Home > Riviste > Minerva Anestesiologica > Fascicoli precedenti > Articles online first > Minerva Anestesiologica 2019 Dec 04

ULTIMO FASCICOLO
 

JOURNAL TOOLS

eTOC
Per abbonarsi PROMO
Sottometti un articolo
Segnala alla tua biblioteca
 

ARTICLE TOOLS

Publication history
Estratti
Per citare questo articolo

 

 

Minerva Anestesiologica 2019 Dec 04

DOI: 10.23736/S0375-9393.19.13932-6

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

A noninvasive postoperative clinical score to identify patients at risk for postoperative pulmonary complications: the airtest score

Carlos FERRANDO 1, 2 , Fernando SUÁREZ-SIPPMAN 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, F. Javier 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 & Critical Care, Hospital Clínic i Provincial Universitario, Barcelona, Spain; 2 CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Melchor Fernández Almagro, Madrid, Spain; 3 Hedenstierna Laboratory, Department Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden; 4 Department of Intensive Care Medicine, Hospital de La Princesa, Madrid, Spain; 5 'edFundación Miguel Servet. Red de Investigación en Servicios de Salud en Enfermedades Crónicas,(REDISSEC), Pamplona, Spain; 6 INCLIVA Clinical Research Institute, Hospital Clinico Universitario de Valencia, Valencia, Spain; 7 Department of Anesthesiology & Critical Care, Hospital Clínico Universitario, Valencia, Spain; 8 Department of Anesthesiology & Critical Care, Hospital Universitario Sant Pau, Barcelona, Spain; 9 Department of Anesthesiology & Critical Care, Hospital Universitario Germans Tries i Pujol, Badalona, Spain; 10 Centro Superior de Investigación en Salud Publica (CSISPFISABIO), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain; 11 Department of Pharmacology, Clinica Corachan, Barcelona, Spain; 12 Department of Anesthesiology & Critical Care, Hospital Universitario Río Hortega, Valladolid, Spain; 13 Department of Anesthesiology & Critical Care, Hospital Universitario y Politécnico La Fe, Valencia, Spain; 14 Department of Anesthesiology & Critical Care, Hospital Universitario Ramón y Cajal, Madrid, Spain; 15 Department of Anesthesiology & Critical Care, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain; 16 Department of Anesthesiology & Critical Care, Hospital General Universitario Gregorio Marañón, Madrid, Spain; 17 Department of Anesthesiology & Critical Care, Hospital Fundación de Alcorcón, Alcorcón, Spain; 18 Department of Anesthesiology, Hospital de la Marina Baixa de la Vila Joiosa, Alicante, Spain; 19 Department of Anesthesiology & Critical Care, Hospital General Universitario, Casa de la Misericordia,Valencia, Spain; 20 Department of Anesthesiology, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain; 21 Department of Anesthesiology & Critical Care, Hospital Universitario Miguel Servet, Zaragoza, Spain; 22 Department of Anesthesiology & Critical Care, Hospital Universitario Virgen del Rocio, Sevilla, Spain; 23 Department of Anesthesiology, Hospital Universitario de León, León, Spain; 24 Department of Anesthesiology & Critical Care, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; 25 Department of Anesthesiology, Hospital de Manises, Valencia, Spain; 26 Department of Anesthesiology, Hospital Privado de Comunidad Mar de Plata, Chauvin, B7602CBM, Mar de Plata, Argentina; 27 Multidisciplinary Organ Dysfunction Evaluation Research Network, Research Unit, Hospital Universitario Dr. Negrin, Las Palmas de Gran Canaria, Spain; 28 Department of Surgery, Universidad de 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 airtest assesses the value of SpO2 while breathing room air. We aimed at building a clinical score that includes the airtest 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 intermediatetohigh risk patients scheduled for abdominal surgery. Arterial oxygenation was assessed on roomair in the preoperative period (preoperative airtest) and 3h after admission to the postoperative care unit (postoperative airtest). The airtest was defined as positive or negative if SpO2 was ≤96% or >96%, respectively. Positive airtests were stratified into weak (9396%) or strong (<93%). The primary outcome was a composite of moderatetosevere PPCs during the first seven post operative 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 airtest, and atelectasis. The area under the receiver operating characteristic curve (AUC) was 0.79 (95% CI: 0.750.82) when including this five independent predictors. We built a simplified score termed “airtest score” by using only the pre and postoperative SpO2, resulting in an AUC of 0.72 (95% CI: 0.670.76) for the derivation and 0.72 (95% CI :0.660.78) 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, noninvasive and inexpensive bedside airtest score, evaluating pre and postoperatively SpO2 measured on roomair, helps to predict the risk for PPCs.


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

inizio pagina