Sorbonne University, Department of Anaesthesia and Critical Care Medicine, Armand Trousseau Hospital, DMU DREAM, GRC 29, AP-HP, 75012 Paris, France;; Université Paris Cité, Centre for Epidemiology and Statistics (CRESS), Obstetrical Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, 75014 Paris, France.
Department of Anaesthesia and Intensive Care, Rennes University Hospital, University Rennes 1, 35000 Rennes, France.
J Clin Anesth. 2024 Dec;99:111626. doi: 10.1016/j.jclinane.2024.111626. Epub 2024 Sep 17.
Monitoring anaesthesia-related severe morbidity constitutes a good opportunity for assessing quality and safety of care in anaesthesia. Several recent studies attempted to describe and define indicators for anaesthesia-related severe morbidity with limitations: no formal experts' consensus process, overlap with surgical complications, no consensual definitions, inapplicability in clinical practice. The aim of this study was to provide a set of indicators for anaesthesia-related severe morbidity based on outcomes and using clinically useful consensual definitions.
1/ scoping review of studies published in 2010-2021 on outcomes of anaesthesia-related severe morbidity with different definitions; 2/ International experts' consensus on indicators for anaesthesia-related severe morbidity with specific definitions using a Delphi process.
After including 142 studies, 68 outcomes for anaesthesia-related severe morbidity were identified and organized in 34 indicators divided into 8 categories (cardiovascular, respiratory, sepsis, renal, neurological, medication error, digestive and others). The indicators were then submitted to the experts. After 2 Delphi rounds, the 26 indicators retained by the experts with their corresponding consensual definition were: acute heart failure, cardiogenic shock, acute respiratory distress syndrome, pulmonary embolism and thrombosis, bronchospasm or laryngospasm, pneumonia, inhalation pneumonitis, pneumothorax, difficult or impossible intubation, atelectasis, self-extubation or accidental extubation, sepsis or septic shock, transient ischemic attack, postoperative confusion or delirium, post-puncture headache, medication error, liver failure, unplanned intensive care unit admission, multiple-organ failure.
This study provides a new consensual set of indicators for anaesthesia-related severe morbidity with specific definitions, that could be easily applied in clinical practice as in research.
监测与麻醉相关的严重发病率是评估麻醉质量和安全性的良好机会。最近有几项研究试图描述和定义与麻醉相关的严重发病率的指标，但存在局限性：没有正式的专家共识过程、与手术并发症重叠、没有一致的定义、在临床实践中不适用。本研究旨在根据结局提供一组与麻醉相关的严重发病率指标，并使用临床上有用的一致定义。
1/ 对 2010 年至 2021 年发表的不同定义的与麻醉相关的严重发病率结局的研究进行范围综述；2/ 使用 Delphi 过程对具有特定定义的与麻醉相关的严重发病率指标进行国际专家共识。
纳入 142 项研究后，共确定了 68 项与麻醉相关的严重发病率结局，并将其组织成 34 个指标，分为 8 类（心血管、呼吸、脓毒症、肾脏、神经、用药错误、消化和其他）。然后将这些指标提交给专家。经过两轮 Delphi 后，专家保留了 26 个指标及其对应的共识定义：急性心力衰竭、心源性休克、急性呼吸窘迫综合征、肺栓塞和血栓形成、支气管痉挛或喉痉挛、肺炎、吸入性肺炎、气胸、困难或无法插管、肺不张、自我拔管或意外拔管、脓毒症或脓毒性休克、短暂性脑缺血发作、术后意识模糊或谵妄、穿刺后头痛、用药错误、肝功能衰竭、非计划入住重症监护病房、多器官功能衰竭。
本研究提供了一组新的与麻醉相关的严重发病率的共识指标，具有特定的定义，可在临床实践和研究中轻松应用。
