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Minerva Anestesiologica 2020 April;86(4):404-15

DOI: 10.23736/S0375-9393.19.13932-6

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

A noninvasive postoperative clinical score to identify patients at risk for postoperative pulmonary complications: the Air-Test Score

Carlos FERRANDO 1, 2 , Fernando SUÁREZ-SIPMANN 2, 3, 4, Julián LIBRERO 5, Natividad POZO 6, Marina SORO 7, Carmen UNZUETA 8, Andrea BRUNELLI 9, Salvador PEIRÓ 10, Alicia LLOMBART 11, Jaume BALUST 1, Cesar ALDECOA 12, Oscar DÍAZ-CAMBRONERO 13, Tania FRANCO 14, Francisco J. REDONDO 15, Ignacio GARUTTI 16, Jose I. GARCÍA 17, Maite IBÁÑEZ 18, Manuel GRANELL 19, Aurelio RODRÍGUEZ 20, Lucía GALLEGO 21, Manuel de la MATTA 22, Jose M. MARCOS 23, Javier GARCÍA 24, Guido MAZZINARI 25, Gerardo TUSMAN 26, Jesús VILLAR 2, 27, Javier BELDA 7, 28, on behalf of the Individualized PeRioperative Openlung VEntilation (iPROVE) Network 

1 Department of Anesthesiology and Critical Care, Hospital Clínic, Institut d’Investigació August Pi i Sunyer, Villarroel, Barcelona, Spain; 2 CIBER of Respiratory Diseases, Carlos III Health Institute, Madrid, Spain; 3 Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden; 4 Department of Intensive Care Medicine, La Princesa Hospital, Madrid, Spain; 5 Red-Fundación Miguel Servet, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Spain; 6 INCLIVA Clinical Research Institute, University Clinical Hospital of Valencia, Valencia, Spain; 7 Department of Anesthesiology and Critical Care, Clinical Hospital of Valencia, Valencia, Spain; 8 Department of Anesthesiology and Critical Care, Sant Pau University Hospital, Mas Barcelona, Spain; 9 Department of Anesthesiology and Critical Care, Germans Tries i Pujol University Hospital, Badalona, Spain; 10 Centro Superior de Investigación en Salud Publica (CSISP-FISABIO), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain; 11 Department of Pharmacology, Corachan Clinic, Barcelona, Spain; 12 Department of Anesthesiology and Critical Care, Río Hortega University Hospital, Valladolid, Spain; 13 Department of Anesthesiology and Critical Care, La Fe University Hospital, Valencia, Spain; 14 Department of Anesthesiology and Critical Care, Ramón y Cajal University Hospital, Madrid, Spain; 15 Department of Anesthesiology and Critical Care, University Hospital of Ciudad Real, Ciudad Real, Spain; 16 Department of Anesthesiology and Critical Care, Gregorio Marañón University Hospital, Madrid, Spain; 17 Department of Anesthesiology and Critical Care, Foundation Hospital of Alcorcón, Alcorcón, Spain; 18 Department of Anesthesiology, la Marina Baixa de la Vila Joiosa Hospital, Alicante, Spain; 19 Department of Anesthesiology and Critical Care, University Hospital of Valencia, Valencia, Spain; 20 Department of Anesthesiology, Dr. Negrín University Hospital, Las Palmas de Gran Canaria, Spain; 21 Department of Anesthesiology and Critical Care, Miguel Servet University Hospital, Zaragoza, Spain; 22 Department of Anesthesiology and Critical Care, Virgen del Rocio University Hospital, Sevilla, Spain; 23 Department of Anesthesiology, University Hospital of León, León, Spain; 24 Department of Anesthesiology and Critical Care, Puerta de Hierro University Hospital, Madrid, Spain; 25 Department of Anesthesiology, Manises Hospital, Valencia, Spain; 26 Department of Anesthesiology, Community Private Hospital of Mar de Plata, Mar de Plata, Argentina; 27 Multidisciplinary Organ Dysfunction Evaluation Research Network, Research Unit, Dr. Negrin University Hospital, Las Palmas de Gran Canaria, Spain; 28 Department of Surgery, University of Valencia, Valencia, Spain



BACKGROUND: Postoperative pulmonary complications (PPCs) negatively affect morbidity, healthcare costs and postsurgical survival. Preoperative and intraoperative peripheral oxyhemoglobin saturation (SpO2) levels are independent risk factors for postoperative pulmonary complications (PPCs). The air-test assesses the value of SpO2 while breathing room-air. We aimed at building a clinical score that includes the air-test for predicting the risk for PPCs.
METHODS: This is a development and validation study in patients -randomly divided into two cohorts- from a large randomized clinical trial (iPROVE) that enrolled 964 intermediate-to-high risk patients scheduled for abdominal surgery. Arterial oxygenation was assessed on room-air in the preoperative period (preoperative air-test) and 3h after admission to the postoperative care unit (postoperative air-test). The air-test was defined as positive or negative if SpO2 was ≤96% or >96%, respectively. Positive air-tests were stratified into weak (93-96%) or strong (<93%). The primary outcome was a composite of moderate-to-severe PPCs during the first seven postoperative days.
RESULTS: A total of 902 patients were included in the final analysis (542 in the development cohort and 360 in the validation cohort). Regression analysis identified five independent risk factors for PPC: age, type of surgery, pre- and postoperative air-test, and atelectasis. The area under the receiver operating characteristic curve (AUC) was 0.79 (95% CI: 0.75-0.82) when including these five independent predictors. We built a simplified score termed “air-test score” by using only the pre- and postoperative SpO2, resulting in an AUC of 0.72 (95% CI: 0.67-0.76) for the derivation and 0.72 (95% CI: 0.66-0.78) for the validation cohort, respectively. The air-test score stratified patients into four levels of risk, with PPCs ranging from <15% to >75%.
CONCLUSIONS: The simple, non-invasive and inexpensive bedside air-test score, evaluating pre- and postoperatively SpO2 measured on room-air, helps to predict the risk for PPCs.


KEY WORDS: Postoperative complication; Predictive value of test; Postoperative pulmonary atelectasis

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