Development and validation of a score to predict postoperative respiratory failure in a multicentre European cohort A prospective, observational study

被引:139
作者
Canet, Jaume [1 ,2 ,62 ]
Sabate, Sergi [3 ,50 ]
Mazo, Valentin [1 ,2 ,62 ]
Gallart, Lluis [4 ,61 ]
de Abreu, Marcelo Gama [5 ,23 ]
Belda, Javier [6 ]
Langeron, Olivier [7 ,19 ]
Hoeft, Andreas [8 ,22 ]
Pelosi, Paolo [9 ,29 ]
Langeron, Olivier [7 ,19 ]
Burimi, Jonela [11 ]
Hoeft, Andreas [8 ,22 ]
Leva, Brigitte [10 ]
Burimi, Jonela [11 ]
Halefi, Toma [11 ]
Hoxha, Aleksander [11 ]
Pilika, Kliti [11 ]
Selmani, Imelda [11 ]
Daout, Veronique [12 ]
Gauthier, Caroline [12 ]
Kahn, David [12 ]
Momeni, Mona [12 ]
Watremez, Christine [12 ]
Straus, Slavenka [13 ]
Djonovic-Manovic, Dejana [14 ]
Juros-Zovko, Marina [14 ]
Komen-Usljebrka, Helga [15 ]
Orlic, Vlasta [15 ]
Stuck, Ivana [15 ]
Balakova, Lenka [16 ]
Kosinova, Martina [16 ]
Krikava, Ivo [16 ]
Stoudek, Roman [16 ]
Stourac, Petr [16 ]
Zadrazilova, Katarina [16 ]
Janvekar, Sanober [17 ]
Karjagin, Juri [18 ]
Roivassepp, Kadri [18 ]
Sormus, Alar [18 ]
Cuvillon, Philippe [19 ]
Ibanez-Esteve, Cristina [19 ]
Langeron, Olivier [7 ,19 ]
Raux, Mathieu [19 ]
Nicolas-Robin, Armelle [19 ]
Winter, Andre [20 ]
Brunier, Malte [21 ]
Engelhard, Kristin [21 ]
Feldmann, Rita Laufenberg [21 ]
Lindemann, Raphaele [21 ]
Mauff, Susanne [21 ]
机构
[1] Hosp Badalona Germans Trias & Pujol, Dept Anaesthesiol, Barcelona 08916, Spain
[2] Hosp Badalona Germans Trias & Pujol, Postoperat Care Unit, Barcelona 08916, Spain
[3] Fundacio Puigvert, Dept Anaesthesiol, Barcelona, Spain
[4] Univ Autonoma Barcelona, IMIM Inst Hosp Mar Invest Med, Hosp Mar, Dept Anaesthesiol, E-08193 Barcelona, Spain
[5] Tech Univ Dresden, Univ Hosp Carl Gustav Carus, Dept Anaesthesiol & Intens Care Med, D-01062 Dresden, Germany
[6] Univ Valencia, Hosp Clin Univ, Dept Anaesthesia & Crit Care, Valencia, Spain
[7] Univ Paris 06, CHU Pitie Salpetriere, Dept Anaesthesiol & Crit Care, Paris, France
[8] Univ Bonn, Dept Anaesthesiol & Intens Care Med, Bonn, Germany
[9] Univ Genoa, IRCCS San Martino Hosp IST, Dept Surg Sci & Integrated Diagnost, Genoa, Italy
[10] Eur Soc Anaesthesiol Aisbl, Brussels, Belgium
[11] Univ Hosp Ctr Mother Theresa, Tirana, Albania
[12] Catholic Univ Louvain, Clin Univ St Luc ASBL, Brussels, Belgium
[13] Clin Ctr Univ Sarajevo Heart Ctr, Sarajevo, Bosnia & Herceg
[14] Gen Hosp Prim Dr Abdulah Nakas, Sarajevo, Bosnia & Herceg
[15] Univ Hosp Rijeka, Rijka, Croatia
[16] Fac Hosp Brno, Brno, Czech Republic
[17] Masaryks Hosp Usti Nad Labem, Usti Nad Labem, Czech Republic
[18] Tartu Univ Hosp, Tartu, Estonia
[19] Hop La Pitie Salpetriere, Paris, France
[20] Klinikum Darmstadt GmbH, Darmstadt, Germany
[21] Johannes Gutenberg Univ Mainz, Med Ctr, Mainz, Germany
[22] Univ Hosp Bonn, Bonn, Germany
[23] Tech Univ Dresden, Univ Hosp Carl Gustav Carus, Dresden, Germany
[24] MISEK Kft, Miskolc, Hungary
[25] Azienda Osped, Padua, Italy
[26] Azienda Osp S Croce e Carle, Cuneo, Italy
[27] Azienda USL 5 Pisa Ospedale F Lotti, Pontedera, Italy
[28] European Inst Oncol, Milan, Italy
[29] IRCCS San Martino, Genoa, Italy
[30] Osped Sant Orsola Malpighi, Bologna, Italy
[31] Univ Insubria, Varese, Italy
[32] Univ Milan, Osped San Paolo, Milan, Italy
[33] Pauls Stradins Clin Univ Hosp, Riga, Latvia
