Ripoll Juan G, Wanta Brendan T, Wetzel David R, Frank Ryan D, Findlay James Y, Vogt Matthew N P
Department of Anesthesiology and Perioperative Medicine, Rochester, MN.
Division of Critical Care Medicine, Rochester, MN.
Transplant Direct. 2019 Dec 24;6(1):e520. doi: 10.1097/TXD.0000000000000965. eCollection 2020 Jan.
The assessment of perioperative risk factors for the development of acute respiratory distress syndrome (ARDS) has been described in various surgical populations. However, there are only limited data among patients undergoing liver transplantation (LT), particularly regarding the influence of intraoperative ventilation parameters. We sought to identify the perioperative risk factors associated with the development of ARDS in LT recipients.
This is a single-center, retrospective cohort study of adult patients who underwent LT at a tertiary academic medical center between January 1, 2006, and January 31, 2016. Postoperative ARDS was identified using the Berlin definition. Multivariable logistic regression analysis was used to identify perioperative risk factors for ARDS.
Of 817 eligible patients who underwent an LT during the study period, 20 (2.45%) developed postoperative ARDS. In the preoperative model, ongoing dialysis (odds ratio, 6.41; < 0.01) was identified as an independent risk factor of ARDS post-LT. A higher mean peak inspiratory pressure per increase of 1 cm HO (odds ratio, 1.31; < 0.01) was the only independent risk factor in the intraoperative model. Patients who developed ARDS postoperatively had significantly greater intensive care unit and hospital stay compared to non-ARDS patients ( < 0.001). There were no significant differences in the 30-day ( = 0.16) and 1-year ( = 0.51) mortality between the groups.
Dialysis at the time of transplant and elevated intraoperative mean peak inspiratory pressure were associated with the development of ARDS. ARDS post LT was associated with increased intensive care unit and hospital length of stay, but not increased mortality.
急性呼吸窘迫综合征（ARDS）围手术期危险因素的评估已在各类手术人群中有所描述。然而，肝移植（LT）患者的数据有限，尤其是关于术中通气参数的影响。我们试图确定LT受者中与ARDS发生相关的围手术期危险因素。
这是一项单中心回顾性队列研究，研究对象为2006年1月1日至2016年1月31日期间在一家三级学术医疗中心接受LT的成年患者。术后ARDS采用柏林定义进行诊断。多变量逻辑回归分析用于确定ARDS的围手术期危险因素。
在研究期间接受LT的817例符合条件的患者中，20例（2.45%）发生了术后ARDS。在术前模型中，持续透析（比值比，6.41；<0.01）被确定为LT术后ARDS的独立危险因素。术中模型中，每增加1 cm H₂O平均吸气峰压升高（比值比，1.31；<0.01）是唯一的独立危险因素。与非ARDS患者相比，术后发生ARDS的患者在重症监护病房和住院时间显著更长（<0.001）。两组之间30天（=0.16）和1年（=0.51）死亡率无显著差异。
移植时透析和术中平均吸气峰压升高与ARDS的发生有关。LT术后ARDS与重症监护病房住院时间和住院时间延长有关，但与死亡率增加无关。
