Risk factor analysis of postoperative acute respiratory distress syndrome in valvular heart surgery

• Published in: Journal of critical care 2016-02, Vol.31 (1), p.139-143
• Main Authors: Chen, Shao-Wei, MD, Chang, Chih-Hsiang, MD, Chu, Pao-Hsien, MD, Chen, Tien-Hsing, MD, Wu, Victor Chien-Chia, MD, Huang, Yao-Kuang, MD, Liao, Chien-Hung, MD, Wang, Shang-Yu, MD, Lin, Pyng-Jing, MD, Tsai, Feng-Chun, MD
• Format: Article
• Language: English
• Subjects: Acute respiratory distress syndrome; Aged; Cardiac Surgical Procedures - adverse effects; Cardiology; Clinical outcomes; Critical Care; Female; Heart surgery; Heart Valves - surgery; Hospital Mortality; Humans; Incidence; Male; Middle Aged; Mortality; Multivariate Analysis; Odds Ratio; Respiratory distress syndrome; Respiratory Distress Syndrome, Adult - epidemiology; Respiratory Distress Syndrome, Adult - etiology; Respiratory Distress Syndrome, Adult - mortality; Retrospective Studies; Risk Assessment; Risk Factors; Taiwan - epidemiology; Valvular heart surgery
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2015.11.002

Abstract Purpose The aim of this study is to investigate the incidence, severity, and outcome of postoperative acute respiratory distress syndrome (ARDS), according to the Berlin definition, in isolated valvular heart surgery. The preoperative and perioperative predisposing factors of this complication were also identified. Methods A retrospective chart review was conducted on 457 patients who underwent isolated valvular heart surgery between January 2010 and December 2012. Clinical characteristics and outcomes were collected. The primary outcome was postoperative ARDS, according to the 2012 Berlin definition for ARDS. Results A total of 37 patients (8.1%) developed postoperative ARDS, with a mortality rate of 29.7%. The multivariate analysis identified that age (odds ratios [ORs], 1.067, P ≤ .001), liver cirrhosis (OR, 7.159; P = .001), massive blood transfusion (OR, 2.980; P = .005), and tricuspid valve replacement (OR, 5.197; P = .012) were independent risk factors of postoperative ARDS. Furthermore, we have determined that the increased severity stages of ARDS were associated with decreased postoperative survival. Conclusions In conclusion, postoperative ARDS, according to Berlin definition, in valvular surgery, was associated with high in-hospital mortality. The severity of ARDS was associated with patient midterm mortality. In multivariate analysis, age, liver cirrhosis, massive blood transfusion, and tricuspid valve replacement were identified as independent risk factors of ARDS.