• Hemang Yadav, Adam Bartley, Sheila Keating, Laurie A Meade, Philip J Norris, Rickey E Carter, Ognjen Gajic, and Daryl J Kor.
• Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota. yadav.hemang@mayo.edu.
• Respir Care. 2018 Nov 1; 63 (11): 1331-1340.

BackgroundPatients who develop ARDS from medical or traumatic causes typically present after the inciting event has already occurred. Postoperative ARDS is unique in that the inciting insult potentially responsible for ARDS is known ahead of time, which provides an opportunity to study the early pathophysiology of ARDS. The objective of this study was to better understand the early pathophysiology of postoperative ARDS through a temporal analysis of key biomarkers of interest.MethodsWe performed a case-control study of adults undergoing elective thoracic, aortic vascular, or cardiac surgery, which placed them at increased risk of developing postoperative ARDS. Biomarkers were measured at baseline, 2 h, and 6 h after the key intraoperative event believed to be responsible for ARDS.ResultsOf the 467 subjects enrolled, 26 developed ARDS and were matched to non-ARDS controls 1:2 based on age, sex, surgical procedure, and surgical lung injury prediction score. Patients with ARDS were more likely to have lower preoperative albumin (P = .029), longer surgery (P = .007), larger amounts of intraoperative fluid (P = .036), and higher intraoperative peak inspiratory pressures (P = .006). Baseline plasminogen activator inhibitor-1 levels were higher in the ARDS group (P = .03). Changes in postoperative biomarker levels from baseline were greater in the ARDS group for interleukin-8 (baseline to 6 h, P = .02) and surfactant protein-D (baseline to 2 h, P = .009).ConclusionsOur study supported the hypothesis that dysregulated coagulation, inflammation, and epithelial injury are pathophysiologic features of early postoperative ARDS. Interleukin-8, plasminogen activator-1, and surfactant protein-D may help predict development of postoperative ARDS.Copyright © 2018 by Daedalus Enterprises.

40 keywords...

hide…