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Research ArticleOriginal Research

Evolution of Validated Biomarkers and Intraoperative Parameters in the Development of Postoperative ARDS

Hemang Yadav, Adam Bartley, Sheila Keating, Laurie A Meade, Philip J Norris, Rickey E Carter, Ognjen Gajic and Daryl J Kor
Respiratory Care June 2018, respcare.06103; DOI: https://doi.org/10.4187/respcare.06103
Hemang Yadav
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
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  • For correspondence: yadav.hemang@mayo.edu
Adam Bartley
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
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Sheila Keating
Blood Systems Research Institute, San Francisco, California.University of California, San Francisco, California.
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Laurie A Meade
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.
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Philip J Norris
Blood Systems Research Institute, San Francisco, California.University of California, San Francisco, California.
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Rickey E Carter
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
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Ognjen Gajic
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
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Daryl J Kor
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.
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Abstract

BACKGROUND: Patients who develop ARDS from medical or traumatic causes typically present after the inciting event has already occurred. Postoperative ARDS is unique in that the inciting insult potentially responsible for ARDS is known ahead of time, which provides an opportunity to study the early pathophysiology of ARDS. The objective of this study was to better understand the early pathophysiology of postoperative ARDS through a temporal analysis of key biomarkers of interest.

METHODS: We performed a case-control study of adults undergoing elective thoracic, aortic vascular, or cardiac surgery, which placed them at increased risk of developing postoperative ARDS. Biomarkers were measured at baseline, 2 h, and 6 h after the key intraoperative event believed to be responsible for ARDS.

RESULTS: Of the 467 subjects enrolled, 26 developed ARDS and were matched to non-ARDS controls 1:2 based on age, sex, surgical procedure, and surgical lung injury prediction score. Patients with ARDS were more likely to have lower preoperative albumin (P = .029), longer surgery (P = .007), larger amounts of intraoperative fluid (P = .036), and higher intraoperative peak inspiratory pressures (P = .006). Baseline plasminogen activator inhibitor-1 levels were higher in the ARDS group (P = .03). Changes in postoperative biomarker levels from baseline were greater in the ARDS group for interleukin-8 (baseline to 6 h, P = .02) and surfactant protein-D (baseline to 2 h, P = .009).

CONCLUSIONS: Our study supported the hypothesis that dysregulated coagulation, inflammation, and epithelial injury are pathophysiologic features of early postoperative ARDS. Interleukin-8, plasminogen activator-1, and surfactant protein-D may help predict development of postoperative ARDS.

  • ARDS
  • postoperative complications
  • respiratory failure
  • prevention
  • biomarker

Footnotes

  • Correspondence: Hemang Yadav MBBS, Department of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905. E-mail: yadav.hemang{at}mayo.edu.
  • The authors have disclosed no conflicts of interest.

  • Copyright © 2018 by Daedalus Enterprises

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Respiratory Care: 64 (2)
Respiratory Care
Vol. 64, Issue 2
1 Feb 2019
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Evolution of Validated Biomarkers and Intraoperative Parameters in the Development of Postoperative ARDS
Hemang Yadav, Adam Bartley, Sheila Keating, Laurie A Meade, Philip J Norris, Rickey E Carter, Ognjen Gajic, Daryl J Kor
Respiratory Care Jun 2018, respcare.06103; DOI: 10.4187/respcare.06103

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Evolution of Validated Biomarkers and Intraoperative Parameters in the Development of Postoperative ARDS
Hemang Yadav, Adam Bartley, Sheila Keating, Laurie A Meade, Philip J Norris, Rickey E Carter, Ognjen Gajic, Daryl J Kor
Respiratory Care Jun 2018, respcare.06103; DOI: 10.4187/respcare.06103
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Keywords

  • ARDS
  • postoperative complications
  • respiratory failure
  • prevention
  • biomarker

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