U.S. Air Force School of Aerospace Medicine, Center for the Sustainment of Trauma and Readiness Skills, Baltimore, United States; University of Maryland School of Medicine, Department of Anesthesiology, R Adams Cowley Shock Trauma Center, US Air Force C-STARS Baltimore, 22 S. Greene Street, T4M14, Baltimore, MD 21201, United States; David Geffen School of Medicine, Ronald Reagan Medical Center, UCLA, 757 Westwood Plz. Suite 3325, Los Angeles, CA 90095, United States.
David Geffen School of Medicine, Ronald Reagan Medical Center, UCLA, 757 Westwood Plz. Suite 3325, Los Angeles, CA 90095, United States.
J Clin Anesth. 2017 Jun;39:122-127. doi: 10.1016/j.jclinane.2017.03.044. Epub 2017 Apr 7.
Risk assessment historically emphasized cardiac morbidity and mortality in elective, outpatient, non-cardiac surgery. However, critically ill patients increasingly present for therapeutic interventions. Our study investigated the relationship of American Society of Anesthesiologists (ASA) class, revised cardiac risk index (RCRI), and sequential organ failure assessment (SOFA) score with survival to discharge in critically ill patients with respiratory failure.
Retrospective cohort analysis over a 21-month period.
Five adult intensive care units (ICUs) at a single tertiary medical center.
Three hundred fifty ICU patients in respiratory failure, who underwent 501 procedures with general anesthesia.
Demographic, clinical, and surgical variables were collected from the pre-anesthesia evaluation forms and preoperative ICU charts. The primary outcome was survival to discharge.
Ninety-six patients (27%) did not survive to discharge. There were significant differences between survivors and non-survivors for ASA (3.7 vs. 3.9, p=0.001), RCRI (1.6 vs. 2.0, p=0.003), and SOFA score (8.1 vs. 11.2, p<0.001). Based on the area under the receiver operating characteristic curve for these relationships, there was only modest discrimination between the groups, ranging from the most useful SOFA (0.68) to less useful RCRI (0.60) and ASA (0.59).
This single center retrospective study quantified a high perioperative risk for critically ill patients with advanced airways: one in four did not survive to discharge. Preoperative ASA score, RCRI, and SOFA score only partially delineated survivors and non-survivors. Given the existing limitations, future research may identify assessment tools more relevant to discriminating survival outcomes for critically ill patients in the perioperative environment.
历史上，风险评估侧重于择期、门诊、非心脏手术的心脏发病率和死亡率。然而，危重患者越来越多地接受治疗干预。我们的研究调查了美国麻醉医师学会（ASA）分级、修订后的心脏风险指数（RCRI）和序贯器官衰竭评估（SOFA）评分与呼吸衰竭危重患者出院存活率的关系。
在 21 个月的时间内进行回顾性队列分析。
一家三级医疗中心的五个成人重症监护病房（ICU）。
350 名患有呼吸衰竭的 ICU 患者，他们接受了 501 例全身麻醉下的手术。
从麻醉前评估表和术前 ICU 图表中收集人口统计学、临床和手术变量。主要结局是出院存活率。
96 名患者（27%）未存活至出院。存活者和非存活者在 ASA（3.7 与 3.9，p=0.001）、RCRI（1.6 与 2.0，p=0.003）和 SOFA 评分（8.1 与 11.2，p<0.001）方面存在显著差异。基于这些关系的受试者工作特征曲线下面积，组间仅有适度的区分度，范围从最有用的 SOFA（0.68）到稍有用的 RCRI（0.60）和 ASA（0.59）。
这项单中心回顾性研究量化了患有高级气道疾病的危重患者围手术期的高风险：每四个患者中就有一个未存活至出院。术前 ASA 评分、RCRI 和 SOFA 评分仅部分划定了存活者和非存活者。鉴于现有局限性，未来的研究可能会确定更能区分围手术期危重患者生存结果的评估工具。
