Birmingham, Queen Elizabeth Hospital, B15 2TT UK.
authors.forename: T
authors.initials: T
authors.lastname: Whitehouse
authors.affiliation: Wellcome-Wolfson Institute for Experimental Medicine, Queen's University of Belfast, 97 Lisburn Road, Belfast BT9 7AE, UK Department of Intensive Care Medicine, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, UK.
authors.forename: D
authors.initials: D
authors.lastname: McAuley
authors.affiliation: Department of Intensive Care Medicine, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK g.d.perkins@warwick.ac.uk.
authors.forename: G
authors.initials: G
authors.lastname: Perkins
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012128:Respiratory Distress Syndrome / Q000209:etiology*; D016896:Treatment Outcome
keywords: oesophageal neoplasms; oesophagectomy; one-lung ventilation; respiratory distress syndrome, adult