Abstract
Purpose
Postoperative hypoxemia is a frequent complication of surgery for acute type A aortic dissection. We tried to determine the factors associated with postoperative hypoxemia.
Methods
Between 1997 and 2003, 114 patients underwent surgery for acute type A aortic dissection. Multivariate logistic regression analysis was done to identify the independent predictors of postoperative hypoxemia, defined by an arterial partial oxygen/inspired oxygen fraction (PaO2/FiO2) ratio of 200 or lower.
Results
The overall in-hospital mortality was 6.1% (7 of 114 patients), being 5.2% in the hypoxemia group and 6.9% in the non-hypoxemia group. The ventilation time and intensive care unit stay were significantly longer in the hypoxemia group than in the non-hypoxemia group (P = 0.0044, P = 0.038, respectively). Logistic regression identified the following variables as predictors for postoperative hypoxemia: body mass index ≥25 (odds ratio [OR], 5.6; 95% confidence interval [CI], 2.1–15.01; P < 0.001), preoperative PaO2/FiO2 ratio ≤300 (OR, 2.6; 95% CI, 1.09–6.13; P = 0.031), and the volume of transfused blood (OR, 1.08; 95% CI, 1.01–1.18; P = 0.037).
Conclusions
Initiating early treatment for hypoxemia and reducing the volume of blood transfused intraoperatively may improve the postoperative clinical course of obese patients with preoperative hypoxemia.
Similar content being viewed by others
References
S Trimarchi CA Nienaber V Rampoldi T Myrmel T Suzuki RH Mehta et al. (2005) ArticleTitleContemporary results of surgery in acute type A aortic dissection: the International Registry of Acute Aortic Dissection experience J Thorac Cardiovasc Surg 129 112–22 Occurrence Handle15632832 Occurrence Handle10.1016/j.jtcvs.2004.09.005
M Messent K Sullivan BF Keogh CJ Morgan TW Evans (1992) ArticleTitleAdult respiratory distress syndrome following cardiopulmonary bypass: incidence and prediction Anaesthesia 47 267–8 Occurrence Handle1566999 Occurrence Handle1:STN:280:By2B3s7htVA%3D
YG Weiss G Merin E Koganov A Ribo A Oppenheim-Eden B Medalion et al. (2000) ArticleTitlePostcardiopulmonary bypass hypoxemia: a prospective study on incidence, risk factors, and clinical significance J Cardiothorac Vasc Anesth 14 506–13 Occurrence Handle11052429 Occurrence Handle1:STN:280:DC%2BD3crgtlykuw%3D%3D Occurrence Handle10.1053/jcan.2000.9488
MY Rady T Ryan NJ Starr (1997) ArticleTitleEarly onset of acute pulmonary dysfunction after cardiovascular surgery: risk factors and clinical outcome Crit Care Med 25 1831–39 Occurrence Handle9366766 Occurrence Handle1:STN:280:DyaK1c%2FjtlGlsw%3D%3D Occurrence Handle10.1097/00003246-199711000-00021
H Plümer A Markewitz K Marohl C Bernutz C Weinhold (1998) ArticleTitleEarly extubation after cardiac surgery: a prospective clinical trial including patients at risk Thorac Cardiovasc Surg 46 275–80 Occurrence Handle9885118 Occurrence Handle10.1055/s-2007-1010238
JT Christenson JM Aeberhard P Badel F Pepcak J Maurice F Simonet (1996) ArticleTitleAdult respiratory distress syndrome after cardiac surgery Cardiovasc Surg 4 15–21 Occurrence Handle8634840 Occurrence Handle1:STN:280:BymB3crmt1w%3D Occurrence Handle10.1016/0967-2109(96)83778-1
