Rong Lisa Q, Di Franco Antonino, Gaudino Mario
Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA.
Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
J Thorac Dis. 2016 Oct;8(10):E1177-E1186. doi: 10.21037/jtd.2016.10.74.
Acute respiratory distress syndrome (ARDS) is a leading cause of postoperative respiratory failure, with a mortality rate approaching 40% in the general population and 80% in the subset of patients undergoing cardiac surgery. The increased risk of ARDS in these patients has traditionally been associated with the use of cardiopulmonary bypass (CPB), the need for blood product transfusions, large volume shifts, mechanical ventilation and direct surgical insult. Indeed, the impact of ARDS in the cardiac population is substantial, affecting not only survival but also in-hospital length of stay and long-term physical and psychological morbidity. No patient undergoing cardiac surgery can be considered ARDS risk-free. Early identification of those at higher risk is crucial to warrant the adoption of both surgical and non-surgical specific preventative strategies. The present review focuses on epidemiology, risk assessment, pathophysiology, prevention and management of ARDS in the specific setting of patients undergoing cardiac surgery.
急性呼吸窘迫综合征（ARDS）是术后呼吸衰竭的主要原因，在普通人群中的死亡率接近40%，在接受心脏手术的患者亚组中则高达80%。传统上，这些患者发生ARDS风险增加与体外循环（CPB）的使用、血液制品输注需求、大量液体转移、机械通气以及直接手术创伤有关。事实上，ARDS对心脏手术人群的影响很大，不仅影响生存率，还影响住院时间以及长期的身体和心理发病率。没有接受心脏手术的患者可被认为无ARDS风险。早期识别高危患者对于确保采取手术和非手术特定预防策略至关重要。本综述重点关注接受心脏手术患者这一特定情况下ARDS的流行病学、风险评估、病理生理学、预防和管理。
