New Tool for Predicting Risk of Acute Respiratory Distress Syndrome

May 5, 2014
Jeannette Y. Wick, RPh, MBA, FASCP

Surgical Rounds®, May 2014,

Since surgical patients who develop acute respiratory distress syndrome (ARDS) face a 40% risk of death, a tool that can accurately predict who will develop ARDS is greatly needed.

Of the approximately 45 million Americans who undergo surgery annually, between 1 million and 4.5 million suffer a postoperative respiratory complication. Patients who develop acute respiratory distress syndrome (ARDS) face a 40% risk of death, compared to just 6% for those who do not develop respiratory failure. In light of this statistic, a tool that can accurately predict which patients will develop ARDS is greatly needed.

A study published in the May 2014 issue of Anesthesiology attempted to validate one such tool known as the surgical lung injury prediction (SLIP) model. SLIP was designed to detect the risk of ARDS and acute lung injury (ALI) in patients undergoing elective surgery. In a previous trial, SLIP had performed poorly, likely due to the fact that the study population was vastly heterogeneous.

However, in this secondary prospective cohort investigation, the researchers successfully identified preoperative ARDS risk factors, modified the tool, and applied it to 1,562 at-risk patients.

According to the study authors, ARDS developed in 117 (7.5%) of patients, through whom the researchers identified the following 9 ARDS predictors:

  • Sepsis
  • High-risk aortic vascular surgery
  • High-risk cardiac surgery
  • Emergency surgery
  • Cirrhosis
  • Admission location outside the home
  • Increased respiratory rate
  • Fraction of inspired oxygen >35%
  • Oxygen saturation >95%

Although the SLIP-2 score still requires validation in additional studies and populations, the authors of the current trial said the tool may help surgeons identify patients at high risk for ARDS.