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- Neto, Ary Serpa, et al.
(författare)
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The LAS VEGAS risk score for prediction of postoperative pulmonary complications : An observational study
- 2018
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Ingår i: European Journal of Anaesthesiology. - 0265-0215 .- 1365-2346. ; 35:9, s. 691-701
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Currently used pre-operative prediction scores for postoperative pulmonary complications (PPCs) use patient data and expected surgery characteristics exclusively. However, intra-operative events are also associated with the development of PPCs.OBJECTIVE: We aimed to develop a new prediction score for PPCs that uses both pre-operative and intra-operative data.DESIGN: This is a secondary analysis of the LAS VEGAS study, a large international, multicentre, prospective study.SETTINGS: A total of 146 hospitals across 29 countries.PATIENTS: Adult patients requiring intra-operative ventilation during general anaesthesia for surgery.INTERVENTIONS: The cohort was randomly divided into a development subsample to construct a predictive model, and a subsample for validation.MAIN OUTCOME MEASURES: Prediction performance of developed models for PPCs.RESULTS: Of the 6063 patients analysed, 10.9% developed at least one PPC. Regression modelling identified 13 independent risk factors for PPCs: six patient characteristics [higher age, higher American Society of Anesthesiology (ASA) physical score, pre-operative anaemia, pre-operative lower SpO2 and a history of active cancer or obstructive sleep apnoea], two procedure-related features (urgent or emergency surgery and surgery lasting ≥ 1 h), and five intra-operative events [use of an airway other than a supraglottic device, the use of intravenous anaesthetic agents along with volatile agents (balanced anaesthesia), intra-operative desaturation, higher levels of positive end-expiratory pressures > 3 cmH2O and use of vasopressors]. The area under the receiver operating characteristic curve of the LAS VEGAS risk score for prediction of PPCs was 0.78 [95% confidence interval (95% CI), 0.76 to 0.80] for the development subsample and 0.72 (95% CI, 0.69 to 0.76) for the validation subsample.CONCLUSION: The LAS VEGAS risk score including 13 peri-operative characteristics has a moderate discriminative ability for prediction of PPCs. External validation is needed before use in clinical practice.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, number NCT01601223.
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| 2. |
- Simonis, Fabienne D., et al.
(författare)
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Potentially modifiable respiratory variables contributing to outcome in ICU patients without ARDS : a secondary analysis of PRoVENT
- 2018
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Ingår i: Annals of Intensive Care. - : Springer Berlin/Heidelberg. - 2110-5820. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Background: The majority of critically ill patients do not suffer from acute respiratory distress syndrome (ARDS). To improve the treatment of these patients, we aimed to identify potentially modifiable factors associated with outcome of these patients. Methods: The PRoVENT was an international, multicenter, prospective cohort study of consecutive patients under invasive mechanical ventilatory support. A predefined secondary analysis was to examine factors associated with mortality. The primary endpoint was all-cause in-hospital mortality. Results: 935 Patients were included. In-hospital mortality was 21%. Compared to patients who died, patients who survived had a lower risk of ARDS according to the 'Lung Injury Prediction Score' and received lower maximum airway pressure (P-max), driving pressure (Delta P), positive end-expiratory pressure, and FiO(2) levels. Tidal volume size was similar between the groups. Higher P-max was a potentially modifiable ventilatory variable associated with in-hospital mortality in multivariable analyses. Delta P was not independently associated with in-hospital mortality, but reliable values for Delta P were available for 343 patients only. Non-modifiable factors associated with in-hospital mortality were older age, presence of immunosuppression, higher non-pulmonary sequential organ failure assessment scores, lower pulse oximetry readings, higher heart rates, and functional dependence. Conclusions: Higher P-max was independently associated with higher in-hospital mortality in mechanically ventilated critically ill patients under mechanical ventilatory support for reasons other than ARDS.
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