Acute Respiratory Distress Syndrome in the Perioperative Period of Cardiac Surgery: Predictors, Diagnosis, Prognosis, Management Options, and Future Directions

Abstract

Acute respiratory distress syndrome (ARDS) after cardiac surgery is reported with a widely variable incidence (from 0.4%-8.1%). Cardiac surgery patients usually are affected by several comorbidities, and the development of ARDS significantly affects their prognosis. Herein, evidence regarding the current knowledge in the field of ARDS in cardiac surgery is summarized and is followed by a discussion on therapeutic strategies, with consideration of the peculiar aspects of ARDS after cardiac surgery. Prevention of lung injury during and after cardiac surgery remains pivotal. Blood product transfusions should be limited to minimize the risk, among others, of lung injury. Open lung ventilation strategy (ventilation during cardiopulmonary bypass, recruitment maneuvers, and the use of moderate positive end-expiratory pressure) has not shown clear benefits on clinical outcomes. Clinicians in the intraoperative and postoperative ventilatory settings carefully should consider the effect of mechanical ventilation on cardiac function (in particular the right ventricle). Driving pressure should be kept as low as possible, with low tidal volumes (on predicted body weight) and optimal positive end-expiratory pressure. Regarding the therapeutic options, management of ARDS after cardiac surgery challenges the common approach. For instance, prone positioning may not be easily applicable after cardiac surgery. In patients who develop ARDS after cardiac surgery, extracorporeal techniques may be a valid choice in experienced hands. The use of neuromuscular blockade and inhaled nitric oxide can be considered on a case-by-case basis, whereas the use of aggressive lung recruitment and oscillatory ventilation should be discouraged.

Novel models for early prediction and prevention of acute respiratory distress syndrome in patients following hepatectomy: A clinical translational study based on 1,032 patients

“…According to relevant studies, the incidence rate of ARDS following cardiac surgery ranges from 0.4 to 8.1% ( 17 , 28 , 36 ). Daryl et al reported a 2.6% (113/4,366) incidence of ALI and ARDS in patients undergoing high-risk surgery, and 3.3% and 22% for patients undergoing spine surgery and high-risk vascular surgery, respectively ( 17 , 19 ).…”

Random Forest-Based Prediction of Acute Respiratory Distress Syndrome in Patients Undergoing Cardiac Surgery

“…In fact, ARDS has been reported in 0.4%-8.1% of patients after cardiac surgery, which is associated with increased in-hospital mortality and hospital costs. 9,10 Of the 1011 patients included in the present study, a total of 53 patients suffered ARDS episodes within 7 days after surgery. The incidence of postoperative ARDS was 5.24%, which is consistent with that reported in previous literature.…”

Effect of preoperative pulse oximeter oxygen saturation on postoperative prolonged mechanical ventilation in patients with tetralogy of Fallot

“…Commonly used parameter to grade the severity of pediatric ARDS is oxygenation index [OI, OI = (FiO 2 × Paw × 100)/PaO 2 ] ( 24 , 25 ). In recent years, improvement in CPB technology has increased the safety of surgery for congenital heart diseases; still, postoperative ARDS remains a life-threatening complication after cardiac surgery in children ( 26 – 28 ). According to domestic and international research, incidence of ARDS in pediatric intensive care unit is 1–4%, and the mortality rate is as high as 22–65% ( 29 ).…”