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

被引：140

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

来源：

EUROPEAN JOURNAL OF ANAESTHESIOLOGY | 2015年 / 32卷 / 07期

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).

引用

页码：458 / 470

页数：13

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