ARDS after Cardiac Surgery: Is It a Problem, a Problem of Definition, or Both?

Piquilloud, Lise

doi:10.1159/000498948

Cited by 4 publications

(4 citation statements)

References 10 publications

(11 reference statements)

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“…Pulmonary complications can be very common after cardiac surgery, and our study found that the incidence of pneumonia after high-risk cardiac surgery was as high as 17.9%, among which emergency surgery, infective endocarditis, and aneurysm accounted for a higher proportion, which was consistent with Kogan's study (1). Pulmonary complications after cardiac surgery are associated with high mortality (1,10), and our study confirmed that the in-hospital mortality of patients with pneumonia was significantly increased in comparison with nonpneumonia patients (9.4 vs. 1.7%). Lung physiotherapy was necessary for post-cardiac surgery patients, although there was always a concern about its impact on bleeding and wound healing.…”

Section: Discussionsupporting

confidence: 89%

Role of Intensified Lung Physiotherapy Bundle on the Occurrence of Pneumonia After Cardiac Surgery

et al. 2022

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ObjectiveThe role of intensified lung physiotherapy bundle after cardiac surgery was investigated.MethodsA before- and after-surgery comparison was conducted between the study from January 1, 2018 to December 31, 2019 (control group), when traditional lung physiotherapy bundle was used, and from January 1, 2020 to May 1, 2021 (study group), when the intensified bundle was used. The baseline data, clinical features, incidence of postoperative pneumonia, and prognoses of all the enrolled cardiac surgery patients were analyzed.ResultsIn accordance with the study criteria, 358 patients were enrolled. The incidence rate of postoperative pneumonia was significantly lower in the study group than in the control group (14.2 vs. 22.7%, P = 0.037), as was in-hospital mortality (1.5 vs. 5.2%, P = 0.043). Patients receiving the intensified lung physiotherapy bundle had much shorter mechanical ventilation time (92 vs. 144 h, P < 0.0001), much shorter intensive care unit (ICU) stay (5 vs. 7 days, P < 0.001), and much shorter hospital stay (17 vs. 18.5 days, P = 0.022). The intensified lung physiotherapy bundle was an independent protective factor enabling the reduced occurrence of pneumonia (P = 0.007). On univariate analysis, this bundle significantly improved in-hospital mortality (P = 0.043).ConclusionsOur intensified lung physiotherapy bundle potentially reduces the rate of postoperative pneumonia after cardiac surgery. This bundle might also be adopted as a suitable reference guide for the prevention of other postoperative pulmonary complications.

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Section: Discussionsupporting

confidence: 89%

Role of Intensified Lung Physiotherapy Bundle on the Occurrence of Pneumonia After Cardiac Surgery

et al. 2022

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“…Postoperative ARDS after cardiac surgery with CPB is a rare but fatal complication that prolongs the duration of mechanical ventilation and hospital stay and even leads to death [12]. CPB is a widely known risk factor for the occurrence of postoperative ARDS [8].…”

Section: Discussionmentioning

confidence: 99%

Association between cardiopulmonary bypass time and clinical outcomes among patients with acute respiratory distress syndrome after cardiac surgery

