Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS - an observational study in 29 countries

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Fältnamn	Indikatorer	Metadata
000		05114naa a2200493 4500
001		oai:DiVA.org:uu-342439
003		SwePub
008		180220s2017 \| \|\|\|\|\|\|\|\|\|\|\|000 \|\|eng\|
024	7	a https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3424392 URI
024	7	a https://doi.org/10.1097/EJA.00000000000006462 DOI
040		a (SwePub)uu
041		a engb eng
042		9 SwePub
072	7	a ref2 swepub-contenttype
072	7	a art2 swepub-publicationtype
100	1	a Hemmes, Sabrine N. T.u Acad Med Ctr, Amsterdam, Netherlands.4 aut
245	1 0	a Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications :b LAS VEGAS - an observational study in 29 countries
264	1	b LIPPINCOTT WILLIAMS & WILKINS,c 2017
338		a print2 rdacarrier
500		a Group Author(s): LAS VEGAS Investigators
520		a BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (VT) size was 500 ml, or 7 to 9 ml kg1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P < 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P < 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high VT and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome. TRIAL REGISTRATION The study was registered at Clinicaltrials.gov, number NCT01601223.
650	7	a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Anestesi och intensivvård0 (SwePub)302012 hsv//swe
650	7	a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Anesthesiology and Intensive Care0 (SwePub)302012 hsv//eng
700	1	a Neto, Ary Serpau Hosp Israelita Albert Einstein, Sao Paulo, Brazil.;Fac Med ABC, Sao Paulo, Brazil.4 aut
700	1	a Binnekade, Jan M.u Acad Med Ctr, Amsterdam, Netherlands.4 aut
700	1	a Canet, Jaumeu Hosp Badalona Germans Trias & Pujol, Barcelona, Spain.4 aut
700	1	a Hedenstierna, Göran,d 1941-u Uppsala universitet,Klinisk fysiologi,Univ Hosp Uppsala, Uppsala, Sweden.4 aut0 (Swepub:uu)goranhed
700	1	a Jaber, Samiru St Eloi Univ Hosp, Montpellier, France.4 aut
700	1	a Hiesmayr, Michaelu Med Univ Vienna, Vienna, Austria.4 aut
700	1	a Hollmann, Markus W.u Acad Med Ctr, Amsterdam, Netherlands.4 aut
700	1	a Mills, Gary H.u Sheffield Teaching Hosp, Sheffield, S Yorkshire, England.4 aut
700	1	a Melo, Marcos F. Vidalu Massachusetts Gen Hosp, Boston, MA 02114 USA.4 aut
700	1	a Pearse, Rupertu Queen Mary Univ London, London, England.4 aut
700	1	a Putensen, Christianu Univ Hosp Bonn, Bonn, Germany.4 aut
700	1	a Schmid, Werneru Med Univ Vienna, Vienna, Austria.4 aut
700	1	a Severgnini, Paolou Univ Insubria, Varese, Italy.4 aut
700	1	a Wrigge, Hermannu Univ Leipzig, Leipzig, Germany.4 aut
700	1	a de Abreu, Marcelo Gamau Univ Hosp Dresden, Dresden, Germany.4 aut
700	1	a Pelosi, Paolou Univ Genoa, IRCCS AOU San Martino IST Hosp, Genoa, Italy.4 aut
700	1	a Schultz, Marcus J.u Acad Med Ctr, Amsterdam, Netherlands.4 aut
710	2	a Acad Med Ctr, Amsterdam, Netherlands.b Hosp Israelita Albert Einstein, Sao Paulo, Brazil.;Fac Med ABC, Sao Paulo, Brazil.4 org
773	0	t European Journal of Anaesthesiologyd : LIPPINCOTT WILLIAMS & WILKINSg 34:8, s. 492-507q 34:8<492-507x 0265-0215x 1365-2346
856	4 8	u https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-342439
856	4 8	u https://doi.org/10.1097/EJA.0000000000000646

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