TK Kaul BL Fields LS Riggins DA Wyatt R Jones D Nagle (1998) ArticleTitleAdult respiratory distress syndrome following cardiopulmonary bypass: incidence, prophylaxis and management J Cardiovasc Surg (Torino) 39 777–81 Occurrence Handle1:STN:280:DyaK1M7jslWrtg%3D%3D
J Milot J Perron Y Lacasse L Létourneau PC Cartier F Maltais (2001) ArticleTitleIncidence and predictors of ARDS after cardiac surgery Chest 119 884–8 Occurrence Handle11243972 Occurrence Handle1:STN:280:DC%2BD3M3hs1Ghsw%3D%3D Occurrence Handle10.1378/chest.119.3.884
M Shiba K Tadokoro K Nakajima T Juji (1997) ArticleTitleBradykinin generation in RC-MAP during storage at 4°C and leukocyte removal filtration Thromb Res 87 511–20 Occurrence Handle9330433 Occurrence Handle1:CAS:528:DyaK2sXmsFeisLg%3D Occurrence Handle10.1016/S0049-3848(97)00180-1
H Kin K Kawazoe T Nakajima T Niinuma T Kataoka S Endo et al. (2003) ArticleTitlePerioperative serum procalcitonin concentrations in patients with acute aortic dissection Eur Surg Res 35 451–4 Occurrence Handle12928604 Occurrence Handle1:CAS:528:DC%2BD3sXmsFaqt7Y%3D Occurrence Handle10.1159/000072231
Y Hasegawa S Ishikawa A Ohtaki Y Otani T Takahashi Y Sato et al. (1999) ArticleTitleImpaired lung oxygenation in acute aortic dissection J Cardiovasc Surg (Torino) 40 191–5 Occurrence Handle1:STN:280:DyaK1M3nslKjtg%3D%3D
A Artigas GR Bernard J Carlet D Dreyfuss L Gattinoni L Hudson et al. (1998) ArticleTitleThe American-European consensus conference on ARDS, part 2 Am J Respir Crit Care Med 157 1332–47 Occurrence Handle9563759 Occurrence Handle1:STN:280:DyaK1c3itlanug%3D%3D
RM Roumen T Hendriks van der Ven-Jongekrijg GA Nieuwenhuijzen RW Sauerwein JW Van Der Meer et al. (1993) ArticleTitleCytokine patterns in patients after major vascular surgery, hemorrhagic shock, and severe blunt trauma. Relation with subsequent adult respiratory distress syndrome and multiple organ failure Ann Surg 218 769–76 Occurrence Handle8257227 Occurrence Handle1:STN:280:ByuD2sbksF0%3D
HH Sievers C Freund-Kaas S Eleftheriadis T Fischer H Kuppe EG Kraatz et al. (2002) ArticleTitleLung protection during total cardiopulmonary bypass by isolated lung perfusion: preliminary results of a novel perfusion strategy Ann Thorac Surg 74 1167–72 Occurrence Handle12400763 Occurrence Handle10.1016/S0003-4975(02)03853-5
LS De Santo G Romano C Amarelli F Onorati M Torella A Renzulli et al. (2003) ArticleTitleSurgical repair of acute type A aortic dissection: continuous pulmonary perfusion during retrograde cerebral perfusion prevents lung injury in a pilot study J Thorac Cardiovasc Surg 126 826–31 Occurrence Handle14502161 Occurrence Handle10.1016/S0022-5223(03)00583-X
GR Bernard A Artigas KL Brigham J Carlet K Falke L Hudson et al. (1994) ArticleTitleThe American-European consensus conference on ARDS. Definitions, mechanism, relevant outcome, and clinical trial coordination Am J Respir Crit Care Med 149 818–24 Occurrence Handle7509706 Occurrence Handle1:STN:280:ByuC28zksVY%3D
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Nakajima, T., Kawazoe, K., Izumoto, H. et al. Risk Factors for Hypoxemia After Surgery for Acute Type A Aortic Dissection. Surg Today 36, 680–685 (2006). https://doi.org/10.1007/s00595-006-3226-5
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s00595-006-3226-5