Acute Respiratory Distress Syndrome Diagnosis after Coronary Artery Bypass: Comparison between Diagnostic Criteria and Clinical Picture
Acute Respiratory Distress Syndrome (ARDS) is a potential complication of cardiac surgery, given that patients undergoing CABG frequently have hypoxemia and pulmonary dysfunction during initial hours after surgery. Thus, ARDS criteria in these patients are more likely to be positive while these criteria may not match the patient`s clinical picture. We aimed to investigate frequency of rapid onset hypoxemia in Pressure of Arterial Oxygen to Fractional Inspired Oxygen Concentration (PaO2/FiO2) less than 200 and diffuse pulmonary infiltrates as two diagnostic criteria forwards and compared these criteria with the clinical picture of the patients after Coronary Artery Bypass Graft (CABG) in this study. The study was prospective case series which carried out in about six months. All patients admitted to intensive care unit of Tehran Heart Center, who had undergone CABG on cardiopulmonary pump (CPB) recruited in the study. After considering inclusion criteria, age, sex, duration of intubation, arterial blood gas and chest radiography, on 24 hours and 48 hours after admission to the ICU were recorded. Then, patients with rapid onset of hypoxemia (PaO2/FiO2≤200mmHg) and diffuse pulmonary infiltrates and without sign or symptoms of obvious heart failure (probable positive ARDS cases) criteria were recorded and comparison between these probable positive cases with clinician`s clinical diagnosis (blinded to the study) was performed. In this study, a total of 300 patients after on-pump coronary artery bypass surgery were included. Postoperatively, 2 (0.66 %) in the 24 hours and 4 (1.33%) patients in 48 hours after surgery were positive for the two ARDS criteria according to the checklists, but; nobody had saved persistently ARDS criteria persistently during 48 hours after surgery. At the same time, clinician did not report any case of ARDS among 300 patients. In this study patients with ARDS criteria had no significant differences in age (P.value=0.937) and sex (P.value=0.533). Duration of intubation in patients with ARDS (14.26 ± 4.25 hours) in the first 48 hours was higher but not statistically different from the group without ARDS (11.60 ± 5.45 hours) (P.value=0.236). ARDS diagnosis based on rapid onset of hypoxemia (PaO2/FiO2≤200 mmHg) and diffuse pulmonary infiltrates and without signs or symptoms of obvious heart failure criteria in patients undergoing CABG could lead to overdiagnosis or misdiagnosis in less than 24 hours follow up. We recommend following patients for more than 24 hours and revise the current ARDS criteria for CABG patients.
Ashbaugh DG, Bigelow DB, Petty TL, et al. Acute respiratory distress in adults. Lancet 1967;2(7511):319-23.
Murray JF. The staff of the Division of Lung Diseases, National Heart, Lung and Blood Institute (1977) Mechanisms of acute respiratory failure. Am Rev Respir Dis 1977;115:1071-8.
Messent M, Sullivan K, Keogh BF, et al. Adult respiratory distress syndrome following cardiopulmonary bypass: incidence and prediction. Anaesthesia 1992;47(3):267-8.
Digiovine B, Chenoweth C, Watts C, et al. The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J Respir Crit Care Med 1999;160(3):976-81.
Milberg JA, Davis DR, Steinberg KP, et al. Improved survival of patients with acute respiratory distress syndrome (ARDS): 1983-1993. JAMA 1995;273(4):306-9.
Kolff WJ, Effler DB, Groves LK, et al. Pulmonary Complications of Open Heart Operations. Their Pathogenesis and Avoidance. Cleve Clin Q 1958;25(2):65-83.
Ead H. Post-anesthesia tracheal extubation. Dynamics 2004;15(3):20-5.
Póvoa P. Serum markers in community-acquired pneumonia and ventilator-associated pneumonia. Curr Opin Infect Dis 2008;21(2):157-62.
Goldman L, Ausiello D, editors. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders; 2008.
Levy BD, Choi AMK. Acute Respiratory Distress Syndrome. In: Lango DL, Kasper DL, Jameson JL, et al, editors. Harrison's Principles of Internal Medicine. 18th ed. Philadelphia, Pa: McGraw-Hill 2012; p. 2205-7.
Milot J, Perron J, Lacasse Y, et al. Incidence and Predictors of ARDS after Cardiac Surgery. Chest 2001;119(3):884-8.
Christenson JT, Aeberhard JM, Badel P, et al. Adult respiratory distress syndrome after cardiac surgery. Cardiovasc Surg 1996;4(1):15-21.
Spivack SD, Shinozaki T, Albertini JJ, et al. Preoperative Prediction of Postoperative Respiratory Outcome: Coronary Artery Bypass Grafting. Chest 1996;109(5):1222-30.
Branca P, McGaw P, Light RW. Factors associated with prolonged mechanical ventilation following coronary artery bypass surgery. Chest 2001;119(2):537-46.
Cheng DCH, Karski J, Peniston C, et al. Early tracheal extubation after coronary artery bypass graft surgery reduces costs and improves resource use. Anesthesiology 1996;85(6):1300-10.
Kollef MH, Wragge T, Pasque C. Determinants of Mortality and Multiorgan Dysfunction in Cardiac Surgery Patients Requiring Prolonged Mechanical Ventilation. Chest 1995;107(5):1395-401.
Anderson RJ, O’Brien M, Mawhinney S, et al. Renal failure predisposes patients to adverse outcome after coronary artery bypass surgery: VA Cooperative study. Kidney Int 1999;55(3):1057-62.
Kopko PM, Holland PV. Transfusion-related acute lung injury. Br J Haematol 1999;105(2):322-9.
Popovsky MA. Transfusion and lung injury. Transfus Clin Biol 2001;8(3):272-7.
Silliman CC, Paterson AJ, Dickey WO, et al. The association of biologically active lipids with the development of transfusion- related acute lung injury: a retrospective study. Transfusion 1997;37(7):719-26.
|Issue||Vol 53, No 1 (2015)|
|Acute Respiratory Distress Syndrome Coronary Artery Bypass Graft cardiopulmonary pump|
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