Prevalence and Causes of the Postoperative Acute Respiratory Failure in the Cardiac Surgery

A.E. Bautin, I.Yu. Kasherininov, D.A. Laletin, V.A. Mazurok, V.E. Rubinchik, A.V. Naymushin, A.O. Marichev, M.L. Gordeev

Almazov North-West Federal Medical Research Centre, Saint-Peterburg

For correspondence: Bautin Andrey Evgenievich — M.D., Ph.D., Head of the Research Division of Anesthesiology and Intensive Care, Almazov North-West Federal Medical Research Centre, Saint-Peterburgs; e-mail: abautin@mail.ru

For citation: Bautin AE, Kasherininov IYu, Laletin DA, Mazurok VA, Rubinchik VE, Naymushin AV, Marichev AO, Gordeev ML. Prevalence and Causes of the Postoperative Acute Respiratory Failure in Cardiac Surgery. Intensive Care Herald. 2016;4:19–26.


Introduction. A variety of pathophysiological mechanisms form several clinical variants of acute respiratory failure (ARF) in the cardiac surgery, It is well known that the main causes of ARF after cardiac surgery are ARDS, cardiogenic pulmonary edema (CPE), exacerbation of chronic obstructive pulmonary disease (COPD), pneumonia, atelectasis and pneumothorax. The aim of this study was to estimate the prevalence of postoperative ARF in cardiac surgery and to identify its main causes. Materials and methods. In a retrospective study were included cases of ARF, which developed after 8859 cardiac surgery procedure in 2008–2012. All cardiac surgery procedure were performed in Almazov North-West Federal Medical Research Centre. The main criterion for inclusion in the study was the presence of persistent hypoxemia with decreased PaO2 / FiO2 ratio less than 300 mm Hg, which required mechanical respiratory support for more than 24 hours of the postoperative period. Exclusion criteria were age less than 18, and cases of ARF requiring respiratory support not longer than 24 hours. Results. Among 8859 patients ARF occurred in 377 cases (4.2 %). The main clinical form was ARDS — 159 cases (1.8 % of the surgery and 42.2 % of the ARF). There were 95 cases of CPE (1.1 %. of the surgery and 25.2 % of the ARF). Exacerbations of COPD was shown in 43 cases (0.49 % of the surgery and 11.4 % of the ARF). In 26 patients ARF was caused by pneumonia (0.3 % of the surgery and 6.9 % of the ARF). There were 22 cases of atelectasis and pneumothorax (0.25 % of the surgery and 5.8 % of the ARF). 9 patients with postoperative ARF died (2.4 %), ARDS was the sole cause of death. There were 107 cases of mild ARDS (67.3 %), moderate ARDS developed in 35 cases (22 %) and severe ARDS was found in 17 cases (10.7 %). All-cases mortality in ARDS was 5.7 %. Mortality was associated with the severity of ARDS. In patients with mild ARDS mortality was 0.9 %, after moderate form died 8.6 % of patients, and in severe cases mortality reached 29.4 %. There were no lethal outcomes, caused by uncontrolled hypoxemia. Conclusions. Our study, including more than eight thousand cardiac surgery, confirmed that ARDS is the main cause of postoperative ARF and its associated mortality.

Keywords: acute respiratory failure, ARDS, cardiac surgery, mechanical respiratory support

Received: 28.11.2016


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