Canet Jaume, Sabaté Sergi, Mazo Valentín, Gallart Lluís, de Abreu Marcelo Gama, Belda Javier, Langeron Olivier, Hoeft Andreas, Pelosi Paolo
From the Department of Anaesthesiology and Postoperative Care Unit, Hospital Universitari Germans Trias i Pujol (JC, VM), Department of Anaesthesiology, Fundació, Puigvert (SS), Department of Anaesthesiology, Hospital del Mar, IMIM (Institut Hospital del Mar d' Investigacions Mèdiques), Universitat Autònoma de Barcelona, Barcelona, Spain (LG), Department of Anaesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (MGDA), Department of Anaesthesia and Critical Care, Hospital Clínico Universitario, University of Valencia, Valencia, Spain (JB), Department of Anaesthesiology and Critical Care, Université, Pierre et Marie Curie-Paris VI, CHU Pitié-Salpêtrière, Paris, France (OL), Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany (AH), and Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino Hospital-IST, University of Genoa, Genoa, Italy (PP) *Members of the PERISCOPE (Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe) group are listed in the Appendix.
Eur J Anaesthesiol. 2015 Jul;32(7):458-70. doi: 10.1097/EJA.0000000000000223.
Postoperative respiratory failure (PRF) is the most frequent respiratory complication following surgery.
The objective of this study was to build a clinically useful predictive model for the development of PRF.
A prospective observational study of a multicentre cohort.
Sixty-three hospitals across Europe.
Patients undergoing any surgical procedure under general or regional anaesthesia during 7-day recruitment periods.
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 (SpO2) less than 90% whilst breathing room air that required conventional oxygen therapy, noninvasive or invasive mechanical ventilation.
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 SpO2; 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).
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).
术后呼吸衰竭（PRF）是手术后最常见的呼吸并发症。
本研究的目的是建立一个对PRF发生具有临床实用价值的预测模型。
一项多中心队列的前瞻性观察研究。
欧洲的63家医院。
在7天招募期内接受全身或区域麻醉下任何手术的患者。
术后5天内发生PRF。PRF的定义为动脉血氧分压（PaO2）低于8kPa，或在呼吸室内空气时经脉搏血氧饱和度仪测量的新出现的氧合血红蛋白饱和度（SpO2）低于90%，且需要常规氧疗、无创或有创机械通气。
224例患者发生PRF（占所研究的5384例患者的4.2%）。发生PRF的患者院内死亡率[95%置信区间（95%CI）]更高[10.3%（6.3至14.3）对0.4%（0.2至0.6）]。回归模型确定了一个预测PRF的评分，其中包括七个独立危险因素：术前SpO2低；至少一种术前呼吸症状；术前慢性肝病；充血性心力衰竭病史；开胸或上腹部手术；手术持续至少2小时；以及急诊手术。受试者工作特征曲线下面积（c统计量）为0.82（95%CI 0.79至0.85），Hosmer-Lemeshow拟合优度统计量为7.08（P = 0.253）。
基于七个客观、易于评估因素的风险评分能够预测哪些患者会发生PRF。该评分可能有助于术前风险评估和管理，并为测试改善结局的干预措施提供依据。该研究已在ClinicalTrials.gov注册（标识符NCT01346709）。
