| Alias |
Respiratory distress syndrome, adult respiratory distress syndrome, or
shock lung |
Pump lung, or systemic inflammatory response syndrome to CPB |
| Incidence |
1.5-8.3 cases per 100,000 population per year[33 Luciani GB, Pessotto R, Mazzucco A. Adrenoleukodystrophy presenting as
postperfusion syndrome. N Engl J Med. 1997;336(10):731-2.]
|
0.4-2.0% of the patients[44 Asimakopoulos G, Smith PL, Ratnatunga CP, Taylor KM. Lung injury and
acute respiratory distress syndrome after cardiopulmonary bypass. Ann Thorac Surg.
1999;68(3):1107-15.]
|
| Etiology |
Trauma, operation, stress, shock, infection, inflammation, fat embolism,
massive blood transfusion and drug interaction |
Cardiac operation under CPB |
| Mechanism |
Complement activation and organ neutrophil sequestration |
Complement activation, organ neutrophil sequestration and circulating
endotoxin activation during CPB |
| Pathology |
Alveolar-capillary membrane damage due to direct toxicity, prolonged
hypoperfusion, or direct cellular damage[1313 Mortelliti MP, Manning HL. Acute respiratory distress syndrome. Am Fam
Physician. 2002;65(9):1823-30.]
|
Same |
| Predisposing risk factor |
>65 years old, smoking cigarettes, chronic lung disease and a history of
alcoholism[1414 Wynne R, Botti M. Postoperative pulmonary dysfunction in adults after
cardiac surgery with cardiopulmonary bypass: clinical significance and implications
for practice. Am J Crit Care. 2004;13(5):384-93.]
|
Cardiac and pulmonary ischemia/ reperfusion, hypothermic cardioplegic
arrest and heparinprotamine interactions |
| Clinical manifestation |
Tachypnea, tachycardia and respiratory alkalosis (12-24 hours after onset);
respiratory failure (48 hours) |
Breathing problems, weakness, anorexia, fever and hypoventilation |
| Diagnosis |
Chest radiographs: diffuse interstitial infiltrates to diffuse, fluffy,
alveolar opacities (acute phase) and reticular opacities (fibroproliferative
stage); chest computed tomography: bilateral alveolar opacities (acute
phase) and bilateral reticular opacities, reduced lung volumes and
occasionally large bullae (fibroproliferative stage)[33 Luciani GB, Pessotto R, Mazzucco A. Adrenoleukodystrophy presenting as
postperfusion syndrome. N Engl J Med. 1997;336(10):731-2.]
|
Same |
| Differential diagnosis |
Cardiogenic pulmonary edema |
Postoperative atelectasis |
| Management |
Etiological therapy, ventilatory support, pharmacologic treatment,
extracorporeal membrane oxygenation support, long-term supportive care and
tracheostomy |
Same |
| Subsequent multiple organ failure (%) |
53.4-80[1212 Ge QG, Hou J, Zhou H, Li T, Xu Y. Multiple organ failure induced by
acute respiration distress syndrome: a report of 15 cases. Mod Surg.
2000;6(1):41-4.,1515 Hayes CM. Acute respiratory distress syndrome (ARDS): a close look at a
complication of shock [Accessed Aug 18, 2014]. Available from:
http://www.emsvillage.com/articles/article.cfm?id=647
http://www.emsvillage.com/articles/artic...
]
|
63.2-91.6[88 Yamazaki S, Inamori S, Nakatani T, Suga M. Activated protein C
attenuates cardiopulmonary bypass-induced acute lung injury through the regulation of
neutrophil activation. J Thorac Cardiovasc Surg.
2011;141(5):1246-52.]
|
| Mortality (%) |
67[1616 Reynolds HN, McCunn M, Borg U, Habashi N, Cottingham C, Bar-Lavi Y.
Acute respiratory distress syndrome: estimated incidence and mortality rate in a 5
million-person population base. Crit Care. 1998;2(1):29-34.]
|
50-91.6[88 Yamazaki S, Inamori S, Nakatani T, Suga M. Activated protein C
attenuates cardiopulmonary bypass-induced acute lung injury through the regulation of
neutrophil activation. J Thorac Cardiovasc Surg.
2011;141(5):1246-52.]
|
