Treatment and characteristics of acute respiratory distress syndrome caused by pulmonary infection after renal transplantation

Objective To evaluate the clinical characteristics and prevention and control measures of acute respiratory distress syndrome(ARDS) caused by pulmonary infection(PI) after renal transplantation.Methods Clinical data of 40 patients with PI and respiratory failure after renal transplantation in an intensive care unit through January,2003 to January,2011 were analyzed retrospectively.Results PI mostly occurred in renal transplant patients after 3-6 months of operation(32 cases,80.00%),the main clinical manifestation was fever,patients in serious condition could develop chest distress,dyspnea,decrease in blood oxygen saturation degree,and eventually ARDS.Early chest radiograph only displayed increased pulmonary markings,blurred or dotted patch.The lung interstitial changes by CT scanning showed increased bilateral subpulmonary markings,reticular or ground glass shadows.Viruses and opportunistic fungi were major infection agents.16 patients were survived and 24 died,the death rate was 60.00%.Early death was mainly due to multiple organ dysfunction caused by severe systemic inflammatory response syndrome,and cause of death in advanced stage was respiratory failure caused by fungi or hospital-acquired resistant bacteria.Conclusion Mortality of ARDS caused by PI in renal transplantation patients is high.Early diagnosis,rational adjust or stop immunosuppressant application,empirical anti-infective therapy and application of glucocorticoid,noninvasive ventilation,rational nutritional support for reducing risk of aspiration,and application of laminar flow ward will gain time for patients' rehabilitation.