Liu

Huang

et al. 2023

Preprint

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Background:Cardiopulmonary bypass (CPB) can lead to lung injury and even acute respiratory distress syndrome (ARDS) through triggering systemic inflammatory response. The objective of this study was to investigate the impact of CPB time on clinical outcomes in patients with ARDS after cardiac surgery. Methods:Totally, patients with ARDS after cardiac surgery in Beijing Anzhen Hospital from January 2005 to December 2015 were retrospectively included and were further divided into three categories according to CPB time during operation. The primary endpoints were the ICU mortality and in-hospital mortality, and ICU and hospital stay. Restricted cubic spline (RCS), logistic regression, cox regression model, and receiver operating characteristic (ROC) curve were adopted to explore the relationship between CPB time and clinical endpoints. Results: Of the 54217 patients who underwent cardiac surgery during the above period, 210 patients developed ARDS after surgery and were finally included. The ICU mortality and in-hospital mortality were 21.0% and 41.9% in all ARDS patients after cardiac surgery respectively. Patients in category3 (CPB time ≥ 173 minutes) had longer ICU stay (P=0.011), higher ICU (P<0.001) mortality and in-hospital(P=0.002) mortality compared with those in category1 (CPB=0). For each ten minutes increment in CPB time, the hazards of a worse outcome increased by 13.3% for ICU mortality and 9.3% for in-hospital mortality after adjusting for potential factors.ROC curves showed CPB time presented more satisfactory power to predict mortality compared with APCHEII score. The optimal cut-off value of CPB time were 160.5 minutes for ICU mortality and in-hospital mortality. Conclusion: Our findings firstly revealed the quantitative relationship between CPB time and clinical outcomes in patients with ARDS after cardiac surgery. Longer time of CPB was associated with poorer clinical outcomes, and could be served as an indicator to predict short-term mortality in patients with ARDS after cardiac surgery.

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“…Postoperative ARDS after cardiac surgery with CPB is a rare but fatal complication that prolongs the duration of mechanical ventilation and hospital stay and even leads to death [ 12 ]. CPB is a widely known risk factor for the occurrence of postoperative ARDS [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Association between cardiopulmonary bypass time and mortality among patients with acute respiratory distress syndrome after cardiac surgery

Hu,

liu,

Huang

et al. 2023

BMC Cardiovasc Disord

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Background Cardiopulmonary bypass (CPB) can lead to lung injury and even acute respiratory distress syndrome (ARDS) through triggering systemic inflammatory response. The objective of this study was to investigate the impact of CPB time on clinical outcomes in patients with ARDS after cardiac surgery. Methods Totally, patients with ARDS after cardiac surgery in Beijing Anzhen Hospital from January 2005 to December 2015 were retrospectively included and were further divided into three groups according to the median time of CPB. The primary endpoints were the ICU mortality and in-hospital mortality, and ICU and hospital stay. Restricted cubic spline (RCS), logistic regression, cox regression model, and receiver operating characteristic (ROC) curve were adopted to explore the relationship between CPB time and clinical endpoints. Results A total of 54,217 patients underwent cardiac surgery during the above period, of whom 210 patients developed ARDS after surgery and were finally included. The ICU mortality and in-hospital mortality were 21.0% and 41.9% in all ARDS patients after cardiac surgery respectively. Patients with long CPB time (CPB time ≥ 173 min) had longer length of ICU stay (P = 0.011), higher ICU (P < 0.001) mortality and in-hospital(P = 0.002) mortality compared with non-CPB patients (CPB = 0). For each ten minutes increment in CPB time, the hazards of a worse outcome increased by 13.3% for ICU mortality and 9.3% for in-hospital mortality after adjusting for potential factors. ROC curves showed CPB time presented more satisfactory power to predict mortality compared with APCHEII score. The optimal cut-off value of CPB time were 160.5 min for ICU mortality and in-hospital mortality. Conclusions Our findings demonstrated the significant prognostic value of CPB time in patients with ARDS after cardiac surgery. Longer time of CPB was associated with poorer clinical outcomes, and could be served as an indicator to predict short-term mortality in patients with ARDS after cardiac surgery.

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ARDS after Cardiac Surgery: Is It a Problem, a Problem of Definition, or Both?

Cited by 4 publications

References 10 publications

Role of Intensified Lung Physiotherapy Bundle on the Occurrence of Pneumonia After Cardiac Surgery

Role of Intensified Lung Physiotherapy Bundle on the Occurrence of Pneumonia After Cardiac Surgery

Association between cardiopulmonary bypass time and clinical outcomes among patients with acute respiratory distress syndrome after cardiac surgery

Association between cardiopulmonary bypass time and mortality among patients with acute respiratory distress syndrome after cardiac surgery

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