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

Research output: Contribution to journalArticle

1 Citation (Scopus)

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 pro-tein-D may help predict development of postoperative ARDS.

Original languageEnglish (US)
Pages (from-to)1331-1340
Number of pages10
JournalRespiratory Care
Volume63
Issue number11
DOIs
StatePublished - Nov 1 2018

Fingerprint

Biomarkers
Interleukin-8
Pulmonary Surfactant-Associated Protein D
Plasminogen Activators
Plasminogen Activator Inhibitor 1
Intraoperative Complications
Lung Injury
Surface-Active Agents
Thoracic Surgery
Blood Vessels
Case-Control Studies
Albumins
Thorax
Inflammation
Pressure
Wounds and Injuries

Keywords

  • ARDS
  • Biomarker
  • Postoperative complications
  • Prevention
  • Respiratory failure

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Evolution of validated biomarkers and intraoperative parameters in the development of postoperative ARDS. / Yadav, Hemang; Bartley, Adam; Keating, Sheila; Meade, Laurie A.; Norris, Philip J.; Carter, Rickey E.; Gajic, Ognjen; Kor, Daryl J.

In: Respiratory Care, Vol. 63, No. 11, 01.11.2018, p. 1331-1340.

Research output: Contribution to journalArticle

Yadav, Hemang ; Bartley, Adam ; Keating, Sheila ; Meade, Laurie A. ; Norris, Philip J. ; Carter, Rickey E. ; Gajic, Ognjen ; Kor, Daryl J. / Evolution of validated biomarkers and intraoperative parameters in the development of postoperative ARDS. In: Respiratory Care. 2018 ; Vol. 63, No. 11. pp. 1331-1340.
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AU - Meade, Laurie A.

AU - Norris, Philip J.

AU - Carter, Rickey E.

AU - Gajic, Ognjen

AU - Kor, Daryl J

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AB - 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 pro-tein-D may help predict development of postoperative ARDS.

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