[34] Kaunas Med Univ Hosp, Kaunas, Lithuania
[35] Vilnius Univ Hosp Santariskiu Clin, Vilnius, Lithuania
[36] ZithaKlinik, Luxembourg, Luxembourg
[37] 10 Wojskowy Szpital Klin Poliklin Bydgoszczy, Bydgoszcz, Poland
[38] Hosp Univ Coimbra, EPE, Coimbra, Portugal
[39] Ctr Hosp Lisboa Ocidental, Lisbon, Portugal
[40] Hosp Fernando Fonseca, Lisbon, Portugal
[41] Inst Portugues Oncol Porto, Porto, Portugal
[42] Emergency Clin Hosp Constanta, Constanta, Romania
[43] Emergency Cty Hosp Clin Anaesthesia & Intens Care, Targu Mures, Romania
[44] Emergency Inst Cardiovasc Dis Prof Dr CC Iliescu, Bucharest, Romania
[45] Krasnoyarsk State Med Univ, Krasnoyarsk, Russia
[46] Clin Univ Navarra, Pamplona, Spain
[47] Consorcio Hosp Gen Univ Valencia, Valencia, Spain
[48] Corp Sanitaria Parc Tauli, Barcelona Sabadell, Spain
[49] Fundacio Althaia, Manresa, Spain
[50] Fundacio Puigvert, Barcelona, Spain
关键词
LOGISTIC-REGRESSION ANALYSIS; RANDOMIZED CONTROLLED-TRIAL; PULMONARY COMPLICATIONS; NONINVASIVE VENTILATION; ABDOMINAL-SURGERY; MECHANICAL VENTILATION; NONCARDIAC SURGERY; GENERAL-ANESTHESIA; DISTRESS-SYNDROME; RISK-FACTORS;
D O I
10.1097/EJA.0000000000000223
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
BACKGROUND Postoperative respiratory failure (PRF) is the most frequent respiratory complication following surgery. OBJECTIVE The objective of this study was to build a clinically useful predictive model for the development of PRF. DESIGN A prospective observational study of a multicentre cohort. SETTING Sixty-three hospitals across Europe. PATIENTS Patients undergoing any surgical procedure under general or regional anaesthesia during 7-day recruitment periods. MAIN OUTCOME MEASURES Development of PRF within 5 days of surgery. PRF was defined by a partial pressure of oxygen in arterial blood (PaO2) less than 8 kPa or new onset oxyhaemoglobin saturation measured by pulse oximetry (SpO(2)) less than 90% whilst breathing room air that required conventional oxygen therapy, noninvasive or invasive mechanical ventilation. RESULTS PRF developed in 224 patients (4.2% of the 5384 patients studied). In-hospital mortality [95% confidence interval (95% CI)] was higher in patients who developed PRF [10.3% (6.3 to 14.3) vs. 0.4% (0.2 to 0.6)]. Regression modelling identified a predictive PRF score that includes seven independent risk factors: low preoperative SpO(2); at least one preoperative respiratory symptom; preoperative chronic liver disease; history of congestive heart failure; open intrathoracic or upper abdominal surgery; surgical procedure lasting at least 2 h; and emergency surgery. The area under the receiver operating characteristic curve (c-statistic) was 0.82 (95% CI 0.79 to 0.85) and the Hosmer-Lemeshow goodness-of-fit statistic was 7.08 (P = 0.253). CONCLUSION A risk score based on seven objective, easily assessed factors was able to predict which patients would develop PRF. The score could potentially facilitate preoperative risk assessment and management and provide a basis for testing interventions to improve outcomes. The study was registered at ClinicalTrials.gov (identifier NCT01346709).
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收藏
页码:458 / 470
页数:13
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