Acute respiratory distress syndrome and other respiratory complications in the development of multiple organ dysfunction syndrome after cardiac surgery with cardiopulmonary bypass

The objective was to assess the impact of postoperative respiratory complications (RC) on the development of multiple organ dysfunction syndrome (MODS) and in-hospital mortality after cardiac surgery, and to identify independent predictors of these complications.

Materials and methods. We performed a single-center retrospective cohort study included 1514 consecutive patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The diagnosis of acute respiratory distress syndrome (ARDS) was established according to the Berlin criteria. Organ dysfunction was assessed using the Sequential Organ Failure Assessment (SOFA) score. The association between RC and the incidence of MODS, dynamics of SOFA score, duration of mechanical ventilation, ICU length of stay, and mortality was evaluated. Multivariate logistic regression was used to identify independent risk factors.

Results. The overall incidence of RC was 14.4% (n = 219). ARDS was diagnosed in 1.7% (n = 26) of patients. The development of RC significantly increased the risk of MODS: 46.2% in the RC group versus 3.8% in the group without RC (p < 0.001). The mean maximum SOFA score was significantly higher in the RC group [9 (7; 11)]; p < 0.001). All patients with ARDS developed MODS. Mortality in the MODS group reached 53.9% and correlated with the maximum SOFA score (r = 0.84) and its change (r = 0.79). Independent predictors of RC were age > 65 years, emergency surgery, CPB duration > 120 minutes, and obesity. ARDS was the strongest independent predictor of MODS (OR 15.4).

Conclusion. Postoperative respiratory complications, particularly ARDS, are critical triggers of multiple organ dysfunction and are responsible for high mortality rates. The SOFA score is a valuable tool for assessing the severity of the condition and the prognosis. Proactive prevention of RC by controlling modifiable risk factors is a key strategy to reduce the incidence of MODS and improve survival.

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