sábado, 20 de junio de 2015

Falla respiratoria postoperatoria/Postoperative respiratory failure

Desarrollo y validación de una puntuación para predecir falla respiratoria aguda postoperatoria en una cohorte multicéntrica Europea. Estudio prospectivo, observacional
Development and validation of a score to predict postoperative respiratory failure in a multicentre European cohort: A prospective, observational study.
Canet J, Sabaté S, Mazo V, Gallart L, de Abreu MG, Belda J, Langeron O, Hoeft A, Pelosi P; PERISCOPE group.
European Journal of Anaesthesiology July 2015 - Volume 32 - Issue 7 - p 458-470
Eliminar las complicaciones respiratorias postoperatorias: la detección preoperatoria abre la puerta a las vías clínicas que individualizan el tratamiento perioperatorio
Eliminate postoperative respiratory complications: preoperative screening opens the door to clinical pathways that individualise perioperative treatment
Staehr-Rye, Anne K.; Eikermann, Matthias
European Journal of Anaesthesiology:
July 2015 - Volume 32 - Issue 7 - p 455-457
Pulmonary complications, including postoperative respiratory failure, represent the second most frequent form of postoperative complications after surgical site infections, with an incidence estimated to range from 2.0 to 7.9%, depending on the definitions and patients studied.1 Postoperative respiratory failure is a severe complication, which leads to a longer hospital stay, higher financial cost and increases the in-hospital death rate by as much as 90-fold.2,3
Validación externa prospectiva de una puntuación predictiva de complicaciones pulmonares postoperatorias.
Prospective external validation of a predictive score for postoperative pulmonary complications.
Mazo V, Sabaté S, Canet J, Gallart L, de Abreu MG, Belda J, Langeron O, Hoeft A, Pelosi P.
Anesthesiology. 2014 Aug;121(2):219-31. doi: 10.1097/ALN.0000000000000334.
BACKGROUND: No externally validated risk score for postoperative pulmonary complications (PPCs) is currently available. The authors tested the generalizability of the Assess Respiratory Risk in Surgical Patients in Catalonia risk score for PPCs in a large European cohort (ProspectiveEvaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe). METHODS: Sixty-three centers recruited 5,859 surgical patients receiving general, neuraxial, or plexus block anesthesia. The Assess RespiratoryRisk in Surgical Patients in Catalonia factors (age, preoperative arterial oxygen saturation in air, acute respiratory infection during the previous month, preoperative anemia, upper abdominal or intrathoracic surgery, surgical duration, and emergency surgery) were recorded, along with PPC occurrence (respiratory infection or failure, bronchospasm, atelectasis, pleural effusion, pneumothorax, or aspiration pneumonitis). Discrimination, calibration, and diagnostic accuracy measures of the Assess Respiratory Risk in Surgical Patients in Catalonia score's performance were calculated for the Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe cohort and three subsamples: Spain, Western Europe, and Eastern Europe. RESULTS: The full Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe data set included 5,099 patients; 725 PPCs were recorded for 404 patients (7.9%). The score's discrimination was good: c-statistic (95% CI), 0.80 (0.78 to 0.82). Predicted versus observed PPC rates for low, intermediate, and high risk were 0.87 and 3.39% (score <26), 7.82 and 12.98% (≥ 26 and <45), and 38.13 and 38.01% (≥ 45), respectively; the positive likelihood ratio for a score of 45 or greater was 7.12 (5.93 to 8.56). The score performed best in the Western Europe subsample-c-statistic, 0.87 (0.83 to 0.90) and positive likelihood ratio, 11.56 (8.63 to 15.47)-and worst in the Eastern Europe subsample. The predicted (5.5%) and observed (5.7%) PPC rates were most similar in the Spain subsample. CONCLUSIONS: The Assess Respiratory Risk in Surgical Patients in Catalonia score predicts three levels of PPC risk in hospitals outside thedevelopment setting. Performance differs between geographic areas.
Desarrollo y validación de una calculadora de riesgo para predecir la insuficiencia respiratoria postoperatoria.
Development and validation of a risk calculator predicting postoperative respiratory failure.
Gupta H1, Gupta PK, Fang X, Miller WJ, Cemaj S, Forse RA, Morrow LE.
Chest. 2011 Nov;140(5):1207-15. doi: 10.1378/chest.11-0466. Epub 2011 Jul 14.
BACKGROUND: Postoperative respiratory failure (PRF) (requiring mechanical ventilation > 48 h after surgery or unplanned intubation within 30 days of surgery) is associated with significant morbidity and mortality. The objective of this study was to identify preoperative factors associated with an increased risk of PRF and subsequently develop and validate a risk calculator. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP), a multicenter, prospective data set (2007-2008), was used. The 2007 data set (n = 211,410) served as the training set and the 2008 data set (n = 257,385) as the validation set. RESULTS: In the training set, 6,531 patients (3.1%) developed PRF. Patients who developed PRF had a significantly higher 30-day mortality (25.62% vs 0.98%, P < .0001). On multivariate logistic regression analysis, five preoperative predictors of PRF were identified: type of surgery, emergency case, dependent functional status, preoperative sepsis, and higher American Society of Anesthesiologists (ASA) class. The risk model based on the training data set was subsequently validated on the validation data set. The model performance was very similar between the training and the validation data sets (c-statistic, 0.894 and 0.897, respectively). The high c-statistics (area under the receiver operating characteristic curve) indicate excellent predictive performance. The risk model was used to develop an interactive risk calculator. CONCLUSIONS: Preoperative variables associated with increased risk of PRF include type of surgery, emergency case, dependent functional status, sepsis, and higher ASA class. The validated risk calculator provides a risk estimate of PRF and is anticipated to aid in surgical decision making and informed patient consent.
Anestesia y Medicina del Dolor
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