Abstract: AIM To analyze related factors of postoperative acute respiratory insufficiency (ARI) following Debakey type I aortic dissection. METHODS Thirty-nine Debakey type I aortic dissection patients who underwent surgery under deep hypothermic circulatory arrest (DHCA) were enrolled in the study. Pre- and postoperative suspected risk factors were analyzed including age, gender, history of hypertension, smoking, body mass index (BMI), preoperative ratio of fraction of inspired oxygen to oxygen pressure (PaO2/FiO2), preoperative malperfusion, duration of onset to operation, amount of transfused red blood cells and plasma within 24 h after surgery, rupture of pleura, postoperative drainage of chest tube within 24 h, cardiopulmonary bypass (CPB) time, deep hypothermic circulatory arrest (DHCA) time and cross-clamping time. Univariate analysis was performed to assess these factors and screen the statistically significant factors for multivariate regression analysis with logistic regression model. RESULTS Thirty ARI patients and nine non-ARI patients were classified. Univariate analysis showed that the factors that reached statistical significance were smoking, BMI>25 kg/m2, preoperative PaO2/FiO2<300, duration of onset to operation<2 weeks, preoperative malperfusion, CPB time>180 min, amount of transfused red blood cells within 24 h>10 U, amount of transfused plasma within 24 h>1 000 ml. Multivariate analysis indicated that BMI >25 kg/m2 (P<0.01), preoperative PaO2/FiO2<300 (P<0.05), preoperative malperfusion (P<0.01), amount of transfused plasma within 24 h>1 000 ml (P<0.05) and CPB time>180 min (P<0.01) were statistically significant risk factors for ARI after surgery. CONCLUSION The risk factors of postoperative ARI following Debakey type I aortic dissection under DHCA include BMI>25 kg/m2, preoperative PaO2/FiO2<300, preoperative malperfusion, amount of transfused plasma within 24 h>1 000 ml and CPB time >180 min.