Acute Respiratory Distress Syndrome after Gastrointestinal Surgery

作者：Horiuchi Atsushi^*; Watanabe Yuji; Sato Kouichi; Yamamoto Yuji; Sugishita Hiroki; Kikuchi Satoshi; Matsuno Yusuke; Kuwabara Jun; Kameoka Kazuhiro

来源：Hepato-Gastroenterology, 2011, 58(110): 1628-1631.

• Acute respiratory distress syndrome
• Gastrointestinal operation
• Management
• Prognostic factors

Background/Aims: Acute respiratory distress syndrome CARDS) occasionally occurs after gastrointestinal surgery involving severe inflammation such as diffuse peritonitis. Management of this condition has been difficult and effective therapies have not yet been established. In the present study the management for ARDS after gastrointestinal surgery was evaluated.
Methodology: A total of 15 patients developed ARDS after gastrointestinal operations performed in our institution. The mean patient age was 75.4 +/- 11.1 years. Onset of ARDS occurred <= 24 hours postoperatively in 12 patients and 3-11 days postoperatively in 3 patients. Treatment for ARDS comprised continuous hemodiafiltration (CHDF), high-dose glucocorticoid therapy or administration of a neutrophil elastase inhibitor (sivelestat).
Results: Four patients died 3-45 days after onset of ARDS (mortality rate, 26.6%). CHDF was performed in 12 patients, 8 patients received high-dose glucocorticoid therapy and 11 patients received sivelestat. No differences in severity scores and clinical data were noted between survivors and non-survivors. PaO(2)/FiO(2) ratio was significantly lower in non-survivors than in survivors from 5 days after starting treatment, whereas no difference was apparent at the onset of ARDS.
Conclusions: Multimodal therapies for ARDS were effective. Longitudinal fluctuation in PaO(2)/FiO(2) ratio after starting treatment appears to offer a prognostic factor for ARDS.

• 出版日期2011-10